Agromet wheat app for estimation of phenology and yield of wheat under Punjab conditions.

The field experiments were conducted at the Research Farm, Punjab Agricultural University, Ludhiana, during rabi seasons of 2017-18 and 2018-19. The wheat varieties, viz. PBW-725, PBW-677, and HD-3086, were sown on 25th October, 15th November, and 5th December during both the crop seasons. Regression equations between grain yield, dry matter, and growing degree days were developed, and their performance efficiency was evaluated using mean square error (MSE), root mean square error (RMSE), mean absolute percentage error (MAPE), Akaike information criteria (AIC), and Schwarz-Bayesian information criteria (SBC), and the lowest values of AIC and SBC were used for wheat yield prediction. Based on historical data, agroclimatic index-based regression models were also developed for grain yield prediction at vegetative and reproductive stages under different dates of sowing. At the reproductive stage, the accumulated growing degree day (AGDD)-based model for 25th October sowing that gave 16 percent error, followed by 15th November sowing with 5.7 percent error, is the best model for yield prediction having minimum error. "Agromet wheat app," which is a mobile-based android app, was developed. This app is simple and has easy user interface which gives information about wheat management practices, weather, and insect-disease warnings and calculation of growing degree days at different phenophases of wheat in English and regional language Punjabi for three agroclimatic zones, viz., submountain undulating zone (Gurdaspur), central plain zone (Ludhiana), and western zone (Bathinda).

Anterior Lamellar Repositioning in the Management of Meibomian Gland Inversion Secondary to Meibomian Gland Dysfunction.

PURPOSE: To describe a simple alternative surgical approach to treat patients with Meibomian gland inversion (MGI; posterior migration of the Meibomian gland orifices) in the upper eyelid, secondary to cicatricial Meibomian gland dysfunction (MGD) not responding to maximal medical management. METHODS: This was a retrospective, noncomparative, interventional case series of all patients with MGI not responding to conservative MGD treatment who underwent anterior lamellar repositioning through a skin crease incision with or without Blepharoplasty, between July 2017 and July 2019. RESULTS: Eleven eyes of 7 patients were included in the study. All patients had a diagnosis of MGD with MGI and had been treated on average for 32 months with intensive medical therapy. Treatment included lubricants, topical ciclosporin 0.1%, topical steroids, and doxycycline. Despite intensive treatment, these patients remained symptomatic with persistent superior ocular surface staining. Following surgery, on average, the patients were followed for 23 months. Ten eyes (91%) had improvement of symptoms and superior ocular surface staining. All patients (100%) demonstrated improvement in the anatomical eversion of the eyelid margin and Meibomian gland orifice. CONCLUSION: A simple upper eyelid everting surgery with anterior lamellar repositioning can be effective in managing patients with MGI giving them symptomatic relief when all medical treatment fail. To the best of the authors' knowledge, this is the first case series describing this simple surgical technique in the management of this subgroup of patients.

Pediatric Periocular Keratin Horns: A Case Series.

There are very few published cases of periocular keratin horns that have been reported in children. This study reports 2 pediatric cases of periocular keratin horns. The authors describe a 7-year-old male child who developed a keratin horn on the right lower eyelid and a 16-year-old female who developed a caruncular keratin horn. Both cases underwent excision biopsy, and subsequent histology confirmed that there was no evidence of malignancy. However, on the basis of the current evidence in adults and the difficulty in drawing firm conclusions from the small number of reported pediatric cases, the authors suggest that these lesions should be carefully managed due to the possibility of premalignant or malignant change at the base of the lesion.

Medial canthal defects following tumour excision: To reconstruct or not to reconstruct?

Laissez-faire following excision of peri-ocular tumours has been described, but is not universally well established. We describe our experience with laissez-faire for managing medial canthal defects following tumour excision and compare our outcomes with full thickness skin grafts. Retrospective comparative case series of 68 patients who underwent reconstruction of a medial canthal defect using laissez-faire with sutured Sorbsan (LFS) (n = 36) or a full thickness skin graft (FTSG) (n = 32) at the same centre. Tumour diagnosis, defect size, time taken to epithelialise, functional and cosmetic outcomes, complications, follow-up duration and any secondary interventions were recorded. Basal call carcinoma was the most common neoplasm excised (63/68, 93%). Defect size ranged from 7 × 5 mm to 25 × 10 mm. Mean time for wound epithelialisation in LFS group was 33 days. Mean duration of follow-up was 32 months (range 1-80 months) for LFS and 30 months (range 6-60 months) for FTSG. Good functional and cosmetic outcomes were achieved in all 68 patients. Review of clinical photographs showed epicanthic fold in 2 patients and visible scar in 1 patient in the LFS group and 3 cases of hypopigmented scar and 7 hypertrophic scars in the FTSG group. No cases required secondary intervention. There were no cases of postoperative infection. LFS in the medial canthal region is less likely to lead to hypertrophic scarring or cicatricial sequelae compared to FTSG (p = 0.02). Both techniques are associated with excellent functional and aesthetic outcomes even for larger defects.

Endoscopic Medial Rectus Sling: A Window Into the Intraconal Orbital Apex.

PURPOSE: Surgical approaches to the medial orbit especially within the cone of orbital muscles necessitate great precision and care to avoid damage to surrounding structures-most importantly the optic nerve. The authors present a novel technique in which access to the medial orbital contents was achieved through an entirely endoscopic approach. METHODS: A 72-year-old Caucasian female presented with loss of vision in the right eye and reduced extraocular movements. Baseline blood tests were within normal limits. Inflammatory markers were slightly elevated. CT scan revealed bilateral medial orbital apex masses. Biopsy of the right orbital apex lesion was performed through an exclusively endoscopic approach in which the medial rectus muscle was retracted infero-medially. RESULTS: This exclusively endonasal approach to the medial intraconal space provided excellent access to the orbital apex, thus allowing successful biopsy of the medial orbital apex lesion. A video of the surgical technique demonstrates its use in this patient (see Video, Supplemental Digital Content 1, available at http://links.lww.com/IOP/A123). CONCLUSIONS: Similar reports of endonasal medialization of the medial rectus for accessing intraconal orbital lesions have been previously described in the rhinological literature. The authors describe a modification that allows for a safe and less invasive approach to the medial intraconal space and intraorbital optic nerve. There is minimal trauma to the surrounding tissues and no further damage to the optic nerve along with no associated adverse clinical sequelae. In addition, this negates the need for an adjuvant external or transconjunctival approach.

Accuracy of clinical diagnosis of benign eyelid lesions: Is a dedicated nurse-led service safe and effective?

This article compares an independent nurse-led benign lesion service with a doctor-led one, and assesses the impact of clinician seniority on diagnostic accuracy rates. Retrospective review of benign lesions referred to a teaching hospital and managed in either a doctor- or nurse-led lid service. All lesions were diagnosed clinically, excised and then sent for histological diagnosis. Lesions were categorized into subtypes. Pre-excision clinical diagnoses were compared with histological diagnoses. Sensitivity, specificity and missed malignancy rates were calculated for each subtype. Accuracy was compared between different grades of doctors and a specialist nurse. 264 and 332 lesions were managed in a doctor-led and nurse-led service, respectively. Rates of accurate sub-typing were 79.6% and 80.4% in the doctor- and nurse-led services, respectively (p > 0.05). Clinician seniority had no bearing. Missed malignancies or pre-malignancies accounted for 1.1% and 1.5% of lesions in the doctor and nurse-led services, respectively (p > 0.05). Overall, the remaining misdiagnoses were benign lesions of another subtype (13.6%) or non-specific histological findings (5.0%) and 98.6% of lesions were confirmed as benign on histology. Overall sensitivity and specificity values were: benign epithelial proliferations 95.6% and 92.2%, epidermal inclusion cysts 92.2% and 88.0%, xanthelasma 97.5% and 100.0%, cysts of Moll 66.7% and 96.6%, naevi 39.4% and 99.8% and molluscum 20.0% and 99.8%, respectively. A dedicated nurse-led service is as effective in managing a range of clinically benign lid lesions as a doctor-led one, and clinician seniority has little impact on the diagnostic accuracy of these lesions.

Full thickness skin grafts in periocular reconstructions: long-term outcomes.

PURPOSE: To evaluate the outcomes of eyelid reconstruction in patients who underwent full thickness skin grafts. METHODS: A retrospective, noncomparative intervention study of patients who underwent periocular reconstruction with full thickness skin grafts between 2005 and 2011. RESULTS: One hundred consecutive Caucasian patients were included in the study, 54 women and 46 men. Mean follow up was 32 months. Indications for full thickness skin grafts were excision of eyelid tumors (98%) and cicatricial ectropion (2%). Site of lid defects were lower lid (60%), medial canthus (32%), upper lid (6%), and lateral canthus (2%). The skin graft donor sites were supraclavicular (44%), upper eyelid (24%), inner brachial (18%), and postauricular (14%).Early postoperative complications included lower eyelid graft contracture (1%) and partial failure (1%). Late sequelae included lower eyelid graft contracture (4%) and hypertrophic scarring (23%). Of the 23 patients with hypertrophic scar, 21 achieved good outcomes following massage with silicone gel and steroid ointment and 2 had persistent moderate lumpiness. No statistically significant association was found between graft hypertrophy and donor site or graft size. As high as 95% of all patients achieved good final eyelid position. Good color match was seen in 94% and graft hypopigmentation in 6%. An association between hypopigmentation and supraclavicular and inner brachial donor site was found to be statistically significant. CONCLUSIONS: Most patients (94%) achieved good eyelid position and color match. Majority (91%) of the early postoperative cicatricial sequelae can be reversed by massage, steroid ointment, and silicone gel application. Full thickness skin grafts have excellent graft survival rates and have minimal donor site morbidity.

Migrated periocular filler masquerading as arteriovenous malformation: a diagnostic and therapeutic dilemma.

Migration of dermal filler is a rare complication in the periocular area. We describe a case that highlights the diagnostic and therapeutic dilemmas posed. A patient presented with a bluish swelling involving the left brow, temple, and glabella. It was ill-defined, mobile, and nontender. An MRI suggested a vascular malformation, while an ultrasound suggested a dermoid. On further questioning, the patient revealed having a permanent polyalkylimide filler injected to the glabella 10 years ago. This raised the possibility of delayed migration. The eyebrow, temple, and glabella were explored through a skin-crease incision. Transparent gel was expressed and cicatrized granulomas were excised. The patient made an excellent recovery through an inconspicuous incision. This case emphasizes the importance of taking a detailed history and revisiting the diagnosis, if necessary. We describe a relatively scar-free approach to remove widely distributed migrated fillers. Clinical and radiologic features of migrated filler can mimic tumor.

Rhinotillexomania: a rare cause of medial orbital wall erosion.

The authors report a rare case of medial orbital wall erosion with an orbital inflammatory mass and resultant lacrimal obstruction secondary to rhinotillexomania. A 67-year-old male with known history of compulsive nose picking (rhinotillexomania) sought treatment for complaints of watering in his OD. Examination revealed a blocked right inferior canaliculus. Nasal endoscopy showed a large nasal septal defect with multiple areas of crusting and bleeding. Hematologic investigations were normal. CT scan confirmed a large nasal septal and right medial orbital wall defect with an adjacent soft tissue mass in the medial orbit. Investigations ruled out systemic pathology. Histologic examination of medial orbital mass, sinus, and nasal mucosa revealed a reactive inflammatory infiltrate with surface Gram-positive cocci. The authors hypothesized that the patient had enlarged an existing nasal septal defect due to repetitive nose picking resulting in recurrent infection and inflammation of sinuses, leading to erosion of his medial orbital wall.

Levator-Muller's muscle recession with tarsorrhaphy: a technique for corneal protection in cases with cicatricial upper eyelid retraction.

AIMS: Cicatricial upper eyelid retraction with exposure keratopathy and impending corneal perforation requires prompt intervention. Standard procedures such as isolated levator recession, botulinum toxin, and lid weights will only induce a partial ptosis. Conventional tarsorrhaphy, though ideal to achieve complete closure, is likely to result in dehiscence in these cases. We describe a one-stage technique of levator and Muller's muscle recession combined with a tarsorrhaphy used in four patients with an impending corneal perforation due to cicatricial lagophthalmos. METHODS: This is an interventional, non-comparative retrospective case series of four patients who had undergone tarsorrhaphy in combination with levator recession. RESULTS: In all four cases, it was not possible to mechanically close the eyelids preoperatively due to cicatricial lid retraction involving the middle lamella. The aetiology for lagophthalmos was varied: (Case 1) bilateral sclerosing metastatic breast cancer involving the lids; (Case 2) severe anterior and middle lamella shortening due to actinic changes; (Case 3) middle and posterior lamella shortening due to glaucoma treatment and multiple surgery (Case 4) due to traumatic facial scarring and seventh nerve palsy. In all cases, the corneal thinning and epithelial defects resolved completely following surgery. In one case, we were able to partially reopen the tarsorrhaphy for further corneal surgery. DISCUSSION: We describe a safe, effective and reversible surgical procedure for managing cases with cicatricial upper eyelid retraction, which would otherwise lead to serious corneal complications.

Visual function and quality of life in patients who had undergone eye removal surgery: a patient survey.

PURPOSE: To measure aspects of self-reported vision-related health status and assess the impact of treatment in patients who have undergone eye removal surgery (evisceration or enucleation), using a patient administered questionnaire. METHODS: In this non-randomised, questionnaire-based cohort study, patients were identified from the Artificial Eye Service referral register from 2003 to 2010. A self-administered questionnaire based upon previously published scales was completed to measure aspects of visual function and the impact of treatment. RESULTS: Thirty-six completed questionnaires were obtained. Mean age at surgery was 54.1 years (range 13-90), with 83% male. Indication for eye-removal was trauma in 14(39%) cases. Ten (28%) had ocular co-morbidity in the fellow-eye. The main reported difficulties were with peripheral vision or distance judgements, in 64% patients. The majority of drivers (66%) had maintained the ability to drive. Self-consciousness was reported in 28(78%) patients, and 56% were able to continue work or activities with no perceived limitations. Overall comfort and aesthetic improvement were noted by the majority. Procedure-specific information leaflets for patients were appreciated. CONCLUSIONS: This survey increases our knowledge of aspects of vision-related health status following ocular pathology or trauma that requires eye removal, and may enable improved pre-operative patient counselling. Effects on peripheral vision may be noted most significantly, but the majority can continue normal activities with little difficulty. Overall improvement in comfort and appearance occurs in most patients, although feelings of self-consciousness are common.

A case report of orbital haemorrhage associated with endoscopic sinus surgery and reversible sight loss: a multidisciplinary approach to management.

We report a case of intraoperative orbital haemorrhage as a complication of endoscopic sinus surgery performed under general anaesthesia. Initial unilateral complete visual loss occurred, but recovered due to accurate and early diagnosis combined with urgent surgical intervention. This patient's case is reported to illustrate the importance of early recognition of clinical signs and how a stepwise approach to management can result in a favourable visual outcome. Moreover, the mechanisms and pathophysiology of visual loss due to orbital haemorrhage following endoscopic sinus surgery are discussed.

Atypical fibroxanthoma of the medial canthus: a rare presentation.

PURPOSE: Atypical fibroxanthoma (AFX) is an uncommon skin tumour occurring primarily in the head and neck. It has rarely been reported in the periocular region. We report a rare case of atypical fibroxanthoma of the medial canthus. METHODS: Clinical and histological findings and management of this case are presented. RESULTS: A 90-year-old Caucasian female had primary excision of a medial canthal mass, which was clinically suspected as basal cell carcinoma by our Plastic surgery colleagues. Histology revealed an atypical fibroxanthoma with incomplete excision, with the tumour involving the deep and peripheral resection margins. Within a few weeks she developed a recurrent mass, which was clinically fixed to deep tissues. She was referred to the Oculoplastic service where she underwent a two-stage excision and reconstruction of the right medial canthus with a full thickness skin graft from her arm. Paraffin fixed sections were used to ensure margin clearance. CONCLUSION: This case emphasises the importance of a diagnostic biopsy. A panel of immunohistochemical markers is essential to make the correct diagnosis of AFX and distinguish it from malignant fibrohistiocytoma and non-keratin expressing squamous cell carcinoma. It usually follows a benign course, but can occasionally demonstrate aggressive local recurrence as well as distant metastasis. Invasion beyond the dermis and a rapid rate of recurrence are suggestive of a more aggressive clinical course. Paraffin fixed sections are preferred over frozen section techniques for this tumour. Medial canthal AFX has not been reported previously.

Role of Temporal artery biopsy in a sequential Giant Cell Arteritis fast-track pathway: a 5-year prospective study.

BACKGROUND: Increasing number of centres are establishing sequential fast track pathways (FTP) for management of giant cell arteritis (GCA), with temporal artery ultrasound (US) replacing temporal artery biopsy (TAB) as the first investigational method. Biopsy is performed as second investigation, when US is negative/inconclusive. This study investigates the role of TAB in a sequential GCA-FTP and its utility in those with negative/inconclusive US. METHODS: Prospective study of patients referred for TAB as part of Coventry sequential GCA-FTP May 2014-June 2019. Analysis included sensitivity and specificity of TAB, impact of arterial specimen length and duration of treatment with corticosteroids on sensitivity of TAB and the clinical predictors for a positive biopsy. RESULTS: A total of 1149 patients with suspected GCA were referred to this GCA-FTP, with 109 (9.5%) referred for TAB. Overall sensitivity of TAB was 47% (specificity: 100%) and in patients with negative/inconclusive US sensitivity was 39% (specificity:100%). Post-fixation arterial specimen length <15 mm showed lower sensitivity (14%), which increased to 52% when specimen length was ≥15 mm. Sensitivity of TAB was highest in first 7 (60%) to 10 days (59%) from starting corticosteroids. Predictors of positive biopsy using univariate logistic regression analysis were jaw claudication (OR = 5.40; p = 0.0057), elevated erythrocyte sedimentation rate (OR = 5.50; p = 0.013) and elevated C-reactive protein (OR = 23.7; p = 0.0043). CONCLUSION: This is the first study to look at the role of TAB in a sequential GCA-FTP. Biopsy plays an important role in GCA-FTP, when US is negative/inconclusive. Sensitivity of TAB improved when specimen length was ≥15 mm and performed within 10 days of commencing corticosteroids.

Orbital carcinoid metastasis: diverse presentations and value of indium-octreotide imaging.

PURPOSE: To report two cases of orbital carcinoid metastasis (OCM) with diverse presentations and the role of Indium-Octreotide scan in management of these patients. METHODS: Clinical, histological and radiological findings and management of the two patients are described. Results are presented. CONCLUSIONS: We wish to highlight the diversity of presentations in orbital carcinoid. One patient presented with headache, while the other presented with recurrent transient ptosis. To the best of our knowledge, there have been no previous reports of OCM presenting as transient ptosis. The value of Indium-Octreotide scan in detecting the true extent of systemic disease and reducing the need for biopsy in carcinoid tumour is discussed.

Variability and time series trend analysis of rainfall in the mid-hill sub humid zone: a case study of Nauni.

The spatiotemporal variability of rainfall, particularly in the context of climate change, has been imperative for examining the cropping patterns, farming sustainable crop production, and food security in rainfed areas. To that end, trend analysis was done to study the change in rainfall patterns in the mid-hills of Himachal Pradesh. The study investigated the historical rainfall data from 1971 to 2020 on a monthly, annual, seasonal, and decadal basis by using the variability analysis methods, viz., standard deviation (SD), coefficient of variance (CV), and transformed annual precipitation departure (Z). The trend analysis was also done by Mann-Kendall (MK) and Sen's slope estimator (SSE) test and linear regression model. The annual rainfall in the region was 1115.1 mm, which showed a decreasing trend (Z = - 0.79 mm/year). Based on the linear regression model, the decrease in annual rainfall was about - 2.28 mm/year. The monthly and seasonal variability of rainfall exhibited a sensitivity to change. The months of January, April, July, and September showed an increasing trend, whereas the rest of the other months showed a decreasing trend. The seasonal rainfall (summer, monsoon, and post-monsoon) showed a decreasing trend, whereas the winter season depicted an increasing trend. During the entire study period, 1988 recorded as the wettest year, with highest annual rainfall of about 2205.0 mm and monsoon rainfall of about 1653.0 mm. The highest annual (2205.0 mm) and monsoon (1653.0 mm) rainfall was recorded in the year 1988. The decadal analysis of the rainfall on an annual basis revealed a decrease in rainfall during the periods 1971-1980, 2001-2010, and 2011-2020 as compared to 1981-1990 and 1991-2000. The rainfall over the study region confirms the strength of the change in trend. Thus, the erratic rainfall pattern makes the cropping calendar shorter and affects the agricultural productivity.

Extraocular muscle enlargement as a paraneoplastic effect of breast carcinoma in a male patient.

The authors report a rare case of a male patient who was diagnosed with breast cancer following investigations for proptosis secondary to extraocular muscle enlargement. A 65-year-old man presented with complaints of double vision and proptosis. CT scan of the orbits showed bilateral superior rectus muscle enlargement. On further investigation, the patient was detected to have a right breast mass. Biopsy of the mass showed an intermediate-grade carcinoma in situ. The patient underwent a right radical mastectomy following which his proptosis and symptoms of double vision resolved. Repeat MRI scans showed reduction in the size of the superior rectus muscle after mastectomy. Extraocular muscle enlargement has not been previously identified as a paraneoplastic effect of breast carcinoma in a male patient. Extraocular muscle enlargement can be a presenting feature of malignancies, and an appropriate systemic workup for the occult primary when all other preliminary tests are negative should be considered.

Outcome of deep lateral wall rim-sparing orbital decompression in thyroid-associated orbitopathy: a new technique and results of a case series.

PURPOSE: To describe a new technique for deep lateral (single) wall orbital decompression surgery, developed by Mr. Geoffrey Rose, for proptosis in patients with thyroid-associated orbitopathy and to analyse the results achieved in our series. METHODS: The study is an interventional, retrospective, non-comparative case series. Twenty-one eyes of seventeen patients underwent the described technique of deep lateral wall orbital decompression for thyroid-associated orbitopathy. All patients had controlled thyroid functions and underwent surgery for cosmetic rehabilitation, with analysis of the reduction in proptosis, changes in visual acuity and post-operative complications. The surgery involved removing the lateral orbital wall whilst preserving the lateral rim, the lateral wall being approached through a horizontal skin incision placed lateral to the lateral canthus. After reflecting the periosteum, most of the bone (deep lateral wall) between the skull base and inferior orbital fissure is removed. RESULTS: A mean reduction in proptosis of 4.81 mm ± 1.23 (SD) (p < 0.0001) with a median of 5.0 mm (range 3-7 mm) was achieved and the best-corrected visual acuity was maintained in all patients. There were no complications during surgery, and post-operative complications included worsening of pre-existing diplopia in one patient (6%) and transient cheek/temple numbness seen in three patients (18%). CONCLUSIONS: This technique of deep lateral wall orbital decompression developed by Mr. Rose is a safe and effective procedure for patients with mild to moderate proptosis. It carries a low risk of morbidity and avoids complications associated with decompressing the floor and medial wall, including new onset of motility disorders.

Orbital inflammation: a rare association of common variable immunodeficiency.

PURPOSE: Ocular associations with common variable immunodeficiency (CVID) are very rare which include granulomatous uveitis, mulitfocal choroiditis and retinal vasculitis. However there have been no reports of orbital involvement, either inflammatory or neoplastic in association with CVID. We describe a unique case of a patient with CVID who developed orbital inflammation. METHODS: Clinical, histological and radiological findings and the management of this case is presented. RESULTS: A 58 year old male with known CVID treated with regular intravenous immunoglobulin infusion, presented with left peri-orbital redness, pain, proptosis and restriction of ocular movements. CT scan showed an ill-defined mass in the left lateral orbit, adjacent to the lacrimal gland. An orbital biopsy revealed a monomorphic lymphocytic infiltrate forming loose lymphoid aggregates in the lacrimal gland tissue. Immunocytochemistry confirmed this to be a reactive inflammatory infiltrate. The patient was successfully treated with a course of oral prednisolone which resulted in improvement of orbital inflammation, ocular movements and proptosis. CONCLUSION: To our knowledge this is the first reported case of non-granulomatous orbital inflammation in association with CVID. This case serves to remind ophthalmologists encountering a patient with CVID that they may have associated orbital inflammatory disease which is responsive to steroid therapy similar to sterile inflammatory masses described in other organs.

Angiomatous meningioma of orbit mimicking as malignant neoplasm: a case report and literature review.

Angiomatous meningioma is a rare and distinct meningioma variant characterised with predominance of microvascularcomponent.There are few reported cases in literature with limited information on ophthalmic manifestations and radiological findings. There is no consistent feature reported so far of this neoplasm to aid in its diagnosis. Authors report an interesting case of Angiomatous Meningioma presenting as an aggressively expanding orbital mass lesion with adjacent bony destruction mimicking a malignant neoplasm.