bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Ocular Complications of Orbital Regional Anaesthesia
Authors: Farooq S.M. , Keng M.Q. , Khan Shabana , Dar Ahsan , Khan Afroz A.
Published: December 2024

Complications following orbital regional anesthesia are rare, but can occur following both needle and blunt cannula (sub tenon) techniques. Each technique has its own risk/benefit profile and ophthalmologist must be prepared to deal with these rare but serious complications. These complications can range from minor effects to sight threatening complications.

Method

An observational study of practice of local anaesthesia(LA) in the deptt. of ophthalmology Govt. Medical college Srinagar J&K was conducted over one year. Doctors administering LA and surgeon operating were asked to report the complications while administering LA and while operating as per the set proforma.

Results

Maximum number of complications reported were minor complications while as only 4 major complications were reported i.e retrobulbar haemorrhage which occurred with peribulbar anesthesia only.

Conclusion

Sharp needle peribulbar block is associated with major complications which could threaten vision, while as subtenon and topical anesthesia results in only minor complications and thus are safer.
Persistent Fetal Vasculature
Authors: Goel Neha , Bhambhwani Vishaal Rajesh , Bhushan Gauri , Thakar Meenakshi , Raina Usha Kaul , Ghosh Basudeb
Published: December 2024

Persistent Fetal Vasculature (PFV), also known as Persistent hyperplastic primary vitreous (PHPV), is a rare congenital developmental malformation of the eye, caused by the failure of regression of the primary vitreous. It can occur in isolation, in association with other ocular disorders and rarely as a part of systemic disorder. Most cases of PFV are sporadic, but it can be inherited as an autosomal dominant or recessive trait. PFV is divided into anterior and posterior types. Characteristic features include microphthalmic eye, white vascularized retrolental tissue with or without a persistent hyaloid artery, centrally dragged ciliary processes, an anteriorly shifted and (or) swollen lens, and varying degrees of lenticular opacification. Radiological investigations (ultrasound, computerised tomography, magnetic resonance imaging) aid in the diagnosis and differentiation from other causes of leucocoria. Although visual potential is limited in PFV, with modern vitreoretinal techniques, aphakic rehabilitation, and aggressive amblyopic therapy, useful vision can be obtained in selected patients. This article presents a current review of PFV, including the pathogenesis, genetics, clinical features, differential diagnosis, and management.
Bilateral Mooren’s Ulcer with perforation and Iris prolapse
Authors: Gajiwala Uday , Ganatra Jyotsom , Patel Rajesh , Shah Parin , Chariwala Rohan
Published: December 2024

Mooren's Ulcer is an idiopathic, rapidly progressive, painful peripheral ulcerative keratitis with no associated scleritis. It's a diagnosis of exclusion which means all other diagnosable systemic disorders that could be responsible for the progressive destruction of cornea must be ruled out. The etiology of Mooren's Ulcer remains uncertain. However, recent studies indicate that it is an autoimmune disease directed against a specific target molecule in the corneal stroma, triggered in genetically susceptible individuals by one of several possible mechanisms. A 40 years old female presented to us on 25th January 2008 from rural tribal area of Sagbara with bilateral peripheral ulcerative keratitis with perforation and iris prolapse in right eye. She is known case of diabetes mellitus for last seven years. Diagnosis of Mooren's ulcer was made after she underwent extensive medical and laboratory testing to rule out an infectious or systemic cause of corneal melt. She benefited by right eye patch graft, left eye tissue adhesive with BCL application, Both eyes conjunctival peritomy and immunosuppressive drugs along with control of diabetes. This case report aims to highlight the diagnosis and treatment of Mooren's ulcer.
MESECTODERMAL LEIOMYOMA OF CILIARY BODY
Authors: Rashid Sabia , Keng M. Q. , Farooq M. , Khan A. R.
Published: December 2024

A 20 year old female presented with a mass over the right iris with decreased visual acuity. Clinical examination revealed a ciliary body mass. Iridocyclectomy was performed. Histopathology and immunohistochemistry proved the mass to be a Mesectodermal Lieomyoma of the Ciliary Body. Ciliary body mesectodermal leiomyomas are rare, benign smooth muscle tumors which need to be differentiated from the malignant lesions. These tumors display a mixed myogenic and neurogenic morphology on microscopy. This case report presents a clinical, microscopical and immunohistochemical features of mesectodermal leiomyoma.
New Insights in Primary Angle Closure Glaucoma
Authors: Dada Tanuj , Kumar Gaurav , Tejwani Lalit , Arora Vishal , Wadhwani Meenakshi , Panda Anita
Published: December 2024

Primary angle closure glaucoma is one of the major causes for irreversible visual loss in Asia. In addition to pupillary block, lens induced mechanisms, plateau iris and supra-ciliary effusions are important contributing factors eluciadated by Ultrasound biomicroscopy. Treatment modalities for management of primary angle closure disease start with a laser iridotomy and include laser iridoplasty, lens extraction, combined procedures with goniosynechiolysis and glaucoma filtering surgery. This article is to give insight into newer concepts in treatment of angle closure based on the improvement in knowledge of pathophysiology and natural history of the disease.
Cataract Surgery in Fuch’s Corneal Dystrophy
Authors: Gupta Shikha , Gogia Varun , Sachdev Ritika , Sinha Rajesh , Sharma Namrata
Published: December 2024

Fuch’s endothelial corneal dystrophy is a progressive disorder of the endothelium wherein a gradual decline of functional endothelial cells over the years, manifesting with visual disturbance in late adulthood. The visual loss in these patients can be either due to cataract or due to corneal dystrophy itself. Determining which patient requires cataract surgery is imperative for an ophthalmologist to visually rehabilitate the patient. However cataract surgery could potentially decompensate an already diseased cornea with borderline endothelial cell reserve. This review will help the surgeons in proper evaluation and practice during surgery to provide the patient with maximal visual gain.
Clinical presentation and outcomes following posterior segment IOFB
Authors: Bhattacharjee Harsha , Deka Satyen , Barman Manab Jyoti , Soibam Ronel , Barthakur Sumita S , Jain Lokesh
Published: December 2024

Purpose:

To review the clinical features, causes of injury, types of foreign bodies, results of vitrectomy and prognostic factors in patients with posterior segment intraocular foreign bodies (IOFB).

Methods:

Study design: Retrospective review of clinical records. Study participants: 108 consecutive patients with posterior segment IOFB presenting at the study hospital between 1994 and 2007; and treated with IOFB removal by intraocular forceps or electromagnet or combination of the two following vitrectomy. Outcome measures: Clinical presentations, investigations, surgical techniques, final anatomical and visual status and duration of follow up. Statistical analysis: Chi-squared test.

Results:

The commonest presenting feature was uniocular visual loss. Work place injuries while chiseling and hammering (67.5%, n=73) without protective eyewear were the commonest. Metallic IOFBs were significantly common at 77.16% (n=98). IOFBs were removed using intraocular magnet (74%, n=80), intraocular forceps (18.5%, n=20) or a combination of the two (7.4%, n=8). Final visual acuity of ≥20/120 was achieved in 32.4% (n=35) cases. Presence of Relative Afferent Pupillary Defect (RAPD) (p<0.001), posterior segment haemorrhage (p<0.001) and Retinal Detachment (RD) (p=0.045) at presentation implied bad prognosis.

Conclusions:

IOFBs were mostly occupational and preventable. Cases presenting with RAPD, posterior segment haemorrhage and RD had bad visual prognosis.
Red blood cell alloimmunization among transfusion-dependent thalassemia major patients in Northeastern Iran
Authors: Mobasheri Leila , Chahkandi Tayyebeh , Talebpour Amir , Sarab Gholamreza Anani
Published: December 2024

BACKGROUND:

Thalassemia is one of the most common congenital hemoglobinopathies globally. Regular red blood cell (RBC) transfusion is of paramount importance in the treatment of thalassemia patients. However, this practice increases the risk of alloimmunization. This study was performed to determine the prevalence of RBC antibodies among multiple-transfused thalassemic patients in southern Khorasan, the eastern side of Iran.

METHODS:

For the purpose of screening unexpected antibodies, blood samples of 68 β-thalassemia major patients were investigated. After determining positive cases through screening phase, the process of antibody identification was carried out using reagent cells.

RESULTS:

The overall rate of alloimmunization was 2.9%, and the most frequent clinically important alloantibodies were anti-Kell and anti-Rh systems. Anti-K was detected in one of the patients. Furthermore, the simultaneous occurrence of anti-E and anti-C was seen in another study subject.

CONCLUSION:

A number of factors might have contributed to the low alloimmunization rate detected in this study, including the homogeneity of the population in South Khorasan, well-matched donors for those patients, first transfusion at an early age, and the use of leukodepleted blood.
Determinants of mortality after massive transfusion - A prospective study
Authors: Venugopal Divya , Innah Susheela Jacob , Rafi Aboobacker Mohamed , Bhaskaran Ramesh
Published: December 2024

INTRODUCTION:

Massive hemorrhage calls for massive transfusions (MTs) to maintain adequate hemostasis. Massive transfusion protocols (MTPs) are the appropriate treatment strategy for such patients replacing conventional use of crystalloids. These help in standardizing and optimizing the delivery of blood components in a well-balanced ratio.

AIM AND OBJECTIVES:

The aim of the study is to propose an ideal ratio of blood components for MTP after assessing relationship between ratios of blood components transfused and mortality.

METHODOLOGY:

MT was defined as receiving >4 packed red blood cell (PRBC) units within 1 h with the anticipation of continued need for blood products. All MT patients above 13 years of age regardless of cause of bleed were included in the study from December 2015 to October 2017 accounting for a total of 61 patients. Subgroup categorization of study population was done, and physician-driven ratios of the blood components were calculated for each case. The ratios were grouped as high (>1), equal (=1), and low (<1) ratios of fresh frozen plasma (FFP):PRBC and platelet: PRBC, and the relationship of these ratios to the clinical outcome in terms of mortality was examined.

RESULTS AND DISCUSSION:

Sixty-one patients underwent MT of which the overall hospital mortality rate was 8.1% with 100% mortality among patients with penetrating trauma followed by 25% with gastrointestinal bleed. Emergency admission was an independent risk factor for mortality. Hypotension before the initiation of MT was detrimental for survival. Efficient communication existed between the treating physicians and transfusion. Majority of survivors received equal ratios of FFP: PRBC and platelet: PRBC, and all nonsurvivors received low ratios of FFP: PRBC. Analysis was statistically indicating better survival with 1:1:1 ratio of PRBC: FFP: platelet.

CONCLUSION:

The need of the hour is to establish an institutional MTP and ensure compliance with the same. A prospective randomized controlled trial needs to be done to overcome the limitations and confounders of the present study and establish a universal protocol.
Evaluating platelet concentrates by platelet indices, thromboelastography, and flow cytometry
Authors: Mukhopadhyay Tapasyapreeti , Subramanian Arulselvi , Albert Venencia , Kumar Anand , Sehgal Tushar , Karjee Sulekha , Pati Harprasad
Published: December 2024

INTRODUCTION:

Platelet transfusion has been therapeutically used in patients with thrombocytopenia and platelet function defects over the years. The use of advanced techniques may add value in assessing the quality of platelet products. The aim of the study was to assess stored platelet concentrates (PCs) prepared in blood banks for platelet indices, clot strength, and platelet function.

MATERIALS AND METHODS:

Apart from the routine quality check parameters (platelet count, volume, pH, swirling, and sterility), 24-h-old PCs derived by the platelet-rich plasma method (PRP-PC) were prospectively assessed for various platelet indices using hematology analyzer and clot strength using thromboelastography (TEG). Platelet function (platelet activation and aggregation) was assessed using flow cytometry and compared with freshly prepared PRP.

RESULTS:

A total of 43 PRP-PCs that were analyzed had a mean volume of 69.1 ± 5.1 mL, a pH of 6.8 ± 0.3, and a platelet count of 738.8 ± 312.9 × 103 cells/μL. Swirling was present in all. The platelet distribution width, mean platelet volume, platelet-large cell ratio, plateletcrit, and immature platelet fraction were 9.4 ± 2.7 fL, 8.7 ± 1.2 fL, 16.9% ± 8.9%, 0.6% ± 0.3%, and 4.4% ± 3.9%, respectively. The r-time, k-time, alpha angle, and maximum amplitude were 15 ± 0.3 min, 2.1 ± 0.4 min, 65.2° ± 2.3°, and 76.1 ± 10.1 mm, respectively. Delayed clot initiation and higher clot strength were observed in in 60% (n = 21) and 71.4% (n = 25) of products, respectively Platelet activation of PRP-PC was significantly lower than PRP (0.4 [0.1%–42%] vs. 10.5 [0.8%–32.4%]; P = 0.002). However, platelet aggregation of PRP-PC was significantly higher than PRP (62.0 [26.7%–88.7%] vs. 33.4 [4.9%–55.8%]; P = 0.003).

CONCLUSION:

Platelet indices, TEG, and flow cytometry analysis provides useful information to assess the quality of PCs. However, the variable effects of processing and storage on platelet activity need further exploration.
Hemolytic disease of fetus and newborn due to maternal AlloAnti-S antibody
Authors: Iyyapan Suresh Kumar , Annadurai Hari Haran , Thangavel Gokhula Prasath , Natesan Hemamalini
Published: December 2024

Hemolytic disease of foetus and newborn (HDFN) is a disease characterized by the destruction of fetal red cells by the maternal antibodies which occurs due to allo immunization in the mother by feto-maternal blood group incompatibility.The antibodies most frequently implicated in HDFN may vary depending on the demographic location under consideration. In areas where RhIg administration is available, ABO antibodies are more commonly implicated. Following ABO antibodies, anti-RhD antibodies which are of IgG type are more commonly implicated in causing HDFN. HDFN caused by other Rh system antibodies namely anti-C, anti-c, anti-E, anti- e, MNS, KEL, FY, JK, and DI systems is less frequent. We have reported one such rare case of Hemolytic disease of fetus and newborn due to Anti--S. During the routine antenatal screening for irregular antibodies, using antibody identification cell panel BIO-RAD (ID Diapanel 11x4) which belongs to lot number (06171.47.x – 06271.47.x), anti-S was identified in the mother serum. The baby was non-hydropic at birth with an increase in bilirubin which required high-intensity phototherapy.
Evaluation of two methods for counting residual leukocytes in leukoreduced packed red cells: Flow cytometry and fully automated cell counter
Authors: Shah Mamta , Bhatnagar Nidhi , Shah Sangita , Pandav Falguni , Shah Hetali , Dixit Anupa , Shetty Trupti , Admane Pushkar , Lath Ankur , Suvasia Prakash
Published: December 2024

BACKGROUND AND OBJECTIVES:

Objective of the study is to explore the possibility of utilization of seven part fully automated hematology analyzer for enumeration of residual leukocytes (residual white blood cells [rWBCs]) in leukoreduced packed red cells (LR-PRCs) prepared from whole blood at a blood center as an alternate to the gold standard method, flow cytometry. In this study, we evaluate the performance characteristic of hematology analyzer against flow cytometry for the estimation of rWBCs in 39 LR-PRC units.

MATERIALS AND METHODS:

PRCs prepared from whole blood donations by 39 donors were leukoreduced and their volumes were noted. The samples from these LR-PRCs were processed on HORIBA Yumizen H2500 hematology analyzer and Backman Coulter DxFlex (B5R3V5) Flow Cytometer and compared.

RESULTS:

A total of 39 LR-PRCs were analyzed. The average volume of these LR-PRC units was 252 mL ranging from 227 to 285 mL/bag. The average rWBC count for all LR-PRC units as per flowcytometry method was 3.1 × 106/bag. There were 5 LR-PRC units with rWBC count more than 5 × 106/bag which did not fulfill the minimum quality control criteria of LR-PRCs as per the Indian standards (DGHS).

CONCLUSION:

The new generation fully automated hematology analyzers could be simple, reliable, economical, and practically best method for assessing the efficacy of leukoreduction in LR-PRCs. They can be adopted by resource-constrained blood centers as an alternative to flow cytometry for this purpose. It can be practically applied to check the quality of leukoreduction in all blood component samples before release from blood center for transfusion to the patients.
Automated red cell exchange in sickle cell disease patients: Retrospective analysis of series of cases in a tertiary care hospital in Eastern India
Authors: Kanungo Girijanandini , Nagrath Priyanka , Samal Priyanka , Mishra Santosh
Published: December 2024

Red cell exchange is important to treat acutely ill sickle cell patients, but it is time-consuming. An automated red cell exchange technique using cell separators developed by different manufacturers helps in removal of sickled hemoglobin and improving blood viscosity. The use of these cell separators permits automated red cell exchange to be performed safely and smoothly with the isovolemic hemodilution. The retrospective analysis of seven cases for automated red cell exchange was performed in IMS and SUM Hospital from September, 2019 to July 2021. One procedure was performed on COBE Spectra Apheresis System and the rest six using Spectra Optia Apheresis System. These procedures were performed on the patients and the decision to perform these procedures was based on clinical indications for red cell exchange following the ASFA guidelines 2019. After only one procedure, all the patients have their sickle hemoglobin reduced to a safe level. End hematocrit was observed to be 33% in three cases, 31.9% in one case, and 30% in the rest three. A total number of red blood cells (RBCs) transfusion in all the cases were 7, 6, 8, 5, 6, 7, and 7 with an average hematocrit of 55%, 56%, 54%, 56%, 55%, 51.7%, and 52.2%, respectively. All the patients partially phenotypically matched, leukoreduced, gamma-irradiated, fresh packed RBCs were provided. Automated red cell exchange came out to be successful in reducing the symptoms along with the improvement in laboratory parameters. New-generation automated apheresis equipment like Spectra Optia, the case series provides better monitoring and also reduces apheresis-related complications.
Evaluating the economic viability of hepatitis E virus serological screening among blood donors: A prospective study from India for advancing blood safety
Authors: Singson Sangthang , Shastry Shamee , Somu G. , Chawla Kiran
Published: December 2024

BACKGROUND:

Hepatitis E virus (HEV) stands out as a significant transfusion-transmissible infection, yet it is not included in the screening protocols of many countries. The present study was conducted to assess the cost-benefit implications of incorporating HEV screening among blood donors which is one of the preventive strategies in reducing transfusion transmissible HEV.

METHODOLOGY:

A decision tree model was prepared to assist the cost-benefit analysis. The serological screening cost of HEV was estimated based with fixed and variable cost. The cost of illness was estimated with direct and indirect cost. Net present value (NPV) and benefit-cost ratio (BCR) was used to measure the economic variability of screening HEV among the blood donors.

RESULTS:

The unit cost of HEV IgM antibody screening is 1000 INR, and the unit cost of illness due to HEV infection is INR 80,122. The NPV and BCR is INR 6,73,001 and 1.7:1 for the probable transfusion-transmitted HEV infection that was averted by the screening of HEV among the blood donors.

CONCLUSION:

Considering the risk of probable HEV transmission through blood transfusion, the study suggests that screening HEV among the blood donors is beneficial in averting transfusion-transmitted HEV infection.
ABO isoagglutinin titers in group “O” blood donors
Authors: Mangwana Sadhana , Kumar Shashi , Gangwar Vivek
Published: December 2024

BACKGROUND:

High titers of anti-A and anti-B are considered to be one reason for hemolytic transfusion reactions and ABO hemolytic disease in fetus and neonates. There is no consensus for critical ABO antibody titers to guide transfusion or transplant decisions. Implementation of ABO titer measurement can favor reduction in transfusion reactions in nongroup “O” recipients.

AIMS:

This study aimed to understand the trend and quantification of anti-A and anti-B antibody titers in Group “O” donors in this geography.

SUBJECTS AND METHODS:

A prospective study was conducted in 218, Group “O” blood donors in the year 2021, during the COVID-19 pandemic. Immunoglobulin (Ig) M antibody titers were measured by hemagglutination and IgG titers by solid-phase red cell adherence. Antibody titers ≥128 for IgG and ≥64 for IgM were considered “high titers.” Epi Info 7.1 software was used for statistical analysis, with P < 0.05 significant.

RESULTS:

About 96.75% of blood donors were male with a median age of 33.16 ± 8.8 years. ABO antibody titers ranged from 0 to 1024. The prevalence of titers of <128 for IgG anti-A and anti-B was 79.36% and 86.24%, respectively, and 88.53% for both anti-A and anti-B IgM (<64). High IgG anti-A antibody titers were exhibited in 20.64% and anti-B titers in 13.76% of donors. None of the recipients showed any hemolytic reactions.

CONCLUSIONS:

The donor population showed predominance of low isoagglutinin titers. Defining critical titers will help formulate institutional guidelines on ABO-incompatible platelet transfusions and transplants. The use of automation in ABO titer assays removes interobserver variations and offers precise, reproducible, and less labor-intensive assays in resource-constrained settings.
Early-onset Unilateral Terrien’s Marginal Degeneration
Authors: Mandal Sohini , Garg Muskan , Sachdeva Gaurav , Agarwalla Anushka , Maharana Prafulla Kumar
Published: December 2024

Purpose:

We aimed to describe the cases that highlight the fact that Terrien’s marginal degeneration (TMD) can present at an early age and should be considered when evaluating young patients with peripheral corneal thinning disorders.

Materials and Methods:

All cases of early-onset unilateral TMD that presented to a tertiary eye care center were included in the study. Three cases of early-onset unilateral TMD were reviewed. Case 1 (10 years, male) presented with superior arcuate band of corneal stromal thinning extending from 9 to 3 o’clock hours. in the right eye with associated corneal vascularization and lipid deposition at the leading edge of the furrow. Case 2 (14 years, female) presented with a superior crescentic band of corneal stromal thinning extending from 10 to 2 o’clock positions in the left eye. Vascularization of the cornea and lipid deposition were observed at the leading edge of the furrow in this case as well. Case 3 (9 years, male) presented with a superior arcuate band of corneal stromal thinning extending from 10 to 2 o’clock positions in his left eye. Corneal vascularization and lipid deposition were observed at the leading edge of the furrow formation.

Results:

A preliminary diagnosis of early-onset unilateral TMD was made in all the cases that was subsequently confirmed on Scheimpflug imaging and anterior segment optical coherence tomography. The mean astigmatism of the affected eye was 4.6 ± 2.3 D. All cases were prescribed spectacle correction, which resulted in significant improvement: 6/60-6/24 (Case 1), 6/36-6/9 (Case 2), and 6/18-6/9 (Case 3).

Conclusion:

A comprehensive case history and meticulous slit-lamp examination are essential, and TMD should be considered a differential diagnosis for peripheral corneal ectatic disorders in childhood.
Smartphone Blast Ocular Injury During Long Term Gaming Addiction in Children after the COVID era
Authors: Patel Santosh Singh , Sachdeo Sushil , Malhotra Reshu , Vishal Vaibhav
Published: December 2024

In its aftermath, the COVID era has left society addicted to smartphones and made us susceptible to injury caused by exploding batteries. These phones use high-density batteries with a long life cycle and are relatively safe despite the potential risk of explosion. Ignition in a lithium-ion battery can occur due to various causes. The failure rate of lithium batteries is extremely low at 1 in 10 million, but in a society with the ever-increasing use of smart devices, this low potential is very real and debilitating. We are presenting a case of a smartphone battery explosion injury in a young 11-year-old child caused by overuse in the charging position, which resulted in a corneal and lid tear of the left eye and loss of digits in the right hand and lacerated wound in the index finger of his left hand. There is an urgent need for creating awareness against such incidences for prevention and prompt management of debilitating injuries that may follow. There is also a need to create awareness about proper usage and battery optimization for the safety of the user.
Ocular Surface Squamous Neoplasia – An Update on Diagnostic Modalities and Management
Authors: Jain Parul , Singh Aastha , Mohapatra Avilasha , Arora Ritu , Reddy Gahan A
Published: December 2024

Ocular surface squamous neoplasia (OSSN) encompasses a group of squamous neoplasms of conjunctival and corneal epithelium such as conjunctival intraepithelial neoplasia, corneal epithelial dysplasia and squamous cell carcinoma. Patients with OSSN present with decreased visual acuity, irritation in the eye, and an ocular surface lesion with varied clinical morphologies, associated prominent feeder vessels, and often a keratin plaque. While the definitive diagnosis of OSSN is histopathological, imaging modalities such as optical coherence tomography (OCT), OCT-angiography, and ultrasound biomicroscopy are noninvasive techniques to identify the disease, its extent and monitor progression. Surgical excision with wide tumor-free margins has been traditionally employed to manage the condition. However, with promising results obtained with medical modalities such as chemotherapy and immunomodulatory agents, there has been a paradigm shift in managing patients with OSSN. This review describes in detail clinical features, latest diagnostic modalities, and management guidelines for OSSN.
Real-time Microscope-integrated Optical Coherence Tomography-guided Stromal Fluid Drainage in Corneal Hydrops for Early Resolution of Corneal Edema
Authors: Sahay Pranita , Agarwal Rinky , Maharana Prafulla Kumar
Published: December 2024

Aim:

This study aims to describe a novel technique of microscope-integrated optical coherence tomography (MiOCT)-guided stromal fluid drainage in corneal hydrops with multiple stromal fluid clefts for rapid resolution.

Materials and Methods:

Eight patients of keratoconus with corneal hydrops with multiple stromal fluid clefts underwent this procedure. Medical management was initiated in all cases at presentation and intervention was performed only in cases with poor response to medical therapy at 3 weeks. The surgical technique comprised of MiOCT-guided localization of the stromal fluid clefts followed by multiple venting incisions into the stromal fluid clefts with micro-vitreoretinal blade and simultaneous air tamponade in the anterior chamber. Corneal massage with Merocel sponge further aided in draining and imbibing fluid through the incision site. Time taken for resolution of corneal edema, requirement for repeat procedure and any complication arising out of this procedure was noted.

Results:

Eight patients of acute corneal hydrops (5–30 years) underwent this procedure. The primary diagnosis was bilateral keratoconus for all. Majority (n = 7/8) of the cases were resolved in 3 weeks and all were resolved in 4 weeks. None of the cases required a repeat procedure. No intraoperative or postoperative complication was noted in any case.

Conclusion:

MiOCT-guided drainage of stromal fluid pockets in cases of corneal hydrops is a safe and effective technique. Real-time monitoring with MiOCT allows for fluid clefts location, instrument depth judgment, and complete drainage of fluid clefts. It is especially useful in cases with severe corneal edema and large fluid clefts where medical management alone fails.
Common Complications of Implantable Collamer Lens Implantation
Authors: Garg Anshul , Chaudhary Sanjay , Pandey Alka
Published: December 2024

The ever-growing need for refractive correction led to the advent of phakic intraocular lenses, wherein the implantable collamer lens (ICL) is a major boon. The latest model of ICL, the V4c is a relatively safe lens, but a few complications have been reported. In this article, we discuss the various complications reported with the ICL for better knowledge of the surgeons. This will further help in providing in depth information of the factors that should be kept in mind before and after performing the surgery to prevent any unwanted complication.
Frequency Based Phacoemulsification, and Calibrated Phacoemulsification Probe Tip: A Journey of Innovations
Authors: Dewan Taru
Published: December 2024

In today’s era, when instruments and machines decide what kind of ophthalmic advances would come up in the future, doctors have silently given the baton to engineers and industry. Even the geniuses among us fall prey to being merely the best users of what the industry offers. No wonder there are only a handful of patent holders among Ophthalmologists. We must not underestimate the innovative and intuitive streak in all of us and reclaim the position of being the driving force in Ophthalmology. Through this article, a small glimpse of the journey to the final development of a calibrated tip and the concept of frequency-based phacoemulsification is presented.
A Rare Case of Peripheral Ulcerative Keratitis Associated with Autoimmune Hepatitis
Authors: Bindiya Chalattil , Veluri Haritha , Singh Manmeet
Published: December 2024

Here, we report a rare case of peripheral ulcerative keratitis (PUK) associated with autoimmune hepatitis. A 14-year-old girl with a past medical history of autoimmune hepatitis and possible overlap syndrome with primary sclerosing cholangitis presented with redness irritation and watering of the right eye (RE) for 10 days. The general examination revealed a poorly built and nourished child. Slit-lamp examination showed a crescent-shaped perforated peripheral corneal ulcer from 3 o’clock to 7 o’clock with iris prolapse extending from 4 o’clock to 6 o’clock with flat anterior chamber in RE. The left eye revealed scarring and thinning in the inferior part of the cornea. We planned to do a patch graft for RE after her general condition improved. We referred her to a pediatrician/pediatric surgeon for further management, but the patient was lost to follow-up thenceforth.
Limbal Dermoid, Lipodermoids and Type 1 Duane’s Retraction Syndrome in a Case of Goldenhar Syndrome
Authors: Tomar Vaishali , Agarwal Rinky , Verma Purva , Dadeya Subhash
Published: December 2024

Goldenhar syndrome (GHS), also described as oculo-auriculo-vertebral dysplasia or hemifacial microsomia, is a rare condition occurring due to a defect in the development of structures derived from the first and second branchial arches. Herein, we report a case of a young male with GHS with limbal dermoid, lipodermoid, type 1 Duane retraction syndrome along with high refractive error and ametropic amblyopia.
A Miniscleral Contact Lens Fitting in a Patient of Unilateral Terrien’s Marginal Degeneration
Authors: Jain Parul , Gupta Isha , Trivedi Nandita , Hariani Avani , Annadevula Gahan Reddy
Published: December 2024

To present the management of corneal ectasia using miniscleral contact lenses. A 22-year-old male presented with unilateral terrien’s corneal degeneration and was visually rehabilitated with miniscleral contact lenses. Miniscleral contact lenses are an emerging way for visual rehabilitation in various corneal diseases.
Decision-making in Refractive Surgery
Authors: Tomar Vaishali , Sultan Tipu , Pandey Kanchita , Khurana Mittali , Singh Aastha , Sahay Pranita
Published: December 2024

Refractive surgery has transformed the landscape of vision correction. It is one of the most commonly performed surgeries after cataract in today’s era. With rapid technological advancements, a variety of surgical options are now available. However, a thorough understanding of the benefits and limitations of each technique is crucial for achieving optimal outcomes. Careful patient examination and comprehensive screening play vital roles in formulating an effective surgical plan. This article delves into the critical factors influencing the decision making in refractive surgery including patient’s preoperative work-up and individualized treatment plans based on patient’s parameters.
A Cerebrum-like Ocular Lesion
Authors: Swain Samabesh
Published: December 2024

The present case is on morphological type of seborrheic keratosis.
Navigating Diagnostic Challenges: A Case of Best Vitelliform Macular Dystrophy Misdiagnosed as Central Serous Chorioretinopathy
Authors: Tripathi Amit Nandan , Rana Vipin , Bandopadhyay Sandeepan , Kumar Pradeep
Published: December 2024

This case report delineates diagnostic challenges in distinguishing best vitelliform macular dystrophy (BVMD) from central serous chorioretinopathy (CSC) in a 32-year-old male misdiagnosed initially with chronic CSC but later confirmed with BVMD. BVMD’s clinical resemblance to CSC, especially during its atrophic stage, complicates differentiation. Essential diagnostic tools including optical coherence tomography, fundus autofluorescence, electrooculogram, and genetic testing were crucial for accurate identification. Recognition of unique features such as autofluorescence and choroidal thickness variations aids in precise differentiation. Emphasizing precision in diagnosis, genetic counseling, and continuous monitoring highlights the imperative need to discern BVMD’s atrophic stage from CSC.
Binocular Vision Anomalies in Children and Young Adults and Effectiveness of Vision Therapy
Authors: Hossain Mohammad Mostafa , Iftekhar Quazi Sazzad , Naznin Sidratul Muntaha , Rashid Chowdhury Shift Toufique Mamunur , Hasan Md Mehedi
Published: December 2024

Purpose:

To figure out the frequency of binocular vision (BV) anomalies in children and young adults with symptoms like blurring, headache, or eyestrain and evaluate vision therapy’s effectiveness (VT).

Methods:

A retrospective review of data was conducted on 45 symptomatic subjects in a tertiary eye care hospital without strabismus or any other ocular pathology. A comprehensive eye examination with BV evaluation was done, and home as well as office VT was applied. The difference between pre- and post-VT BV parameters was decided by statistical analysis.

Results:

Among 45 subjects, binocular vision anomalies were found in 44 (97.78%). Thirty-five subjects (79.54%) had convergence insufficiency followed by fusional vergence dysfunction in 3 (6.82%), convergence excess in 3 (6.82%), divergence insufficiency in 1 (2.27%), accommodation insufficiency with convergence insufficiency in 1 (2.27%) and accommodative infacility in 1 (2.27%). Statistically, a significant difference was found in pre- and post-VT binocular vision parameters.

Conclusion:

Binocular vision anomalies are common in children and young adults with blurring, headache, or eyestrain, and vision therapy effectively improves BV parameters.
Role of Binocular Vision Therapy in Strabismic and Nonstrabismic Conditions
Authors: Sharma Preeti , Singh Prem Kumar , Gautam Kritika , Ganesh Suma
Published: December 2024

Binocular vision refers to the ability of both eyes to work together as a coordinated team, allowing us to perceive depth, judge distances accurately, and have a single, clear, and fused image of the world. However, certain conditions can disrupt this harmonious coordination, leading to strabismus (misalignment of the eyes) or nonstrabismic visual issues. Binocular vision therapy (BVT) is a specialized form of vision therapy that aims to enhance binocular vision skills and improve visual function. This review article explores the importance and role of BVT in both strabismic and nonstrabismic conditions.
A Rare Case Report of Spontaneous Suprachoroidal Hemorrhage
Authors: Amung Hage , Singh Kirti , Joon Annu , Saraf Priya , Singh Arshi
Published: December 2024

Suprachoroidal hemorrhage (SCH) is uncommon ocular event with poor prognosis. The case presented was a 64-year-old elderly patient who manifested with painful spontaneous SCH without any inciting factor except for geographical atrophy in fellow eye. The secondary angle closure glaucoma with secondary hyphema was managed conservatively, with no gain of vision.
Tolosa-Hunt Syndrome in a Young Subject
Authors: Garg Rajiv , Rana Gunjan , Madan Siddharth , Nigam Nilesh
Published: December 2024

Tolosa-Hunt syndrome (THS) is a non-specific inflammation of the cavernous sinus or superior orbital fissure which causes painful, usually unilateral ophthalmoparesis or ophthalmoplegia. A 22-year-old lady presented with diminution of vision, pain in her right eye (OD) accompanied-with protrusion of the right eyeball and drooping of right upper eyelid. There was no other significant history or any other systemic complaint. Best corrected visual acuity (BCVA), color vision, contrast sensitivity, slit lamp examination, indirect ophthalmoscopy, Hertel’s exophthalmometry, worth four dot test, strabismus evaluation using prism bars, forced duction test, visual field charting, ultrasound B- scan, contrast-enhanced computed tomography of the head and orbit, and hematological investigations were performed. A decrease in the visual acuity, corneal sensations, contrast sensitivity in the affected eye was observed. Proptosis, severe ptosis, exotropia with right hypotropia and limitation of ocular movements was seen OD. Crossed diplopia was present and visual field charting demonstrated a right hemi-field defect. Erythrocyte sedimentation rate (ESR) was raised. All routine and other blood tests were normal. A high dose of oral systemic steroids led to dramatic improvement and amelioration of pain with restoration of BCVA, contrast sensitivity, ocular motility, ptosis, strabismus and diplopia. Tolosa Hunt Syndrome (THS) is a rare observation in a young patient. It is a diagnosis of exclusion and other systemic associations must be ruled out. A dramatic improvement is seen in the symptoms of pain, ophthalmoplegia, visual loss, ptosis, strabismus and diplopia after starting high dose systemic steroids.
Low Vision and Rehabilitation
Authors: Gogate Parikshit , Shaikh Muskan , Telap Sharad , Gogate Siddharth , Phadke Supriya
Published: December 2024

Low vision and rehabilitation are not widely known and practiced in ophthalmology clinics even if there are significant number of blind and visually impaired patients who cannot be improved by spectacles, lenses or surgery. People of all age groups may have visual impairment, and each have their unique difficulties and demands in life. Fortunately, many of these patients have some residual vision. This vision can be used to improve the quality of life of these patients. There are variety of low vision and rehabilitation devices ranging from optical, non-optical aids to assistive devices to utilize this residual visual. Every patient needs to be treated individually depending upon his visual acuity, difficulties and requirements. But this can be done only by increasing knowledge and understanding of low vision among ophthalmology community. To assess and improve the knowledge regarding low vision treatment and rehabilitation we conducted 14 low vision orientation and training programs in different institutes in Pune, western Maharashtra. A total of 147 eye care personnel: ophthalmologists, optometrist, vision technicians, nurses and other staff members. There was a significant improvement in post training programs assessment, mainly in rehabilitation and counselling. A proper training and awareness among ophthalmology community will have tremendous positive impact in improving the quality of life of these blind patients.
An overview of Blindness in the Northeast India and Experience on Effective Community Eye Care by a Regional Non-Governmental Eye Care Institution
Authors: Bhattacharjee Harsha , Deori Nilutparna , Grover Sumit
Published: December 2024

Eye care in India is challenged with accessibility, availability and inequality with wide regional variation inspit of serious concerted attempt of the National Programme for Control of Blindness & Visual Impairment and non government eye care providers The scenario of blindness as well as eye care facilities in the Northeastern region is relatively different in comparison to rest of the country. This article covers the complex blindness scenario of Northeast India, limitations of reach-out and reach-in model of community eye care and the advantage of integrated people centered eye care. The article also highlight Sri Sankaradeva Nethralaya’s mission for sight through people centered eye care along with reach-out and reach-in programme in order to achieve avoidable blindness free villages.
Descemet’s Membrane Detachment - An Update
Authors: Beniwal Abhijeet , Venugopal Anitha , Vanathi Murugesan , Tandon Radhika
Published: December 2024

Descemet’s membrane is basement membrane of corneal endothelial cells, which in turn are responsible for maintaining corneal transparency. Numerous causes can lead to Descemet’s membrane detachment (DMD), with the most common etiology being post-surgical. Older age, blunt instruments and faulty technique predispose to DMD. DMD management is an emergency in order to avoid permanent damage leading to scarring of cornea. Various classifications of DMD and management protocols have been described. DMD should be suspected in cases of unexplained edema after surgery. Anterior segment optical coherence tomography (ASOCT) is the most important investigation to pick up DMD and also quantify its extent. Desmetopexy with air/gas is initial treatment of choice, could be aided by viscoelastic/suture fixation. Non responsive cases might need endothelial keratoplasty.
Comparison of Surgical Outcomes of Cataract Extraction by Manual Small Incision Cataract Surgery and Phacoemulsification in Phacomorphic Angle Closure
Authors: Singh Deepika , Rewri Parveen , Aggarwal Sagarika
Published: December 2024

Purpose:

To compare the surgical outcomes of cataract extraction in eyes with phacomorphic angle closure by manual small incision cataract surgery (MSICS) and phacoemulsification.

Methods:

A prospective, randomized, comparative study included patients of phacomorphic angle closure (PMAC) between August 2018 to December 2019, at a tertiary care teaching facility in rural western Haryana of Northern India. Patients were randomly allocated to one of the two groups-MSICS group and PHACO group, for cataract surgery. Surgical outcomes were compared in terms of intraoperative events, visual acuity, intraocular pressure (IOP) and endothelial cell loss (ECL). Association between delay in presentation, IOP at presentation and surgical outcomes were studied.

Results:

The difference between surgical outcomes by MSICS and phacoemulsification in eyes with PMAC was not significant. The median un-aided visual acuity at final follow-up was 0.5. A total of 18 (56%) gained un-aided visual acuity of ≥0.5, six (37%) in MSICS group and 12 (75%) in PHACO group (χ2 4.57, p 0.03). The mean IOP at final follow up was 12.5mmHg, with no significant difference between two groups (p 0.7). ECL in MSICS group was 5.64 (±1.1) % and in PHACO group 5.89 (±1) % (p 0.5). Eyes with lower pre-operative endothelial cell count suffered higher loss (Spearman r 0.364, p 0.04).

Conclusions:

Both MSICS and phacoemulsification are safe and effective for cataract extraction in eyes with PMAC with anterior chamber depth (ACD) of 1.15-2.09 mm.
Trials in Neuro-ophthalmology: An Overview
Authors: Sharma Akshita , Madan Siddharth
Published: December 2024

High quality clinical evidence which is derived from well designed and implemented clinical trials helps to provide advancement in clinical care and the best treatment for patients. The field of ophthalmology abounds with such high-quality clinical trials and the results of these serve as guides to clinicians worldwide. A properly designed and executed randomized clinical trial remains one of the best methods in most circumstances to assess the efficacy of medical or surgical intervention for a given disease. Neuro-ophthalmology, this sub-specialty of Ophthalmology, is not lacking with its share of clinical trials which provide Level 1 clinical evidence.
Giant Choroidal Tuberculoma as a Presenting Feature of Tuberculosis
Authors: Verma Shweta , Jyoti Kudrat
Published: December 2024

Tuberculosis (TB) is a very common systemic disease in India. As per the Global TB Report 2021, the estimated incidence of all forms of TB in India for 2020 was 188/100,000 population. Ocular TB may not be associated with clinical evidence of pulmonary TB; up to 60% of patients with evidence of extrapulmonary TB may not have been diagnosed pulmonary TB. Choroidal tuberculomas have been reported in the literature as a manifestation of ocular TB secondary to pulmonary TB. Here, we present a case of giant choroidal tuberculoma who presented to our OPD without any prior history of pulmonary TB.
Bilateral Subconjunctival Hemorrhage in a Young Female following COVID 19 Vaccination
Authors: Mandal Sohini , Ananya P.R. , Maharana Prafulla Kumar
Published: December 2024

A 21-year-old female presented to our centre with bilateral subconjunctival hemorrhage, a day after being administered Covishield vaccine. There were no other ocular or systemic complaints or history of adverse effects following immunization. Complete blood counts were within normal limits with slightly deranged blood clotting parameters. Subsequently, the patient was treated conservatively and was kept on close follow up which revealed complete resolution of the hemorrhage in a week’s duration.
Iatrogenic Induced Complete Herniation of Vitreous - Atypical Presentation of Vitreous Touch Syndrome without Corneal Edema/ Decompensation in a Bilateral Aphakic Patient with Pseudoexfoliation Glaucoma
Authors: Ramesh Prasanna Venkatesh , Ramesh Shruthy Vaishali , Ramesh Meena Kumari , Rajasekaran Ramesh
Published: December 2024

A 70-year-old female presented with blurring of vision and gush of warm fluid in the left eye (OS). She gave history of ocular surgery without lens implantation 20 years back in OS and five years back in the right eye (OD). On examination, visual acuity was hand movements in OS. The slit lamp examination revealed pseudoexfoliation with aphakia in both eyes with complete herniation of intact vitreous knuckle, bulging through the pupillary aperture and touching the corneal endothelium without corneal decompensation in OS and remnant posterior capsular rent in OD without vitreous disturbance.