bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypopyon uveitis as a presenting manifestation of biopsy-proven sarcoidosis – A case report
Authors: Babu Kalpana , Hegde Preethi , Mittal Govind S
Published: July 2023

A 68-year-old lady was referred for evaluation of bilateral hypopyon uveitis by her ophthalmologist. She had a history of bilateral cataract surgery 8 months ago and had received intravitreal dexamethasone implants for recurrent bouts of anterior uveitis with cystoid macular edema (CME) in both eyes 4 months ago. Systemic history was significant for diabetes mellitus and recurrent skin lesions. Aqueous tap was negative for infection on culture and polymerase chain reaction (PCR). Skin biopsy showed non-necrotizing granulomas, negative for Mycobacterium tuberculosis and fungi, suggestive of sarcoidosis. She received oral steroids and methotrexate, which resulted in resolution of ocular and skin lesions. This case highlights a rare presentation of hypopyon in ocular sarcoidosis.
Could this be a lead for a solution to negative dysphotopsia?
Authors: Potharaju Nagabhushana R
Published: July 2023

Negative dysphotopsia (ND) was diagnosed when the mydriatic effect waned off by 4 h after intraocular lens implantation providing time for the institution of immediate rectification measures. ND was a peripheral temporal visual field defect (VFD) and manifested as a 100% black shadow having an inner arc with a sharp, smooth, and concave edge and outer border extending to the temporal periphery. ND disappeared when two fingers were kept blocking the ND over the affected side within ≤1” of the temple. The extent of VFD varied with eye movement. Clinically, intraocular lens is the cause of ND and not neuroadaptation.
A new phenotype of Kartagener's syndrome
Authors: Nagaraj Kalpana Badami , Tumbadi Kavitha L , Ravi B , Shilpa Y D , Bhavna G , Hemalatha B C
Published: July 2023

Kartagener's syndrome (KS) is Primary Ciliary Dyskinesia, autosomal recessive disorder characterised by triad of situs inversus of viscera, sinusitis, bronchiectasis due to ciliary dysfunction. Primary ciliary dyskinesia - retinitis pigmentosa syndrome is an X-linked ciliary dysfunction of respiratory epithelium and photoreceptors of retina leading to ocular disorders associated with chronic bronchiectasis, sinusitis and. sensorineural hearing loss. Here we present one such case of Kartagener's syndrome with Retinitis Pigmentosa (RP) which was also associated with Retinal Detachment (RD) in short stature individual reported for the first time, to the best of our knowledge which could be a new phenotypic presentation in Primary Ciliary Dyskinesia.
Pseudo-ophthalmomyiasis externa due to Musca domestica (Housefly)
Authors: Jha Rakesh K , Manoj G M , Kaushik Jaya
Published: July 2023

Ophthalmomyiasis is infestation of the eye by fly larva which leads to variable clinical presentations depending on the scale of penetration, species of the fly, and the involved ocular framework. A case of accidental external ophthalmomyiasis, who presented with symptoms mimicking of an acute catarrhal conjunctivitis, is being reported, which was managed with prompt mechanical removal of the larva under topical anesthesia along with supportive treatment. The patient had rapid recovery in the follow up with subsequent microbiological taxonomic identification of the retrieved larvae as of Musca domestica (housefly).
A rare case of phacomatosis pigmento vascularis with glaucoma in an Indian child
Authors: Shah Chintan , Sen Pradhnya , Jain Richa , Sood Devindra , Mohan Amit , Jain Elesh
Published: July 2023

We present a rare case of phacomatosis pigmentovascularis in a 6-year-old child. The child had one functioning eye with severe glaucoma at presentation. We managed the case with primary Ahmed glaucoma valve implantation followed by two needling attempts. After 3 years of follow-up, the intraocular pressure was well maintained with the addition of two antiglaucoma medications.
Syndromic Cherry – Goldberg Cotlier syndrome
Authors: Gulati Megha , Dureja Rohit , Ger Marina , Panchal Bhavik
Published: July 2023

The cherry-red spot in typical central retinal artery occlusion occurs because of the reddish color of the vascular choroid and retinal pigment epithelium seen through the foveola while the adjacent inner retina is opacified. We report a case of a bilateral pseudo-cherry-red spot in association with conjunctival telangiectasia and corneal posterior stromal clouding.
Optic nerve infiltration and combined vascular occlusion as a sign of relapse in acute myeloid leukemia
Authors: Arthi Mohankumar , Sujitha D , Dabir Supriya Gautam , Khatri Manoj , Rajan Mohan
Published: July 2023

Leukemic infiltration of the optic nerve is considered as a neuro-ophthalmic emergency and may be indicative of systemic and/or central nervous system relapse of the disease. These patients have hyperleukocytosis characterized by increased viscosity of blood causing leukostatic retinopathy and retinal vascular occlusions. In this case report, we describe a young male with simultaneous infiltrative and leukostatic manifestations in the posterior segment of the eye, which was the initial sign of relapse of leukemia. The case highlights the importance of meticulous and early eye examinations in patients with hematological malignancies, as it may impact the long-term survival of the patient.
Successful management of sub-Tenon's abscess in an adult after strabismus surgery
Authors: Dadeya Subhash , Aggarwal Himshikha
Published: July 2023

Periocular and orbital infections post-strabismus surgery are uncommon, with most of these cases reported in children. We report a rare case of sub-Tenon's abscess in a 27-year-old female following strabismus surgery, which was successfully managed with systemic and topical antibiotics without any requirement for surgical drainage of the abscess.
Conjunctival fibroepithelial polyp – A rare case
Authors: Sayeed Khalida , Iqbal Javed , Malhotra Rubie
Published: July 2023

Fibroepithelial polyp, one of the most common benign cutaneous lesions, was seen as a conjunctival mass, which, to the best of our knowledge, is the second ever reported case of fibroepithelial polyp involving conjunctiva, although it can have atypical presentation and has been reported at sites like ureteropelvic junction, genitals, bronchi, tonsils, and outer ear canal. The common benign and malignant conjunctival lesions are pterygium, pingecuela, pannus, pyogenic granuloma, limbal dermoid, papilloma, squamous cell carcinoma, lymphoma, Kaposi sarcoma, and malignant melanoma. Therefore, the possibility of fibroepithelial polyp affecting uncommon sites cannot be negated.
Diffuse anterior scleritis following micropulse transscleral laser
Authors: Nivash Archana , Mohan Sujatha , Anand Niranjana , Ariga Murali
Published: July 2023

We report a case of scleritis following micropulse transscleral laser therapy (TLT) in an elderly female with medically uncontrolled primary open-angle glaucoma. She had completed antitubercular treatment (ATT) for pulmonary tuberculosis 20 years ago. Along with scleritis, there were vitritis and macular edema post laser. Systemic blood investigations for connective tissue disorders were negative. She had latent tuberculous infection with positive Mantoux test and quantiferon TB gold. She responded favorably to topical steroids with no vision loss. Though TLT, with its pulsed laser delivery, is considered safe, caution must be exercised in patients susceptible to inflammation.
Branch retinal artery occlusion post-vitreo-retinal surgery – A case report
Authors: Meshram Madhuri , Nene Amit S , Ramteke Pushpanjali , Shenoy Pratik , Rawlani Hitesh , Shah Smitesh
Published: July 2023

We report a case of 50 year old female patient who underwent vitreo-retina surgery in left eye for retinal detachment and presented with branch retinal artery occlusion (BRAO) one month post surgery. Surgical procedures included scleral buckling, pars plana vitrectomy and silicon oil injection. Her best corrected visual acuity (BCVA) was 1/60 and intraocular pressure was 46 mm of Hg. Partial SOR was done which resulted in reperfusion and improvement in visual acuity. Early intervention is the key in managing such complications.
Bilateral macular telangiectasias with macular edema in a patient on incessant diethylcarbamazine medication – A case report
Authors: Agrawal Saurabh
Published: July 2023

Macular telangiectasia is characterized by bilateral alterations of the macular capillary network and neurosensory atrophy, but it is very rarely associated with macular edema. Presented here is a case with bilateral macular capillary telangiectasias with severe macular edema and subretinal fluid accumulation. Here, a proposed mechanism for the injury to the capillaries, causing telangiectasias and edema, is the toxicity of drug diethylcarbamazine, which the patient had been self-administering for lymphatic filariasis for 20 years. The drug at increased concentrations is known to accentuate free radical–mediated cellular injury by inhibiting the lipooxygenase pathway.
Mucous membrane pemphigoid mimicking a corneal ulcer
Authors: Juneja Aarzoo , Puthalath Athul S , Aggarwal Himanshi , Gupta Neeti , Mittal Sanjeev K
Published: July 2023

Mucous membrane pemphigoid (MMP) is a subepithelial blistering disorder affecting multiple mucous membranes, with ocular involvement in 70% of cases. A 50-year-old man had complaints of gradual and painless diminution of vision associated with redness since three months and had been diagnosed and managed as corneal ulcer outside. The patient did not improve clinically and presented to us with the above complaints. On systemic evaluation, he was found to have multiple skin lesions along with oral and genital ulcers. Punch biopsy of the lesions was suggestive of MMP. The patient was started on topical antibiotics and steroids along with systemic steroids and azathioprine. After one-month follow-up, there was improvement in both the ocular and skin lesions. MMP is a common cause of chronic cicatrizing conjunctivitis. One must be vigilant to diagnose and treat MMP before it presents as a blinding complication.
Analysis of primary repair in cases of ocular dog bite injury
Authors: Bhadra Tania R , Ghosh Rudra P , Mitra Ankita , Singh Arun K , Bhadra Tanmoy
Published: July 2023

Ocular dog bite injuries are reported mostly in children and are commonly associated with severe adnexal injuries. We studied six ocular dog bite injuries that presented in the emergency unit of a tertiary institute within six hours of injury between April 2021 and March 2022. All patients had lid laceration and one case had canalicular tear with severe tissue loss in the lower lid. Wound apposition was done with loose sutures on skin and minimal trauma to tissues. Wound healing was good in all cases. This approach of lid injury repair helps to reduce chances of infection while achieving good cosmesis.
An unusual presentation of vernal keratoconjunctivitis
Authors: Panda Bijnya B , Mohapatra Nachiketa , Vishwanath Shilpa
Published: July 2023

Vernal keratoconjunctivitis is diagnosed mainly on the basis of typical signs and symptoms of allergic conjunctivitis such as conjunctival papillae, limbal gelatinous thickening, peri-limbal Horner–Trantas dots, and shield ulcers. Limbal hyperplasia can be a rare finding in such patients, which mimics an ocular surface neoplasm and is difficult to diagnose clinically unless a histopathological examination is done. We report a case of a young boy with a longstanding history of allergic conjunctivitis refractory to topical corticosteroids who presented with a giant isolated limbal conjunctival nodule and was successfully managed without any recurrence.
Bilateral pseudopterygia following pediatric cataract surgery
Authors: Dhillon Hennaav K , Agarkar Sumita , Rajagopal Rama , Kumar Krishna S
Published: July 2023

Pseudopterygia are the advancement of the conjunctiva onto the corneal surface in the setting of active or old ocular surface inflammation. Pterygia and pseudopterygia are exceptional conditions in children.[1] We report a case of a 3-year-old child with a visually significant bilateral double-headed pseudopterygium, which developed following pediatric cataract surgery. The child was managed with pseudopterygium excision with conjunctival autograft and amniotic membrane grafting followed by visual rehabilitation.
Keratomalacia in a young diabetic
Authors: Shakrawal Jyoti , Bhatnagar Kavita R , Agarwal Nikhil , Roy Falguni
Published: July 2023

A 38-year-old male presented with complaints of gradual and painless diminution of vision in both the eyes for 1 month. He also had a history of on and off diarrhea for the past 4 months. He was a known case of latent auto-immune diabetes mellitus. Ophthalmic examination showed bilateral conjunctival xerosis and inferior corneal ulceration with stromal edema and Descemet's folds. With the suspicion of vitamin A deficiency-induced keratomalacia, a complete workup was performed. He turned out to be a case of chronic calcific pancreatitis, and stool test was also positive for steatorrhea. The patient was started on oral vitamin A supplementation. Topical lubricants and prophylactic antibiotics were also started in both the eyes with the application of bandage contact lens. Visual acuity improved within a period of 2–3 weeks of treatment and is now on regular follow-up.
Macular corneal dystrophy with keratoconus – Case report and review of literature
Authors: Hashia Renu , Chatterjee Debapriya
Published: July 2023

We report a case of macular corneal dystrophy with suspected keratoconus on clinical examination in a 20-year-old female. On Scheimpflug imaging, anterior sagittal and posterior sagittal maps were suggestive of keratoconus. Anterior segment optical coherence tomography showed focal areas of hyperreflectivity in the anterior stroma with diffuse thinning. We report this case to illustrate that high astigmatism and thinning, commonly present in macular dystrophy, may have features suggestive of keratoconus. Corneal haze precludes an accurate assessment of the posterior corneal curvature.
Inadvertent intralenticular injection of ozurdex which presented as secondary glaucoma
Authors: Shankar Anitha Priya Arun , Parivadhini A
Published: July 2023

A 58-year-old male presented with a progressive decrease in vision after he received intravitreal ozurdex injection 6 months ago for diabetic macular edema. Visual acuity in the right eye and left eye was 20/630 and 20/125, respectively. The right eye lens showed intralenticular dexamethasone implant. Intraocular pressure was 40 mmHg in the right eye and 16 mmHg in the left eye. Fundus examination revealed nonproliferative diabetic retinopathy with macular edema in both eyes. As the patient's intraocular pressure was not controlled by maximum medical therapy, he was listed for phacoemulsification with intraocular lens implantation.
A case of choroidal neovascular membrane in Best vitelliform macular dystrophy treated with intravitreal brolucizumab
Authors: Panigrahi Pradeep K , Srija Yamijala Neha , Thareja Japesh , Satapathy Jasmita , Minj Anita
Published: July 2023

A 21-year-old healthy male presented with loss of vision associated with metamorphopsia in the right eye of 6 weeks duration. The patient was a known case of best vitelliform macular dystrophy in both eyes. Clinical and imaging studies lead to a diagnosis of the choroidal neovascular membrane (CNVM). The diseased eye was treated with a single dose of intravitreal brolucizumab. Significant gains in visual acuity and reduction in the subretinal fluid were noted over 2 months of follow-up. Intravitreal brolucizumab can be an effective option in treating CNVMs associated with macular dystrophy.
A rare case of Urrets-Zavalia syndrome following trabeculectomy in a pediatric patient
Authors: Johri Tripti , Dubey Sunita
Published: July 2023

A child with bilateral advanced steroid-induced glaucoma and uncontrolled intraocular pressure (IOP) on maximum medical therapy underwent trabeculectomy surgery. The eye developed a dense anterior chamber inflammation with a high IOP in the postoperative period, which was managed medically. The IOP got controlled in the following visits, but the pupil remained mid-dilated, fixed, and nonreactive to pilocarpine, and a provisional diagnosis of Urrets-Zavalia syndrome was made. Urrets-Zavalia syndrome is a rare postsurgical complication characterized by a fixed dilated pupil with iris atrophy. This is the first such case reported in a pediatric patient following trabeculectomy.
A diagnostic impasse
Authors: Narvekar Yash K , Usgaonkar Ugam P S , Naik Aparna
Published: July 2023

A four-year-old female presented to the department of ophthalmology with history (given by the mother) of noticing drooping of the left upper lid and small eye since birth. On examination, the patient was found to have mild ptosis, miosis, and mild iris hypochromia of the left eye. A diagnosis of Horner's syndrome was made. Retrospective evaluation revealed that the patient was diagnosed as a case of tracheoesophageal fistula (TEF) and esophageal atresia on first day of life and underwent surgical intervention on the second day of life. We present this case as that of diagnostic challenge with respect to the etiology of Horner's syndrome.
Isolated superior rectus muscle hematoma with quiet eye after blunt orbital trauma – A case report
Authors: Shrivastava Om Shankar , Patle Shimali
Published: July 2023

After orbital trauma, medial rectus (MR) and inferior rectus (IR) muscles are the most frequently injured, while the oblique muscles are the least frequently injured. This can be probably because of the anatomical specifications of these muscles within the orbit. It is very unusual to find an isolated muscle injury or hematoma without any other orbital or ocular damage. We report here the case of a 7-year-old boy who presented with an isolated superior rectus muscle (SRM) hematoma after a blunt orbital trauma.
Severe anterior capsular contraction with complete occlusion of capsulotomy after femtosecond laser-assisted cataract surgery
Authors: Singh Swati , Sachdev Mahipal S , Gupta Hemlata
Published: July 2023

Anterior capsular contraction syndrome can cause a remarkable loss of sight in the postoperative period, requiring early laser or surgical treatment for visual rehabilitation. Despite several studies comparing the outcomes of femtolaser cataract surgery and conventional phacoemulsification, the incidence of anterior capsular contraction after laser cataract surgery is not known. We present a case of severe anterior capsular contraction with total occlusion of capsular opening in a patient after 7 weeks of uneventful femtolaser-assisted cataract surgery, who was treated with neodymium: yttrium aluminum garnet laser anterior capsulotomy. There is no other published report of complete occlusion of femtolaser capsulotomy by capsular contraction and fibrosis.
Atypical presentation of calcific band keratopathy
Authors: Goren Lee , Segev Fani
Published: July 2023

To report an unusual presentation of calcific band keratopathy and to hypothesize what causes this presentation, as well as its management with ethylenediaminetetraacetic acid (EDTA) chelation using dipotassium-ethylenediaminetetraacetic acid (K2-EDTA). We have conducted a review of the literature on the pathogenesis and treatment of calcific band keratopathy while focusing on the role of hypercalcemia, dry eyes, and corneal exposure. A 53-year-old patient developed an atypical calcific band keratopathy attributed to her ocular and medical history, which included end-stage renal disease (ESRD), hypercalcemia, glaucoma, dry eyes, and chronic use of eye drops. Within two months after starting the administration of oral vitamin D supplements, white/grey opacities appeared on the patient's cornea, as well as hypercalcemia. The patient was instructed to desist vitamin D supplements. Superficial epithelial keratectomy with EDTA chelation using K2-EDTA was performed while abstaining from the limbal opacities. After a 30-day period, the patient's cornea remained clear, and no recurrence of corneal opacities was observed. To the best of our knowledge, this is the first published case that reports this type of unique presentation of calcific band keratopathy. The hypothesis for the reason of the unique clinical presentation of our case will be discussed.
Enhanced Depth Imaging-Spectral Domain-Optical Coherence Tomography imaging of choroidal tubercles with multiple pigment epithelial detachments in a case of miliary tuberculosis
Authors: Elango Mudaliar Ashwini , Bosco Arokiam John , Thanikachalam S , Kavitha Josephine R
Published: July 2023

Choroidal tubercles in miliary tuberculosis have been rarely reported. A 65-year-old male diagnosed with miliary tuberculosis was started on antitubercular therapy (ATT) and referred for fundus screening, which revealed lesions suggestive of choroidal tubercles and pigment epithelial detachments (PEDs), confirmed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). Choroidal tubercles were identified in Enhanced Depth Imaging-Spectral Domain-Optical Coherence Tomography (EDI-SD-OCT) as nodular hyperreflective lesions with thickening of overlying choriocapillaris– Retinal Pigment Epithelium (RPE)–Bruch's complex, myoid–ellipsoid junction disruption, and increased choroidal thickness. Choroidal thickening and PED decreased following ATT. EDI-SD-OCT is the investigative tool of choice to identify choroidal tubercles and inflammation. EDI-SD-OCT can be utilized as a biomarker in choroidal studies. PED may result due to choroidal inflammation.
A unique case of haptic protusion from iris after neodymium-yttrium aluminum garnet laser capsulotomy
Authors: Srividya Kalluri Satya , Balamurugan S , Mishra Snigdha , Venkatesh R
Published: July 2023

Neodymium-ytrrium aluminium garnet capsulotomy is the gold standard for the treatment of posterior capsular opacification and is most commonly performed as an outpatient procedure. Here, the authors report a rare and probably the first encounter of a complication post laser capsulotomy seen in a 54 years old female who presented with defective vision and pain for 6 months after the procedure. Examination revealed one of the haptics of intraocular lens piercing through the iris into the anterior chamber, causing chronic inflammation leading to cystoid macular edema. The exact position of the intraocular lens and it's haptics were confirmed using anterior segment optical coherence tomography.
Traumatic anterior phacocele
Authors: Agarwal Richa , Tripathi Alka , Agnihotri Kritika
Published: July 2023

A 72-year-old lady complained sudden-onset loss of vison in the left eye after falling from bed. She was only able to perceive light from the left eye. Anterior segment examination showed a solid subconjunctival mass in the superonasal quadrant adjacent to limbus, suggestive of anterior phacocele. Ultrasound B-scan confirmed the diagnosis, and patient was taken for surgery which led to good visual recovery. Appropriate and timely diagnosis and management of such cases can improve prognosis of such cases.
An unusual case of orbital abscess due to Morganella morganii and Klebsiella pneumoniae, following acute on chronic dacryocystitis
Authors: Nayak Rashmi K , Banerjee Barnini , Pai Vijaya H
Published: July 2023

Orbital abscess secondary to dacryocystitis is rare.[1]
Morganella morganii is a gram-negative rod and a facultative anaerobic enteric bacterium causing opportunistic infection, often isolated as a cause of nosocomial infection, specifically in urinary tract or wound infections. Risk factors may be old age, presence of concomitant bacteremia, hospitalization, recent surgery, concurrent antibiotic use, and immunocompromised hosts.[2] According to authors' knowledge, till date, only one case of orbital abscess due to M. morganii has been reported secondary to sinusitis. There are no reports of orbital abscess due to M. morganii following dacryocystitis till date.[3] We report a rare case of orbital abscess secondary to dacrocystitis caused by M. morganii and Klebsiella pneumoniae in an immunocompetent patient.
Intravitreal clindamycin-induced macular infarct in a case of ocular toxoplasmosis
Authors: Patel Megha B , Nene Amit S , Shah Smitesh , Shenoy Pratik , Ramteke Pushpanjali , Padwal Sonali , Pirdankar Onkar H
Published: July 2023

Intravitreal clindamycin is one the modalities in managing ocular toxoplasmosis. Here we report clindamycin-induced macular infarct followed by full thickness macular hole with epiretinal membrane and macular atrophy. A 54-year-old male diagnosed with ocular toxoplasmosis in the right eye was treated with intravitreal injection of clindamycin and dexamethasone. Patient developed macular infarction with epiretinal membrane (ERM) and full thickness hole, with corresponding decrease in visual acuity and was managed with vitrectomy. Clindamycin injection has potential to cause retinal complications, and hence, one needs to be extremely cautious while preparing the proper concentration of clindamycin as it requires appropriate dilution.
Adverse skin reaction due to ripasudil eye drops
Authors: Medikonda Malleswari , Gogineni Harshitha
Published: July 2023

Topical anti-glaucoma medications are the mainstay of therapy in Glaucoma. All anti-glaucoma medications are associated with adverse effects. As ripasudil hydrochloride hydrate 0.4% is a relatively new drug, we describe a series of patients who developed allergic contact dermatitis after the use of topical Ripasudil. Twelve eyes of seven patients treated with topical ripasudil that subsequently developed allergic contact dermatitis were included in the case series. All seven patients developed itchy, hyperpigmented lesions around periocular areas which got relieved after cessation of the drug.
Refractory keratitis – A microbial cocktail or infectious enigma?
Authors: Mukhija Ritika , Beniwal Abhijeet , Rajaura Kumar Kartikay , Kashyap Seema , Tandon Radhika
Published: July 2023

A 39-year-old adult male presented to the outpatient department of a tertiary care eye hospital with keratouveitis and responded to treatment for viral keratouveitis. On a follow-up, the clinically ulcer suggested fungal keratitis, which was supported by in vivo confocal scan. The episode was managed with antifungal therapy. Tear film polymerase chain reaction (PCR) found cytomegalovirus DNA. Repeated episodes were likewise managed, but ultimately there was stromal scarring which required penetrating keratoplasty. Surprisingly, histopathology of specimen showed microsporidia. Till last follow-up, the graft was clear and the patient had 20/40 vision. Microsporidia should be a differential in refractory stromal keratitis.
Peripheral ulcerative keratitis in a patient with systemic lupus erythematosus
Authors: Mohan Sujatha , Prasad Madhumita , Mohan Madhuvanthi , Mohan Sashwanthi
Published: July 2023

Systemic lupus erythematosus (SLE) can have various ophthalmic manifestations, of which a rare but serious association is peripheral ulcerative keratitis (PUK), which can progress to corneal melt and perforation. Adequate immuno-suppression and close follow-up are required in these patients to prevent ocular and systemic progression of disease. We report a case of PUK in SLE which progressed rapidly despite immuno-suppression and required surgical intervention.
Orbital emphysema
Authors: Chakroborti Chandana , Megha Banka A , Naskar Soumi , Thomas Sonia R
Published: July 2023

Orbital emphysema (OE) is an uncommon, benign, and self-limiting condition that results from trapping of air in loose periorbital subcutaneous tissues. We report a series of five cases of OE, four post traumatic, and one after forceful nose blowing. They presented with acute periorbital swelling. The clinical diagnosis was confirmed on imaging promptly. They were counseled to keep a keen eye for any signs of deterioration and kept on close follow-up. Some key clinical and radiological clues which indicated a relatively low risk of deterioration were noted, so they were conservatively managed with cold compression, avoidance of nose blowing/sneezing, nasal decongestants, oral antibiotics, and anti-inflammatories. Complete resolution of symptoms occurred within 2–3 weeks. Timely diagnosis, thorough patient counseling, conservative management, close monitoring, and expedient surgical intervention on deterioration are keystones in OE management.
Giant lacrimal mucocele in an adult – A case report
Authors: Choudhury Haimanti , Choudhury Himadri , Choudhury Hirendra K
Published: July 2023

Encysted lacrimal mucocele refers to diffuse, centrifugal enlargement of the lacrimal sac resulting from combined proximal and distal obstructions in lacrimal drainage system. Its presence in adults is an extremely rare event. The authors describe a case of giant lacrimal mucocele in an adult female presenting with only mild epiphora. The patient underwent aspiration of pus followed by external dacryocystorhinostomy (DCR). Patient's symptoms of epiphora resolved after surgery.
A case report of retained intracameral eyelash following trauma
Authors: Amung Hage , Jain Parul , Gupta Isha , Mehta Arun
Published: July 2023

Intraocular cilium is a very rare intraocular foreign body. We report a 24-year-old male patient who presented with self-sealed corneal laceration with retained eyelash in the anterior chamber, following an injury with a plastic object. In view of the anterior chamber reaction, topical and oral steroids were started and surgical removal of the intraocular eyelash was performed.
Traumatic lenticele – A rare case report
Authors: Saxena Navneet , Khan Saba Firdos , Tripathi Richa
Published: July 2023

Traumatic subconjunctival dislocation of the lens (phacocele or lenticele) is of relatively rare occurrence. We report an unusual case of subconjunctival dislocation of the cataractous lens following blunt ocular trauma by cow horn in an elderly patient without having any previous ocular surgery or trauma. Blunt trauma resulted in indirect scleral rupture with subsequent dislocation of the crystalline lens in the subconjunctival space. The pathophysiological mechanism, clinical presentation, and management are discussed in this case report.
Sellar mass presenting as monocular temporal hemianopia
Authors: Singh Gurcharan , Gofer Kebede
Published: July 2023

A 56-year-old male presented with diminished vision in his left eye since 6 months. Humphrey visual field examination showed monocular left eye temporal hemianopia extending onto inferonasal field. Right eye field was essentially normal. Computed tomography scan of brain and orbits showed enhancing sellar mass with extension into suprasellar area having solid and cystic components. This is a rare visual field presentation of a sellar mass.
Active concurrent central serous chorioretinopathy and pachychoroid neovasculopathy managed with combination therapy of photodynamic therapy and anti-vascular endothelial growth factor agent
Authors: Garg Barun , Gupta Isha , Goel Sugandha , Senger Deepak , Saurabh Kumar , Roy Rupak
Published: July 2023

Pachychoroid disease spectrum includes central serous chorioretinopathy (CSR) and pachychoroid neovasculopathy (PNV). Pachychoroid phenotype is characterized by choroidal hyperpermeability, dilated choroidal vessels (pachyvessels), and focal or diffuse increase in choroidal thickness. Newer imaging modalities have aided in the diagnosis of choroidal diseases. Herein, we present a case of active concurrent CSR with PNV in a middle-aged patient with successful treatment by photodynamic therapy and intravitreal anti-vascular endothelial growth factor (VEGF) (ranibizumab) injection.
A rare case of Evans syndrome presenting as retrobulbar neuritis
Authors: Shah Virna M , Hema VK , Kumar Karthik
Published: July 2023

Evans syndrome (ES) is a rare disease characterized by simultaneous development of autoimmune hemolytic anemia and immune thrombocytopenia with or without immune neutropenia. We report the first case of ES presenting as retrobulbar neuritis. Purpose of this report is to create awareness about ES. A 25-year-old female presented with sudden painful loss of vision. Neuroimaging confirmed retrobulbar neuritis. She had menorrhagia and iron-deficiency anemia. She had pallor, hepatosplenomegaly, and hemolytic anemia. She was treated with intravenous steroids. ES is a disease of high morbidity.
Tenon's graft melt
Authors: Anitha Venugopal , Madkaikar Aditee , Ravindran Meenakshi
Published: July 2023

A 48-year-old female underwent a Tenon's patch graft for a perforated ulcer done during coronavirus disease 2019 (COVID-19) times. Five months later, the patient presented to us with Tenon's graft melt due to the infection of the graft and the corneal stroma with Curvularia. The patient was successfully treated with appropriate topical, commonly used antifungal therapy with a good outcome. To our knowledge, this is the first documentation of case describing the predisposing factors, clinical features, and the management of autologous Tenon's graft infection with Curvularia fungus, a rare occurrence in literature.
Microwave ablation is superior to radiofrequency ablation in the treatment of hepatocellular carcinoma below 5 cm - A systematic review and meta-analysis
Authors: Zhang Lingkai , Du Fei , Zhang Yongxuan , Yangdan Cairang , Wang Haijiu , Ren Li
Published: July 2023

The purpose of this study was to systematically evaluate the prognosis of patients with hepatocellular carcinoma (HCC) smaller than 5 cm using microwave ablation (MWA) versus radiofrequency ablation (RFA). PubMed, Cochrane Library and Embase databases were searched for studies reporting comparisons of two interventions (MWA versus RFA) for patients with early-stage HCC published up to 31 December, 2022. The analysis evaluated the recurrence-free survival (RFS), overall survival (OS) and complications. A total of 894 patients were enrolled in six studies (two randomised controlled trials and four propensity score cohort studies). There were 446 patients in the MWA group and 448 patients in the RFA group. Compared with RFA, MWA had a significant advantage in the post-operative 1-, 2-, 3- and 5-year RFS (odds ratios [OR] = 0.58, 95% confidence interval [CI]: 0.40, 0.84; OR = 0.60, 95% CI: 0.45, 0.80; OR = 0.56, 95% CI: 0.33, 0.93; and OR = 0.44, 95% CI: 0.30, 0.65). The OS of MWA was significantly higher than that of RFA in 5 years after ablation (OR = 0.48, 95% CI: 0.34, 0.68). Moreover, MWA had an advantage in the incidence of complications (OR = 2.23, 95% CI: 1.16, 4.29). In the comparison of percutaneous MWA and RFA in the treatment of HCC with a diameter smaller than 5 cm, MWA may have more advantages in improving the prognosis.
Tumor Resection, Reconstruction, and Ankle Fusion for Recurrent Giant Cell Tumor of the Distal Tibia
Authors: Agrawal Alok C. , Ojha Mukund Madhav , Banerjee Somok
Published: July 2023

Giant cell tumor (GCT) is a common, mostly benign, locally aggressive tumor of bone. Distal femur, proximal tibia, and distal radius appear to be the most affected parts of the skeleton. We are reporting a case of recurrent GCT involving the distal tibia treated with resection and arthrodesis of the ankle using contralateral fibular strut graft. A male patient presented to us with pathological fracture of the left distal tibia due to recurrent GCT. Radiological assessment was suggestive of locally aggressive tumor involving the meta-epiphyseal region. The patient underwent wide margin excision of tumor and ankle fusion using the contralateral fibula as a second pillar to increase the stability of construct. GCT involving the distal tibia is a rare presentation and demands meticulous efforts to manage after recurrence. Resection of tumor mass and ankle arthrodesis is a good option as it provides a stable ankle and overall good patient satisfaction.
Bilateral Outpatient Total Knee Arthroplasty – Is it Feasible, Safe, and Worth Considering: A Pilot Study
Authors: Rajan Sunil , Jain Saurabh , Dhosariya Chetan Singh , Goyal Ashish
Published: July 2023

Introduction:

Outpatient total knee arthroplasty (TKA) in selected patients has proved to be beneficial to both patients and health-care systems in terms of safety, reoperations, readmission rate, complications, cost-effectiveness, increased patient satisfaction, and improved outcome scores. However, these benefits of outpatient TKA have been limited to unilateral TKA. Hence, we reviewed the results of bilateral outpatient TKA in five patients to educate surgeons about the feasibility, safety, benefit, and area of research for bilateral outpatient TKA and its worth consideration in selected groups of patients to decrease patient morbidity and cost.

Materials and Methods:

Five bilateral knee arthroplasties done as outpatient surgeries at our center were reviewed for patient satisfaction, readmission, reoperation, emergency visit without readmission, unplanned clinic visits, and complications. All these cases followed proper selection criteria, adequate preoperative planning, and strict adherence to our standard operating protocols.

Results:

Five patients of bilateral outpatient TKA with a mean age of 48.6 years were included in the study. All patients have excellent outcomes at 1-month follow-up. The mean Knee Society Score was 91. None of the patients required reoperation or revision surgery. All the patients demonstrated a high level of satisfaction, without any complications of instability, infection, ileus, urinary tract infection, or deep vein thrombosis.

Conclusion:

Bilateral outpatient TKA can be considered a suitable alternative with benefits of reduced hospital stay, and hence decreased morbidity and cost, early mobilization and recovery, economical advantages, minimal pain owing to multimodal analgesia, faster return to normalcy, and less mental stress or disturbances, but in selected patients at specialized center only. The study stresses on the fact of bilateral outpatient TKA should also considered a key area of research in the field of outpatient TKA in addition to other areas of universal selection criteria, ideal risk assessment tool, safety aspect, surgical duration, ambulation, and reasons for not able to discharge.
Are we Really Improving the Quality of Life after Hemiarthroplasty of the Hip in the Elderly? An Observational Study
Authors: Adarsh T. , Mruthyunjaya  , Likhit C. S. , Khan Nawab Akthar
Published: July 2023

Introduction:

Hip fractures are the major cause of disability and functional impairment in the elderly. Studies have correlated the results from treating femoral neck fractures; however, little has been described the quality of life (QOL) after hemiarthroplasty in these patients.

Objective:

An assessment of physical, psychological, social relationships, and environmental domains of QOL after hemiarthroplasty in elderly patients and to analyze the postsurgical impact on the activity of daily living and functional outcome of the hip.

Methods:

Prospective observational study was conducted on 100 elderly patients who underwent hemiarthroplasty. The hip function was scored with the Harris Hip Score (HHS) and activities of daily living were rated by the Barthel Index. Health-related QOL was rated by the World Health Organization QOL: Brief version applied before and 6 months after surgery.

Results:

There was fair to good HHS and decreased dependency in the activities of daily living with preserved function by the end of 6 months. Postsurgery ambulation showed that 30% of them used a walker for ambulation due to fear of falls. QOL improved but did not return to presurgery levels. The psychological domain was the most affected, followed by the environmental and social domains.

Conclusion:

Results showed the need for improvisation of various aspects of postoperative care such as designated rehabilitation protocols, fall clinics, psychotherapy and relaxation, and geriatric care for associated comorbidities. Implementing such a comprehensive specialty care approach along with good surgery will improve the QOL to presurgical level.
Successful Outcome in Posttraumatic Superficial Femoral Artery Pseudoaneurysm following Distal Femur Fracture
Authors: Mohan Lalith , Vemulapalli Sai Charan , Patnala Chandrasekhar , Syed Asif Hussain Khazi , Kumar K. K. Kiran , Kund A. Sundeep
Published: July 2023

A 60-year-old woman sustained right femur fracture and presented to us after taking native massage therapy for 6 weeks. Radiographs showed suspected posteromedial soft tissue shadow. Further imaging confirmed a rare pseudoaneurysm of the superficial femoral artery. After vascular surgery consultation, a single-stage procedure was planned. Through medial approach to distal femur, Pseudo aneurysm was haemodynamically isolated, opened and its contents evacuated. Neck of pseudo aneurysm is located and ligated. Distal femur plating (broad DCP) was done through the same exposure. Since traumatic pseudoaneurysms are rare entities, surgeons should have a high degree of suspicion for preoperative identification. It facilitates simultaneous vascular repair and fracture fixation. It avoids two-stage incisions, two incisions, intraoperative or postoperative catastrophe, and medicolegal complications. Hence, we advocate to look out for vascular injury in distal femur fractures at a delayed presentation.
An Ultrasound-Assisted Technique to Fix the Avulsion Fracture of the Posterior Tibial Spine
Authors: Kumar Gautam , Jacob Biju , Edakalathur Jefin Jose , Chandy Lazar J. , Simon Rajesh
Published: July 2023

Background:

The fixation of posterior tibial avulsion fractures has been predominantly open reduction and internal fixation that leads to longer incision, severe scarring and higher risk to neurovascular injury while using the posterior approach. The arthroscopic methods have a steep learning curve, and fracture fixation is usually with fibre wire.

Aim:

Ultrasound assisted fixation of PCL avulsion fracture.

Material and Methods:

The patient is placed prone; the limb is placed in 20-degree flexion and neutral rotation. The US is used to identify the popliteal artery and nerve. The blunt tip of a K wire is inserted under US guidance. After confirming the position with an image intensifier, a 3.5 mm cannulated screwdriver is passed over the K wire. The final reduction is confirmed with image intensifier in anteroposterior and lateral views.

Results:

We present 11 cases of the posterior tibial avulsion fracture, which have been fixed with percutaneous screw fixation. The procedure was done under image intensifier guidance and ultrasound assistance. We have a minimum 1 year and a maximum of 10 years of follow up, where most of the patients had an excellent outcome.

Conclusion:

The authors felt with the ultrasound-assisted fixation technique, there is minimal or no scarring with stronger fixation. The procedure is safe, devoid of morbidities associated with open reduction and can be easily replicated at most trauma centers.
Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Preoperative Radiographic Findings and Risk Factors for Reoperation at 3–6 Years Postoperatively
Authors: Johnson Andrea H. , Stock Laura A. , Brennan Jane C. , Turcotte Justin J. , Petre Benjamin M.
Published: July 2023

Introduction:

Hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) has been demonstrated to improve outcomes but carries inherent risks of complications and the need for revision arthroscopy or conversion to total hip arthroplasty (THA). The objective of this study is to evaluate preoperative radiographs, patient outcomes, and risk factors for reoperation in patients undergoing HA for FAIS.

Methods:

A retrospective review of 351 consecutive patients undergoing HA for FAIS from July 2015 to June 2018 was conducted. The primary endpoints were revision hip arthroscopy (RHA) and THA. Univariate and multivariate analysis was performed to evaluate the risk factors for these endpoints.

Results:

By the end of the study period, 21 (6.0%) patients had undergone an RHA and 27 (7.7%) patients had undergone a THA. When comparing patients who had an RHA to those that did not, there were significant differences in preoperative radiographic characteristics, including smaller sourcil angle (P = 0.012) and lower Tönnis grade (P = 0.038) between groups. These patients were also more likely to have had a postoperative injection in the 1st year (P < 0.001). No factor was independently predictive of revision HA in multivariate analysis. Patients who underwent a subsequent THA were significantly older (P < 0.001) and required more suture anchors for repair (P < 0.001) than those that did not. On preoperative radiographs, Tönnis grade (P = 0.43) skewed higher. The multivariate regression models generated area under the curve of 0.740 and 0.864 for RHA and THA, respectively, indicating acceptable to strong predictive performance.

Conclusion:

Individual preoperative patient characteristics and radiographic findings are of limited value in assessing risk for RHA or THA after HA for FAIS. However, predictive models incorporating demographic and radiographic findings hold promise for identifying patients at risk for these outcomes. Further study is needed to refine models and assess their value in preoperative patient selection and counseling.
Adversarial examples in random neural networks with general activations
Authors: Montanari Andrea , Wu Yuchen
Published: July 2023

A substantial body of empirical work documents the lack of robustness in deep learning models to adversarial examples. Recent theoretical work proved that adversarial examples are ubiquitous in two-layers networks with sub-exponential width and ReLU or smooth activations, and multi-layer ReLU networks with sub-exponential width. We present a result of the same type, with no restriction on width and for general locally Lipschitz continuous activations.

More precisely, given a neural network

f(\,\cdot\,;\mathbf{\theta})

with random weights

\mathbf{\theta}

, and feature vector

\mathbf{x}

, we show that an adversarial example

\mathbf{x}'

can be found with high probability along the direction of the gradient

\nabla_{\mathbf{x}}f(\mathbf{x};\mathbf{\theta})

. Our proof is based on a Gaussian conditioning technique. Instead of proving that

f

is approximately linear in a neighborhood of

\mathbf{x}

, we characterize the joint distribution of

f(\mathbf{x};\mathbf{\theta})

and

f(\mathbf{x}';\mathbf{\theta})

for

\mathbf{x}' = \mathbf{x}-s(\mathbf{x})\nabla_{\mathbf{x}}f(\mathbf{x};\mathbf{\theta})

, where

s(\mathbf{x}) = \operatorname{sign}(f(\mathbf{x}; \mathbf{\theta})) \cdot s_d

for some positive step size

s_d

.