bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular cysticercosis at a teaching hospital in Northern India
Authors: Maurya Rajendra P. , Mishra C. P. , Roy Meghna , Singh Virendra P. , Singh Mahendra K. , Yadav Mahima , Al-Mujaini Abdullah S.
Published: May 2024

BACKGROUND:

Ocular cysticercosis (OC) is common in tropical countries. This study aimed to analyze the clinical presentation patterns, management and treatment outcomes of OC cases seen at a teaching hospital in North India.

METHODS:

This study took place between March 2014 and February 2019. A total of 36 patients with OC were analyzed to determine clinical presentation and outcomes.

RESULTS:

Of the 36 patients, 13 (36.11%) were male and 23 (63.89%) were female. The most frequently affected age group was 10–29 years (n = 22; 61.11%). All of the patients had unilateral lesions, with involvement of the left eye in 22 (61.11%) and the right in 14 (38.89%). The majority of cases were isolated to the ocular region; however, five (13.89%) demonstrated neural involvement as well. In terms of cyst location, 15 (41.67%) were orbital, 13 (36.11%) were subconjunctival and four each (11.11%) were intraocular or on the eyelid. The most common clinical presentations were subconjunctival masses or proptosis in 13 each (36.11%) and periorbital swelling in 12 (33.33%). Most patients received medical treatment (n – 23; 63.89%), while the others required surgical excision. Recurrence was noted in seven patients (19.44%), of which three underwent surgery while the rest were treated medically. Two patients (5.56%) developed phthisis.

Conclusions:

In this study, OC cysts were more often orbital or subconjunctival compared to findings reported from Western countries. In addition, a female preponderance was noted in contrast to previously reported findings. Advanced radioimaging is crucial to ensure early diagnosis and treatment.
Outcomes of Descemet stripping endothelial keratoplasty in cases of corneal endothelial dysfunction
Authors: Srujana Dubbaka , Bista Nabaratna , Agrawal Mohini
Published: May 2024

BACKGROUND:

Automated microkeratome is commonly used to get donor lenticules for Descemet stripping endothelial keratoplasty (DSEK); however, manual dissection of donor lenticules is also being done with good outcomes.

AIM:

The aim of this study was to describe the results of manual DSEK performed in cases of corneal endothelial dysfunction caused due to pseudophakic bullous keratopathy, iridocorneal endothelial syndrome, and postpenetrating keratoplasty graft failure.

MATERIALS AND METHODS:

This was a retrospective observational study. The medical records of all patients with corneal decompensation who underwent DSEK at a tertiary care center performed by the same surgeon were reviewed. A standard DSEK with manually dissected donor lenticules was performed in all cases with the exception of the Descemet membrane not being removed in two cases. A comprehensive ophthalmic examination was performed preoperatively and at each postoperative visit in all patients.

RESULTS:

Eight eyes of seven patients (four males and three females) were included. The mean age was 64.8 years (range, 49–74 years). The average follow-up was 10.9 months (range, 5–22 months). There was one case of primary graft failure which was managed by repeat DSEK. In the rest, corneas remained clear at the last follow-up. No rebubbling was done as none of the cases showed graft detachment. The preoperative best-corrected visual acuity (BCVA) was 20/2000 or less, and postoperatively, BCVA attained was 20/30 in four eyes and one eye achieved 20/80.

CONCLUSIONS:

Manual DSEK performed in eyes with corneal decompensation allowed rapid restoration of corneal clarity while minimizing intraoperative and postoperative complications.
Optical density changes of subretinal hyperreflective material in age-related macular degeneration after switching therapy from ranibizumab to aflibercept
Authors: Filik Armagan , Gungel Hulya
Published: May 2024

BACKGROUND:

Subretinal hyperreflective material (SHRM) is a hyperrefiective material seen on optical coherence tomography (OCT) and located under the retina and above the retinal pigment epithelium. This study aims to examine the effect of SHRM on the functional prognosis of age-related macular degeneration (AMD) patients who switched from intravitreal ranibizumab to intravitreal aflibercept treatment.

MATERIALS AND METHODS:

This is a retrospective, nonrandomized clinical study. AMD patients meeting the switching criteria underwent a complete ophthalmic examination, including spectral-domain OCT and fundus fluorescein angiography. The best-corrected visual acuity and OCT parameters were measured at the switch and 3, 6, 12, and 24 months after. SHRM(+/−), maximum SHRM thickness, and subjective and objective reflectivity stages of SHRM (grades 1–3) were evaluated.

RESULTS:

SHRM was observed in 24/48 (50.0%) of eyes at the time of the switch. The differences in maximum SHRM thicknesses were not statistically significant. SHRM's mean subjective reflectivity stages at the switch and subsequent examinations were 2.37, 2.75, 2.75, 2.74, and 2.81; SHRM's objective reflectivity staging also confirmed them. Functional changes after the switch showed a significant VA loss in the SHRM(+) group and significant gain in the SHRM(−) group.

CONCLUSION:

This study showed that the presence of SHRM and higher optical reflectivity at the switch from ranibizumab to aflibercept caused a poor prognosis after the switch. On the other hand, SHRM(−) patients achieved good functional results after the switch.
Type-3 macular neovascularization in a case of long-standing macular telangiectasia type-2
Authors: Chandran Kiran , Desai Sachin , Giridhar Anantharaman
Published: May 2024

We report a rare case of type-3 macular neovascularization (MNV) in an established case of macular telangiectasia type-2 (MacTel). A 49-year-old healthy Indian woman was diagnosed with MacTel (Gass and Blodi stage 3 in the right eye [OD] and stage 2 in the left eye [OS]) in our retina clinic in January 2004. She was subsequently seen 10 years later with MacTel progression in OD (stage 4) and drusenoid changes in both eyes. She recently complained of sudden onset diminution of vision in OS of 1 week duration. The best-corrected visual acuity, when she attended this day, was 20/500 (OD) and 20/60 (OS). Fundus revealed pigment deposition in the macula in OD and a large pigment epithelial detachment (PED) in OS with drusen in both eyes, suggesting coexisting age macular degeneration (AMD) and MacTel (stage 4 OD; stage 2 OS) bilaterally. Multimodal imaging with spectral-domain optical coherence tomography showed drusen, a large trapezoid PED with central apical disruption, outer retinal hyperreflective material, intraretinal fluid, and inner retinal cavitation. Indocyanine green angiography revealed “hotspot” at center of the PED with hairpin-loop vessels. Optical coherence tomography angiography demonstrated network at apex of the PED. These features confirmed a diagnosis of type-3 MNV (classical retinal angiomatous proliferation [RAP] lesion) in OS along with features of AMD and MacTel. There was resolution of intraretinal fluid and reduction in height of PED following three loading doses of intravitreal ranibizumab in OS. Although type-3 neovascularization has been described in MacTel, to the best of our knowledge, this is the first documentation of classical RAP features of MNV with all described multimodal imaging features. The type-3 neovascularization typically described in association with MacTel is retinal-retinal, retinal-subretinal, and retinochoroidal anastomosis (RCA). Although RAP is also associated with RCA, the features seen in our case, i.e., triad of erosion at the roof of PED, inverted flap in the PED, and hotspot in the center of PED, have not been documented in association with MacTel.
Uveitis masquerade syndromes
Authors: Ganesh Sudha K. , Ahmed Arshee S.
Published: May 2024

The aim of this series is to report challenges faced in diagnosis of three cases of recurrent or atypical uveitis not responding to conventional treatment. A high index of suspicion, aided by newer techniques, such as cytology, immunohistochemistry, flow cytometry of ocular fluids, and contrast-enhanced magnetic resonance imaging, may be necessary for a prompt diagnosis of uveitis masquerade syndromes.
A complete clinical review of idiopathic macular telangiectasia
Authors: Jayasri P. , Stephen A. Mary
Published: May 2024

Idiopathic macular telangiectasia refers to a disease entity characterized by telangiectasia and alteration of the juxtafoveal capillary network. It can present uniocularly or binocularly and is subdivided into three groups which have varied appearances. Group I occurs in males which is easily identifiable and has macular edema. Group II has no sex predilection and difficult to distinguish by clinical examination and often requires the need of optical coherence tomography and angiographic modalities. Group III is not so common with its progressive nature and associated with neurological diseases. This article is aimed to provide complete details about idiopathic macular telangiectasia/idiopathic juxtafoveal telangiectasia/parafoveal telangiectasia including various groups, pathology, presentation, and management.
Indications for penetrating keratoplasty in Iranian patients
Authors: Eidizadeh Mojtaba , Ebadi-Soflou Leila , Khoushabi Aashkan Safarzadeh
Published: May 2024

BACKGROUND:

The outcome of penetration into keratoplasty (PK) related to corneal disease is responsible for corneal blindness. The aim of this study is to evaluate the indications and visual outcome of PK in Imam Khomeini Hospital in Kermanshah from March 2017 to March 2019.

MATERIALS AND METHODS:

Data were reviewed from the medical records of 115 PK done in the Department of Ophthalmology, Imam Khomeini Hospital, Kermanshah, from March 2017 to March 2019. Data analysis done using paired Student's t-test for hypothesis testing of grouped values of preoperative and the last follow-up best-corrected visual acuity in cases of optical and therapeutic grafts. P <0.05 was considered statistically significant.

RESULTS:

In this study, the data of 115 eyes of 108 patients were reviewed. The most common indication for keratoplasty was corneal scarring including adherent leucoma, 34 (29.56%). Therapeutic keratoplasty was done for 26 patients. One case of tectonic graft was included in therapeutic keratoplasty group for analysis. There was statistically significant difference (P = 0.0001) in best-corrected visual acuity improvement from 1.36 logMAR + 0.024 (standard deviation [SD]) preoperatively to 0.357 logMAR + 0.42 (SD) postoperatively and 1.4 logMAR + 0.000 (SD) preoperatively to 0.15 logMAR + 0.55 (SD) postoperatively for optical and therapeutic grafts, respectively.

CONCLUSION:

Active or treated infectious keratitis was one of the most important indications for keratoplasty. Symptoms of poor prognosis were more pronounced in this part of the country. Patients' vision after corneal transplantation was encouraging, especially in cases of optical keratoplasty.
Persistent hyperplastic primary vitreous in a child with incontinentia pigmenti and infantile spasms
Authors: Madan Siddharth , Chaudhuri Zia
Published: May 2024

Incontinentia pigmenti (IP) is a rare neurocutaneous syndrome of X-linked dominant inheritance (1:40000 births in the Caucasian population) which is usually lethal in males. It commonly presents with skin, central nervous system, and dental anomalies. Ophthalmic associations of IP include intra-ocular anomalies such as leukocoria, megalocornea, corneal edema, band keratopathy, bullous keratopathy, iridocorneal attachments, macular capillary dropout, peripheral arteriovenous shunts, retinal neovascularization, vitreous hemorrhage, preretinal fibrosis, traction retinal detachment as well as strabismus. We report an 18-month-old developmentally delayed female child with diagnosed IP and infantile spasms conforming to the west syndrome triad, who presented with left eye microphthalmia and persistent hyperplastic primary vitreous and discuss this rare ophthalmic presentation.
Comparative evaluation of diabetic retinopathy screening programs in regular ophthalmology clinics versus integrated diabetic clinics within rural health-care services
Authors: Amritanand Anika , Arthur Anupriya , Horo Saban , Obed Prathibha , Ramamurthy Prashanth , Rebekah Grace , Abraham Vinod Joseph , Paul Padma
Published: May 2024

BACKGROUND:

Robust integration of diabetic retinopathy (DR) screening within health systems is essential to prevent DR-related blindness. This, however, remains a challenge in the developing world. The aim of this study was to evaluate two models of DR screening programs within rural general health-care services.

MATERIALS AND METHODS:

This was a retrospective observational study from two rural health centers. Demographic and clinical data of patients completing DR screening were analyzed. Patients were screened in regular ophthalmology clinics (ROC) or integrated diabetic clinics (IDC). Referral and treatment completion data were retrieved from the clinical charts at the base hospital.

RESULTS:

A total of 2535 DR screenings were conducted for 2296 patients. The total population prevalence for any DR was 14.2% (95% confidence interval [CI]: 12.8%–15.6%) and vision-threatening DR (VTDR) was 4.7% (95% CI: 3.8%–5.6%). In the ROC and IDC groups, respectively, the prevalence of any DR was 20.4% and 8.2%, VTDR, 7.8% and 1.7%, and blindness, 1.4% and 0.4% (all P < 0.001). Referral completion rates were higher in the ROC group (44.8% vs. 25.2%, P < 0.001), while treatment completion in both was similar (69.6% vs. 70.6%). Referral and treatment completion rates for referable DR were 61.2% and 48.2%, and for VTDR, 62% and 38.8%, respectively. Only 11.45% of patients completed the repeat screening follow-up.

CONCLUSIONS:

Patients attending IDCs had a significantly lower prevalence of any DR, VTDR, and blindness demonstrating the advantages of integrated diabetic care in a rural setting. However, referral uptake and DR treatment completion need strengthening.
A case of non-Hodgkin lymphoma diagnosed after 35-month of initial presentation as recurrent vitritis with multiple negative biopsies
Authors: Majumder Parthopratim Dutta , Moreker Mayur R. , Khadilkar Satish V. , Bhosale Bharat , Khetan Vikas
Published: May 2024

To report a case of non-Hodgkin lymphoma (NHL) that was diagnosed 35-month of initial ocular manifestation. Retrospective chart review. A 53-year-old male presented with painless diminution of vision in both eyes. He subsequently underwent extensive laboratory investigations including multiple vitreous biopsies with a suspicion of intraocular lymphoma. Cytology from the vitreous aspirate failed to diagnose any relevant pathology. After 35-month from the onset of his ocular symptom, a brain biopsy revealed a round cell tumor suggestive of NHL. Even with high index of suspicion, consultation with ocular oncologist, imaging, and diagnostic vitrectomy, the diagnosis of lymphoma remains challenging
Accommodative insufficiency in post-COVID-19 case with refractive error
Authors: Alrashidi Sultan H.
Published: May 2024

The aim of the case report is to present refractive error with accommodative insufficiency as a possible postinfectious manifestation of coronavirus disease-2019 (COVID-19). Three weeks after the COVID-19 infection, a 22-year-old subject presented with blurring of distance and near vision with a frontal headache after prolonged near work. The patient was not using any refractive correction before the COVID-19 infection. This case report describes the diagnosis, management, and treatment of accommodative dysfunction in a patient with a history of COVID-19 infection.
Management of neurovascular emergencies with ophthalmic manifestations
Authors: Goyal Jawahar Lal , Singh Shalini , Mishra Sarvesh Chandra , Singh Shipra , Singh Divya
Published: May 2024

Patients with neurovascular disorders sometimes approach the ophthalmologists with mild ophthalmic clinical features such as conjunctival congestion, slowly progressive proptosis, lateral rectus palsies and at other times with ophthalmic emergencies like sudden increase in proptosis, ophthalmoplegia, diplopia, and ptosis before the onset of neurological manifestations which may be life-threatening if not detected in time. The aim of this article is to focus on ophthalmic manifestations of neurovascular emergencies and role of ophthalmologists in its management. In this communication, to make the ophthalmologist aware of clinical presentations, the imaging modality of choice, diagnostic features, medical and interventional treatments. We have searched PubMed, Web of Science, Google Scholar and reviewed some of the commonly encountered neurovascular emergencies with ocular manifestations such as carotid-cavernous fistula, cerebral venous sinus thrombosis, cerebral artery aneurysms, arterio-venous malformations.
Peripapillary nerve fiber layer in patients with iron deficiency anemia: A cross-sectional study in a tertiary eye care center in Central India
Authors: Joshi Rajesh Subhash , Ingle Rajesh Namdeo
Published: May 2024

AIMS:

The aim of this study is to evaluate the effect of iron-deficiency anemia (IDA) on peripapillary retinal nerve fiber layer (RNFL) thickness using spectral-domain optical coherence tomography (SD-OCT).

SETTINGS:

The study was conducted at tertiary eye care center in Central India.

DESIGN:

This study was a prospective, cross-sectional, case–control, and observational study.

MATERIALS AND METHODS:

In the present study, 58 eyes of patients with IDA were compared with 58 eyes of healthy individuals. All individuals underwent a thorough hematological, clinical, and ophthalmic examination, followed by peripapillary RNFL analysis using SD-OCT.

RESULTS:

A total of 116 eyes were included in the study. The average RNFL thickness (RNFLT) in the cases was 97.26 ± 5.96, and 102.32 ± 6.26 (P = 0.005) in controls. There was a significant RNFL loss in the temporal (66.76 ± 6.1, P = 0.02), superior (119.66 ± 10.47, P = 0.01), nasal (73.59 ± 9.52, P = 0.003), and inferior (129.05 ± 10.96, P = 0.001) quadrants in the cases and controls. Serum hemoglobin, iron, ferritin, total iron-binding capacity, and transferrin saturation were lower in the cases (P < 0.05). A positive correlation was observed between average RNFLT and hemoglobin (r = 0.321), iron (r = 0.122), ferritin (r = 0.152), and transferrin (r = 0.190) levels.

CONCLUSIONS:

In patients with IDA, RNFLT was decreased in all quadrants compared to normal healthy individuals. The inferior and nasal RNFL showed a significant decrease in thickness. The presence of myopia, glaucoma, and diabetic and hypertensive retinopathy can exert an additive effect in the thinning of RNFLs and cause significant visual loss; hence, the correction of anemia is essential. There is a pressing need to raise public and health professional awareness of these problems and their prevention, diagnosis, and management.
Digital contrast sensitivity chart with varying visual acuity: Development and validation
Authors: Hegde Prateeksha G , Rao Diwakar , Prudhvi B. , Hegde Namratha
Published: May 2024

BACKGROUND:

Contrast sensitivity (CS) evaluation is very much necessary for the diagnosis and management of eye conditions. Several disadvantages seen in the traditionally used Pelli-Robson (PR) chart persuaded us to develop a novel digital device for the evaluation of CS at various levels of visual acuity (VA) for early detection of deteriorating vision.

MATERIALS AND METHODS:

The new chart was constructed on the Debian software. Letters were constructed at each level of VA from 6/60 to 6/6 with a contrast of 0–2.25 logCS. The newly constructed chart was validated against the PR chart. The data were analyzed on the SPSS software version 23. The Pearson’s correlation test was used to find out the correlation between the digital CS chart (DCSC) and PR charts.

RESULTS:

On successful construction of a DCSC with varying VA, 56 participants were examined with a mean age of 20.43 ± 1.44 years. The mean CS with PR was 1.84 ± 0.13 logCS, whereas DCSC was 2.09 ± 0.14 logCS. The correlation between the two charts was moderate having r = 0.489 with P = 0 (confidence interval 95%).

CONCLUSION:

A newly developed CS chart is efficient in examining the CS in clinical practice and has good repeatability; it may help in the early detection and monitoring of ocular diseases.
Full thickness macular hole with subfoveal pigment epithelial detachment in chronic central serous chorioretinopathy: A therapeutic challenge
Authors: Manayath George J. , Amar Sreelakshmi P. , Vidhate Swapnil Shivaji , Kumarswamy Karan A. , Venkatapathy Narendran
Published: May 2024

We describe the diagnostic and therapeutic strategies employed in the management of a patient with subfoveal pigment epithelial detachments (PEDs) combined with full-thickness macular hole (FTMH) and discuss the possible pathophysiology of these diseases occurring concurrently. A 38-year-old patient with a history of central serous chorioretinopathy (CSC) presented with FTMH overlying a large subfoveal serous PED. Multimodal imaging confirmed the same and intravitreal anti-vascular endothelial growth factor (VEGF) injections and eplerenone failed to resolve the PED. Spontaneous resolution of the large PED was observed later and pars plana vitrectomy with internal limiting membrane peeling closed the macular hole successfully. However, the PED with fibrinous CSC recurred postoperatively and low fluence photodynamic therapy (PDT) was done to tackle the same. At 10 months’ follow-up, the final vision was 6/9, the macular hole remained closed, and the PED had not recurred. Macular hole formation may be the result of choroidal hyperpermeability and leakage in the backdrop of CSC which gives rise to an exudative component causing mechanical stretching and disruption of the overlying sensory retina. Spontaneous uncomplicated resolution of large subfoveal PED in CSCR is rare. This case was managed with a combination of intravitreal anti-VEGF injections, surgery, and PDT. The therapeutic challenge here was the timing of surgery.
Bilateral enucleation for retinoblastoma
Authors: Machakuri Khaleel , Kaliki Swathi
Published: May 2024

PURPOSE:

To study the clinical profile of patients who underwent bilateral enucleation for retinoblastoma (RB).

METHODS:

Retrospective study of 14 cases.

RESULTS:

Of >3000 RB cases, 14 (<1%) underwent bilateral enucleation for treatment of RB. The mean age at diagnosis of RB was 26 months (median, 24 months; range, 5–72 months). All patients had bilateral RB at presentation. Intraocular RB was evident in 23 (82%) eyes and orbital tumor extension was noted in 5 (18%) eyes. Based on the International Classification of Intraocular RB, tumors were classified as Group B (n = 1; 4%), D (n = 4; 14%), or E (n = 14; 50%) at presentation. Based on the International RB Staging System, tumors were classified as Stage 1 (n = 23; 82%) or Stage 3 (n = 5; 18%). Two patients (four eyes with intraocular RB) had undergone prior treatment before presenting to us and thus could not be classified. Primary treatment included systemic chemotherapy (n = 27; 96%) or enucleation (n = 1; 4%). Five patients were lost to follow-up for a mean duration of 15 months (median, 12 months; range, 7–24 months) during treatment and presented with the orbital extension of RB in one (n = 4; 29%) or both (n = 1; 7%) eyes. Secondary enucleation was performed in 27 (96%) eyes. Over a mean follow-up period of 49 months (median, 29 months; range, 3–340 months), there was no evidence of metastasis and 1 (7%) child died due to pneumonia.

CONCLUSION:

Bilateral enucleation is rare in the treatment of RB. Advanced tumor presentation or noncompliance to treatment necessitates bilateral enucleation.
Year 1 of COVID-19 pandemic in India
Authors: Das Anthony Vipin , Kaliki Swathi
Published: May 2024

PURPOSE:

The purpose of the study is to describe the impact of lockdown and unlock phases of the COVID-19 pandemic on the presentation of ocular and periocular tumors at a referral center in India.

MATERIALS AND METHODS:

This cross-sectional, hospital-based study included 5811 patients presenting between March 25, 2017, and March 31, 2021. The data on the patients diagnosed with ocular and periocular tumors in one or both eyes presenting during the lockdown and unlock phases were compared with the respective time periods in the previous 3 years before COVID-19.

RESULTS:

The patient numbers dropped by 85% (45/295) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 33% reduction in patients requiring inter-state travel. There was complete recovery of the outpatient numbers to 105% (139/132) of pre-COVID-19 volumes by March 2021. This gradual incremental trend was seen in patients with malignant tumors (145%) and was lower in those with benign tumors (89%) than pre-COVID-19 volumes by March 2021. There was an increase in the patients presenting with malignant tumors (49%; P = 0.45) during the lockdown phase. The proportion of patients requiring inter-state travel showed a near-complete recovery to 88% of pre-COVID-19 distribution by March 2021.

CONCLUSION:

The 1st year of the COVID-19 pandemic saw a significant decline in the number of patients presenting with ocular and periocular tumors. There was an increase in the proportion of malignant tumors and a decrease in benign tumors during the lockdown phase. During unlock period, there was a near-complete recovery in the patients requiring inter-state travel to access eye care services.
Tuck in versus cauterisation of graft edge in pterygium management
Authors: Kodavoor Shreesha Kumar , Rathi Neha , Dandapani Ramamurthy
Published: May 2024

PURPOSE:

To compare and evaluate surgical outcome between tuck in and cauterisation in the management of primary pterygium.

MATERIALS AND METHODS:

Two groups of 56 eyes and 58 eyes with primary pterygium underwent pterygium excision with conjunctival autograft fixation by tucking in alone (Group 1) and with cauterization (Group 2), respectively. A retrospective comparative analysis was done between the two groups.

RESULTS:

This study included a total of 114 eyes in the final analysis. The recurrence was noted in 3 eyes in Group 1 (5.35%), whereas only 1 eye (1.72%) in Group 2. Other complications included graft edema in 25 eyes (44.64%), in Group 1 and 29 eyes (50%) in Group 2, subconjunctival hemorrhage seen in 28 eyes (50%) in Group 1 and 32 eyes (55.17%) in Group 2, graft retraction observed in 28 eyes (50%) in Group 1 and 13 eyes (22.4%) in Group 2, granuloma formation was seen only in one patient (1.72%) in Group 2, graft loss was observed in four patients (7.14%) in Group 1 and 2 patients (3.44%) in Group 2.

CONCLUSION:

Graft fixation in pterygium surgery using low-cost procedures with tuck in or cauterization proves to be tolerable, safe and successful method. An additional step of fixing the graft to the cut conjunctival margin using bipolar cautery proves to be safer.
Awareness and practice regarding use of digital devices and ocular health among Saudi adolescents
Authors: AlDarrab Abdulrahman
Published: May 2024

PURPOSE:

To review the knowledge of ocular health and practices of digital device usage among adolescent Saudi Arabia population.

METHODS:

This cross-sectional web-based survey was conducted in 2021 at a university in central Saudi Arabia. We asked questions regarding demographics, knowledge related to computer vision syndrome (CVS), and the use of digital devices for participants’ daily activities. The acceptable grades of knowledge (“excellent” and “good”) and practice scores were associated with the determinants using the nonparametric method of analysis.

RESULTS:

Of 521 participating students, knowledge about CVS and its relation to digital device usage were excellent in 41 students (7.9%), good in 161 (39%), poor in 300 (57.6%), and very poor in 19 (3.6%). Twenty-eight (5.4%) students scored an “excellent” grade on practices for digital device usage, 216 (41.4%) scored “good,” and 277 (53.2%) scored “poor.” The knowledge score median was 1.0 (interquartile range 1.0; 2.0), and the practice score median was 6.0 (4.0; 9.0). Health studies students had better knowledge than other students (P = 0.004). Smartphone users had worse knowledge than users of other devices (P = 0.017). Females (P < 0.001) and health studies students (P = 0.004) were significantly associated with acceptable practices of using digital devices.

CONCLUSIONS:

Awareness of ocular health because of abuse of digital devices was poor among participating students. The practice of digital device use was not healthy and needed improvement through preventive measures and counseling.
Multimodal imaging including optical coherence tomography angiography of benign familial fleck retina
Authors: Manayath George J. , Verghese Shishir , Gosalia Hirika Vipul , Kanakath Anuradha , Narendran Venkatapathy
Published: May 2024

A 44-year-old woman presented with complaints of pain in the right eye (RE). Fundus examination revealed disc edema in the RE along with retinal flecks sparing the macula in both eyes (BE). Fundus autofluorescence demonstrated a symmetrical pattern of white flecks in BE. Spectral-domain optical coherence tomography (SD-OCT) revealed the lesions at the level of retinal pigment epithelium with impingement onto the outer retina. SD-OCT angiography through the flecks revealed hyperreflective lesions at the level of avascular retina. RE B-scan revealed a T-sign. Based on these findings, she was diagnosed with BE benign familial fleck retina (BFFR) with RE posterior scleritis. We describe the multimodal imaging features in a middle-aged patient with BFFR and provide an insight into the probable pathogenesis.
Sphingomonas paucimobilis endophthalmitis postpenetration ocular trauma: A rare case report
Authors: Alias Nur-Syifa Athirah Qistina , Bari Muhd-Syafi Abd , Jabbari Aidila Jesmin , Salam Adzura
Published: May 2024

Endophthalmitis is an uncommon purulent inflammation of the intraocular fluids secondary to endogenous or exogenous causes. It is known that posttraumatic endophthalmitis had a notably poor visual outcome, and it poses therapeutic challenges. Therefore, early organism detection would be beneficial in therapeutic management and are able to reduce long-term complications. This case report describes a patient with a rare positive culture-proven Sphingomonas paucimobilis endophthalmitis due to penetrating ocular trauma by a metal brush over the right eye. A 36-year-old man presented with progressively worsening right eye redness and blurring of vision with pain for 3 days following ocular penetration by a metal brush during grinding. On initial presentation, his visual acuity was 6/12 over the right eye and 6/6 over the left eye. His visual acuity deteriorated to hand movement 5 days later with worsening of ocular infection over the right eye despite topical and oral antibiotics. B-scan revealed dense vitreous infiltration. A vitreous tap was done, and a combination of intravitreal vancomycin and ceftazidime was administered. Vitreous culture isolated Gram negative S. paucimobilis. The patient was planned for early vitrectomy; however, the patient opted for conservative treatment. Therefore, the patient received intravitreal vancomycin and intravitreal ceftazidime injections every 48–72 h. Published articles on S. paucimobilis endophthalmitis postocular penetration are extremely limited. This case report may provide a better understanding of the presentation and is able to aid with early diagnosis and treatment initiation for future reference.
Urbach–Wiethe disease
Authors: Banerjee Prabrisha , Mukherjee Bipasha
Published: May 2024

Urbach-Wiethe Disease is an uncommon entity with autosomal recessive inheritance. We describe the clinical and histopathological findings of lipoid proteinosis in this clinical image. Cicatricial alopecia, atrophic scar on face, moniliform blepharosis and alopecia are the characteristic features of this disease entity. Hoarseness of voice and seizure can also be seen in these patients. Skin biopsy confirms the diagnosis. Multidisciplinary involvement is recommended for the management of these cases.
Presumptive ocular tuberculosis: A case series of rare cases
Authors: Singh Arti , Singh Balvant Kumar , Singh Vinod Kumar , Nagarajan Srishti
Published: May 2024

Ocular tuberculosis (TB) may present with various clinical manifestations and may involve any part of the eye. In 80% of cases, pulmonary involvement is not found. Here, we are presenting three cases of presumptive ocular TB with three rare manifestations. The first case is of bilateral retinal detachment involving one eye after another, the second case is of tubercular phlyctenular keratoconjunctivitis with keratolysis, and the third case is of bilateral neuroretinitis with extensive cerebral involvement. Despite the availability of various tests, clinical findings, tuberculin skin test, chest X-ray, and computed tomography of the chest is still the primary basis of diagnosis of ocular TB in the tubercular endemic area, even in rare cases.
Fractured dexamethasone implant (OZURDEX®) following intravitreal injection
Authors: Aljohani Saud M. , Al-Shehri Abdulaziz M. , Al-Rubaie Khalid R.
Published: May 2024

Dexamethasone implant (Ozurdex™) is a relatively safe medication with few adverse events can happen. We demonstrate clinical course and images of a rare case of fractured intravitreal Ozurdex™ implant that observed immediately following injection and its final outcome.
An unusual rise in cases of assault in ophthalmic practice during COVID-19 lockdown in a tertiary care hospital
Authors: Shahid Erum , Fasih Uzma , Taqi Uzma , Jafri Asad Raza
Published: May 2024

OBJECTIVE:

The objective of the study is to report an unusual rise in cases of assault with ocular injury and their medicolegal implications presenting in an eye department of a tertiary care hospital during COVID-19 lockdown.

MATERIALS AND METHODS:

A retrospective, observational case series was conducted in the Department of Ophthalmology, Abbasi Shaheed Hospital, Karachi. Data were retrieved from the medicolegal records of the patients from April 1, 2019, to July 31, 2019, and similar months in 2020. We included all the patients of assault with ocular injury as alleged, registered as medicolegal cases. Patients with accidental injuries were excluded from the study.

RESULTS:

There was 34.3% increase in cases of assault with ocular injury as alleged with 72.35% reduction in the outpatient department patients. The ratio of cases of assault in 2019 and 2020 is 1:4.62. The mean age of the patients in the lockdown year was 33.74 ± 11.9 standard deviation (SD) and in preCOVID year 2019 was 39.74 ± 15.9 SD. Blunt trauma was experienced by 57 (66.3%) and penetrating injury in 2 (2.3%) patients. Sixteen (18.6%) patients had no ocular involvement. Home was the place of assault in 32 (37.2%) and street in 27 (31.4%) individuals. Fist was the source of assault in 46 (53.3%) and rod or stick in 15 (17.4%) individuals.

CONCLUSION:

There is a fourfold increase in patients of assault during 4 months of COVID-19 lockdown in 2020 as compared to the same time period in 2019. Most of these patients were young age, male gender, and uneducated. The most common place of incident was home, and fist was the most common source of infliction. Most of the injuries were superficial and had minimum effect on visual acuity.
Analysis of orbitofacial anthropometry in children with pseudostrabismus
Authors: Kavitha V. , Mooss Vidya S. , Ravishankar H. N. , Heralgi Mallikarjun M. , Puliappadamb Haridas Mundot
Published: May 2024

AIM:

The aim of the study was to analyze orbitofacial anthropometric parameters such as inner and outer canthal distances (ICD and OCD), palpebral fissure length (PFL), interpupillary distance (IPD), and canthal index (CI) in children with pseudostrabismus and to compare the measured IPD (mIPD) with calculated IPD (cIPD).

MATERIALS AND METHODS:

This was a prospective study of sixty children (6 months–18 years) with pseudostrabismus. ICD, OCD, PFL, and IPD were measured by digital Vernier caliper. The formula used was cIPD: 0.21+0.24 ICD+0.58°CD for males and 1.4+0.31 ICD+0.41°CD for females. Values measured by caliper were compared with that calculated by the formula. The formula used was CI: ICD × 100/OCD. Data were analyzed statistically.

RESULTS:

The mean age was 6.66 ± 3.57 years. Telecanthus was the most common finding (55%). The mean ICD and OCD in males were 30.89 ± 3.33 mm and 87.96 ± 8.09 mm and in females were 30.91 ± 3.05 and 86.22 ± 6.81 mm, respectively. The mean right eye PFL in males was 28.53 ± 2.63 mm and in females was 27.66 ± 2.22 mm and left eye PFL in males was 28.53 mm ± 2.63 and in females was 27.66 ± 2.22 mm. CI in males was 35.10 ± 1.65 and in females was 35.84 ± 1.71. Mean mIPD and cIPD: male – 55.37 ± 4.75 mm and 58.56 ± 5.34 mm, female – 53.32 ± 4.74 mm and 46.26 ± 3.71 mm. A good agreement was found between mIPD and cIPD.

CONCLUSION:

This study helps in documenting the anthropometric pattern of the orbitofacial parameters in children with pseudostrabismus which can act as reference data. This helps in the management of orbitofacial, craniofacial syndromes/deformities and lid reconstructive surgeries in retaining ethnical features and obtaining better function. In children’s spectacle frame 1 and lens making, where measuring IPD is difficult, cIPD can be a simple alternative.
Ocular Neisseria gonorrhea in a patient on immune checkpoint inhibitors
Authors: Sopeyin Anuoluwapo , Park Michael Minchul , Pointdujour-Lim Renelle
Published: May 2024

Although immune checkpoint inhibitors have revolutionized the treatment of cancers, their role in the pathogenesis of chronic infections remains unclear. Here, we present the case of a patient on a cocktail of checkpoint inhibitors who presented with severe bilateral gonococcal conjunctivitis, orbital cellulitis and vitritis, without a history of genital infection.
Evaluation of lacrimal duct probing in adults with 0.02% and 0.04% mitomycin-C in primary acquired nasolacrimal duct obstruction
Authors: Saini Manu , Bajaj Mandeep Singh , Pushker Neelam , Meel Rachna , Saini Kulbhushan , Chaurasia Shweta , Mehta Aditi
Published: May 2024

PURPOSE:

The purpose of the study is to evaluate the safety and efficacy of adjunctive use of mitomycin-C (MMC) using two different concentrations 0.2 mg/ml and 0.4 mg/ml for lacrimal duct probing to treat the nasolacrimal duct obstruction (NLDO) in adults.

SUBJECTS AND METHODS:

Prospective, an interventional comparative randomized pilot study of lacrimal duct probing conducted in the two study groups 0.02% MMC group (n = 30) and 0.04% MMC group (n = 30) in confirmed primary acquired NLDO of <1-year duration. Patency of lacrimal duct probing confirmed by syringing was compared at 1, 3, and 6-month follow-up in the two study groups, and corresponding subjective improvement of watering was appraised according to Kraft and Crawford grading.

RESULTS:

Patency of lacrimal duct probing in 0.02% MMC versus 0.04% MMC group was 66.66%/73.33% (P = 0.71) at 1 month, 46.66%/66.66% (P = 0.09) at 3 months and 46.66%/66.66% (P = 0.03) at 6-month follow-up, respectively. Subjective improvement of watering (no watering and mild watering) observed in 0.02% MMC versus 0.04% MMC group was 46.66%/73.33% (P = 0.03), at 1 month, 66.66%/83.33% (P = 0.13) at 3 months and 56.66%/73.33% (P = 0.17) at 6-month follow-up.

CONCLUSION:

Adult lacrimal duct probing with 0.04% MMC was associated with significant higher objective success rate than adult lacrimal duct probing with 0.02% MMC, without added concurrently side effects.
Bilateral central serous chorioretinopathy in a patient with angioid streaks
Authors: Torabi Hamidreza
Published: May 2024

This report describes a case of bilateral central serous chorioretinopathy (CSCR) in a patient with angioid streaks. A 39-year-old male was referred for worsening vision. Best-corrected visual acuity (BCVA) at presentation was 5/10 in his right eye and 4/10 in his left eye. Fundus examination, fluorescein angiography, and optical coherence tomography were compatible with angioid streaks in both eyes associated with macular atrophy due to previous CSCR attack in the right eye and active nonresolving CSCR in the left eye. Macular laser photocoagulation was done in the left eye. After 3 months, subretinal fluid was absorbed and BCVA improved to 7/10. CSCR may occur rarely in patients with angioid streaks and ophthalmologists should consider CSCR in cases with angioid streaks and vision deterioration.
Outcomes of combined procedures compared to various single techniques for involutional entropion
Authors: Al-Mujaini Abdullah S. , Ul Kadir Syeed Mehbub , Maurya Rajendra Prakash
Published: May 2024

BACKGROUND:

To describe the outcomes of triangular tarsectomy and limited orbicularis myectomy with lower eyelid retractor plication compared to an everting sutures (ES) technique or lateral tarsal strip (LTS) procedure for the correction of lower eyelid involutional entropion.

METHODS:

A nonrandomized clinical study was carried out at two tertiary eye hospitals between January 2016 and December 2019. Patients in Group A underwent triangular tarsectomy and limited orbicularis myectomy with lower eyelid retractor plication. Group B had ES, and Group C underwent a LTS procedure. All participants were operated by one surgeon and underwent 1-year follow-up.

RESULTS:

A total of 78 patients in whom 84 eyelids were affected by lower eyelid involutional entropion were included in the study. The success rate was higher in Group A compared to Group B and Group C (100% vs. 86.7% vs. 95.8%;P< 0.05). Recurrence at a 1-year follow-up was noted in only four (13.3%) eyelids in Group B and one (4.2%) in Group C. However, patient’s in Group C experienced a higher frequency of minimal postoperative complications, including short-term pain (100%), tenderness on the lateral canthal area (100%), tightness of the eyelid (91.7%), and ecchymosis (54.2%) compared to Group A. Patients of Group B experienced minimal or no postoperative complications.

CONCLUSIONS:

Triangular tarsectomy and limited orbicularis myectomy with eyelid retractor plication may be considered the standard procedure for correcting lower eyelid involutional entropion with no recurrence compared to LTS technique or minimally invasive and cost-effective ES procedure.
Evaluating the application of argon laser on pterygium surgery: Report of 30 patients
Authors: Arish Mohammed , Dakkali Mohammad Sedigh
Published: May 2024

BACKGROUND:

The recurrence rate plays a key role in using various treatments of pterygium. This study assessed the effectiveness of argon laser therapy before the excision of pterygium on the recurrence rate.

MATERIALS AND METHODS:

The eyes (n = 60) of patients (n = 30) were divided into two groups based on the treatment. All eyes had undergone pterygium excision with the bare sclera technique. Three weeks before surgery, an argon laser was applied to 30 eyes. Patients have been followed up for 1 year, and the progression of pterygium has been evaluated at days 1, 7, 14, and 30, and then, every 2 months until month 6 and then every 3 months until month 12. Recurrence was defined as more than 1 mm growth of pterygium from the limbus.

RESULTS:

In the group with adjuvant argon laser therapy, the mean size of pterygium was 3.7 ± 0.47 mm before surgery and 2.3 ± 0.98 after 12 months (P = 0.001). These were 3.8 ± 0.43 mm and 2.4 ± 1 mm in the other group (P = 0.001). The recurrence of the pterygium was 76% (23/30) in the group treated with an argon laser and 90% (27/30) in another group (P = 0.16). There was no correlation between pterygium sizes before surgery and the pterygium recurrence rate in both eyes (P = 0.272 [right] and 0.916 [left]).

CONCLUSION:

Argon laser therapy on pterygium before surgery cannot decrease its recurrence rate, but its application gives a good vision and clarifies the surgery’s target area.
Surgical performance and the positivity rate for novel coronavirus (severe acute respiratory syndrome coronavirus 2) in an ophthalmic setup during the coronavirus disease 2019 pandemic
Authors: Alam Md. Shahid , Mistry Suraj , Das Sudipta , Mukherjee Suchetna , Kumar Amitabh , Rao Girish Shiva
Published: May 2024

AIM:

To describe, the impact of ongoing coronavirus disease 2019 (COVID-19) pandemic on ophthalmic surgeries at a tertiary eye care center of East India during and after the lockdown, and the positivity rate for novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]).

MATERIALS AND METHODS:

A retrospective study of all ophthalmic surgeries performed during and after lockdown from April 1, 2020 to August 31, 2020, with comparison to the corresponding period in the previous year (2019) was done. Eligible patients were tested for novel coronavirus (SARS-CoV-2) preoperatively as per the institutional protocols.

RESULTS:

A total of 569 surgeries were performed during the study period compared to 3458 performed in 2019, (P = 0.00001). The maximum number of surgeries were performed in June (191, 33.57%) and July (189, 33.22%) and in the subspecialty of vitreo-retina (337, 59.23%) followed by cataract (101, 17.75%). The most common vitreoretinal procedures were intravitreal injections (223, 66.17%) and retinal detachment surgery (56, 16.62%). Emergency surgeries performed were 30 (5.275%) compared to 76 (2.20%) during the same duration in the previous year (P = 0.00004). Ninety-four (16.52%) cases were screened for COVID-19. A total of 10 (10.64%) cases tested positive for SARS-CoV-2. Only one of these cases was symptomatic.

CONCLUSION:

There was a drastic decline in the number of both elective and emergency surgeries during and after the lockdown period of the COVID-19 pandemic when compared to the corresponding previous year duration. The maximum number of surgeries was performed in the vitreoretinal subspecialty. The positivity rate for SARS CoV-2 amongst the patients tested was 10.64% and most of these patients were asymptomatic.
Ligneous conjunctivitis exacerbated by Pseudomonas aeruginosa - Diagnostic and therapeutic approach
Authors: Tariq Madiha , Zahid Muhammad Abdullah , Khan Taimoor Ashraf , Shah Hira Ghafar
Published: May 2024

Ligneous conjunctivitis is a rare disease in which pseudomembranes develop on the mucosal surfaces of the eye. Only a handful of cases have been reported in the past 100 years. Although plasminogen deficiency is largely implicated in the pathogenesis of this condition, infectious agents are also thought to play a role in worsening the disease. Treatment is usually challenging. We present a case of 3-year-old female in whom a multidrug-resistant Pseudomonas aeruginosa was isolated from the culture of the pseudomembranes. To the best of our knowledge, this is the first time P. aeruginosa has been implicated as an exacerbation factor. Furthermore, we have given merit to the triple regimen of corticosteroids, heparin, and cyclosporine as being effective. We also added antibiotics to target the infectious organism.