Anterior Segment Evaluation Research Articles

Evaluation of the macula, retinal nerve fiber layer and choroid thickness in premature ovarian failure using spectral-domain optical coherence tomography.

The aim of our study is to describe the basal findings at the first diagnosis of the disease in patients with premature ovarian failure (POF) and to draw attention to the early changes in the macula, optic nerve head and choroid. In a prospective case-control study, 90 patients with POF and 90 control patients were evaluated. All participants underwent the same ophthalmic examination, including visual acuity, intraocular preasure measurement, anterior and posterior segment evaluation, macular and coroidal thickening, and retinal nerve fiber layer (RNFL) measurements with the same device (Spectral Domain OCT, software version 5.6.3.0, Heidelberg, Germany). The median age was 30.00 (28.00-31.00) in the control group and 29.00 (27.00-31.00) in the POF group (p = 0.249). The median thickness of the temporal outer macular region was statistically significantly thinner in the POF group (295.00 (289.00-303.25)) compared to the control group (306.00 (290.75-328.00)) (p < 0.001). There was a statistically significant decrease in all choroidal regions (p < 0.001), including the central, nasal 500, nasal 1500, temporal 500, and temporal 1500 regions in the POF group according to the control group. An increase in intraocular pressure in the postmenopausal period has been reported, suggesting a link between the postmenopausal decline in sex hormones and glaucoma. Our study is the first to monitor changes in choroidal, retinal thickness and RNFL in POF images showing early menopausal symptoms.

Correlation between optical coherence tomography angiography measured vessel density and retinal nerve fiber layer thickness in moderate primary open angle glaucoma cases and normal controls

: Aim of this study was to establish a correlation between findings obtained from Optical Coherence Tomography Angiography (OCT-A) and Retinal Nerve Fiber Layer (RNFL) thickness measurements in a series of moderate Primary Open Angle Glaucoma (POAG) cases and normal controls. In this observational cross-sectional study a total of 100 eyes were included, comprising 50 eyes with glaucoma and 50 control eyes without glaucoma. All participants underwent comprehensive anterior and posterior segment evaluations, intraocular pressure (IOP) measurement using Goldmann applanation tonometer, gonioscopy, visual field testing, and OCT imaging, which included OCT-A. The OCT-A imaging was performed using the RTvue XR Avanti by Optovue. Two types of analysis were conducted: a comparative analysis between the normal and glaucomatous groups using an unpaired t-test to assess differences in RNFL thickness and vessel density values, and a correlation analysis within each group to examine the strength of correlation between RNFL loss and reduction in vascular density. The results showed a significant reduction in vessel density index in all quadrants of glaucomatous eyes compared to normal eyes. Moreover, this reduced vessel density was found to be significantly correlated with the reduction in RNFL thickness in glaucoma patients. Specifically, the uperior and inferior quadrants exhibited the strongest correlation with each other. The severity of vascular compromise demonstrated a significant correlation with the extent of retinal nerve fiber loss in patients with glaucoma. OCT-A can serve as a valuable adjunct in the diagnosis of glaucoma and monitoring its progression.

Implementation of anterior segment ophthalmic telemedicine.

The growing push to integrate telemedicine into ophthalmic practices requires physicians to have a thorough understanding of ophthalmic telemedicine's applications, limitations, and recent advances in order to provide well tolerated and appropriate clinical care. This review aims to provide an overview of recent advancements in the use of ophthalmic telemedicine for anterior segment eye examinations. Virtual care for anterior segment evaluation relies on appropriate technology, novel workflows, and appropriate clinical case selection. Recent advances, particularly in the wake of the COVID-19 pandemic, have highlighted the utility of home-based assessments for visual acuity, external evaluation, tonometry, and refraction. Additionally, innovative workflows incorporating office-based testing into virtual care, termed 'hybrid telemedicine', enable high-quality ophthalmic testing to inform clinical decision-making. Novel digital tools and workflows enable high-quality anterior segment evaluation and management for select ophthalmic concerns. This review highlights the clinical tools and workflows necessary to enable anterior segment telehealth.

Therapeutic approach to ocular coloboma - a case report of a 37-year-old patient with high myopia and choroidal coloboma of the right eye

Introduction: Coloboma is a congenital malformation caused by a defect of optic fissure closure. We report a rare case of choroidal coloboma and management of possible complications. Clinical case: A 37-year-old patient presented for the current evaluation of uveal coloboma located in the inferior-nasal quadrant with the involvement of the optic disc and advanced high myopia. Conclusions: The management of coloboma includes follow-up of visual acuity level, anterior segment and fundus evaluations. Retinal detachment, cataract and choroidal neovascularization may occur secondary to the defect. Pars plana vitrectomy, autologous neurosensory retinal transplantation and laser therapy are considered methods in present case.

Choroidal Thickness and brolucizumab intravitreal injection: Cause or effect of intraocular inflammation?

Purposeto analyze the structural changes of choroidal thickness in patients with brolucizumab-related exudative vitritis after intravitreal injection, using EDI-OCT. MethodsOne hundred eyes of one hundred patients, affected by exudative age related-macular degeneration treated with brolucizumab intravitreal injection between January 2022 and august 2023 at Eye clinic of University of Federico II Naples, were enrolled. All eyes underwent macular examination using Enhanced Deep Imaging-OCT (Spectralis, Heidelberg Engineering inc.) preoperatively and at each postoperative check (1, 3, 6, 12 months). Anterior segment evaluation at slit lamp before and after injection was performed. ResultsOf the 100 treated eyes, 4 showed inflammatory signs related to exudative vitreitis, with inflammation signs at slit lamp examination and confirmed by OCT and B scan ecography. EDI-OCT revealed, in all of these 4 patients, a significant increase of choroidal thickness compared to baseline. Conclusionchoroidal thickness could be correlated in the inflammatory response generated in patients undergoing treatment with brolucizumab.

Correlation of anterior segment optical coherence tomography and ultrasound biomicroscopy in congenital corneal opacity

To investigate the correlation between swept-source anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in congenital corneal opacity (CCO). All children with unilateral or bilateral congenital corneal opacities who underwent examination under anesthesia (EUA) and anterior segment optical coherence tomography (AS-OCT) imaging from January 1, 2022, to December 31, 2022, were included. Main outcome measures were corneal and anterior segment evaluation and correlation of UBM and AS-OCT findings. A total of 22 eyes of 15 patients were imaged using both technologies. The age at first EUA ranged from 11 days to 4 years. Different phenotypes were classified based on the clinical examination, UBM, and AS-OCT findings. Fourteen eyes were diagnosed with Peters anomaly, congenital corneal staphyloma was observed in 4 eyes, 2 eyes had coloboma, 1 eye had peripheral sclerocornea, and 1 eye was diagnosed with congenital primary aphakia. AS-OCT and UBM findings were closely correlated in 18 of 22 eyes (82%) but AS-OCT failed to provide detailed information in 4 eyes (18%) where UBM revealed more details. Although AS-OCT offers valuable preliminary data for initial assessment and counseling, it may not consistently provide precise assessments in all cases. Therefore, UBM should be considered for definitive evaluation.

Bilateral Ocular Ischaemic Syndrome due to Carotid Artery and Cardiovascular Disease: A Case Report

Introduction : Ocular ischemic syndrome (OIS) is a rare but potentially blinding and fatal condition caused by carotid artery disease or other systemic condition results in ocular hypoperfusion.&#x0D; Case Illustration : A 62-year-old male with sudden bilateral vision loss, swelling, redness and pain of both eye for 7 days. There were dilated conjunctival and episcleral vessels, visual acuity of the right eye was hand movement and 0.05 for left eye, intraocular pressure (IOP) was 33 mmHg in right eye and 37 mmHgfor left eye. Anterior segment evaluation revealed rubeosis iris, mild anterior chamber reaction, and temporal angle neovascularization on gonioscopy. Both direct and consensual light reflexes were sluggish. Fundus examination showed normal optic disc, minimal hemorrhages at mid-periphery, narrowed arterioles, and minimal cotton wool spot. Macular OCT demonstrated discrete hyperreflectivity of inner retinal layers. From Macular Angiography OCT, ETDRS Central vessel density were 11.2% and 17.6% for the right eye and left eye, respectively. In both eyes, paracentesisof anterior chamber, intravitreal and intracameral injections of anti-VEGF were performed. Brain Magnetic Resonance Angiography Imaging revealed moderate stenosis of both distal carotid artery circulation. Percutaneous Coronary Angiography showed extensive stenosis in coronary artery, with low Ejection Fraction.&#x0D; Discussion : For the cardiovascular management, a pacemaker was implanted. One week after procedure, BCVA were 1/60 and 0.15, and IOPs of 17 and 18 mmHg, for the right and left eye, respectively. The patient was scheduled to have laser retinal photocoagulation.&#x0D; Conclusion : Quick clinical diagnosis, targeted workup for systemic associations, and prompt treatment might preserve life and sight in OIS.

Evaluation of pseudoexfoliation syndrome in eyes undergoing cataract surgery in tertiary care centre of Uttarakhand

Background: Pseudoexfoliation (PEX) syndrome, an age related microfibrillopathy having varied prevalence and associated with dense cataract, poorly dilating pupil resulting in challenging cataract surgeries. The present study aimed to evaluate pseudoexfoliation syndrome in eyes undergoing cataract surgery in tertiary care centre of Uttarakhand. Materials and methods: A hospital based prospective study carried out from January 2021 to June 2022 and approved by the Institutional Ethical Committee. A total of 1000 eyes of 1000 patients to be operated underwent complete ophthalmic evaluation including refraction, tonometry, gonioscopy, slit lamp biomicroscopy for presence of pseudoexfoliation, cataract grading, and fundus examination. Patients with PEX were diagnosed and data analysed. Results: A total of 54 PEX cases were diagnosed with 29 (53.7%) males and 25(46.3%) were females having mean age of 67.48 + 9.79 years, mean CCT was 528.46 + 18.49 micron and mean IOP was 19.81 + 5.88 mmHg. Prior to cataract surgery, an IOP of more than 21 mm Hg was noted in 40.7% (n=54) of pseudoexfoliative eyes. PXM on pupillary margin present in 51 (94.4%), on anterior lens capsule in 37 (68.5%), on iris in 31 (57.4%), on cornea in 5 (9.3%), phacodonesis in 6 (11.1%), Iris transillumination defect in 3 (5.6%), PXM on trabecular meshwork in 24 (44.4%) and sampaolesi line in 13 (24.1%). Conclusion: PEX presents challenges that necessitate thorough preoperative planning for a safe surgery and a satisfactory postoperative result. Therefore, dilated anterior segment evaluation should be emphasised in daily practise to avoid early PEX patients from being undiagnosed.

Assessment of safety profile of phacoemulsification in hard cataract

Purpose: The aim of the study was to assess safety of phacoemulsification in hard cataract by evaluating the post-operative endothelial cell loss and visual acuity. Materials and Methods: This is a hospital-based, prospective study conducted on 70 eyes of 70 patients with hard cataract. At the time of admission, detailed evaluation of anterior segment using slit lamp bio microscopy was done and cataract graded using LOCS III. Posterior segment was evaluated using indirect ophthalmoscopy under 20D/B-Scan. All patients with hard cataract underwent phacoemulsification procedure. The visual acuity and endothelial cell density assessed using Snellens chart and specular microscopy pre-operatively and post-operatively on Day 1, Day 7, and Day 30, respectively. Descriptive statistics, namely, mean, standard deviation to express continuous variables wherever applicable. Correlation between endothelial cell loss and cataract grading and correlation between final endothelial cell loss and final best-corrected visual acuity (BCVA) is analyzed by using Pearson’s Chi-square test and Pearson’s correlation coefficient. P value &lt;0.05 is considered as statistically significant. Results: Among 70 eyes, 40 (57.1%) had NO4-NC4, 18 (25.70%) had NO5-NC5, and 12 (17.1%) had NO6-NC6 cataract grading. The endothelial cell loss was 4.28%, 6.19%, and 7.15% on post-operative day 1, 7, and 30, respectively. There was a positive correlation showing that, as the cataract grading increased the endothelial cell loss increased too. The BCVA of 6/9 was achieved in 2 (2.8%), 6/6 in 68 (97.2%) at the end of four weeks. Conclusion: Although density of cataract has unfavorable influence on early post-operative corneal endothelial cell loss, it did not significantly influence final BCVA. The technique of phacoemulsification for hard nuclear cataract is worthy to be spread due to safety, effectiveness with good visual outcomes.

Retinal Toxicity from Ectoparasiticide Exposure or Coincidental?

Case Report: A 42 Year old male presented with complaints of sudden painless diminution of vision in RE for 3days, after fall of ectoparasticide (DELTAMETHRIN1.25%) in Right Eye. Uncorrected visual acuity in Right eye: counting fingers at 1/2metre, Left Eye: 6/6. Anterior segment evaluation showed Right and Left eye within normal limits. Pupils were 3mm round, regular, reactive to light in OU. Dilated Fundus Examination using indirect ophthalmoscopy showed Right Eye C:D:0.5, A:V 2:3 with subretinal fluid accumulation in macula and Left Eye normal fundus picture. A diagnosis of RE Central serous Chorioretinopathy (CSCR) was made using Optical Coherence Tomography. Discussion: With an incidence rate of 9.9 per 100,000, or roughly six times higher than that of women, CSCR mostly affects men. Acute or subacute central vision loss or distortion is the most prevalent symptom, and it typically affects men between the ages of 20 and 50.With regard to illnesses like CSCR, this case study aims to provide clinicians with more insight into the diagnosis, treatment, and management of pesticide-induced ocular damage. Conclusion: This is rare case of retinal toxicity following exposure to Deltamethrin.For an accurate diagnosis and management of CSCR, it is imperative to comprehend its risk factors, particularly the exposure to pesticides. Emphasizing eye protection and preventative health measures will help us safeguard our vision from environmental risks such as pesticide exposure.

Optical coherence tomography-angiography for anterior uveal tract evaluation in normal subjects and in pathology

Purpose: to assess the potentials of optical coherence tomography-angiography (OCTA) in the evaluation of anterior segment (AS) uveal vessels in normal and pathological conditions.Material and methods. 20 healthy volunteers (40 eyes) with no ophthalmic pathology (the control group) and 85 previously untreated patients (85 eyes) with suspected tumors of the irido-ciliary area (the iris, the ciliary body and the peripheral sections of the choroid) were examined. All participants had optical coherence tomography (OCT) and OCTA of AS, with the qualitative assessment of scans (vessels pattern, lumen, tortuosity) and the quantitative assessment (vessel density index, VD%, for the affected zone). In ciliary body or choroid pathologies, VD index was measured for the conjunctiva in the focus projection. VD index included mean and local VD, as well as VD of perifocal tissues. In addition, B-mode ultrasound scanning and ultrasound biomicroscopy were performed.Results. OCTA scans in 4 sectors of the normal iris showed a predominantly radial pattern of conjunctival vessels positioning, with their lumen remaining the same along their entire visible length. The lowest VD value (38.5%) was registered in the temporal iris segment, while the highest (43.9%) was revealed in the inferior quadrant. In the iris tumors area, intrinsic vascularity molded in various vascular patterns was observed. Melanomas could be suspected because of the vessels oriented along the axis of the tumor and by non-uniform lumen of the vessels.Conclusion. AS-OCTA is an informative method for the visualization of iris vessels in normal conditions and in iris pathology and may be considered a valuable addition to the standard visualization techniques.

Clinical assessment of corneal complications of manual small incision cataract surgery at tertiary care centre

: To assess corneal complications and visual outcome of manual small incision cataract surgery.: This study comprises of 227 patients in a tertiary care centre in Kolar district, who underwent MSICS were examined for corneal complications and visual outcome postoperatively on Day 1, 1 week, and at the end of 6 week also visual acuity (VA) assessment, anterior segment evaluation with slit lamp biomicroscopy, posterior segment evaluation using indirect ophthalmoscopy, and keratometry was done.227 participants were included in the study, of whom 138 (61%) were female and 89 (39%) were male. The maximum number of patients being in the age group of 61-70 (42.7%). OCTET grading was done for corneal edema patients and on post op Day 1, total 62 patients who had corneal edema in the study were graded according to OCTET classification, and 6 patients (9.6%) had grade 1, 17 patients (27.4%) had grade 2 and 39 patients (63%) had grade 3. At the end of 6 week postoperatively, 45 patients had clear cornea, and 5 patients (8%) had grade 1, 6 patients (9.5%) had grade 2, and 7 patients (11.1%) had grade 3, and 82.3% of patients had VA of 6/6 to 6/9 followed by 11% had 6/12 to 6/18 and 6.6% had 6/24 to 6/36.: Small incision cataract surgery is most cost-effective surgery if corneal endothelium is protected during surgery and will have early visual rehabilitation.

Prevalence rate of amblyopia suspect among Yemeni workers

Background: Defective vision of one eye and strabismus, influence daily life and pertinent to education and occupation. This study outlined the prevalence rate and etiology of amblyopia suspect in Yemeni males who came to fulfill visa applications for works outside the country.&#x0D; Method: A cross sectional community-based study enrolled adult males, ages 18 to 55 years. From an 8827 visa applicants, sample of (1162) referred to the outpatient clinic for visual clearance, these had defects in visual acuity equal or less than 6/12, glasses wear and abnormal looking eyes, lid or orbit. In the clinic, they underwent documentation of their basic data, unaided, aided vision, refraction, anterior and posterior eye segment evaluation to outline the defective vision cause. The amblyopia limited by unable to see the 6/9 line or worse in one eye after best correcting glasses without any organic eye lesion.&#x0D; Results: out of (1162) referred for visual clearance applicants, there were (472) eyes, with prevalence rate 5.3%, had amblyopia of variable degrees from could not attain 6/9 in visual acuity to less than 6/60. Among the amblyopic eyes, (411) 4.66% in prevalence rate had a preventable refractive elements with a percentage of 87.08%. These who were drivers would lose their target work. (53) 22.9 % of these having decreased visions were illiterate. The study found (948) 81.6% had no glasses at time of screening. Conclusion: The prevalence rate of amblyopia was high 5.3%, the controllable refractive amblyopia occupied 87.08%.

Evaluation of corneal structural changes in post-COVID-19 patients using anterior segment optical coherence tomography and specular microscopy

Purpose To detect corneal structural changes in people who have recovered from COVID-19 infection by specular microscopy and anterior segment optical coherence tomography (AS-OCT). Moreover, the study compares corneal endothelial and structural parameters between those who have recovered from COVID-19 and individuals who have neither been infected nor vaccinated. Methods This is a prospective observational case–control comparative study involving 108 eyes from 54 individuals. The participants are divided into two groups: the case group (individuals recovered from COVID-19 infection) with 54 eyes (27 individuals) and the control group (individuals with no history of COVID-19 infection or vaccination) with 54 eyes (27 individuals). Both groups are matched for age and sex. The study involves architectural analysis of the cornea using anterior segment OCT and evaluation of the corneal endothelium using specular microscopy. Results The case group’s mean cell density (CD) was 2445.5±310.6 cells/mm, while the control group was 2689.6±398.7 cells/mm (P value 0.001). This indicates a statistically significant decrease in CD among individuals in the case group compared with the control group. The case group’s mean cell area (SD) standard deviation was 169.6±115.2. In contrast, in the control group, it was 135.87±39.29 (P value 0.004), signifying a statistically significant increase in the case group. There was also a statistically significant increase in the average cell area (AVE) in the case group compared with the control group (P value 0.024). However, there were no statistically significant differences in other specular parameters, such as coefficient of variation (CV) or 6A or in the pachymetry. Similarly, no statistically significant differences in AS-OCT parameters were observed between both groups. Conclusion The study reveals a decrease in corneal endothelial cell count and an increase in the average cell area among individuals who have recovered from COVID-19 during their recovery period. However, it is noteworthy that the specular microscopy parameters remained within the clinically normal range for both groups, and visual acuity was unaffected.

Evaluation of Anterior Segment and Intraocular pressure Changes in Phakic Eyes After Pars Plana Vitrectomy with Silicone Oil Injection Using Ultrasound Biomicroscopy

Evaluation of Anterior Segment and Intraocular pressure Changes in Phakic Eyes After Pars Plana Vitrectomy with Silicone Oil Injection Using Ultrasound Biomicroscopy

Şaşılık Cerrahisinin Refraksiyon Kusuru ve Ön Segment Ölçümleri Üzerine Etkisi

Aim: This study aimed to investigate the effects of horizontal strabismus surgery on refractive error and anterior segment parameters.&#x0D; Material and Methods: Fifty-four eyes of 27 patients were included in this study. Patients underwent repeated refraction measurements and anterior segment evaluation preoperatively, first week, first month, third month, and sixth month postoperatively. Patients were divided into three groups, those who underwent resection (group 1), recession (group 2), and healthy eyes without any surgical intervention (group 3).&#x0D; Results: The mean age of the patients was 24.4±11.1 years and 14 (51.9%) were female. There was a statistically significant difference in central corneal thickness in group 2 before and after surgery (p=0.037). The mean central corneal thickness was highest in the first week with 548.14±40.42 µm and lowest in the first month with 541.50±41.75 µm after surgery. There was a statistically significant difference in cell density (p=0.004) and mean cell area (p=0.004) between groups 1 and 2 in the first week after surgery. The cell density level was statistically significantly higher in group 1 in all postoperative measurements. In addition, the mean cell area level was statistically significantly lower in group 1.&#x0D; Conclusion: Strabismus surgery has an effect on anterior segment parameters in addition to correcting eye movements and visual axis. Depending on the type of intervention, the number of affected anterior segment parameters also varies. In the management of the patient in the postoperative period, the anterior segment structures should be carefully evaluated at each examination and the findings should be noted.

Ocular involvement—An unusual initial presentation of chronic myeloid leukemia: A case report

ABSTRACT Chronic myeloid leukemia (CML) patients frequently exhibit systemic symptoms such as fatigue, abdominal discomfort, weight loss, and fever but rarely can have atypical initial presentation in the form of ophthalmic manifestations, which can precede the diagnosis of the primary malignancy. We describe a case of a 29-year-old male who presented in our ophthalmology out-patient department (OPD) with complaints of painless, diminution of vision, which was sudden in onset in right eye (RE) and loss of vision in left eye (LE) for four and seven days, respectively. There had been a history of loss of weight and appetite for the past 2 months. The visual acuity (VA) recorded was finger counting two meters in RE and perception of light in LE with an inaccurate projection of rays in both eyes (BE). The anterior segment evaluation of both eyes (BE) was normal. Fundus revealed multiple elevated yellow subretinal lesions with exudative detachment in the RE and no view in the LE. Ultrasound-Brightness (USG B) scan in the LE revealed multiple hyperreflective echoes likely vitreous hemorrhage. Optical coherence tomography (OCT) showed subretinal hyperreflectivity with surrounding edema in RE suggestive of leukemic infiltrates. On further systemic investigations, chronic myeloid leukemia-chronic phase (CML-CP) was detected; hence, the diagnosis of RE exudative retinal detachment (RD) and LE vitreous hemorrhage with CML-CP was made. Ophthalmic involvement is more often seen in acute than chronic leukemia, which makes the diagnosis challenging. We describe a unique case of a young patient with CML-CP who initially presented with ocular involvement preceding systemic diagnosis. This case report illustrates the importance of a primary care physician or an ophthalmologist in the early diagnosis and prompt management of hematological malignancy, as ophthalmic manifestations may be a rare initial presenting feature in CML-CP. These conditions require urgent referral to a hematologist by a primary care physician in the view of early commencement of therapy.

Unilateral macular branch retinal vein occlusion in a healthy Indian woman following coronavirus disease vaccination: a case report and comprehensive literature review

Background: The coronavirus disease (COVID-19) vaccines exert ocular adverse effects, including episcleritis, scleritis, anterior and recurrent uveitis, acute macular neuroretinopathy, paracentral acute middle maculopathy, ophthalmic vein thrombosis, Graves’ disease, arteritic anterior ischemic optic neuropathy, non-arteritic anterior ischemic optic neuropathy, central serous chorioretinopathy, Vogt-Koyanagi-Harada disease, multifocal choroiditis, cranial nerve palsies such as facial or abducens nerve palsy, acute zonal occult outer retinopathy, acute zoster ophthalmicus following re-activation of the varicella-zoster virus, acute retinal necrosis, and multiple evanescent white dot syndrome. In this case report, we explored the possibility of macular branch retinal vein occlusion and its association with COVID-19 vaccination. Case Presentation: A 44-year-old healthy woman presented with unilateral nonprogressive blurring of vision in the right eye (OD). Her best-corrected distance visual acuity (BCDVA) in OD was 20 / 40. The anterior-segment evaluation was normal. Fundus evaluation of the OD revealed macular branch vein occlusion. She had a history of COVID-19 vaccination within 1 month. The interleukin-6 level was elevated six folds to 30.5 pg / mL. However, COVID-19 immunoglobulin G (IgG) antibodies were negative. Infective etiologies, such as tuberculosis and dengue, were ruled out. Spectral-domain optical coherence tomography (SD-OCT) of the OD showed hyperreflective dots in the posterior vitreous, inner retinal swelling, and cystoid changes in the macula. The maximum central macular thickness was 486 mm. A single dose of bevacizumab was administered at OD intravitreally. At the final follow-up 2.5 months later, her BCDVA had improved to 20 / 20 OD. Fundus evaluation revealed fewer retinal hemorrhages and cotton wool spots. SD-OCT of the OD showed a normal foveal contour and absence of cystoid spaces. Her maximum central macular thickness was 236 mm. Conclusions: A temporal effect of vein occlusion secondary to COVISHIELD™ vaccination may occur in the absence of systemic risk factors. The interleukin-6 level was elevated, and the remaining blood test results were within normal limits. Since this is a case report, it is limited by the absence of strong evidence to prove this causal relationship between macular branch retinal vein occlusion and the specific brand of COVID-19 vaccination.

Medium to long term follow up study of the efficacy of cessation of eye-rubbing to halt progression of keratoconus.

To study the progression of keratoconus after cessation of eye rubbing with a minimum follow up of three-years. Retrospective, monocentric, longitudinal cohort study of keratoconus patients with a minimum of 3 years follow-up. One hundred fifty three eyes of seventy-seven consecutive patients with keratoconus were included. Initial examination consisted of anterior and posterior segment evaluation using slit-lamp biomicroscopy. At the initial visit, patients were thoroughly informed of their pathology and instructed to stop rubbing their eyes. Eye rubbing cessation was assessed at all the follow-up visits at 6 months, 1 year, 2 years, 3 years, and yearly afterward. Corneal topography using the Pentacam® (Oculus®, Wetzlar, Germany) was used to obtain maximum and average anterior keratometry readings (Kmax and Kmean), as well as thinnest pachymetry (Pachymin, μm) in both eyes. The main outcomes measured were maximum keratometry (Kmax), mean keratometry (Kmean), and thinnest pachymetry (Pachymin) values at various time points to assess for keratoconus progression. Keratoconus progression was defined as a significant augmentation of Kmax (>1D), Kmean (>1D), or significant diminution of Pachymin (>5%) throughout the total follow-up duration. One hundred fifty three eyes of seventy-seven patients (75.3% males) aged 26.4 years old, were followed for an average of 53 months. Over the course of the follow-up, there was no statistically significant variation of ∆Kmax (+0.04 ± 0.87; p = 0.34), ∆ Kmean (+0.30 ± 0.67; p = 0.27) nor ∆Pachymin (-4.36 ± 11.88; p = 0.64). Among the 26 of the 153 eyes which had at least one criterion of KC progression, 25 admitted continuing eye rubbing, or other at-risk behaviors. This study suggests that a significant proportion of keratoconus patients are likely to remain stable if close monitoring and strict ARB cessation are achieved, without the need for further intervention.

Occular manifestation of a case of lamellar ichthyosis

A baby full term born of LSCS to a otherwise healthy mother was referred for ophthalmology department. On ophthalmological torch light examination, the patient had equal upper and lower lid bilateral ectropion. There was missing eye lashes noted. The anterior segment evaluation was found to be within normal limit without evidence of corneal opacities. Lamellar ichthyosis otherwise termed as Collodion baby is a infrequent disease; and there is no well-known management protocol. The Patient was managed conservatively by the use of Hydroxy propyl methyl cellulose (2% w/v) eye ointment and lubricant (Carboxy methyl cellulose 0.5%) eye drops. Thus, surgical intervention was avoided and patient was managed medically on ointments and drops