Eye Care Center Research Articles

Understanding the treatment paradigm and the sequencing of antiglaucoma fixed-dose combinations in a tertiary center in South India.

To analyze the medical management of primary open-angle glaucoma (POAG) and ocular hypertension (OHT) and the placement of fixed-drug combination drugs (FDC) in the treatment paradigm at a tertiary eye care center in South India. Retrospective study (January 2011-December 2015) of newly diagnosed POAG and OHT patients (≥18 years) with ≥5 years follow-up. Primary outcome included percentage use of different antiglaucoma drugs (at initiation) and FDCs at the first, second, and third progression (sequencing). Secondary outcomes: Percentage discontinuation for different FDCs, efficacy parameters (decrease in intraocular pressure (IOP)/visual field), adverse events, and the median number of antiglaucoma medications (AGMs) after 5 years. Three hundred and seventy eyes (198 patients) were analyzed; 84% of them had POAG. Prostaglandin analogs (PGAs) were the most common (66.2%). FDCs were started in 48 eyes (12.9%), with brimonidine + timolol combination being the most common. FDC usage at subsequent modifications was 10.1%, 24.04%, and 30.0%. Beta-blockers and PGAs were the most frequently prescribed AGMs in our practice pattern, with β-blockers being the most consistent one. This study is a fairly large study with a minimum of a 5-year follow-up of patients with POAG and OHT and gives insights into the treatment patterns, use of FDCs, and the need for multiple medications over time.

Ocular fish hook injuries

PurposeFishing stands out as a widely enjoyed leisure pursuit. While ocular fishing injuries are infrequent, they carry the potential for severe ocular trauma, and safe extraction of a fish hook can pose challenges. We here in report a series of 21 cases of penetrating injury to the cornea by fish hook, detailing successful surgical interventions employed for their management. The report not only outlines different techniques for the removal of fish hooks but also provides clarification on terminologies associated with various components of a fish hook. MethodsThis was a retrospective study conducted at tertiary eye care centers in South India. Our hospitals cater to the states of Telangana, Andhra Pradesh, and Odisha. All medical records of patients who attended the emergency department from the period of 2003 to 2023 were evaluated and all patients with fish hook injury were included in the study. This is the longest and largest study in India. ResultsTwenty-one cases of ocular fish-hook injuries were presented to the emergency room between 2003 and 2023. Patients were between the ages of 9 and 59 years (mean, 29.4 years), and 90.4 % (19 out of 21) were males. Patient demographics, injury characteristics, surgical interventions, and visual outcomes were meticulously documented. Out of 21 cases, three cases (14.3 %) had blunt trauma, 17 cases (80.9 %) had penetrating injury and one case had lid laceration. Patients had better visual outcomes after the second surgery. Out of 21 cases, 7 (33.3 %) had post-operative visual acuity (VA) between 20/20 and 20/40. Three (14.3 %) had post-operative VA between 20/60 and 20/125. Five (23.8 %) had post-operative VA between 20/200 and 20/600. Six cases (28.6 %) had poor visual outcomes of which two had no perception of light (NPL), two had Hand movements and the other two had the perception of light present and projection of rays inaccurate ConclusionThis extensive case series underscores the complexity of ocular injuries caused by fish hooks and emphasizes significance of tailored surgical approaches for optimal visual outcomes. The hook can be successfully removed with minimal trauma to ocular structures by understanding structure of fish hook and by employing appropriate method of extraction.

Blindness And Visual Impairments Causes In Patients Presenting To Tertiary Eye Care Centers Of Peshawar

Background: Blindness remains a significant issue, particularly in underdeveloped regions, with an estimated 38 million blind and 110 million visually impaired worldwide. Cataracts and glaucoma are primary causes. Many cases are preventable or treatable. Pakistan's Vision 2020 initiative targets blindness prevention, but its impact needs assessment. This study aims to determine the prevalence and causes of blindness and visual impairment among patients at tertiary eye care centers of Lady reading Hospital and Kuwait Teaching Hospital Peshawar. . Methods: The study reviewed hospital records from LRH and KTH eye care centers in February 2017. Patients with visual acuity below 3/60 were classified as blind, and below 6/18 as visually impaired. Data included age, gender, and causes of decreased visual acuity. Results: The study included 100 cases, with 55 males and 45 females. Participants averaged is 42.78 ± 20.75 years old. Blindness frequency was 10%, higher in females (13.33%) than males (7.2%). Visual impairment occurred at a rate of 39%, slightly higher in females (40%) than males (38.1%). Most cases (84.6%) were moderate visual impairment (n=33). Cataracts were the leading cause (37%), followed by uncorrected refractive errors (28%), among others. Conclusion: Despite Vision 2020 efforts, cataracts remain the leading cause of blindness in tertiary eye care hospitals. Extensive studies are required to assess the burden of avoidable blindness and understand why these causes persist.

More than “just a red eye”: A case series of Oestrus ovis ocular infestation

This case series intends to highlight clinical signs and symptoms of external ophthalmomyiasis caused by larvae of Oestrus ovis. Data were collected from January 2022 to January 2023 at a tertiary eye care center in central India regarding presenting features of patients with external ophthalmomyiasis. In total, 59 cases of established ophthalmomyiasis with a similar organism were recorded. An acute red eye can be caused by a wide spectrum of pathologies, some being as uncommon as a fly larva. Hence, it is important to perform a thorough ophthalmic examination in all patients presenting with inflamed red eyes of unknown cause.

Burnout at a tertiary eye care center significantly higher after the start of COVID-19

ObjectiveTo better understand the burnout rates among ophthalmologists before and after the start of COVID-19 in the United States. DesignRetrospective observational study integrating cross-sectional data from annual faculty surveys conducted in 2018, 2021, and 2022, plus a separate, single-item burnout survey administered prospectively in 2022 and repeated six months later to faculty members, trainees, and staff members. SubjectsUniversity of Michigan faculty, trainees, and staff at a tertiary eye care center (Kellogg Eye Center), and Women in Ophthalmology (WIO) members. MethodsA validated, single-item burnout assessment on a 5-point scale was electronically distributed to WIO and Kellogg physicians and staff in late 2022. Links to wellness resources were provided at submission. The survey was redistributed after six months, with an added question on resource utilization. Responses were compared to Kellogg's Annual Faculty Survey in 2018, 2021, and 2022, which included the same single-item burnout measure. All responses to the single-item scale were dichotomized based on presence of burnout. Self-reported wellness resource utilization was also assessed. OutcomesSelf-reported measures of burnout. ResultsA total of 73, 91, and 81 ophthalmologists on faculty completed the Annual Faculty Survey in 2018, 2021 and 2022, representing a response rate of 64 %, 79 %, and 69 %. The response rate for the single-item survey sent to Kellogg among ophthalmologists in 2022 was 43 %. The Kellogg ophthalmologist burnout rate in 2018 was 39.7 % and was significantly higher in 2021 at 70.3 % (p = 0.0001), and in 2022 at 70.4 %. Burnout rates amongst WIO members and Kellogg ophthalmologists were similar. While no respondents to the single-item survey in 2018 reported the most severe burnout score, in 2021, responses shifted to include the most severe answers. Some respondents reported utilizing wellness resources, follow-up results did not demonstrate significantly decreased burnout in any group. ConclusionsIn 2018, ophthalmologists’ burnout rates at this academic eye center were in line with national averages. However, a significant increase in burnout was seen in 2021 onwards, with a shift towards more severe burnout responses. Though numerous factors may account for these changes, COVID-19 may be a significant contributor. Future work may focus on specific contributors to increased rates of burnout amongst ophthalmologists.

Comparative Evaluation of Topographic Parameters Using Three Different Topographers in Keratoconic and Cross-linked Keratoconic Corneas.

To compare the parameters of three different topographic devices (Pentacam HR, Oculus Optikgeräte GmbH; Sirius, Costruzione Strumenti Oftalmici; and Cassini, i-Optics) in grading the severity of keratoconus in cross-linked and non-cross-linked eyes. This was a prospective comparative interventional study done in a tertiary eye care center, wherein 114 eyes of 68 patients with keratoconus were divided into two groups: 62 eyes that were observed and 52 eyes that were cross-linked. All eyes were evaluated on all three topographers at baseline, 3-month follow-up, and 6-month follow-up. The Sirius showed significantly lower values of mean flat keratometry in comparison to the Pentacam HR (limits of agreement [LoA]: 1.75 to 3.51%) and Cassini (LoA: 1.75 to 3.51%). The mean steep keratometry values were higher for the Cassini in comparison to the Pentacam HR (LoA: 4.39 to 7.02%) and Sirius (LoA: 3.51 to 6.14%). The mean steep keratometry values of the Sirius were significantly lower than those of the Pentacam HR and in both the cross-linked and observation groups (LoA: 3.51 to 6.14%). The mean keratometry values were significantly higher in the Cassini compared to the Pentacam HR (LoA: 3.51 to 8.77%) and significantly lower in the Sirius in comparison to the Pentacam HR (LoA: 3.51 to 6.14%). The mean difference in astigmatism was also statistically significant between the three tomographers in both groups, with the Cassini showing higher values (LoA: 3.51 to 5.26%) and the Sirius lower values than the Pentacam HR (LoA: 5.26 to 6.14%). The authors conclude the three devices cannot be used interchangeably. The Cassini showed better agreement and correlation with the Pentacam HR in the staging of keratoconus, whereas the Sirius tended to underdiagnose and under-stage the disease. [J Refract Surg. 2024;40(4):e260-e269.].

Frequency of Non-strabismic Binocular Vision Anomalies among Optometrists in a Tertiary Eye Care Center in Southern India.

Lifestyle in the modern era has drastically changed across the globe, and the healthcare profession was no exception. The increased time spent in the virtual space for various purposes, including online classes and webinars, is hypothesized to increase the risk of vision-related disorders such as asthenopia, dry eyes, and visual fatigue. The purpose of this study was to evaluate fusional vergence and ocular accommodation among optometry professionals in a tertiary eye care center during the immediate post-coronavirus disease 2019 (post-COVID-19) lockdown period. Optometrists posted in the general out-patient department, specialty clinics, and the ocular diagnostics department were included in the study. A total of 65 optometrists were included in the study. All optometrists underwent a comprehensive binocular vision assessment. Convergence Insufficiency Symptom Survey questionnaires were administered to all optometrists at the beginning of the assessment. Out of 65 optometrists, 48 (73.8%) were women. The mean (standard deviation) age of the participants was 24 (3) years. Eleven (16.9%) optometrists had normal binocular vision parameters, and the rest 54 (83.1%) had non-strabismic binocular vision anomalies. Reduced accommodative facility and convergence insufficiency were seen among 43 (66.2%) optometrists, whereas 30 (46.2%) had reduced accommodative facility alone. Twelve (18.5%) participants were symptomatic as per the convergence insufficiency symptom survey. This study highlights the fact that a large proportion of optometrists have undetected non-strabismic binocular vision anomalies in a tertiary eye care center. It is important for eye care professionals to undergo regular binocular vision assessments in association with ophthalmic examinations and relevant management. This will ensure that these dysfunctions do not impede work productivity and overall quality of life.

Spontaneous expulsive choroidal hemorrhage: A rare ocular catastrophe - A case report

Spontaneous expulsive choroidal hemorrhage is described as a sudden accumulation of blood in the potential space between the choroid and sclera, with the source of the blood being the long or short posterior ciliary arteries. It is observed exclusively in the geriatric population with atherosclerotic vessels associated with hypertension.[4] Massive spontaneous choroidal hemorrhage in the absence of surgery or trauma is an infrequent event, described in isolated case reports, and it results in devastating vision loss.[8] We report a case of a 74-year-old patient with uncontrolled hypertension with a sudden loss of vision in the left eye, later diagnosed as spontaneous expulsive choroidal hemorrhage. The patient was treated conservatively with topical steroids, cycloplegics, antibiotics, antiglaucoma medications, and tight bandages with nil visual prognosis. The patient initially refused surgical management and got discharged against medical advice. However, having been mentally prepared, the patient underwent evisceration at a tertiary eye care center nearby.

Rubinstein Taybi syndrome with secondary glaucoma: An unusual case report and review of literature

Rubinstein Taybi syndrome is a rare neurodevelopmental disorder characterized by broad thumbs and first toe, microcephaly, developmental delay, beaked nose, talon cusps, and various systemic abnormalities like cardiac defects, hearing loss, respiratory infections, and ocular abnormalities which are common with this syndrome. The various ocular abnormalities reported in the literature are corneal opacities, lacrimal gland abnormalities, strabismus, coloboma, retinal dysfunction, and congenital glaucoma. We hereby report the case of a 7-year-old boy who presented in the glaucoma clinic of a tertiary eye care center with large eyeballs and a typical dysmorphic face characterized by high-arched brows with a low-hanging columella, grimacing smile, talon cusps, diffuse corneal haze, and enlarged corneal diameters (12.5 mm) and who was subsequently diagnosed with congenital glaucoma after evaluation under anesthesia (EUA). EUA revealed raised intraocular pressure (IOP) of 22 mmHg, and optic never head cupping in the right eye (RE) was 0.8:1 the other eye had a total leucomatous corneal opacity. The child was started on topical antiglaucoma medication in RE, and subsequent evaluation revealed well-controlled IOP on these medications.

Ophthalmic manifestations as the first presenting feature in dengue fever: a 10-year study.

Purpose: To report patients who first presented with various ocular manifestations and eventually ascertained to have underlying dengue. Methods: A prospective study was conducted at multiple tertiary eye-care centers in India from 2012 to 2022. Cases reporting initially with ocular features along with fever/past history of fever over the last two weeks or with clinical features of dengue were selected. After an ophthalmological examination, patients underwent complete serological and biochemical analysis and those with reduced platelet counts were evaluated for dengue. Results: Out of 564 cases, 15 patients were verified to be afflicted with dengue eventually. A rising trend of cases was seen every year and out of 15 cases, eight cases were reported during the Covid-19 pandemic (from 2020 to 2022), but were COVID-negative. 9 cases presented with acute redness followed by diminished vision. Seven cases presented a history of fever over the last few days and one had traveled from dengue endemic area. The various ocular presentations included subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth-nerve palsy, and vitreous hemorrhage. On serological examination, all 15 patients were detected to have low platelets. All cases responded well with supportive treatment and the ocular features subsided in all within a couple of weeks with good visual recovery. Conclusion: In a tropical nation, such as India, with endemic dengue zones and increasing figures of dengue lately, ophthalmologists must include dengue fever among the differential diagnoses in various ocular presentations like subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth nerve palsy, and vitreous hemorrhage. Abbreviations: DHF = dengue hemorrhagic fever, PCR = polymerase chain reaction, RT-PCR = real-time automated reverse transcriptase (RT-PCR), SD = standard deviation, MAC-ELIS = IgM antibodies capture enzyme-linked immunosorbent assay, RE = right eye, LE = left eye, CECT = Contrast-enhanced computed tomography.

Retrospective assessment of accuracy of nine intraocular lens power calculation formulae in eyes with axial myopia.

To compare the accuracy of nine conventional and newer-generation formulae in calculating intraocular lens power in eyes with axial myopia. Tertiary eye care center, Bengaluru, India. Retrospective cross-sectional, comparative study conducted in India. Patients undergoing uneventful phacoemulsification in eyes with axial length >26 mm were included. Preoperative biometry was done using Lenstar LS 900 (Haag-Streit AG, Switzerland). Single eye of patients undergoing bilateral implantation was randomly selected. Optimized lens constants were used to calculate the predicted postoperative refraction of each formula, which was then compared with the actual refractive outcomes to give the prediction errors, following which subgroup analysis was performed. The Kane formula, Barrett universal II, Emmetropia Verifying Optical (EVO) 2.0, Hill Radial Basis Function (Hill RBF) 3.0, Olsen formula, along with Wang Koch-adjusted four formulae, that is, Sanders Retzlaff Kraff/Theoretical (SRK/T), Holladay 1, Haigis, and Hoffer Q formula, were compared for intraocular lens power calculations. One hundred and sixty-five eyes that fulfilled all the inclusion criteria were studied. Hill RBF 3.0 had the lowest mean and median absolute prediction errors (0.355 and 0.275, respectively) compared to all formulas. In subgroup analysis (26-28, >28-30, and >30 mm), significant difference was seen only in extremely long eyes (>30 mm). The Hill RBF 3.0 formula generated the maximum percentage of eyes with refractive errors within ±0.25, ±0.5, ±0.75, and ±1 D (46%, 76.2%, 89.9%, and 95.8%, respectively). This is the first study evaluating all the formulas exclusively in the myopic eyes. Hill RBF 3 was found to be superior in accuracy to all other formulas.

The Impact of COVID-19 Pandemic on Ocular Oncology Services at Cipto Mangunkusumo Hospital, Indonesia

Background:: Delay of diagnosis and treatment in ocular oncology services due to the COVID-19 pandemic is very disadvantageous. This study aimed to evaluate the impact of COVID-19 on new patients with suspected eye tumors in terms of volume, characteristics, and waiting time for a procedure. Methods: : A retrospective study based on hospital records of new patients was held in the ocular oncology clinic of Cipto Mangunkusumo Hospital, a tertiary eye care center in Jakarta, Indonesia. Patients were analyzed descriptively based on three time periods: pre-COVID-19, COVID-19 social restriction, and post-COVID-19 social restriction. Each patient was stratified according to case priority during the COVID-19 pandemic suggested by Indonesia’s Ophthalmologist Association (IOA). Results: During the COVID-19 social restriction between March to June 2020, new patient volume decreased by 73.1%, with a 75.5% decline in referrals from the governmental hospital. Elderly, pediatric, and highly educated patients were less likely to visit the clinic. Patients with acute onset, invasive or metastatic tumors, and advanced T-stage were more likely to be referred to the hospital. Third-priority cases referred with a lower ratio during COVID-19 social restriction (29% vs 44.9% in pre-COVID-19 and 35.1% in post-COVID-19 social restriction) and had to wait longer for the procedure (41 (18–60) days vs 28.5 (11–63) days in pre-COVID-19 and 16.5 (7–67) days in post-COVID-19 social restriction). Conclusions: : As the healthcare service was overwhelmed by COVID-19 patients, referral to ocular oncology services was severely disrupted, particularly in elderly, pediatric, and early T-stage patients. Strategies are needed to ensure that highly prioritized cases may access the services.

Clinical Characteristics and Treatment of Ophthalmic Sequelae of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis at a Tertiary Eyecare Centre in Hungary.

This study analysed the causative factors and clinical characteristics of acute and chronic ocular sequelae of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) treated at a large third-referral centre in a developed country (Hungary) over a 15-year period. This was a retrospective review of patients with acute and/or chronic SJS/TEN who were managed between 2006 and 2020 at the Department of Ophthalmology of Semmelweis University in Budapest, Hungary. For each subject, clinical data, including patient demographics, clinical history, causative agents of SJS/TEN, and conservative and surgical treatment details, were reviewed. Ninety-six eyes of 48 patients were included (28 female; 58.3%); the age at disease onset was 32.1 ± 22.4years. The most common causative factors were medicines (n = 36; 75.0%). Among these drugs, 29.2% were nonsteroidal anti-inflammatory drugs (NSAIDs) (n = 14), 20.8% were antibiotics (n = 10) and 14.6% were antiepileptic drugs (n = 7). In patients with chronic SJS/TEN, the most commonly found ocular sequelae were conjunctival hyperaemia in 45 (56.3%) eyes, symblepharon in 38 (47.5%) eyes, trichiasis/distichiasis in 37 (46.3%) eyes, corneal neovascularization in 31 (38.8%) eyes and corneal scarring in 29 (36.3%) eyes. In patients with chronic SJS/TEN, the most frequently used topical conservative treatment included antibiotics in 53 (66.3%) eyes, preservative-free artificial tears in 50 (62.5%) eyes and topical corticosteroids in 42 (52.5%) eyes of 40 patients. The most frequently performed ocular surgeries for managing chronic ocular sequelae in patients with SJS/TEN were epilation for trichiasis (n = 27; 33.8%), cataract surgery (n = 14; 17.5%), entropion surgery (n = 12; 15.0%), penetrating keratoplasty (PK) (n = 11; 13.8%) and amniotic membrane transplantation (n = 4; 5.0%). Our results suggest that NSAIDs, antibiotics and antiepileptic drugs are the most common causative factors for SJS/TEN in Hungary. Like in other countries, in Hungary, the ocular management of patients with acute and chronic SJS/TEN is heterogeneous, and most cases do not follow modern therapeutic guidelines.

Does ranibizumab biosimilars fare as well in macular neovascularisation?

To evaluate the effectiveness and safety profile of Ranibizumab Biosimilar in Macular Neovascularisation and compare outcomes with patent Ranibizumab.A retrospective analysis during the period 2017-2020 was conducted at a tertiary eye care centre in South Kerala on patients with wet AMD who had received Razumab, a biosimilar of Ranibizumab as a loading dose followed by PRN schedule. This was compared to a similar data obtained from patented Ranibizumab (Lucentis) during the same period. Endpoints analyzed included improvement in BCVA, proportion of patients with persistent IRF/SRF and complications at 1 year. Of 164 eyes analyzed 76 eyes received Razumab and 88 eyes received Lucentis with 32% and 50% males in each group. After the loading dose both drugs showed similar efficacy and the final vision (median logmar; 0.24 vs 0.17; p 0.189), presence of residual CME (31.6% vs 18.2%; p 0.469) and SRF (57.9% vs 61.9%; p 0.796) were similar in both groups at 12 months. The mean number of injections was 8 in the Razumab group comparable to Lucentis (6.4). Acceptability and less drop outs were seen in Razumab patients compared to Lucentis. Though some eyes developed mild uveitis (4.3%) with one of the initial batches of Razumab, it was not evidenced later. No other safety concerns or side effects were reported with the biosimilar.The Biosimilar Razumab is as effective as the patent molecule in reducing macular fluid and improving visual acuity in patients with macular neovascularization over 1 year on a PRN schedule. Being cheaper it is a safe alternative for patients who often need long term management.

Clinical profile and challenges faced in the management of optic neuritis: the Indian scenario.

Optic neuritis (ON) is a relatively common ophthalmic disease that has recently received renewed attention owing to immunological breakthroughs. We studied the profile of patients with ON with special reference to antibody-mediated ON and the challenges faced in its management. Caserecords of patients with ON presenting to a tertiary eye-care center in South India were analyzed. Data on demographics, presenting visual acuity (VA), clinical features, seropositivity for aquaporin-4 immunoglobulin G (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG), details of magnetic resonance imaging (MRI) of orbits and brain, and treatment were collected. Among138cases with acute ON, male: female ratio was 1:2. Isolated ON was present in 41.3% of cases. Antibody testing of sera was performed in 68 patients only due to financial limitations. Among these, 48.5% were MOG-IgG-seropositive, 11.76% were AQP4-IgG-seropositive, and 30.88% samples were double seronegative. Other causes included multiple sclerosis (n = 4), lactational ON (n = 4), tuberculosis (n = 2), invasive perineuritis (n = 2), COVID-19 vaccination (n = 2), and COVID-19 (n = 1). The mean presenting best corrected visual acuity (BCVA) was 1.31 ± 1.16 logMAR (logarithm of the minimum angle of resolution). The mean BCVA at 3months was 0.167 ± 0.46 logMAR. Only initial VA ≤ 'Counting fingers' (CF) had a significant association with the visual outcome for final VA worse than CF. The steep cost of investigations and treatment posed challenges for many patients in the management of ON. MOG-IgG-associated ON is common in India. Unfortunately, financial constraints delay the diagnosis and timely management of ON, adversely affecting the outcome.

Clinicodemographic profile of orbital exenteration in a tertiary eye care center - A 20-year experience.

This study aimed to determine the clinical indications for orbital exenteration, demographic profile of these patients, and clinicopathologic correlations in the current times and to compare these results with previous published data. It was a retrospective study. All exenterations performed at a tertiary eye care center over a period of 20 years (from January 2001 to June 2020) were retrospectively evaluated. Patient records were reviewed to obtain demographic data, presenting symptoms and their duration, laterality, and clinical and histopathologic diagnosis. A total of 352 cases (males:females = 222:130) who underwent exenteration were identified. Patients age ranged from 11 months to 87 years (mean: 43.86 years, median: 50 years). The most common indication for exenteration was found to be eyelid malignancy in 54.36%, followed by retinoblastoma in 18.75% and primary orbital tumors in 14.49%. Out of 156 cases of eyelid malignancies requiring exenteration, squamous cell carcinoma (SCC) was the most common histologic subtype ( n = 94, 60.26%), followed by sebaceous gland carcinoma ( n = 40, 25.64%) and basal cell carcinoma ( n = 20, 12.82%). The most common primary orbital tumors requiring exenteration were adenocystic carcinoma of the lacrimal gland in adults and rhabdomyosarcoma in the pediatric age group. Benign conditions requiring exenteration included fulminant fungal orbital infections and lymphangioma among others. The number of exenterations performed have significantly increased in terms of absolute numbers. However, the ratio of exenteration to other tumor-related surgeries, mainly excision biopsy, has reduced compared to that reported from a previous study. The most common indication in our study remains eyelid malignancy followed by intraocular malignancy. However, SCC has emerged as the most common tumor histologic subtype requiring exenterations.

Management of symblepharon with Gore-tex as a novel treatment option for ocular chemical burns.

To assess the clinical outcomes of symblepharon release in patients with ocular surface chemical injury using Gore-Tex as a novel treatment option. This was a retrospective analysis of 23 eyes of 22 chemical injury patients done during a period of January 2014 to December 2021 at a tertiary eye care centre in South India. All patients underwent symblepharon lysis along with Gore-Tex application over the sclera with minimum 1 year follow up. The patients were assessed for demographic details, visual acuity, intraocular pressure, anterior and posterior segment details, photographic documentation, preoperative diagnosis, previous surgical details in recurrent cases, surgical procedures, final visual acuity, surgical outcomes, and complications. The clinical outcomes were assessed and outcomes were defined as success, partial success, or failure. The median age was 17 years (IQR, 12-39 years). Among them 10 eyes with symblepharon had grade 3 length, 12 eyes grade 3 width and 12 eyes had grade 3 loss of palisades of Vogt. The success was achieved in 52.2% of the patients; partial success in 34.8% and 13.3% had failure. The mean duration of recurrence was 6.75 ± 3.6 months. Failure was noted in young patients with mean age 9.75years and with grade 3c symblepharon. There was no sight threatening complications noted. The study showed very good results with Gore-Tex as a novel treatment option for chemical injury patient with symblepharon formation. It can be easily employed to prevent the symblepharon recurrence of various ocular surface disorders.

Clinical Presentation and Treatment Outcomes of Pupillary Block Glaucoma Following Vitreoretinal Surgery

ABSTRACT Purpose To describe the clinical presentation and treatment outcomes of pupillary block glaucoma (PBG) following vitreoretinal surgery (VR surgery). Material and Methods Retrospective observational study of 6941 patients, who underwent VR surgery at a tertiary eye care centre in South India between January 2015 and December 2019. Amongst them, clinical data of 61 patients who developed PBG were taken for statistical analysis. Results Mean (SD) age was 53.90 (13.4) years and the incidence of PBG was .87%. Median (IQR) time of onset of PBG following VR surgery was 3.33 (1.1–6.6) months and majority were pseudophakic (75%). PBG resolved with Nd:YAG laser peripheral iridotomy (LPI) alone in 50 (82%) patients, whereas 11(18%) patients required additional interventions like surgical iridectomy, trabeculectomy or diode laser cyclophotocoagulation (CPC) either as a stand-alone procedure or in combination with silicone oil removal (SOR). Mean (SD) intraocular pressure at the onset of PBG was 41.61 (14.5) mmHg, which reduced drastically following LPI to 24.28 (14.9) mmHg which further dropped significantly at 6 months follow up to 20.34 (13.9) mmHg. Conclusions Incidence of secondary PBG after VR surgery was .87%, and we observed diabetes mellitus, combined cataract and VR surgery, use of 1000cs SO endotamponade, intraoperative endolaser and multiple VR surgical interventions as common associations. Majority of the patients with PBG after VR procedures resolved with LPI and medical management. Few individuals (18%) required additional laser or surgical intervention for IOP control.

Insights into ocular syphilis in Nepal.

This study aims to elucidate the demographic characteristics, clinical features, diagnostic approaches, and medical management of patients with ocular syphilis, known as 'the great masquerader,' at a tertiary eye care center in Nepal. We conducted a retrospective review involving 15 eyes from ten patients with ocular syphilis treated at a uveitis referral center between 2020 and 2022. Lumbar puncture was performed if neurosyphilis was suspected. Treatment success was defined as the absence of ocular inflammation in both eyes and a decrease in Veneral disease research laboratory (VDRL) titres after completing therapy. A total of 15 eyes of 10 patients were diagnosed with syphilitic uveitis based on positive treponemal and non-treponemal serological tests. The mean age of the patient was 39.9years (range 22-54years) with an equal distribution between males and females. HIV coinfection was not found in any of the patients. Syphilitic uveitis was the primary presentation in nine patients (90%), while one patient presented with recurrent nodular scleritis. Ocular involvement was bilateral in 50% (5 patients). The mean duration between the initial symptom and the first presentation was 8.7weeks (range: 4days to 24weeks). The most common ocular findings was panuveitis (6 eyes). Eight patients with early syphilis received weekly intramuscular injections of benzathine penicillin G for 3 weeks whereas 2 patients with neurosyphilis were treated with intravenous ceftriaxone 1 gm twice a day for 14 days. Signs and symptoms of majority of patients improved with systemic therapy for syphilis. Syphilitic uveitis should be included in the differential diagnosis of any form of ocular inflammation.

Cataract surgery and environmental sustainability: a comparative analysis of single-use versus reusable cassettes in phacoemulsification

ObjectiveTo compare sustainability, financial implications and surgical efficiency of two phacoemulsification cassette systems for cataract surgery: a machine with single-use cassettes and another with daily, reusable ones.MethodsObservational study involving retrospective...