Hazy Cornea Research Articles

Two-year Results of Gonioscopy-assisted Transluminal Trabeculotomy in Primary Congenital Glaucoma.

Gonioscopy-assisted transluminal trabeculotomy yielded a 45% reduction in intraocular pressure in primary congenital glaucoma, with a success rate of 86.6%. Hyphema was the most common complication. We did not encounter any vision-threatening complications. To assess the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in primary congenital glaucoma (PCG) and identify the potential prognostic factors for adverse outcomes. This prospective study included patients aged <14 years, presenting with PCG from November 2019 till November 2021. We excluded eyes with hazy cornea, secondary glaucoma, peripheral anterior synechiae ≥ 90°, and eyes in which the extent of GATT was <270°. Success was defined as a final intraocular pressure (IOP)<18 mmHg with IOP reduction>20%. Primary outcomes were reduction in IOP and medications, secondary outcomes were complications and correlation of IOP reduction and surgical success with possible risk factors. We included 60 eyes of 50 patients aged 1-156 months (mean: 25.5±36.5). A 353°±21° incision was created, with 85% achieving a 360° incision. There was a significant reduction in IOP and medications at all follow-up intervals up to 2 years, with a mean of 45% IOP reduction. The final success rate was 86.6%, with 76.7% being controlled without medications. There was a significant positive correlation between the preoperative cup-to-disc ratio (CDR) and failure rates (P=0.03) and between the incision extent and the IOP reduction (r=0.4, P=0.001). Hyphema was the most common complication, affecting 33%, and resolved spontaneously in all cases. No vision threatening complications occurred. GATT is a safe and effective procedure in eyes with PCG and clear cornea, including eyes that had previous failed glaucoma surgery. Circumferential GATT is associated with more favorable outcomes, while eyes with a larger CDR are at a higher risk for failure.

Bilateral Glaucoma in An Infant with Phacomatosis Pigmentovascularis and Sturge-Weber Syndrome: A Rare Case Report

Prevalence of concurrent PhakomatosisPigmentovascularis (PPV)and Sturge-Weber syndrome (SWS)is unknown due to its rarity and sporadic occurrence. In this case report, we present a rare case of bilateral glaucoma in an infant with PPV and SWS. Athree-month old male infant presented with hazy cornea and visible black spots in the upper sclera and presented with intraocular pressure (IOP) of 40 and 52 mmHg in the left and right eye, respectively. Trabeculectomy-Trabeculotomy for both eyes was done which initially decreased IOP. However, high IOP recurred, and the patient was treated with topical medication.At one year follow-up, the patient had normal IOP and was responsive to light and object. Our case is a rare presentation of concurrent SWS, PPV, and bilateral glaucoma. The potential systemic comorbidities of this condition highlights that it is imperative that these patients are diagnosed early, treated promptly, and are monitored periodically.

Surgical outcomes of pediatric glaucoma in Indian eyes

Abstract Purpose: To evaluate the surgical outcomes of pediatric glaucoma in a cohort of Indian population. Materials and Methods: We conducted a single-center retrospective study including pediatric glaucoma patients who had undergone surgery between January 2012 and January 2022. The surgeries performed were trabeculectomy with mitomycin-C or Ologen, combined trabeculectomy with trabeculotomy (CTT), Ahmed glaucoma valve (AGV) implantation, and diode laser transscleral cyclophotocoagulation. Success was defined as complete if intraocular pressure (IOP) was between 6 and 21 mmHg in children who were examined on slit lamp, or between 6 and 18 mmHg in patients examined under general anesthesia, in the absence of any glaucoma medication and as qualified, with glaucoma medication at the last follow-up. Outcome measures included IOP at the last follow-up, number of glaucoma medications, any complications, and additional surgeries. Results: Seventy-eight eyes of 68 children were included. The most common glaucoma types were primary congenital glaucoma (30.8%), followed by posttraumatic glaucoma (17.9%) and postvitreoretinal surgery glaucoma (16.7%). The mean IOP reduced from 34.17 ± 9.35 mmHg preoperatively to 21.38 ± 9.61 mmHg at the last follow-up (P &lt; 0.001). The number of glaucoma medications reduced from 2.55 ± 1.10 preoperatively to 1.76 ± 1.26 at the last follow-up (P &lt; 0.001). Success was achieved in 62.8% of eyes and the mean survival time was 3.62 years. Among all procedures, AGV implantation had a longer survival time (mean 4.86 years). Conclusion: Pediatric glaucoma management remains a challenge. Majority of the cases remain refractory in spite of multiple surgical interventions. AGV and CTT could be offered as primary surgery in cases of pediatric glaucoma with hazy cornea where goniotomy may not be an option.

Outcomes of Treating a late case of Herpes Zoster Ophthalmicus masquerading as Orbital Cellulitis: A Case Report

Abstract&#x0D; Introduction : Herpes zoster ophthalmicus (HZO) refers to a reactivated varicella-zoster virus involving the V1 nerve division. Although rare, previous reports have mentioned HZO cases masquerading as orbital cellulitis (HZO-OC). This report depicts the use of acyclovir, corticosteroids and citicoline in our HZO-OC patient with treatment delay.&#x0D; Case Illustration : A healthy 66 year old man presented to our clinic 4 weeks after signs of orbital cellulitis followed by vesicular rash following the CN V(1) dermatome were felt which was untreated. The right palpebra was edematous and erythematous. Hazy cornea, mixed injection, grade IV reverse RAPD, diminished direct and consensual reflex and external ophthalmoplegia of the right eye were noted. The diagnosis of HZO-OC with multiple cranial neuropathies OD was established. Topical and symptomatic treatment were given resulting no improvement. Ptosis of the right palpebra became present. The patient was then given systemic acyclovir, methylprednisolone and citicoline. Ophthalmoplegia improved after 2 months and ptosis improved after 4 months.&#x0D; Discussion : The use of systemic acyclovir and corticosteroids in HZO-OC patients were given promptly in previous literature. Multiple cranial nerve in our patient was thought to occur due to treatment delay. As improvement was not noted after topical treatment, these systemic treatments along with citicoline were added. Citicoline was added due to its ability to promote neural regeneration.&#x0D; Conclusion : Systemic acyclovir, corticosteroids and citicoline may still be beneficial for HZO-OC patients with delayed treatment.

EYEBALL SAVING ON UNILATERAL OCULAR TRAUMA AFTER MOTOR VEHICLE ACCIDENT: AN EMERGENCY ROOM CASE REPORT

Introduction : One of the main causes of reduced or lost vision is ocular trauma. The second common cause of ocular trauma, particularly among younger people, was motor vehicle accidents (MVA).&#x0D; Case Illustration : A 16-year-old female with a history of MVA was brought to the emergency room. She complained of pain with her left eye. Visual acuity was no light perception. Linear wound was found from limbus to limbus and 0.5cm beyond the limbus to medial. The lens cannot be assessed because of the prolapse of the iris and choroid, abnormal corneal and iris structures, and active hemorrhage. CT Scan showed collapsed and deformed on the left bulbi.&#x0D; Discussion : In this case, initial surgery was performed by exploration and reposition of the eyeball then close the wound through primary hecting on the cornea. Following surgery, 8 days later, patient went for an eye ultrasonography checked and showed that the left globe was ruptured, along with a subcutaneous hematoma and emphysema. Even though, patient’s visual acuity improved into the stage of light perception. The left eye's follow-up examination revealed hyperemic conjunctiva, a hazy cornea with a horizontal scar-forming, and securely closed sutures. Iris seems superior, however, it was impossible to see the pupil.&#x0D; Conclusion : Ocular trauma causes tremendous morbidity as well as psychological and social distress, and an economic burden. Thus, proper diagnosis and therapy are related to the prognosis of visual acuity, eye anatomy, and future complications.

Enucleation and Dermato-fat Graft for Retinoblastoma Management : A Case Report

Introduction : Retinoblastoma is the most common intraocular malignant tumor found in children before 3 years old can occur unilaterally, bilaterally, hereditary or sporadic. Incidence of about 1:14,000-20,000 individuals. This tumor originated from embryogenic retinal cells. Retinoblastoma gene (RB1) located in the 13q14 chromosome&#x0D; Case Illustration : A 3-year-old girl presented with leukocoria. Her parents notice whitish in her right eye swollen, teary, painful since 2 months ago. No family history. Visual acuity (VA) on the oculus dextra ( OD) no light perception, oculus sinistra (OS) 6/6. Intraocular pressure on OD n-1/palpation, OS n/palpation. Examination under anasthesia for diagnostic found there weren’t palpebral edema, conjunctival injection, hazy cornea, pupil, lens couldn’t be evaluated on OD. Ultrasound showed sugest vitreous seeding and ptisis. CT scan showed solid mass with calcification and diagnosed retinoblastoma stage group E. Patient was treated with chemoreduction using Vincristine, Etoposide, Carboplatine combined enucleation with dermato-fat graft. We did nervus opticus dissection and histopathological examination which showed retinoblastoma.&#x0D; Discussion : The common signs of retinoblastoma is leukocoria. The priority is saving life followed by globe preservation. Treatment based on the stage of the disease. We did chemotherapy in this patient, followed by enucleation and dermato-fat graft. Enucleation stills the main therapy for saving life with nervus opticus dissection as possible. Dermato-fat graft has been shown to grow along with the expanding orbit in children therefore shows cosmetics.&#x0D; Conclusion : This report illustrates a case of Retinoblastoma. The chemotherapy and enucleation using safe dermato-fat graft procedure with implant followed by a well fitted prosthesis for better cosmetics

Knowledge and Attitude to Eye Disorders among pediatricians in Saudi Arabia

Background: Pediatric eye disease can affect any part of the eye and potentially lead to a permanent eye injury. The study aimed to assess the knowledge and attitudes of pediatricians in Saudi Arabia towards common eye conditions in children. Methods: A self-administered questionnaire, distributed online and in hard copy, measured responses from 105 participants using Statistical Package for the Social Sciences (SPSS) for analysis. Participants had a mean age of 32 ± 9.0 years and a mean practice experience of 6 ± 6.8 years, with 59% being female and 56.2% pediatric residents. Results: The causes of a red painful eye were identified, with glaucoma (96.5%), conjunctivitis (95.2%), corneal abrasions/trauma (93.3%), and uveitis (89.5%) being most commonly reported. Leukocoria was recognized as sight-threatening by 89.5% and life-threatening by 88.6% of participants. Causes of strabismus, including central causes (89.5%) and amblyopia (88.6%), were acknowledged. Signs of congenital glaucoma, such as a large cornea (88.6%), hazy cornea (86.7%), and excessive tearing (76.2%), were well-identified. Approximately 70.5% of participants conducted eye examinations for children, citing a lack of equipment as the main obstacle. For retinopathy of prematurity (ROP) screening, 59% would refer premature babies at 4-6 weeks or 32 weeks. Immediate referral to an ophthalmologist for painful red eyes was endorsed by 82%, while 9.5% suggested eye drops. A high percentage (92.4%) would promptly refer cases of strabismus to an ophthalmologist. Conclusion: In conclusion, pediatricians exhibited good knowledge of common eye disorders but demonstrated a need for improved understanding of retinopathy of prematurity and the importance of regular eye examinations. Initiatives like workshops and educational programs are recommended for enhancing knowledge in pediatric eye diseases.

Indocyanine green-assisted goniotomy in eyes with hazy cornea.

Corneal haze, due to edema or opacity, is a major contraindication for performing ab interno angle surgeries such as goniotomy in children with primary congenital glaucoma (PCG), despite otherwise favorable surgical outcomes expected in these patients. In this case series involving patients of PCG with moderate corneal haze, the authors describe a technique for performing goniotomy in cases with compromised visibility by using indocyanine green (ICG) to aid in the visualization of angle structures. The authors used 0.2% ICG intracamerally, which stained the anterior and posterior trabecular meshwork (TM) with different intensities, before proceeding with goniotomy. The junction between the two zones was discernible due to the contrast imparted by ICG staining, despite poor visibility, allowing the surgeon to incise the TM at the correct site. The possibility of performing goniotomy in such patients with the help of ICG can revolutionize our surgical approach to patients with PCG and corneal edema.

SUSPECTED FUCHS’ ENDOTHELIAL CORNEAL DYSTROPHY IN A NEONATE WITH MYOTONIC DYSTROPHY TYPE 1

Purpose: To report a novel case of FECD in a neonate with myotonic dystrophy type 1. Observations: A 32-week neonate admitted to the NICU (Neonatal Intensive Care Unit). Patient was suspected to have myotonic dystrophy, which was confirmed with DMPK PCR (Polymerase Chain Reaction) and Southern Blot Analysis. Ocular evaluation revealed iris transillumination, bilateral hazy cornea, intraocular pressure (IOP) of 18mmHg for right eye and 22mmHg for left eye, and the centre cornea thickness (CCT) was 862 microns and 887 microns for right and left eye, respectively. The thick and hazy corneas were suggestive of Fuchs’ endothelial corneal dystrophy (FECD). Conclusions: This may be the first reported case of FECD in neonate with DM1. Knowledge that FECD may present in neonates with DM1 allows for earlier identification and treatment, resulting in decreased vision loss from FECD.

Cornea plana in a family from Pakistan: Case series and literature review on the principles of management.

Cornea plana (CP) is a rare ocular condition existing in two distinct clinical and hereditary forms: a milder, autosomal dominant type I and a more severe, autosomal recessive type II. The condition is more commonly found in Finnish, Saudi, and Czech families. We report three brothers from a consanguineous marriage that presented with complaints of decreased vision of varying degrees. All three of them have blue, thick, and hazy corneas with shallow anterior chamber depths. The additional features of CP type II were seen in the older two brothers including arcus lipoids, ill-demarcated limbus, and an accommodative squint. They were managed by the correction of refractive errors through spectacles and detailed counseling with follow-up visits to look for progressive complications. The management is mainly centered around optically or surgically correcting the developmental anomalies. This is complimented with proper genetic counseling and regular follow-up visits to look for and manage complications. There are, however, novel therapies that can be considered in these patients including corneal transplants or corneal stromal stem cellular therapies.

A review of techniques and outcomes of endothelial keratoplasty in congenital hereditary endothelial dystrophy.

Congenital hereditary endothelial dystrophy affects the Descemet membrane and endothelium, resulting in corneal decompensation. Penetrating keratoplasty (PKP) has been the gold-standard surgical management until recently; however, at present, endothelial keratoplasty (DSEK/DSAEK/n-DSEK: Descemet-stripping or non-Descemet stripping endothelial keratoplasty and DMEK/n-DMEK: Descemet membrane endothelial keratoplasty) is being preferred due to lesser intraoperative and postoperative complications, early visual recovery, and comparable visual outcomes. Endothelial keratoplasty (EK) can be challenging, especially in pediatric eyes with CHED due to smaller eyeballs, shallow anterior chambers, phakic status, and poor intraoperative visibility due to thick and hazy corneas. A total of 198 articles matched our search strategy. After screening for duplication and going through the titles and abstracts, 12 relevant original articles, one case series, and six case reports were included in this review. Various surgical modifications have to be adopted in comparison to adult eyes to overcome the aforementioned difficulties. Regardless, studies have shown favorable visual outcomes with better graft survival and fewer complications in eyes that underwent EK compared to PKP. Hence, timely surgical intervention and strict amblyopia management can result in better final visual outcomes. The purpose of this review is to summarize various intraoperative difficulties and the surgical modifications required, different surgical techniques, visual and graft-related outcomes, and various complications of EK in CHED eyes.

An Iris Heterochromia Typical of Rubella

We report a unique iris morphology associated with congenital rubella syndrome (CRS) in 4 unrelated children (Fig A-D). A concentric heterochromia with a ring of lighter pigmentation around the pupillary margin surrounded by darker pigmentation, along with stromal hypoplasia of the iris in both eyes, was noted. All children were born with bilateral congenital cataract, hazy cornea, and were positive for Rubella immunoglobulin (Ig)M. All children had deafness, and patient B had congenital heart disease. Such a characteristic iris heterochromia, if observed, could point toward a diagnosis of CRS (Magnified version of Fig A-D is available online at www.aaojournal.org).

An iris puncture technique for restoration of the anterior chamber in vitrectomy for pediatric vitreoretinopathies.

PurposeTo present a novel usage of iris puncture-assisted lensectomy with anterior vitrectomy or vitrectomy in pediatric patients with the absence of anterior chamber caused by various advanced vitreoretinopathies complicated with capsule-endothelial, iris-endothelial adhesion, and secondary glaucoma.DesignProspective study.Materials and methodsForty-one patients were enrolled in this consecutive, prospective study. The iris puncture was performed in all patients using a 20G Vitrectomy Microsurgical Knife, followed by the lensectomy with anterior vitrectomy or vitrectomy. Demographic information, the number of iris puncture times, surgical procedure, intraoperative and postoperative complications, therapy, and prognosis were collected. Patients were followed up for at least 6 months.ResultsA total of 18 female patients and 23 male patients were included, with a mean age of 9.5 ± 7.5 months. The formation of anterior chamber formation was achieved in 28 (68.3%) eyes, with only 1 initial episode of iris puncture, 11 (26.8%) patients required 2 episodes, and 3 episodes of iris puncture, with additional external drainage of subretinal fluid, were needed in the remaining 2 (4.9%) patients. Except for iris incarceration, which occurred in 7 (17%) eyes during operation, there was no iridodialysis or subretinal fluid overflow during operation. At the last visit (mean: 12.16 ± 5.38 months of follow-up), all eyes had a reconstructed anterior chamber with normal depth. No synechiae between the iris and the cornea occurred after surgery. The mean postoperative intraocular pressure was 6.23 ± 1.64 mmHg. A hazy cornea vanished in 31 out of 41 (75.6%) eyes, relieved in 8 out of 41 eyes (19.5%), and 2 out of 41 eyes (4.88%) did not change. In the 25 eyes accepting vitrectomy and lensectomy, 20 out of 25 (80%) achieved different degrees of reattachment.ConclusionThe innovative iris puncture technique is effective, simple, and safe management for the anterior chamber disappearance caused by various advanced pediatric vitreoretinopathies, which helped to lower the intraocular pressure and offers a chance for lensectomy with anterior vitrectomy or vitrectomy.

Gonioscopy and Angle-Based Glaucoma Surgical Training on Human Eyes in the Wet Lab.

Human corneoscleral rims provide a low cost model and resource to enhance angle based glaucoma surgical training skills. To understand the feasibility, utility, and efficacy of a low-cost model for performing anterior chamber angle gonioscopy and micro-surgery on human corneoscleral tissues in wet lab on resident skill enhancement. Post-keratoplasty residual corneoscleral rims and/or the expired donor corneoscleral buttons were included for the purpose of this study. Initially, inverted rims were used to demonstrate the basic angle anatomy on a slit lamp bio-microscope. Central hazy cornea was then replaced with an artificial cornea and an artificial anterior chamber to simulate indirect gonioscopy, direct gonioscopy, goniotomy, and other angle-based surgeries. Direct gonioscopy and goniotomy exercises (as a means to simulate intraoperative gonioscopy and other angle-based surgeries respectively) were evaluated quantitatively, and the rest qualitatively. A total of 65 residents were included in the exercise. The mean age was 26.69±1.74 years. Amongst these, 55 ophthalmology residents performed the basic examination, that is, slit lamp mounted angle anatomy examination (n=55) and artificial chamber mounted indirect gonioscopic examination through artificial cornea (n=55). In the second exercise, 10 glaucoma fellows performed the direct gonioscopic and the goniotomy exercises on artificial chamber. The fellows demonstrated a statistically significant improvement in interpretation and surgical skill enhancement concurrent with reduction in time taken with increasing number of attempts ( P <0.05). In the third simulation exercise, micro-stent placement within the Schlemm's canal, subconjunctival space, and the suprachoroidal space was re-produced successfully on multiple occasions. The residual human corneoscleral rims proved to be an important resource for teaching both the basic examination skills and those required for transitioning to advanced intraoperative gonioscopy and goniotomy skills. These low cost, easy to adapt models can be incorporated within the curriculum for improved glaucoma training of both the residents and the glaucoma fellows.

Association of VEGF Gene Polymorphism (rs699947) with Glaucoma and In-Silico Study of Antiglaucoma Bioactive Compounds.

Vascular endothelial growth factor (VEGF) is a useful expert in various maturation and other problems such as glaucoma. VEGF gene is located on the short arm of chromosome 6. It has 8 exons and 6 introns. This investigation was planned to check out the relationship of VEGF polymorphism with glaucoma patients and to cause in silico limitation of carbonic anhydrase to diminish the intraocular strain of watery humor to fix glaucoma. In this examination, a large portion of the glaucoma patients (n = 70) were males (66%) when contrasted with females (34%) as the p-value was 0.025 which showed critical outcomes and subsequently demonstrated that the sickness was more predominant in males. Glaucoma for the most part influences people between the ages of 50-60years followed by the age bunch between 30 and 40years. Around 36 (51.4%) were experiencing watering in the eyes, 28 (40%) had photophobia, 9 (12.8%) had a hazy cornea, 6 (8.6%) had expanded eye globe, and 15 patients (21.3%) had rosy eyes. Factual tests showed that VEGF quality SNP rs699947 had no huge relationship with glaucoma (POAG). In this study, various carbonic anhydrase inhibitor phytochemicals and synthetic chemicals were screened in silico which may be used as antiglaucoma drugs.

Efficacy And Surgical Outcome of Trabeculectomy with Mitomycin-C In Congenital Glaucoma with Hazy Cornea

Glaucoma is characterized by an optic neuropathy associated with raised intraocular pressure (IOP) and visual field defect Objective: To determine the efficacy and outcome of trabeculectomy augmented with anti-metabolite mitomycin-C in children with childhood glaucoma. Methods: A total of 40 eyes of 22 diagnosed cases of congenital glaucoma were studied. All these children underwent mitomycin-C augmented trabeculectomy from July 2017 to August 2020. The primary outcome was control of postoperative intraocular pressure (IOP) at the end of one year. A target pressure of &lt;15mmHg was set as target pressure to label a successful surgical outcome. Results: The mean age of the patients enrolled in the study was 26.8± 12.2 years (range: 8 – 32 months) with a male to female ratio of 7:4. The mean ± SD IOP before trabeculectomy surgery was (31.5± 8.6) (range: 21 – 53) mmHg. At the one-year follow-up, the mean postoperative IOP was (19.4± 7.9) (range: 9 – 48) mmHg. Target IOP &lt; 15 mmHg was successfully achieved in 27 (67.5%), 24 (60.0%) and 22 (55.0%) eyes at postoperative 1, 6 and 12 months respectively. Repeat trabeculectomy was required in 5 (12.5%) eyes, while 5 (12.5%) eyes developed corneal perforations and 3 (7.5%) eyes developed phthisis bulbi. Conclusion: Trabeculectomy with mitomycin C can be a primary surgical intervention in congenital glaucoma. However, repeat surgery may be required and other related surgical complications can occur after this surgery in patients with uncontrolled IOP.

An Overview of Intraoperative OCT-Assisted Lamellar Corneal Transplants: A Game Changer?

Intraoperative optical coherence tomography (iOCT) is a noninvasive imaging technique that gives real-time dynamic feedback on surgical procedures. iOCT was first employed in vitreoretinal surgery, but successively served as a guidance in several anterior segment surgical approaches: keratoplasty, implantable Collamer lens (ICL) implantation, and cataract surgery. Among all of those approaches, the unbeatable features of iOCT are fully exploited in anterior and posterior lamellar keratoplasty, and the purpose of this review is to focus on the advantages and shortfalls of iOCT in these techniques, in order to assess whether this technology could be a real step forward. In deep anterior lamellar keratoplasty (DALK), iOCT is useful to evaluate the needle depth into the corneal stroma, the big bubble dissection plane, and residual stromal bed, thus aiding the standardization of the technique and the reduction of failures. In Descemet stripping automated endothelial keratoplasty (DSAEK), iOCT allowed for clear visibility of fluid at the graft/host interface, allowing for immediate rescue maneuvers and granting the best graft apposition. In Descemet membrane endothelial keratoplasty (DMEK), iOCT can track the lenticule unfolding in real time and assess graft orientation even in severe hazy corneas, thus optimizing surgical times, as well as avoiding the use of potentially hazardous exterior markers (such as the “S” stamp) and preventing unnecessary manipulation of the graft. Overall, the role of iOCT appeared crucial in several complicated cases, overcoming the difficulties of poor visualization in a fast, non-invasive way, thus raising this approach as possible gold standard for challenging conditions. Further improvements in the technology may enable autonomous centering and tracking, overcoming the current constraint of instrument-induced shadowing.

Surgical trends in glaucoma management: The current Indian scenario.

To assess the current trend in the surgical management of glaucoma in India. An anonymous online survey evaluating the preferred choices in the surgical management of glaucoma was circulated among the members of Glaucoma Society of India (GSI). Survey responses were compared to prior survey among GSI members in 2013 and members of American Glaucoma Society (AGS), 2016. A total of 175 of 879(20%) GSI members participated in the survey of which 75.3% of the survey participants were practicing in the private sector. Trabeculectomy with or without augmentation with Mitomycin C(MMC) was the first-choice glaucoma incisional surgery for 96.6% of the survey participants. Of the participants doing tube surgery, use of valved GDD was the preferred choice (83.4%). Re-trabeculectomy was the preferred approach (60.7%) in case of trabeculectomy failure. For paediatric glaucomas, combined trabeculotomy with trabeculectomy was the preferred surgical approach for both hazy cornea (84.5%) as well as clear cornea (66%). For a POAG patient without prior incisional surgery and presenting with visually significant cataract, phacoemulsification with trabeculectomy was the preferred management approach by 58.7% of the participants. Trabeculectomy continues to be the clear winner for the Indian glaucoma surgeon because of its cost effectiveness, lack of expensive instrumentation, and a more robust surgical training for trabeculectomy during residency programs. A higher proportion of angle closure disease precludes the use of minimally invasive glaucoma surgery and very often tube shunts also. Economics, ease of access and follow-up made a combined cataract and glaucoma surgery a preferred choice among Indian surgeons.

A Floppy Infant with Facial Dysmorphism.

A Floppy Infant with Facial Dysmorphism.

Neonatal Herpes Zoster Ophthalmicus: Two Rare Cases

Two neonates one at age of 15 days and another at age of 20 days were presented with redness, watering, periocular and lid swelling, photophobia and vesicular lesions over forehead on right side of face. Ocular examination revealed ciliary and conjunctival congestion, chemosis, and hazy cornea due to stromal edema. Though herpes zoster is very rare in neonates, the diagnosis of herpes zoster ophthalmicus was made on basis of clinical examination and treated with systemic and topical anti-viral, topical antibiotic and corticosteroid. Both neonates showed dramatic response in seven days treatment and completely cured within four weeks. High clinical suspicion in vesiculo-papular lesion of child of any age can help in early diagnose and early treatment can prevent sequelae of HZO.