Slit-lamp Research Articles

Profile and Visual Outcome of Patients having Keratoconus Attending Tertiary Eye Hospital, Nepal

Background: Keratoconus is a bilateral, asymmetric, chronic, progressive ectasia of the cornea in which patients experience distorted vision that is usually treated with rigid contact lenses when spectacles no longer provide adequate vision. The aim of the study is to find out the clinical profile and visual outcome of the patient having Keratoconus. Materials and Methods: The hospital based cross sectional study was done at Biratnagar Eye Hospital, Biratnagar. All the diagnosed Keratoconus patients referred from cornea clinic to contact lens clinic for contact lens trial were included in this study between 1stJanuary 2017 to 31st December 2019. Diagnosis was done by using keratometry and pachymetry findings or by using corneal topography findings and slit lamp examination. Results: Total 133 patients were enrolled in the study among them the mean (±SD) age was 20.2 (±6.9) with a minimum of 9 and a maximum of 50 years of age. Most of them were male 89 (67%) and 78 (58.7%) patients were between 16 to 25 years of age group. Most of the eyes had moderate 161 (63.4%) type in which the amount of refractive was high 201 (79%) and RGP contact lens 245 (96.4%) was tried for vision correction. Normal vision (0.0 to 0.5 Log MAR) was found in 255 (96%) of eyes among them 194 (73%) of eyes got better than 0.2 log MAR visual acuity after the contact lens trial. Conclusion: Keratoconus was found mostly in younger male patients and gas permeable contact lenses were most commonly used treatment modality.

Late Onset Corneal Haze Post Photorefractive Keratectomy

Introduction: Photorefractive keratectomy (PRK) is a surface ablation procedure to correct refractive errors. Regardless of the safety and efficacy, corneal haze may occur after PRK, and it remains one of the most feared complications because it can impair good visual outcomes. Case Presentation: A 20-year-old woman complained of blurred vision in her right eye (RE) after undergoing PRK elsewhere six months before admission with a history of refraction of S-12.75 C-1.75 x 10° preoperatively and S-0.75 postoperatively. Six-month postoperative uncorrected visual acuity (UCVA) was 0.01, best corrected visual acuity (BCVA) was 0.5 with S-7.00 C-0.75 x 50°. A slit lamp examination revealed grade three corneal haze. Anterior optical coherence tomography (OCT) showed the hyperreflective area with 132 μm deep into the stroma. The patient underwent phototherapeutic keratectomy (PTK) and mitomycin-C (MMC) treatment to a depth of 50 μm Ø6.5mm transition zone 0.5 mm. Two months later, UCVA was 0.2, BCVA was 0.63 with S-2.50 C-0.50 x 90°, and slit lamp examination revealed no haze remaining. Conclusions: This case illustrates the potential risk for corneal haze development, mainly when PRK is performed at greater treatment depths. However, with phototherapeutic keratectomy and mitomycin-C treatment, an excellent visual outcome and vision restoration can be obtained.

Case Finding and Management of Childhood Cataracts: The Role of a Child Eye Health Programme in Kaduna State, Nigeria

Abstract Objective: To evaluate the output of a child eye health programme in terms of identification, referral, and volume of paediatric cataract surgeries in Kaduna State, Nigeria. Materials and Methods: This was a retrospective review of the North-West Nigeria Child Eye Health Initiative programme referral registers at primary, secondary and tertiary hospitals in Kaduna State. Theatre registers of children 0–16 years who had cataract surgery at National Eye Centre Kaduna between 2016 and 2019 were also reviewed. Information on numbers of children, age, sex, laterality of cataract and programme status were summarised as frequencies, percentages and mean ± standard deviation. The initial 2 years of the programme (2018–2019) were compared with the 2 years (2016–2017) preceding them. Results: Between January 2018 and December 2019; primary health workers screened 41,552 children and referred 2,316 (5.6%). Of those referred 1772 (76.5%) presented at one of three zonal secondary hospitals where nurses identified 492 (27.8%) with leukocoria using torchlights and referred them to the tertiary hospital. At the tertiary hospital, 364 (74.0% of 492) attended and 262 (72.0% of 364) were confirmed to have operable cataracts after dilated slit lamp examination by ophthalmologists. Between 2016 and 2017 (pre-programme years), 201 children had cataract surgery compared to 352 in 2018 and 2019 (programme years) of whom 239 (67.9% of 352) were beneficiaries of the programme. The proportion of girls who had cataract surgery declined from 39.8% to 35.0%, while mean age increased from 5.7 ± 4.2 years to 7.5 ± 4.1 over 4 years. More children with unilateral cataracts (214 [60.8%]) presented during the programme years (Fishers exact test, P = 0.004), whereas unilateral cataract (207 [60.2%]) was significantly more common in males than females (Fisher’s exact P = 0.017). Conclusion: The programme has resulted in improved case detection of childhood leukocoria at primary eye care level. additionally, the eye health referral system in Kaduna State has been strengthened with increasing numbers of children accessing services: majority boys, older children, and unilateral cataracts.

Effect of Electromagnetic Radiation Induced DRY EYE Conditions in Human Eye

Purpose-The aim of this study is to determine the impact of dry eye induced due to electromagnetic radiation produced during use of digital screen. Methodology- The project was held through camping and OPD work during the clinical posting in Haryana and New Delhi. The invitation to participate in the camping was done through social media, hoarding and pamphlet. Data collection was done in Microsoft excel sheet basis on age group. To detect dry eye in patents eye few test was done such as shimmer test, TBUT test, by slit lamp examination few things were observed which was essential to detect dry eye such as Conjunctival Congestion, Meibomitis Dots, and Corneal shine. After all this the statistical analysis was done. Result- The EMR affected individuals were excessively used mobile phones, laptops, tablets, and PCs. According to this data, 60% of child experiences mild dry eye, 66.6% of young experiences moderate dry eye, 74 % of adult experiences serve dry eye. The test results of the present investigative study suggest that all the test results were significant at p < 0.05. Conclusion- The result of the study suggests that excess use of mobile phones, tablets, laptop, and computer leads to dry eye among the patients specially having working hours more than or at least 8-10 hours.

Pilot Safety Study of a Microfabricated Device for Anterior Stromal Puncture to Treat Corneal Epithelial Disease in the Optical Axis.

Anterior stromal puncture is an inexpensive and widely used technique at the slit lamp to treat recurrent corneal erosions (RCE), common sequelae of corneal abrasions, trauma, and epithelial basement membrane dystrophies (EBMDs). The purpose of this study was to determine safety of a novel anterior stromal micropuncture device (termed a "plexitome") for use in the optical axis of the cornea. We performed an IRB-approved clinical pilot study on 45 patients with diverse corneal pathologies to determine the safety of the plexitome device and examined corneal healing responses clinically for a minimum of 30 days after treatment. Follow on efficacy data was collected for treated patients with RCE.Micropuncture treatment was performed either through loose epithelial tissue or after debridement using a cotton tip at the slit lamp. After "imprinting," patients were treated with topical medications including antibiotics, hypertonic saline/ointment, bandage contact lenses, and/or patching according to the treating physician's routine care for the condition. Micropuncture using the "plexitome" device did not create visible scars in the corneal stroma of the 45 patients treated and followed for at least 30 days. Photographic evidence of imprinting was seen at in 1 patient at 30 days. There were no significant adverse events associated with treatment. Micropuncture of the cornea using the "plexitome" device does not create optically evident anterior stromal scarring after treatment. Micropuncture using the device may be an effective way of treating RCE and other corneal manifestations of EBMD in the optical axis, which is not currently possible using standard anterior stromal puncture methods.

Analysis of Phenotypes Associated with Deficiency of PAX6 Haplotypes in Chinese Aniridia Families.

To examine the clinical phenotype and genetic deficiencies present in Chinese aniridia families with PAX6 haplotype deficiency. A comprehensive questionnaire and ophthalmological assessments were administered to both affected patients and unaffected relatives. The clinical feature analysis included the evaluation of visual acuity, intraocular pressure, slit-lamp anterior segment examination, fundus photography, and spectral domain optical coherence tomography. To identify the mutation responsible for aniridia, targeted next-generation sequencing was used as a beneficial technique. A total of 4 mutations were identified, consisting of two novel frameshift mutations (c.314delA, p.K105Sfs*33 and c.838_845dup AACACACC, p.S283Tfs*85), along with two recurring nonsense mutations (c.307C>T, p.R103X and c.619A>T, p.K207*). Complete iris absence, macular foveal hypoplasia, and nystagmus were consistent in these PAX6 haplotype-deficient Chinese aniridia families, while corneal lesions, cataracts, and glaucoma exhibited heterogeneity both among the families and within the same family. In our study, two novel PAX6 mutations associated with aniridia were identified in Chinese families, which expanded the phenotypic and genotypic spectrum of PAX6 mutations. We also analyzed the clinical characteristics of PAX6 haplotype deficiency in Chinese aniridia families.

What do the blind feel? Psychological distress and satisfaction with life of blind persons: A community-based study

Background: Progressive loss of visual acuteness is known to be associated with anxiety, insecurity, loss of independence, and altered social functioning, which may lead to low mood and subsequently depression. Emotionally adjusting to vision loss can dramatically change one’s independence. Reduced workplace productivity in adults with visual impairment is associated with lower rates of workforce participation and increased rates of anxiety and depression. Most studies for psychological comorbidities in the legally blind population are conducted in individuals who present to the psychiatry or psychology department/clinics or to facilities for blindness certification. Due to the paucity of community-based data in the Indian scenario, the current study was undertaken. Aim: To evaluate the psychological distress and satisfaction with life of people who were diagnosed as blind in the community. Materials and Methods: The sample was based on the identification of blind persons in a door-to-door screening for eye and vision problems in 44535 individuals conducted in 2015–16 in the middle to lower socioeconomic populations in the suburban area of Yerawada, Maharashtra. Those who were suspected of having low vision underwent a detailed clinical examination including visual acuity estimation, portable slit lamp examination, I-Kare tonometry, and fundoscopy, conducted by an ophthalmologist to assess and verify the lack of vision. Subsequently, the General Health Questionnaire-12 (GHQ-12) and Satisfaction with Life Scale (SWLS) were also applied upon revisiting the participants in 2020–2021. Results: The majority of participants were middle-aged or elderly and no significant gender variation was noted in terms of blindness. Maximum psychological disability was seen after 6 to 15 years after the onset of blindness. More than 80% of the patients with complete blindness had some psychiatric comorbidity or distress and more than half reported that their daily activities were affected due to their diagnosis. Blind persons had significantly higher scores on the GHQ-12 and significantly lower scores on SWLS. Complete blindness was positively correlated with GHQ-12 scores and negatively correlated with SWLS scores and the age of the subject. Conclusion: This study demonstrates that psychological distress and low levels of satisfaction with life are common among the severely visually impaired and blind. There is a dire need to improve access to rehabilitation services and psychological support for the blind and their caregivers.

Prevalence of Certain Corneal Conditions and their Demographic Risk Factors; Tehran Geriatric Eye Study.

Corneal abnormalities are one of the important reasons for visual impairment. There is little evidence of the prevalence of different types of corneal abnormalities. The aim of this study was to assess the prevalence of various corneal abnormalities and identify the key risk factors associated with these abnormalities in an elderly population residing in Tehran. The Tehran Geriatric Eye Study (TGES) was conducted as a cross-sectional study, utilizing a population-based approach and employing stratified cluster random sampling. The study focused on individuals aged 60 years and above residing in Tehran. An ophthalmologist performed a slit lamp examination to evaluate the eyelid, cornea, and crystalline lens. The prevalence of posterior embryotoxon (PE), punctate epithelial defect (PED), pigment on endothelium (POE), corneal dystrophy (CDys), corneal vascularization (CV), and corneal degeneration (CDeg) were estimated to be 0.08% (95% confidence interval [CI]: 0.02 to 0.40), 8.77% (95% CI: 6.64 to 11.51), 0.57% (95% CI: 0.33 to 0.98), 0.53% (95% CI: 0.33 to 0.82), 0.95% (95% CI: 0.60 to 1.52), and 44.87% (95% CI: 41.80 to 47.98), respectively. Overall, approximately 49.08% of the participants exhibited some form of corneal abnormality in at least one eye. The multiple logistic regression model revealed that increasing age was significantly associated with PED, CV, and CD. Furthermore, illiterate participants had a significantly higher prevalence of PE. The findings of this study indicate that approximately half of the elderly population aged 60 years and above in Tehran have at least one corneal abnormality, with corneal degeneration being the most prevalent. Age was identified as the primary determinant of corneal abnormalities.

Tear Film Hyperosmolarity is Associated with Increased Variation of Light Scatter Following Cataract Surgery.

To study the association between tear film hyperosmolarity and ocular light scatter in a cataract surgery population. Contiguous, 20-second objective scatter index (OSI) scans were recorded in hyperosmolar (≥320 mOsm/L) and normal subjects (<308 mOsm/L) with cataract nuclear opacity ≥3. OSI was measured at screening, baseline and 90 days following surgery. Along with symptoms of ocular surface disease, slit-lamp examination included corneal staining (0-3), tear film breakup time (TBUT) and evaluation of meibomian gland disease (MGD). An additional cohort of hyperosmolar subjects were measured for OSI at screening, baseline, and 5, 10, 15 and 30 minutes following instillation of 0.18% sodium hyaluronate (HA). Thirty-one eyes of 31 patients were included. There was a significant difference in post-operative OSI variation when comparing hyperosmolar (0.65±0.30, N=11) to normal subjects (0.33±0.11, N=10, p=0.005). Of note, there were no significant differences in OSI variation when subjects were sorted by staining (p=0.9), TBUT (p=0.7), symptoms (p=0.7), or MGD status (p=0.9). Instillation of 0.18% HA (N=10) did not alter OSI at 5 minutes, but significant reductions in OSI of 28.8%, 38.5% and 36.7% (all p < 0.001) were observed at 10, 15 and 30 minutes. Hyperosmolar patients exhibited significantly increased variation in light scatter following cataract surgery that was undifferentiated by staining or TBUT. Elevated osmolarity may be indicative of light scatter equivalent to that of a grade 2-3 cataract.

Traumatic Rosette cataract: A case report

Rosette cataract is characterized by a star-shaped opacity that forms in the lens of the eye after blunt or penetrating trauma. Traumatic cataracts constitute a significant portion of ocular injuries, with rosette cataract being a distinctive subtype. Understanding its formation and progression is critical for effective management. Blunt trauma to the eye causes a shock wave that disrupts the lens fibres. This disruption leads to the characteristic rosette pattern due to peculiar lens fibres arrangement. Patients may present with blurred vision, glare, and photophobia due to associated traumatic iritis. The rosette pattern may be visible upon slit-lamp examination. In early stages, observation and protective eyewear may be recommended. Significant visual impairment due to rosette cataract will require cataract surgery. Either small incision cataract surgery or Phacoemulsification with intraocular lens (IOL) implantation is the standard treatment for advanced cases. Timing of surgery depends on the degree of visual impairment and patient’s needs.

Exorbital Lacrimal Gland Ablation and Regrafting Induce Inflammation but Not Regeneration or Dry Eye.

The study evaluated the regenerative responses of the lacrimal functional unit (LFU) after lacrimal gland (LG) ablation. The LG of Wistar rats was submitted to G1) partial LG ablation, G2) partial ablation and transplantation of an allogeneic LG, or G3) total LG ablation, (n = 7-10/group). The eye wipe test, slit lamp image, tear flow, and histology were evaluated. RT-PCR analyzed inflammatory and proliferation mediators. The findings were compared to naïve controls after 1 and 2 months (M1 and M2). G3 presented increased corneal sensitivity, and the 3 groups showed corneal neovascularization. Histology revealed changes in the LG and corneal inflammation. In the LG, there was an increase in MMP-9 mRNA of G1 and G2 at M1 and M2, in RUNX-1 at M1 and M2 in G1, in RUNX-3 mRNA at M1 in G1, and at M2 in G2. TNF-α mRNA rose in the corneas of G1 and G2 at M2. There was an increase in the IL-1β mRNA in the trigeminal ganglion of G1 at M1. Without changes in tear flow or evidence of LG regeneration, LG ablation and grafting are unreliable models for dry eye or LG repair in rats. The surgical manipulation extended inflammation to the LFU.

Wilson's Disease presenting as status epilepticus: a case report

Wilson’s disease (WD) is a rare disorder of copper metabolism, caused by a mutation in the ATPB7 gene, resulting in a defect in copper elimination leading to its accumulation in various organs, with the liver being the most common. Here, we describe a case of a 19-year-old boy who presented with a history of hallucinations and status epilepticus. Initial investigations were normal, but due to a rising trend in alanine transaminase (ALT), a slit lamp examination was performed, revealing Kayser-Fleischer (KF) rings in the eyes. The patient was diagnosed with WD due to the presence of these KF rings and increased urinary copper excretion. Wilson’s disease should be suspected in cases where the first manifestation of symptoms is neurological without evidence of prior such symptoms and no evidence of other neurological disorders.

Microinvasive intrascleral double continuous suture repair surgery for cyclodialysis clefts.

The traditional suturing method for cyclodialysis cleft usually requires an incision in the sclera for direct suturing, resulting in greater damage and a high risk of postoperative complications. The purpose of this work is to propose a newly intrascleral double continuous suture repair technique for the treatment of cyclodialysis clefts. Seven patients with cyclodialysis cleft underwent microinvasive intrascleral double continuous suture repair surgery to restore the attachment of the detached ciliary body to the sclera without scleral incision. All operations were performed by the same surgeon. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), slit lamp and corneal examination results, ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT) results were recorded. Closure of the cyclodialysis cleft was achieved in 7 eyes and no obvious complications occurred after the operation. Intraocular pressure increased from preoperatively 6.8 ± 1.35 mmHg (range: 4.8-8.0 mmHg) to postoperatively 12.5 ± 4.0 mmHg (range: 8.0-20.0 mmHg) (paired sample T test, P < 0.01). Best-corrected Snellen visual acuity improved from preoperatively range 20/2000-20/63 to range 20/200-20/25 at final follow-up. In short, intrascleral double continuous suture repair surgical is safe and effective in treating cyclodialysis cleft, with minimal surgical trauma.

Metabolic changes in the eye lens in the progression of cataract

Background. Cataract is one of the main causes of decreased visual acuity in the world, and therefore scientists are continuing researches on the mechanisms of development of this ophthalmic pathology.The aim. To study metabolic changes in a cloudy lens using an experimental model.Materials and methods. The study was carried out on adult male Wistar rats (n = 60), which were divided into control (n = 30) and experimental (n = 30) groups. Experimental cataract were simulated by daily ultraviolet irradiation (λ = 300–350 nm) during 6 months for 20 minutes. At the months 2, 4 and 6 of the study, we carried out a biomicroscopic examination of the anterior eye of animals using a slit lamp to monitor the development of cataract. Lenses were collected to determine the content of stearoyl-coenzyme-A desaturases and melatonin using enzyme immunoassay.Results. At the stage of initial cataract, the content of the stearoyl-coenzyme A desaturase was statistically significantly lower than the control values by 38 %; at the stage of immature cataract – by 30 %; at the stage of mature cataract – by 15.4 %. It was revealed that at the month 6 of the study, the concentration of melatonin in lens homogenates was 17 % lower when compared with the control. A statistically significant correlation was established between stearoyl-coenzyme A desaturase and melatonin (r = 0.32).Conclusion. Melatonin and stearoyl-coenzyme A desaturase play an important role in a number of biochemical processes that ensure the proper functioning of the visual analyzer. Changes in the concentration of these biological molecules can play a key role in the pathogenesis of cataract and a number of other ophthalmic diseases

Malignant glaucoma: disease course and treatment

Diagnosis of malignant glaucoma presents a challenge due to subtle symptoms in early stages of the disease, making increased intraocular pressure a pivotal indicator, often accompanied by inflammation and corneal edema. Diagnostic modalities, including ultrasound biomicroscopy and anterior segment optical coherence tomography, play crucial roles in visualizing anatomical changes in the ciliary body and anterior chamber. The classic slit lamp examination, complemented by tonometry, remains a fundamental diagnostic tool. A stepwise therapeutic approach is essential, beginning with pharmacological interventions aimed at intraocular pressure reduction and subsequent restoration of the anterior chamber configuration. The first stage of treatment is pharmacotherapy. Laser therapies, such as iridotomy and Nd:YAG laser treatment, address angle closure. In resistant cases, a surgical approach, such as irydo-zonulo-hialoidotomy may be considered.

Analysis of the relationship between solar greenhouse operation and occupational high incidence diseases

Objective: To understand the health status of solar greenhouse workers, to provide scientific basis for the development of occupational high incidence diseases prevention and control strategies. Methods: In July 2019, a random cluster sampling method was used to select 245 workers engaged in solar greenhouse vegetable cultivation in Daba Village, Jingyuan County, Baiyin City, Gansu Province as the solar greenhouse operation group. Matched by gender, age, marital status, body mass index (BMI), 282 people from adjacent Shaliang Village who did not engage in solar greenhouse operation were selected as the control group. Field investigation and health examination were carried out among the study subjects. The general situation, facial features examination results, ophthalmic examination results, bone and joint examination results and skin examination results were compared between the two groups. And the multiple logistic regression analysis was used to analyze the influencing factors of abnormal bone and joint examination (upper limbs, lower limbs, hands and spine bone joints) in study subjects. Results: There were statistically significant differences in smoking age and alcohol consumption between the two groups (P<0.001). Compared with the control group, the abnormal detection rates of nose examination, throat examination, slit lamp examination, conjunctival examination, lower limb bone joint examination, hand bone joint examination, spine examination, head and neck skin examination, trunk skin examination, upper limb skin examination, and lower limb skin examination in the solar greenhouse operation group were higher, and the differences were statistically significant (χ(2)=11.53, 7.94, 9.92, 27.93, 79.32, 81.42, 9.43, 6.79, 9.76, 4.34, 8.29, P<0.05). Multivariate logistic regression analysis showed that after adjusting for gender, age, marital status, education level, BMI, compared with the control group, solar greenhouse operation was a risk factor for abnormal bone and joint examination (OR=1.178, 95%CI: 1.151-2.143, P=0.001) . Conclusion: Solar greenhouse operation has a certain harmful effect on health of workers, and solar greenhouse workers have an increased risk of abnormal diseases of upper limbs, lower limbs, hands and spine bone joints.

Aspergillus Endophthalmitis Secondary to Infectious Scleritis: Utility of Diagnostic PCR.

To describe a case of delayed-onset Aspergillus fumigatus endophthalmitis secondary to infectious fungal scleritis diagnosed with broad range polymerase chain reaction (PCR) from scleral nodular debridement and vitreous sampling during vitrectomy. Retrospective case report with slit lamp photography, optical coherence tomography, and fundus photography. A 76-year-old man presented with right eye worsening vision and pain concerning for progressive nodular scleritis and endophthalmitis eight months following a reportedly innocuous tree branch injury. Following the injury, he underwent an MRI, surgical exploration, subconjunctival antibiotic administration, and culturing due to persistent foreign body sensation. Cultures were negative, and the patient was started on oral NSAIDs, oral prednisone, and periocular triamcinolone injections following negative/normal infectious and rheumatologic workup for scleritis. The patient was referred for worsened scleritis with development of endophthalmitis. He underwent lamellar sclerectomy, debridement, and culture of purulent material from scleral nodules in coordination with diagnostic vitrectomy, vitreous sampling, and subconjunctival and intravitreal antibiotic and antifungal treatment. Broad range PCR was positive for Aspergillus fumigatus and targeted antifungal treatment initiated. The eye did not regain visual function and was enucleated for progressive pain six months following diagnosis. Fungal scleritis and endophthalmitis results in significant morbidity. Diagnostic vitrectomy and broad range PCR can aid in prompt diagnosis and targeted treatment, and may be useful in refractory cases.

A Survey of Current Gonioscopy Practice in the United Kingdom.

This survey highlights a deficiency in gonioscopy practices across the UK, particularly in the utilization of indentation gonioscopy and training of junior ophthalmologists. Recommendations include standardizing practice and enhancing training opportunities to improve patient care. Gonioscopy is an important general skill learned and practiced by all grades of ophthalmologists. The aim of this study is to discover the general attitude, perception, and practice of gonioscopy among ophthalmologists in the UK. A National gonioscopy survey was carried out by utilizing an anonymous electronic questionnaire of 18 questions. The questionnaire was electronically distributed online, using the survey tool, Microsoft 2016 "MS Forms" to all grades of ophthalmologists in the UK. A total of 146 responses were analyzed. Overall, 89% of the participants felt "comfortable in performing slit lamp gonioscopy," but only 38% of junior trainees (ophthalmic specialist trainees years 1-3) felt comfortable in gonioscopy. Only 13% of the junior trainees felt they had adequate training in performing gonioscopy compared with 68% of the total respondents. Surprisingly, the majority of consultants (58%) did not "strongly agree" to be confident in assessing the angle and its configuration on gonioscopy. The most commonly used gonioscopic lens in this survey was the Zeiss four-mirror gonio lens, but only 38% of participants performed indentation gonioscopy routinely. The majority of the participants utilized the modified Shaffer's classification for gonioscopy. Fewer than expected numbers performed gonioscopy routinely for new patients with glaucoma. This survey suggests that gonioscopy is not being performed according to the UK national recommendations, and few ophthalmologists perform indentation gonioscopy. Additional gonioscopy training in the curriculum may be helpful.

India's Pink-Eye Mystery: Decoding the 2023 Conjunctivitis Outbreak.

The pink eye outbreak in 2023 was caused due to humid weather conditions in most regions of India. The most affected states include Delhi, Gujrat (21% cases), Maharashtra (30%), Himachal Pradesh (4%) and Karnataka (4%). The epidemiological data indicates that males have a high prevalence rate as compared to females; urban areas were most affected, and professionals as well as students were the population group that had the highest prevalence rate. The most common clinical manifestations were the presence of red eye, eye discharge, grittiness, and eyelashes being stuck together. One of the hallmarks of histopathology is a cobblestone formation of flattened nodules with central vascular centers. Conjunctivitis is a virusmediated immune response accompanied by inflammation, which proceeds the immune reaction, giving rise to vasodilation, pseudo membrane formation, and conjunctivital discharge. The gold standard for the diagnosis of Conjunctivitis is the Adenoplus kit using PCR technology; apart from this slit lamp biomicroscope can be used for the evaluation. It is the need of the hour to spread awareness about the Pink Eye disease and the measures to prevent it.

Repeat Femtosecond-Assisted Anterior Lamellar Keratoplasty for Recurrence of TGF B I Dystrophy in Eyes After Previous FALK.

To report the management of recurrent TGF BI dystrophy after prior femtosecond-assisted anterior lamellar keratoplasty (FALK) with repeat FALK. Clinical and histopathological study of 2 eyes of 2 patients with a recurrence of TGFBI dystrophy. Patient 1 had Reis-Buckler corneal dystrophy, and patient 2 had granular corneal dystrophy GCD type 1. Patient 1 had FALK 8 years ago, when she was 23 years old. Patient 2 had FALK 7 years ago at the age of 24 years. Slit-lamp examination showed recurrence in the subepithelial layer of the anterior lamellar graft as confluent chalky white granular deposits. Anterior segment optical coherence tomography highlighted the deposits in the subepithelial region of the anterior lamellar graft. The anterior lamellar graft with deposits was removed and replaced with another graft created using femtolaser dissection of a healthy donor. The parameters for femtosecond laser-assisted donor dissection was similar to the size and depth as the previously used donor. The best-corrected visual acuity was restored to 20/30 in patient 1 and 20/25 in patient 2. The histology of the anterior lamellar graft showed eosinophilic deposits between the epithelium and the Bowman layer in both samples. In addition, the corneal sample from patient 2 revealed Bowman layer breach at some places and few deposits at 1 edge of the lamellar graft. Repeat FALK with a healthy donor is effective in the management of recurrence of deposits. The histology of the recurrence in the anterior lamellar graft revealed eosinophilic deposits predominantly between the epithelium and Bowman layer.