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To assess the prevalence of abortion among population groups and changes in rates between 2008 and 2014.We used secondary data from the Abortion Patient Survey, the American Community Survey, and the National Survey of Family Growth to estimate abortion rates. We used information from the Abortion Patient Survey to estimate the lifetime incidence of abortion.Between 2008 and 2014, the abortion rate declined 25%, from 19.4 to 14.6 per 1000 women aged 15 to 44 years. The abortion rate for adolescents aged 15 to 19 years declined 46%, the largest of any group. Abortion rates declined for all racial and ethnic groups but were larger for non-White women than for non-Hispanic White women. Although the abortion rate decreased 26% for women with incomes less than 100% of the federal poverty level, this population had the highest abortion rate of all the groups examined: 36.6. If the 2014 age-specific abortion rates prevail, 24% of women aged 15 to 44 years in that year will have an abortion by age 45 years.The decline in abortion was not uniform across all population groups.

The regenerative capacity of the vertebrate retina varies substantially across species. Whereas fish and amphibians can regenerate functional retina, mammals do not. In this perspective piece, we outline the various strategies nonmammalian vertebrates use to achieve functional regeneration of vision. We review key differences underlying the regenerative potential across species including the cellular source of postnatal progenitors, the diversity of cell fates regenerated, and the level of functional vision that can be achieved. Finally, we provide an outlook on the field of engineering the mammalian retina to replace neurons lost to injury or disease.

Mucus fishing syndrome is a chronic inflammatory ocular surface condition characterised by repetitive self-extraction of mucous strands from the eye.A man in his 30s presented with bilateral ocular redness, itch, irritation, tearing and sticky mucoid discharge for 3 months. Examination disclosed bilateral bulbar and tarsal conjunctival injection. Fluorescein staining disclosed a well-circumscribed area of tarsal conjunctival epithelial defect near the inferior lacrimal punctum in both eyes. The patient admitted to a habit of mechanically removing mucus from his eyes several times a day. Demonstration of the mucus extraction process disclosed direct contact of his fingers with the excoriated tarsal conjunctiva in each eye. He was diagnosed with mucus fishing syndrome and his condition resolved within a month after he stopped fishing mucus from his eyes and had a course of topical antibiotics and steroids.Mucus fishing syndrome is an important diagnostic consideration in patients with chronic conjunctivitis.

To describe a case of acute-onset neovascular glaucoma (NVG) after a neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy in a diabetic vitrectomized eye of a patient with severe systemic and ocular comorbidities. A man in his 50s underwent a Nd:YAG capsulotomy for visually significant posterior capsular opacification with a previous history of vitrectomy with silicone oil in situ for diabetic retinopathy. He had systemic and ocular comorbidities implicating an advanced ischaemic status, both systemically and locally. Five days post Nd:YAG capsulotomy, extensive neovascularisation of the iris and angles was noted. Despite maximum antiglaucoma medication, an evisceration ensued due to intractable NVG. This case report highlights the importance of irreversible complications after a seemingly simple capsulotomy in eyes with advanced ocular conditions and systemic comorbidities necessitating extreme caution.

A female patient in the age group 55–60 years presented to us with blurring of vision in both eyes. On slit-lamp examination, numerous circular to oval fleck-like discrete blue opacities at the level of deep corneal stroma and Descemet’s membrane was observed. These lesions were predominantly seen in the central two-thirds of the cornea. Considering the age of presentation and the clinical features, the probable diagnosis of ‘deep blue dot corneal degeneration’ was made.

Two male patients with known systemic disorders who presented with complaints of nyctalopia underwent a complete ophthalmic examination including electrophysiological evaluation and serum vitamin A (retinol) levels. A significant vitamin A deficiency was detected, supplementation started and repeat electroretinogram (ERG) testing was carried out to monitor the timeline of recovery. Restoration of rod and generalised cone function was rapid within the first week of receiving treatment and near normal recovery was seen after 1 month of supplementation. Serial monitoring of ERG changes in vitamin A deficiency (VAD) associated night blindness plays an important role to demonstrate functional recovery post-treatment. The different effects of VAD on rod and cone function, and their rate of recovery, may reflect differences in the visual cycle between the two photoreceptors. We report the serial ERG changes in VAD related night blindness secondary to intestinal lipofuscinosis and liver cirrhosis in two patients.

A man in his 20s presented to the neurosurgery department 2 years ago with headache and blurred vision. He was diagnosed to have a suprasellar mass on neuroimaging. Best-corrected visual acuity in the right eye was 6/36 and that in the left eye was 6/60. Automated visual fields showed a temporal hemianopia in the right eye and an advanced field defect in the left eye. His hormonal profile was normal, and he underwent partial excision of suprasellar tumour, which was a histopathologically proven paraganglioma (PGL). Subsequently, the patient underwent radiotherapy and his vision and visual fields showed improvement. Follow-up examination 3 years later showed a left retinal capillary hemangioblastoma (RCH), which was treated with green laser photocoagulation, resulting in complete sclerosis. This case is unique because of the extremely rare coexistence of a sellar PGL and RCH, which to our knowledge has not been reported so far.

A female geriatric patient with major depressive disorder, current episode severe, received eight right unilateral electroconvulsive therapy (ECT) treatments over the course of 3 weeks. After her third treatment, she began experiencing brief visual hallucinations, each lasting less than 5 s, consisting of dark to grey coloured, poorly defined geometric shapes and objects. These episodes occurred only during the day with no change in consciousness. With each additional treatment, the episodes increased in frequency, reaching a crescendo of approximately 20 episodes per day. After terminating ECT, the frequency of these episodes decreased and then ceased 6 weeks later. Neuroimaging and ophthalmological investigations discounted a space occupying lesion or vision loss. This case demonstrates a close temporal relationship between ECT and new onset visual hallucinations. Clinicians should be aware of the possibility that elderly depressed patients may develop visual hallucinations during a course of ECT.

Despite the advancements in the surgical management of glaucoma, childhood glaucoma remains a challenging surgical disease worldwide. An early adolescent boy with primary congenital glaucoma, status after glaucoma drainage device (GDD) implantation, on maximum medical therapy, was presented with a swelling in the superotemporal orbital region. The patient had undergone an uneventful GDD implantation 2 years prior to presentation. A similar swelling, which was diagnosed to be a Tenon’s cyst, had been excised on three earlier occasions. Given that the repeat capsular excision would also have the same likelihood of failure, and poor intraocular pressure control, a non-valved, cost-effective Aurolab aqueous drainage implant (AADI, Aurolab, Madurai, India) implantation was done inferonasally. In this patient, AADI proved to be a safe and effective alternative for the known GDDs.

A 54-year-old man, with history of undergoing deep anterior lamellar keratoplasty (DALK) 20 months ago, presented with mature senile cataract in the same eye. While undergoing phacoemulsification, a large, central Descemet membrane detachment (DMD) was noted, separating the donor cornea from the host predescemetic layer. No DM tears were noted. Stromal puncture was done at the graft host junction to reduce the extent of DMD. This was followed by a large intracameral air bubble insertion, which resulted in complete resolution of DMD on the first postoperative day. DMD during hydration of wound is a unique complication to be anticipated while doing cataract surgery in an operated DALK eye.

Ocular surface melanoma (OSM) is rare. An 81-year-old Caucasian woman presented with a 4-month history of right eye pain and reduced vision. Histopathological examination of the excisional biopsy identified invasive amelanotic melanoma of the conjunctiva expressing Melan A and SOX10. X-ray of chest, CT of liver and MRI of the brain and orbit did not identify macroscopic metastases. She was given adjuvant topical mitomycin-C 0.04% for four cycles of 2 weeks. Her vision improved and the cornea was clear at 6 months.

A postpartum woman presented with sudden-onset left eyelid swelling and severe pain. Clinical examination revealed left exophthalmos and ophthalmoplegia with marked resistance to retropulsion of the left globe. The patient was not able to perceive light in the affected left eye and a relative afferent pupillary defect was present. CT orbits showed an enhancing lesion in the left retrobulbar space, suggestive of a lateral rectus haemorrhage. An emergency left lateral canthotomy and inferior cantholysis was performed. A day later, an MRI showed expansion of the left lateral rectus with significant mass effect on the globe. As the visual acuity remained reduced at counting fingers and there was a persistent relative afferent pupillary defect (RAPD), an exploratory orbitotomy and haematoma evacuation was performed. Three days postoperatively, the visual acuity had returned to 6/6. Eye movements normalised within 2 weeks and follow-up imaging revealed near complete resolution of the haematoma.

Nasopharyngeal carcinoma is very rarely associated with bilateral vision loss, and only in advanced disease. We report a case of bilateral severe compressive optic neuropathy as a first presentation from massive nasopharyngeal carcinoma with poor visual outcome despite corticosteroid, chemotherapy and radiotherapy. Red flag symptoms and signs of mass lesions in the posterior nasal space should be investigated and treated promptly to prevent devastating visual and prognostic consequences.

In this paper, we derive a recurrence relation of anti-forcing polynomial for catacondensed hexagonal systems.

Purpose To describe the use of glycerine in improving media clarity in cases with edematous cornea. Methods Retrospective case-series including patients with posterior segment pathologies needing surgical invention and having corneal edema. Each case was studied for the role of topical application of glycerine instead of viscoelastic agents and the course of surgery. The cases were followed up for minimum 3-months duration. Results Six cases with corneal edema having posterior segment pathology underwent surgery with intraoperative topical application of glycerine. The corneal edema was seen to clear with progression of surgery and was maintained until the end of surgery. Procedures like vitreoretinal surgery, identification of break, internal limiting membrane peeling, intraocular lens explantation, scleral indentation, DSEK graft removal, and subretinal band removal could be performed in these cases. Conclusion Intraoperative glycerine use during vitreoretinal surgeries is helpful in improving the corneal clarity and maintaining it till the end of surgery.

Purpose: The optic nerve head (ONH) undergoes complex and deep 3D morphological changes during the development and progression of glaucoma. Optical coherence tomography (OCT) is the current gold standard to visualize and quantify these changes, however the resulting 3D deep-tissue information has not yet been fully exploited for the diagnosis and prognosis of glaucoma. To this end, we aimed: (1) To compare the performance of two relatively recent geometric deep learning techniques in diagnosing glaucoma from a single OCT scan of the ONH; and (2) To identify the 3D structural features of the ONH that are critical for the diagnosis of glaucoma. Methods: In this study, we included a total of 2,247 non-glaucoma and 2,259 glaucoma scans from 1,725 subjects. All subjects had their ONHs imaged in 3D with Spectralis OCT. All OCT scans were automatically segmented using deep learning to identify major neural and connective tissues. Each ONH was then represented as a 3D point cloud. We used PointNet and dynamic graph convolutional neural network (DGCNN) to diagnose glaucoma from such 3D ONH point clouds and to identify the critical 3D structural features of the ONH for glaucoma diagnosis. Results: Both the DGCNN (AUC: 0.97$\pm$0.01) and PointNet (AUC: 0.95$\pm$0.02) were able to accurately detect glaucoma from 3D ONH point clouds. The critical points formed an hourglass pattern with most of them located in the inferior and superior quadrant of the ONH. Discussion: The diagnostic accuracy of both geometric deep learning approaches was excellent. Moreover, we were able to identify the critical 3D structural features of the ONH for glaucoma diagnosis that tremendously improved the transparency and interpretability of our method. Consequently, our approach may have strong potential to be used in clinical applications for the diagnosis and prognosis of a wide range of ophthalmic disorders.

Neuronal ceroid lipofuscinosis is a rare childhood neurodegenerative disease, classified under the spectrum of progressive myoclonic epilepsy (PME). Cognitive decline, seizures including myoclonus, vision loss and ataxia are the commonly described manifestations of this illness. While visual failure in this disease is largely attributed to retinal, macular degeneration and optic atrophy, with this index case, we report an atypical presentation in the form of higher order visual dysfunction. The pattern of cognitive regression has further been explored here with higher order visual dysfunction and language regression being the predominant manifestations, stemming from an involvement of bilateral occipitoparietal/occipitotemporal networks. Yet another unique feature of this case also lies in the occurrence of myoclonic-atonic seizure, a semiology rarely reported before in PME.

Presented here is a case of hybrid retinopathy of prematurity (ROP) with features of both aggressive posterior ROP and ridge-like staged ROP with extensive candle wax-like preretinal deposits plastered on the surface of the retina from optic disc to vascular–avascular junction at a postmenstrual age (PMA) of 34 weeks. The baby was too sick for laser photocoagulation and so underwent intravitreal bevacizumab at half adult doses in both eyes. The deposits melted dramatically within 1–2 weeks of antivascular endothelial growth factor injection without any signs of recurrence till the last visit at 58 weeks of PMA.

A 56-year-old woman presented with floaters and diminution of vision in the right eye for 1 week. On examination, visual acuity was 20/400 in the right eye and 20/60 in the left eye. Indirect ophthalmoscopy revealed vitritis in the right eye and subretinal deposits in both eyes. Vitreous biopsy of the right eye revealed large B-cell-type primary intraocular lymphoma and the patient underwent multiple intravitreal methotrexate injections (400 μg/0.1 mL) in the right eye and systemic chemotherapy for bilateral disease. Following biweekly injections of methotrexate, her visual acuity improved considerably from 20/400 to 20/60 with resolution of vitritis. However, following eighth dose of intravitreal methotrexate, she experienced visual decline to 20/120 along with photophobia, redness and watering. Whorl-shaped opacities, limbitis and corneal haze were noted on slit-lamp examination. Intravitreal methotrexate was stopped, and the patient was started on frequent topical lubricants, loteprednol, topical folinic acid and oral folic acid. Complete resolution of corneal toxicity was observed at 3 weeks and the injections were suspended as there was no recurrence at 6 months follow-up.

Medical imaging technologies can improve the diagnosis and clinical management of many ophthalmic diseases. Cross-sectional ophthalmic imaging devices are essential clinical tools for diagnosing and monitoring medical conditions that affect the anterior segment of the eye. Optical imaging technologies such as optical coherence tomography (OCT) and Scheimpflug imaging (SI) are well developed and widely used in the field of ophthalmology due to its non-invasive and non-contact characteristics. For any single anterior chamber cross-sectional (tomographic) imaging technology, there is a practical compromise between image size and image resolution. In order to obtain large field-of-view (FOV) cross-sectional images of the whole anterior chamber and high-resolution cross-sectional images of the fine corneal layers, measurements by multiple devices are currently required, e.g., OCT and SI devices. This incurs a significant device capital cost, time cost of technicians and clinicians and patients as well as inconvenience to the patients. This project presents a novel raster scanning tomographic imaging device that acquires simultaneously large FOV Scheimpflug and high-resolution spectral domain OCT (SD-OCT) cross-sectional images using the same illuminating photons to overcome the need of multiple devices for cross-sectional imaging. Based on this new idea, two imaging modalities have been developed: a Point-Scanning (PS) device and Line-Field (LF) device. First, a novel imaging device that combines PS-OCT and Scheimpflug image has been developed using fibre optics due to the advantages of its compactness and portability. This new imaging device can take a large-FOV Scheimpflug image covering the whole anterior chamber with an image depth of 12.5 mm and a high-resolution OCT image of cornea with an axial resolution of 2.7µm (nG=1.37). This device allows both Scheimpflug image and OCT images to be obtained simultaneously by raster scanning of the same infrared illuminating light. A pair of polarisers are used in Scheimpflug images during raster scanning in order to address the issues related to the surface reflection. Twelve porcine and fourteen bovine eyes were measured ex-vivo using the device. It was demonstrated that the device has the capability of acquiring simultaneously large FOV SI images covering whole anterior segment of eye and high axial resolution OCT images of cornea resolving thin corneal layers including the epithelium, stroma, and the Descemet’s and Endothelium complex. Second, another new device that combines LF-OCT and SI imaging has been developed. This enables entire high-resolution OCT B-scan image and large FOV SI cross-sectional image to be obtained simultaneously in parallel in a single shot. This imaging configuration with its increased imaging speed has the potential to minimise the image artefacts caused by patients’ involuntary motion or blinking during an in-vivo examination. Third, a new thickness correction method has been developed to correct the thickness distortion in the Scheimpflug image caused by the refraction of the light beam in the cornea. There is a reasonable agreement in the overall central corneal thicknesses (CCT) obtained from the simultaneous OCT and Scheimpflug measurements, which demonstrates the accuracy and reliability of the thickness correction method for the Scheimpflug device. In addition, using the proposed new device both OCT and SI images were taken simultaneously at the same cornea position using the same illumination light, the physical thickness of the cornea obtained by OCT and SI should be the same. This provides a unique method for directly measuring the refractive index of each individual cornea samples. To be concluded, there are three significant contributions of this thesis: the idea of combining a SD-OCT and SI to a single device is proposed and implemented using scanning-point configuration in order to obtain OCT and Scheimpflug images simultaneously. Then, the imaging speed is largely improved by further developing line-field configuration. Consequently, the motion artefact will be reduced for in-vivo measurement, which paves the way to develop further this technology to a commercial medical imaging device. In addition, a modified Scheimpflug thickness correction method is proposed and developed to correct thickness error caused by light refraction. As this correction method only works for central cornea region, a new correction method that is suitable for the whole corneal is proposed and implemented.

The effect of randomised controlled trials (RCTs) is diminished by inconsistent outcome reporting, precluding the efficient synthesis of data into systematic reviews and meta-analyses. Amblyopia, strabismus, and ocular motility disorder patients constitute a significant proportion of those seen in ophthalmology generally and in paediatric ophthalmology specifically, making efficient synthesis of research data a greater necessity. Core Outcome Sets (COS), defined as agreed standardised sets of outcomes that should be measured and reported, as a minimum, in all clinical trials in a health area, have been found to help with the problem of inappropriate and inconsistent outcomes. The objective of this research was to develop three COS for amblyopia, strabismus, and ocular motility disorders. The methods comprised a systematic review to identify reported outcomes and establish whether there was outcome reporting inconsistency as suggested by other studies; qualitative semi-structured focus group meetings with patients, carers and healthcare professionals to establish outcomes of their importance; and finally, a Delphi online survey and consensus meetings with stakeholders to reach agreement on what should be included in the COS. The systematic review, which included 142 trials, systematic reviews, and other studies, identified significant heterogeneity in outcome reporting, and populated the Delphi process with 24 outcomes for amblyopia, 47 for strabismus, and 68 for ocular motility disorders. The qualitative study reflected the fact that long-term outcomes and quality-of-life aspects are the greatest priority of patients and carers, and resulted in the addition of 7, 14, and 10 outcomes to the three conditions, respectively. Although consensus between stakeholders was not reached conclusively in the Delphi survey, it resulted in the identification of the most critical outcomes, which were then collapsed into nine to ten core outcomes in the consensus meetings, with significant overlap between the three conditions. All three conditions shared the core outcomes: adverse events, cost, vision-related quality of life, and ocular alignment. The strabismus and ocular motility disorder core sets included, in addition, patient satisfaction, symptoms, binocular vision, ocular movement, and deviation. The ocular motility disorders COS included clinical signs, additionally. The amblyopia set, distinct from the sets for the other two conditions, included best corrected distance and near visual acuity, compliance, refraction, and treatment-related and long-term impacts. Implementation of these COS will improve outcome consistency, which will facilitate the comparison and combination of clinical trials and therefore synthesis of their data into meta-analyses. Further consideration must be given to increasing the uptake of the COS to maximise its usefulness, and future work will be required to standardise methods and timings of measurements. Continuous review and update of the COS to match future new interventions may be required.

Aqueous misdirection syndrome is a rare but serious condition that can present after routine phacoemulsification surgery. This report examines a case of myopic surprise following an uncomplicated left eye (LE) phacoemulsification surgery. The patient had previous bilateral peripheral iridotomies for narrow anterior chamber angles. Repeat biometry measurement of the pseudophakic LE did not show shallow anterior chamber, and intraocular pressure (IOP) was normal at initial presentation. However, approximately 3 years postoperatively, LE IOP was raised. Surgical management was considered as medical and laser procedures did not stop deterioration. Clinical presentation of aqueous misdirection syndrome may be subtle and can occur weeks to years after routine uncomplicated phacoemulsification surgery. Myopic surprise may be the only initial presenting sign. Patients who are at risk of aqueous misdirection syndrome should be followed up closely after cataract surgery with accurate gonioscopic assessments for early diagnosis and treatment to prevent optic nerve damage.

Posterior embryotoxon, an anteriorly displaced Schwalbe’s line, is the most common feature of Axenfeld Rieger syndrome. We report a case of Axenfeld anomaly with unusual corneal manifestation, that is, a fairly symmetric, hyperproliferated posterior embryotoxon mimicking double cornea as well as a double pupil.

Purpose To highlight a case of chorioretinitis sclopetaria, with concomitant macular hole formation and orbital emphysema, caused by a commercial-grade pressure washer. Patient A 19-year-old male presented to the emergency department with a left eye injury, incurred after being sprayed with a commercial-grade pressure washer. He endorsed ipsilateral blurred vision, pain, and linear floaters. Left eye visual acuity was 20/40. Dilated fundus exam showed inferior vitreous hemorrhage, retinal whitening, and pre-, intra-, and sub-retinal hemorrhages, consistent with chorioretinitis sclopetaria. Optical coherence tomography revealed a full-thickness macular hole. Computed tomography scan of the orbits showed subcutaneous and post-septal orbital emphysema. Two months following injury, vitreous and retinal hemorrhages and macular hole resolved. Five months following injury, visual acuity improved to 20/20. Discussion Chorioretinitis sclopetaria is defined as a full-thickness chorioretinal disruption resulting from a high-velocity projectile passing adjacent to or into the orbit without penetrating the globe. Chorioretinal deformation and ocular comorbidities are influenced by the velocity of the missile and its spatial relationship to the orbit. While this pattern of injury is typically associated with indirect trauma to the globe by a BB or a bullet, this is the first report of chorioretinitis sclopetaria precipitated by a high-velocity liquid missile.

Purpose To describe with multimodal imaging including the use of ultra-widefield optical coherence tomography (OCT) imaging a distinct phenotype of autosomal recessive nanophthalmos associated with a novel mutation of the MFRP gene (membrane-type frizzled-related protein). Methods Case report and review of the relevant literature. Patients Single patient followed by the Weill Cornell Medicine Department of Ophthalmology Retina and Glaucoma Services. Results A patient with a novel homozygous mutation in the MFRP gene (c.472C>T) presented with nanophthalmos, optic disc drusen, foveal hypoplasia, and extensive peripheral retinoschisis, which was revealed to be multilevel retinoschisis on ultra-wide field OCT. Unlike other reported cases, the findings associated with this novel mutation did not include foveoschisis nor clinically obvious retinitis pigmentosa. The patient underwent prophylactic peripheral laser iridotomy in both eyes. Conclusion Here we present a patient with nanophthalmos, optic disc drusen, and foveal hypoplasia associated with extensive peripheral retinoschisis imaged by ultra-widefield OCT, but not foveal retinoschisis or prominent retinitis pigmentosa. The findings may expand the clinical spectrum of MFRP-associated nanophthalmos.

BACKGROUND/PURPOSE To describe the association between autosomal dominant Best disease and peripapillary angioid streak-like changes. METHODS Case report of two siblings. RESULTS A 76-year-old Caucasian male was referred for evaluation of bilateral macular changes and worsening visual distortion over the preceding 2 years. Best corrected visual acuity (BCVA) measured 20/30 in the right eye and 20/80 in the left eye. Funduscopic examination revealed multifocal yellow lesions in the posterior pole that were hyper-autofluorescent on short-wavelength excitation and corresponded with subretinal hyperreflective material on optical coherence tomography. The posterior pole examination was interesting due to the juxtapapillary involvement of the vitelliform lesions as well as the presence of bilateral peripapillary angioid streak-like changes despite no history of conditions associated with angioid streaks. On further workup, an electro-oculogram revealed reduced Arden ratios and a known heterozygous missense mutation in BEST1 (c.903T>G; p.D301E) was found. The patient's 69-year-old younger brother was brought in and found to have a remarkably similar phenotype, including the presence of angioid streak-like changes associated with the same BEST1 mutation. CONCLUSIONS These two cases demonstrate the possibility of late-onset multifocal vitelliform disease due to dominantly inherited BEST1. A consistent phenotype in this family with macular lesions extending into the peripapillary region, associated with angioid streak-like changes, suggests susceptibility of this region to changes in dominant BEST1-vitelliform macular dystrophy.

PURPOSE To present a new technique to treat refractory retinal detachment secondary to optic disc pit. METHODS An interventional case report. RESULTS A 25-year-old man with congenital optic disc pit had two failed vitrectomies involving laser around the optic disc, internal limiting membrane peel and flap to plug the disc pit, and gas tamponade to reattach the retina. With all options running out, a further vitrectomy with autologous retinal transplant and silicone oil tamponade was carried out to treat the refractory serous retinal detachment; the silicone oil was removed at 6 weeks after the last procedure. The retina remained successfully attached at 6 months post-surgery with the patient maintaining his baseline visual acuity. CONCLUSION The use of autologous retinal transplant is a new approach to treat refractory retinal detachment secondary to congenital optic disc anomalies, and adds to our options of dealing with this complex condition when first-line approaches have failed.

Purpose To describe central serous chorioretinopathy (CSCR) cases presenting as uveal effusion syndrome, providing new insights into "pachychoroid spectrum" diseases. Methods Clinical charts, color fundus photographs, fluorescein angiography, indocyanine green angiography, optical coherence tomography, ultrasound imaging, cerebral magnetic resonance imaging and biometry of four eyes of three patients were assessed. A literature review was conducted. Results The three patients had peripheral choroidal detachment and inferior bullous retinal detachment associated with CSCR features detected using multimodal imaging, including fluorescein and indocyanine green angiography. The choroid was thick in the three patients, and uveal effusion occurred after steroid treatment in all cases. Subretinal fluid drainage and deep sclerectomy with flaps of 4x4 mm in both inferior quadrants were performed in 3 eyes of 2 patients with good outcomes. One patient was treated with photodynamic therapy. All three patients developed a typical leopard-spot pigmentary pattern in the fundus. Conclusion A severe presentation of highly exudative CSCR may occur in rare cases with a peripheral choroidal detachment mimicking uveal effusion syndrome. These severe cases highlighted the role of choroidal thickening and hyperpermeability, choroidal vein dilation and possible scleral thickening in both entities.

Objective Homeless and marginally housed populations experience a higher prevalence of visual impairment relative to the general population. The aim of this pilot study is to present a novel model for conducting ocular screening clinics for homeless individuals during a pandemic and to describe the status of ocular health in this population during this time. Methods In this cross-sectional study, 3 outdoor tent-based ocular screening clinics were held in a park in Toronto. Most participants were recruited from local shelters, but additional spots were allocated for homeless individuals on a drop-in basis. Prior to enrolment, each participant underwent COVID-19 screening via a questionnaire and temperature measurement. Those who screened negative received a comprehensive eye examination, including vision testing, dilated fundus examination, and autorefraction. Results Eleven individuals completed all assessments. The mean age of participants was 54.5 years, and 11 of the participants were male. Visual impairment was found in 5 individuals. Refractive error via pinhole testing was found in 1 patient. Ocular pathology in this sample was found in 4 participants. Two patients required a referral to an ophthalmologist. From a psychosocial perspective, 4 participants reported significant difficulties. Conclusions This novel tent-based ocular screening program provides a viable option for screening in a pandemic.

Objective To characterize the multimodal retinal findings of myopic macular pits, a feature of myopic degeneration. Methods A case series of patients with myopic macular pits were studied with multimodal imaging including color fundus photography, fundus autofluorescence (FAF), near infrared reflectance (NIR), spectral domain optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), fluorescein angiography (FA) and indocyanine green angiography (ICG). Results Nine eyes of 6 patients with myopic macular pit were examined. Four patients presented with multiple pits and 3 with bilateral involvement. All pits were localized in a region of severe macular chorioretinal atrophy associated with myopic posterior staphyloma. In 3 eyes, the entrance of the posterior ciliary artery through the sclera was noted at the base of the pit. Schisis overlying the pit or adjacent to the pit was identified in 3 patients. Conclusion Myopic macular pits are an additional rare sign of myopic degeneration, developing in regions of posterior staphyloma complicated by severe chorioretinal atrophy and thin sclera.

Objective To evaluate the long-term structural and microvascular retinal effects of internal limiting membrane peeling for full-thickness macular hole (FTMH) using en face adaptive optics optical coherence tomography (AO-OCT), conventional OCT, and OCT angiography (OCTA). Design Interventional case series. Participants Patients with FTMH treated with vitrectomy, internal limiting membrane peeling, and gas tamponade. Methods Eleven eyes with FTMH that had at least 12 months of postoperative follow-up were enrolled in the study. En face AO-OCT was used to image the superficial retina in the peeled and nonpeeled areas. En face structural OCT was performed to image the inner retinal dimples (IRDs), macular thickness, and retinal nerve fibre layer (RNFL). En face OCTA was used to examine the integrity of the peripapillary nerve fibre layer (NFL) plexus. Results AO-OCT showed RFNL wrapping around the IRDs, and no obvious peripapillary NFL plexus dropout was seen with OCTA. Scattered hyper-reflective dots were observed on the surface of the peeled retina in all patients imaged with AO-OCT. No significant differences were found in IRD number (91.5 ± 24.4 versus 77.2 ± 14.7; P = 2.07), IRD proportionate area (8.36 ± 3.34 versus 7.53 ± 2.60; P = 0.159), or macular thickness between the 6- and 12-month (or greater) postoperative visits. Conclusion IRDs do not to progress beyond 6 months postoperatively, and no obvious damage to RFNL and peripapillary NFL plexus was detected. Hyper-reflective dots on the surface of the retina suggestive of possible Muller cell reactive gliosis were identified with AO-OCT.

Background The objective of this study was to evaluate pattern and distribution of neovascularization of optic disc (NVD) and elsewhere (NVE) in proliferative diabetic retinopathy (PDR). Methods A cross-sectional study was conducted among freshly detected cases of PDR. Fundus fluorescein angiographic images of 61 eyes were assessed. Parameters studied for NVD were their number and location and for NVE were their number, location, type of leak, and distance from center of optic disc. Results Of 61 eyes, 29 eyes (47.5%) had NVD with a total of 49 leaks. Of these 49 NVD leaks, the maximum was concentrated in the superotemporal quadrant with 21 leaks (42.9%; 95%CI 28.8–57.8%). Of 61 eyes, 50 eyes (82%) had NVE with 97 leaks. Of 97 NVE leaks, 41 were found in the superotemporal quadrant (42.3%; 95%CI 32.3–52.7%). Maximum NVE was found within the circle of radius 3–6 mm centered on optic disc (p value = 0.001) with no leaks in central macula. Of 29 eyes with NVD, only 7 eyes had >1/3 area of disc involvement. Also, of 18 eyes with concurrent NVD and NVE, only 2 eyes had >1/3 area of disc involvement which is a high-risk characteristic of PDR. Conclusion Neovascular lesions have a predilection for superotemporal part for both NVD and NVE. NVE leaks were almost double the number of NVD leaks. Maximum NVE leaks were found at posterior pole with no central macular involvement. This study provides comprehensive data and further adds to knowledge of neovascularization for early diagnosis and management of PDR.

Purpose To describe two cases of catastrophic, bilateral retinal vascular occlusion following intravitreal (IVT) bevacizumab injection. Methods Case series. Main outcome measures included clinical and fluorescein angiography (FA) findings. Results Case 1 - A 65-year-old woman with calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasis (CREST) syndrome developed acute, severe, bilateral visual loss two weeks following bilateral IVT bevacizumab injection for proliferative diabetic retinopathy. Examination and FA revealed moderate anterior chamber inflammation, bilateral perivascular retinal hemorrhages and near total retinal vascular occlusion. Extensive testing revealed moderately elevated anti-B2 glycoprotein (antiphospholipid) antibodies. Case 2 - An 85-year-old man with polymyalgia rheumatica and left eye exudative age-related macular degeneration experienced severe, bilateral, sequential visual loss in the left then right eye approximately three weeks following IVT bevacizumab left eye injection. Examination revealed bilateral panuveitis, diffuse perivascular exudates, and intraretinal hemorrhages. FA showed diffuse venous leakage. Extensive testing revealed an elevated anti-nuclear antibody and mildly elevated anti-cardiolipin antibody. Conclusion Patients with underlying retinal vascular vulnerabilities may be at increased risk of catastrophic, bilateral retinal vascular occlusion following treatment with IVT bevacizumab. The moderate to severe intraocular inflammation in both cases, and the contralateral involvement following unilateral IVT injection in Case 2, suggest a possible delayed immune-mediated mechanism.

Studies have shown cortical alterations in individuals with autism spectrum disorders (ASD) as well as in individuals with high polygenic risk for ASD. An important addition to the study of altered cortical anatomy is the investigation of the underlying brain network architecture that may reveal brain-wide mechanisms in ASD and in polygenic risk for ASD. Such an approach has been proven useful in other psychiatric disorders by revealing that brain network architecture shapes (to an extent) the disorder-related cortical alterations. This study uses data from a clinical dataset—560 male subjects (266 individuals with ASD and 294 healthy individuals, CTL, mean age at 17.2 years) from the Autism Brain Imaging Data Exchange database, and data of 391 healthy individuals (207 males, mean age at 12.1 years) from the Pediatric Imaging, Neurocognition and Genetics database. ASD-related cortical alterations (group difference, ASD-CTL, in cortical thickness) and cortical correlates of polygenic risk for ASD were assessed, and then statistically compared with structural connectome-based network measures (such as hubs) using spin permutation tests. Next, we investigated whether polygenic risk for ASD could be predicted by network architecture by building machine-learning based prediction models, and whether the top predictors of the model were identified as disease epicenters of ASD. We observed that ASD-related cortical alterations as well as cortical correlates of polygenic risk for ASD implicated cortical hubs more strongly than non-hub regions. We also observed that age progression of ASD-related cortical alterations and cortical correlates of polygenic risk for ASD implicated cortical hubs more strongly than non-hub regions. Further investigation revealed that structural connectomes predicted polygenic risk for ASD (r = 0.30, p

Freezing of gait (FoG) is identified as a sudden and brief episode of movement cessation despite the intention to continue walking. It is one of the most disabling symptoms of Parkinson's disease (PD) and often leads to falls and injuries. Many computer-aided FoG detection methods have been proposed to use data collected from unimodal sources, such as motion sensors, pressure sensors, and video cameras. However, there are limited efforts of multimodal-based methods to maximize the value of all the information collected from different modalities in clinical assessments and improve the FoG detection performance. Therefore, in this study, a novel end-to-end deep architecture, namely graph fusion neural network (GFN), is proposed for multimodal learning-based FoG detection by combining footstep pressure maps and video recordings. GFN constructs multimodal graphs by treating the encoded features of each modality as vertex-level inputs and measures their adjacency patterns to construct complementary FoG representations, thus reducing the representation redundancy among different modalities. In addition, since GFN is devised to process multimodal graphs of arbitrary structures, it is expected to achieve superior performance with inputs containing missing modalities, compared to the alternative unimodal methods. A multimodal FoG dataset was collected, which included clinical assessment videos and footstep pressure sequences of 340 trials from 20 PD patients. Our proposed GFN demonstrates a great promise of multimodal FoG detection with an area under the curve (AUC) of 0.882. To the best of our knowledge, this is one of the first studies to utilize multimodal learning for automated FoG detection, which offers significant opportunities for better patient assessments and clinical trials in the future.

Purpose To present novel findings in stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR), including the largest series of optical coherence tomography angiography (OCT-A) findings to date. Methods A retrospective case series with multimodal imaging was obtained and reviewed. Results All three patients were women, ages 59-63. Two cases were unilateral and one was bilateral. Vision ranged from 20/20 to 20/60 in the affected eyes. Peripheral retinoschisis was observed in all three patients. All patients were followed for a minimum of one year. In one case, progressive macular retinoschisis leading to foveal involvement was observed over two years, with an associated vision decline from 20/25 to 20/60. Attempted interventions included topical dorzolamide in all cases and intravitreal bevacizumab in one patient; however, no treatment effect was observed. Foveal avascular zone (FAZ) size was within normal limits (mean 280[micro]m). In all SNIFR eyes, the retinoschisis cavities were nonvascular. Conclusion Novel findings regarding SNIFR include the progressive nature of foveal involvement and the lack of response to topical dorzolamide and intravitreal bevacizumab. FAZ was normal in all eyes, consistent with the relatively preserved vision in these cases. Retinoschisis cavities were nonvascular in all eyes, a finding which may give insight into the mechanism of this disease.

Background Obesity is a chronic condition, affecting central and peripheral nervous system. Studies on cranial nerve conduction in obesity are scarce and unclear; therefore, we planned this study. The aim of this study was to evaluate optic and auditory nerve conductions in obesity. Methods It was a case-control study, with inclusion of 40 young males (20 obese and 20 controls) in age group of 18–30 years. We recorded pattern reversal visual evoked potential (PRVEP) and brainstem auditory evoked potential (BAEP). The PRVEP P100 latency and BAEP absolute and interpeak latencies were analyzed. Results In obese individuals, BAEP absolute latencies of wave V were significantly prolonged in both the ears and wave I in left ear. In addition, significant prolongation of interpeak latency III–V was observed in both the ears and I–V latency, in right ear among obese cases. A positive correlation was seen between body mass index and interpeak latency I–V. In PRVEP recordings, P100 latency did not show any significant difference in both the groups. Conclusion Therefore, we can conclude that obesity does not affect optic nerve conduction, but auditory nerve conduction is affected. BAEP I–V interpeak latency may be an indicator of subclinical auditory conduction defects in young obese males.

Non-arteritic anterior ischaemic optic neuropathy (NAION) typically presents with sudden painless vision loss in those with vascular risk factors and a ‘disc-at-risk’.[1][1] Following the initial insult, most patients remain stable or may notice slight improvement in their vision. However, a

A 58-year-old man presented with a 3-month history of painless blurred vision in the right eye. There was no antecedent history of trauma, flashes and floaters. Best-corrected visual acuity was 20/200 in the right eye and 20/30 in the left eye. Right eye intraocular pressure (IOP) was 9 mm Hg

A 4-year-old boy presented with acute febrile illness with altered sensorium, decreased responsiveness to command, excessive sleepiness, headache and generalised-onset motor seizures for the past 2 days with intact bladder and bowel control. There was no history of jaundice, change in the colour of

A 49-year-old woman was referred to the retina clinic with incidentally noted retinal pigmentation. She had long-standing poor left visual acuity (VA) due to a compressive optic neuropathy treated by surgery in childhood. She also had chronic angle closure glaucoma, treated with bilateral laser

A 14-year-old female presented with progressive diminution of vision in the right eye. She had left-sided loss of vision since 1 year of age. The patient had aggressive behaviour with irrelevant talking. She was intellectually disabled and had a history of delayed motor and language milestones. On

Porphyria cutanea tarda is the most common type of porphyria. It is associated with a deficiency of uroporphyrinogen decarboxylase enzyme responsible for heme synthesis. Clinical manifestations are predominantly dermatological and very rarely present with ocular involvement. Although scleral thinning in the interpalpebral area is a well-documented entity, sight-threatening corneal involvement is rarely described. We, herein report a case of a 58-year-old man who presented with ocular surface dryness, photophobia and mild redness. Slit-lamp biomicroscopy revealed corneo-scleral thinning in both eyes. The diagnosis was confirmed with a urine porphyrin test, serum iron and serum ferritin levels. We started him on conservative management after which he was lost to follow-up. He presented again after 6 years with total corneal opacification and progressive loss of vision in the right eye.

We report a case of pseudophakic bullous keratopathy (PBK) in which clinical examination failed to identify a retained lens fragment (RLF) which was subsequently diagnosed using anterior segment optical coherence tomography (AS-OCT) A 79-year-old man underwent routine phacoemulsification in the

An endoscope is a useful adjunct for the retinal surgeon to overcome haze of a compromised anterior segment. It allows early surgery in trauma and infections which translates to better results. Intraocular glass foreign body is a challenging condition, demanding highly skilled surgical expertise. We present endoscopic removal of an intraocular foreign glass body in a badly traumatised and infected eye. The surgical challenge was accentuated by an imaging misdiagnosis of ‘twin metallic foreign bodies’.

Purpose To determine if smartphone photography could be a useful adjunct to blindness prevalence surveys by providing an accurate diagnosis of corneal opacity. Methods A total of 174 patients with infectious keratitis who had undergone corneal culturing over the past 5 years were enrolled in a diagnostic accuracy study at an eye hospital in South India. Both eyes had an ophthalmologist-performed slit lamp examination, followed by anterior segment photography with a handheld digital single lens reflex (SLR) camera and a smartphone camera coupled to an external attachment that provided magnification and illumination. The diagnostic accuracy of photography was assessed relative to slit lamp examination. Results In total, 90 of 174 enrolled participants had a corneal opacity in the cultured eye and no opacity in the contralateral eye, and did not have a penetrating keratoplasty or missing photographs. Relative to slit lamp examination, the sensitivity of corneal opacity diagnosis was 68% (95%CI 58-77%) using the smartphone's default settings and 59% (95%CI 49-69%) using the SLR, and the specificity was 97% (95%CI 93-100%) for the smartphone and 97% (95%CI 92-100%) for the SLR. The sensitivity of smartphone-based corneal opacity diagnosis was higher for larger scars (81% for opacities 2 mm in diameter or larger), more visually significant scars (100% for eyes with visual acuity worse than 20/400), and more recent scars (85% for eyes cultured in the past 12 months). Conclusion The diagnostic performance of a smartphone coupled to an external attachment, while somewhat variable, demonstrated high specificity and high sensitivity for all but the smallest opacities.

Retinoblastoma is the most common intraocular tumour of the eye in children. It constitutes 11% of all cancers within the first year of life. In one-third of cases, it occurs bilaterally; usually, before 5 years of age without any gender predilection.[1 2][1] Trilateral retinoblastoma term is used

Cavitary optic disc anomalies can cause maculopathy. The most common of these associated with maculopathy is the optic disc pit. Very rarely, maculopathy can accompany optic disc coloboma. We report a case of combined cavitary disc anomalies (coloboma and disc pit) with maculopathy. A 22-year-old

A 55-year-old Caucasian woman presented with a 1-week history of left eye redness and blurred vision. Her medical history included previous small bowel resection and ileostomy for ischaemic bowel. Ophthalmic examination revealed a left corneal ulcer requiring hospital admission for intensive topical antibiotics. Overnight she became systemically unwell and was diagnosed with urinary tract infection requiring intravenous antibiotics. Her corneal condition deteriorated resulting in corneal perforation, which required a surgical gluing procedure. Despite surgery, the cornea perforated on two further occasions. At this stage, vitamin A deficiency (VAD) was suspected, due to the corneal melting response that was occurring. VAD was subsequently confirmed by serology and had occurred in this case due to malabsorption as a result of short bowel syndrome caused by previous small bowel surgery. The patient was treated with intramuscular vitamin A and eventually made a good visual and systemic recovery.

We report a case of conjunctival erosion due to ligature suture knot exposure following Aurolab aqueous drainage device (AADI) implantation. A 48-year-old man, a known case of primary angle-closure glaucoma, had failed trabeculectomy with mitomycin-C and Ahmed glaucoma valve (AGV) in the right eye. The right eye had a large posterior AGV bleb with hypertropia and limitation of extraocular movement on downward gaze and uncontrolled intraocular pressure (IOP). An inferonasal AADI was performed uneventfully. At the 1-month postoperative visit, a small conjunctival erosion was noted over the ligature (6-0 vicryl) suture knot. However, there was no leak. Two weeks later, there was hypotony and a leak was noted at the site of the absorbed ligature. Immediate surgical repair was performed by re-ligature of the AADI tube with 8-0 vicryl and the ligature knot was placed under the scleral patch graft and the conjunctival defect was sutured. Early intervention helped in successfully healing the conjunctival erosion, reversal of the hypotony and well-controlled IOP. Adequate covering of the entire subconjunctival tube including its ligated part by a patch graft may prevent this complication.