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With the growing popularity of lamellar keratoplasty for selective replacement of diseased corneal tissue, it is important to understand the risk of developing an infection after the procedure. Although lesser than that postpenetrating keratoplasty, the reports on post lamellar keratoplasty infectious keratitis are not negligible. Trends of acute infections arising within 2 months of surgery are a subject of interest. Most of these infections are reported post Descemet’s stripping endothelial keratoplasty with a preponderance of Candida species. A donor to host transmission of infection is not uncommon. Among the Candida cases, about 80% seem to occur due to a donor to host transmission. Infections presenting as or progressing to endophthalmitis lead to a poor visual outcome. Strict aseptic measures and protocols during corneal tissue harvesting, tissue processing, tissue storage and surgery are essential to prevent occurrence of these infections. After the infection has occurred, determining the aetiology and drug susceptibility through microbiological testing is vital. This helps to guide treatment protocols and hence determines final outcome of these cases. Most cases require some form of surgical management for resolution of infection, most often a graft removal and therapeutic keratoplasty. Secondary surgical interventions are performed to restore graft clarity and achieve a good final visual outcome.

Xeroderma pigmentosum is a condition caused due to a defective DNA repair mechanism when exposed to ultraviolet radiation. Many of the patients with this disorder develop severely oedematous cornea with varying degrees of anterior corneal haze, which necessitates a full-thickness keratoplasty or selective endothelial keratoplasty. Presence of corneal oedema suggests that these patients have a dysfunctional endothelium. The purpose of this study is to evaluate the corneal endothelium in the patients with xeroderma pigmentosum when clinical specular microscopy was feasible.Thirteen patients with classic skin changes of xeroderma pigmentosum were included in the study conducted during January 2010-December 2012. An age-matched group of 13 volunteers were included as controls who were emmetropes without any history of ocular or systemic illness. Corneal endothelium was assessed using specular microscopy from the central clear area of cornea.The mean age of the patients with xeroderma pigmentosum was 16.6±7.2 years and that of the controls was 17.4±6.9 years (p=0.78). The number of analysed cells and endothelial cell density were significantly higher in controls (p0.001), whereas the average cell area, coefficient of variation of cell area and maximum cell area were significantly higher in xeroderma pigmentosum (p≤0.007).The specular microscopic findings in patients with xeroderma pigmentosum are suggestive of an accelerated endothelial cell loss. It is pertinent that the treating physicians must be involved in emphasising proper ocular protection from ultraviolet radiation to prevent avoidable blindness from xeroderma pigmentosum.

Aims To evaluate and compare outcomes of Descemet9s stripping endothelial keratoplasty (DSEK) with non-DSEK (nDSEK) in pseudophakic corneal oedema (PCE). Methods The study was a prospective, non-consecutive, comparative, interventional case series. Twenty-six patients with PCE were randomised into two groups. Group 1 comprised of those cases that had undergone conventional DSEK, and group 2 consisted of those that had nDSEK for PCE between 2010 and 2012. The data on demographics and clinical characteristics were collected from all patients. Any intraoperative and early and late postoperative complications were also noted. The primary outcome measure was postoperative functional success. Graft survival and complications were analysed as secondary outcomes. Results The median best-corrected visual acuities at 6 months postoperatively in groups 1 and 2 were 0.18 (IQR 0.10–0.30) and 0.44 (IQR 0.18–0.51), respectively (p=0.11). Corneal oedema cleared in all patients. During the early postoperative period, a patient in group 2 had lenticule detachment managed by rebubbling. Conclusions nDSEK has outcomes similar to DSEK in PCE with advantages of decreased surgical time and avoidance of inadvertent pull on the posterior stromal fibres that may occur during Descemet9s stripping.

Aim To determine the prevalence, risk factors and the severity of visual loss caused by steroid-induced glaucoma (SIG) among children. Methods Five-year records of all paediatric glaucoma cases presenting to the glaucoma services of our tertiary care centre were evaluated. Data of children presenting with SIG were recorded with respect to their visual acuity, highest baseline intraocular pressure, cup:disc ratio, perimetry and need of glaucoma filtering surgery. Parents were interviewed to assess the indication of steroid use, type of steroid used, person prescribing it and the duration of use. The prevalence of visual impairment was calculated based on WHO criteria. Results Of 1259 cases of paediatric glaucoma presenting at our centre over 5 years, 59 children (4.7%) were diagnosed with SIG. Of these, 51 (87%) had been prescribed topical steroids for vernal keratoconjunctivitis (VKC). The median duration of steroid use was 18 months (range 1 month to 8 years). Also, 82% of children with VKC had been prescribed steroids by the treating ophthalmologist and 52% had been on topical steroids for >1 year. Glaucomatous optic neuropathy was the cause of blindness in 37.3% (22/59) and low vision in 23.7% (14/59) children. And 27% (16/59) were unilaterally blind at presentation. Conclusions A third of the children presenting with SIG to our tertiary care centre were bilaterally blind at presentation. Ophthalmologists need to consider steroid-sparing agents to treat VKC and monitor these children closely for glaucoma if they prescribe topical steroids in order to prevent unnecessary childhood blindness.

Background To describe mutations in the transforming growth factor-beta induced ( TGFBI ) gene in Asian patients with Bowman9s membrane as well as stromal corneal dystrophies, and to elucidate their structural implications, using model peptides. Methods Twenty-two unrelated Asian families were examined clinically including visual acuity testing and ocular examination with slit lamp biomicroscopy. Genomic DNA was extracted and the 17 exons of the TGFBI gene were amplified by PCR and sequenced bi-directionally. Biophysical techniques were used to characterise the wild type and mutant model peptides. Results Molecular genetic analysis identified a variety of mutations in our patient series including a novel heterozygous C to A transversion mutation in exon 14 (c.1859C→A), resulting in a substitution of a highly conserved alanine residue by aspartic acid (p.A620D). Clinical presentation in the patient with the p.A620D included subepithelial scarring in addition to the linear branching opacities usually seen with lattice dystrophy. Using model peptides, we showed that A620D mutant peptide alters the secondary structure and conformational stability, and increased amyloid formation. Conclusion A novel mutation (A620D) in transforming growth factor-beta induced protein (TGFβIp) is described, expanding the repertoire of mutations in this protein. Using model peptides, we demonstrated that A→D substitution leads to perturbation of the secondary structure that may be responsible for the amyloid formation in lattice corneal dystrophy.

Cataract surgery in eyes with coloboma can present intraoperative challenges and pose greater risk of complications because of the associated ocular malformations.1 2 There may be associated scleral weakness in the fetal cleft region, zonular deficiency, poor pupillary dilatation and accompanied microphthalmos. In addition, these eyes are to be handled with great caution due to the increased risk of retinal detachment, association of maculopathy and poor surgical results. There are very few reports on the outcomes of cataract surgery in eyes with congenital coloboma owing to its relatively infrequent occurrence. The aim of this study is to describe our experience of cataract surgery in 26 eyes of 25 patients with congenital iridolenticular choroidal coloboma. From January 2009 to December 2010, 25 patients (26 eyes) with congenital iridolenticular choroidal coloboma underwent cataract surgery through the anterior segment route. The charts were reviewed for demographics, extent of coloboma, type and density of cataract, surgical approach, intraoperative surgical details and postoperative outcomes. Biometry was performed using the Ocuscan RxP ophthalmic ultrasound system (Alcon laboratories, Forth Worth, Texas, USA) and a manual keratometer (Bausch and Lomb Keratometer). Axial length measurement was done by locating the patient's preferred fixation point and taking an average of the 10 most accurate axial length readings. …

Conventional endothelial keratoplasty (EK) entails stripping off the Descemet's membrane (DM) and transplantation of the posterior lamellar graft. However, isolated cases published in the literature support the feasibility of EK without stripping the DM in patients with failed grafts.1 2 Based on our observation of favourable outcomes after EK without stripping the DM in patients with no clinical evidence of DM pathology, we hypothesise that Descemet's stripping may be an avoidable intraoperative step in EK for the indications where it is expected to be normal and optically clear. We report our clinical observations in four patients who underwent EK without DM removal for indications other than failed grafts. Four cases where EK was performed without DM stripping are described (table 1). DM removal was deferred in these eyes as there were no clinical features suggestive of altered/pathological DM based on slit-lamp examination and intraoperative evaluation. View this table: Table 1 Clinical information ### Surgical technique The donor graft dissection was done using the Moria microkeratome (Moria/Microtek Inc., Doylestown, Pennsylvania, USA). A 4–5 mm scleral or limbal incision was made and the posterior lamellar graft was inserted using sheets of intraocular lens (IOL) glide …

The Burkholderia cepacia complex is a group of genetically distinct, phenotypically similar, Gram-negative bacteria noted for their environmental versatility. Burkholderia species are implicated in a wide array of disease processes such as pneumonia, sepsis, urinary-tract infection, meningitis and endocarditis. It is intrinsically resistant to aminoglycosides, and first- and second-generation cephalosporins.1 We present the clinical picture and treatment outcomes of Burkholderia keratitis based on a series of four cases. This is a retrospective case series of four patients with culture-positive Burkholderia keratitis seen at a tertiary eye-care centre in India, between January 2006 and January 2008. All patients presented with chief complaints of pain, redness and watering. They …

Keratitis caused by Pseudomonas spp is characterised by a rapidly progressive course, with suppurative infiltrate that results in the breakdown of collagen with subsequent melt and perforation.1 Satellite lesions, which are a characteristic of fungal keratitis,2 have not been described with this organism. We report three cases of culture proven Pseudomonas keratitis that presented with satellite lesions (figures 1 and 2). Figure 1 Slit-lamp photograph (of the right eye) of patient 1 showing satellite lesions. The superior lesion was superficial; others are at a deeper level. Figure 2 Slit-lamp photograph (of the right eye) of patient 2 showing multifocal lesions. All three patients presented with complaints of pain, redness, watering and decrease in vision (table 1). None of them were contact lens wearer. Slit-lamp biomicroscopic examination showed central epithelial defect associated with underlying stromal infiltrate. The surrounding cornea showed intense cellular reaction …