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Purpose: To evaluate the effect of extralesional triamcinolone acetonide (TA) injection in the treatment of small chalazion (diameter ≤ 5 mm). Methods: Prospective interventional clinal study that included patients diagnosed as chalazion of small size not responding to conservative management for at least 2 weeks. All patients were treated with extralesional TA injection (4 mg). Successful resolution of a chalazion was defined as a decrease in size to 1 mm or smaller. Results: Thirty-eight patients were included in the study. The resolution was achieved in 33 (87%) patients. Nineteen (50%) patients had complete resolution after the first injection, and 13 (34.2%) patients had complete resolution after the second injection. Chalazion near the lower punctum needed more times of injections than those elsewhere (P = 0.02). Conclusions: Extralesional TA injection is effective in the treatment of both primary and recurred small chalazia. It is a simple and cost-saving procedure and can be considered an alternative first-line treatment for small chalazion.

Purpose: Prolonged postoperative topical corticosteroids are commonly given after pediatric cataract surgery to control inflammation. This study was undertaken to compare the efficacy, safety, and compliance of postoperative topical steroids and adjunctive intracameral (I/C) triamcinolone acetonide (tricort) and posterior subtenon (PST) triamcinolone in modulating postoperative inflammation after surgery. Methods: Forty-eight eyes of children with pediatric cataract between the ages of 5 and 10 years were randomized into three equal groups (T, I, S) before surgery. Group T received postoperative topical 1% prednisolone tapered over 4 weeks; Group I received adjunctive intraoperative I/C 1.2 mg/0.03 ml tricort and topical 1% prednisolone for 2 weeks postoperatively, and Group S received a single 0.5 ml (40 mg/ml) PST tricort without topical steroids. Signs of inflammation, intraocular pressure (IOP), and central corneal thickness were assessed at day 1, week 1, week 3, week 6, and week 12 postoperatively with optical coherence tomography (OCT) macula to rule out cystoid macular edema at the sixth and 12th weeks postoperatively. Results: Posterior synechiae were present in two eyes out of 16 in groups T and I, which resolved. Severe anterior chamber cells were present in four eyes out of 16 in group T, in two eyes in group I, and in one eye in group S, which resolved. All groups had comparable pre- and postoperative IOP. Conclusion: In pediatric cataracts, outcomes were better with PST tricort and the adjunctive I/C tricort compared to postoperative topical prednisolone, for modulating postoperative inflammation. [ABSTRACT FROM AUTHOR]

Purpose: To study the safety and efficacy of pre-operative suprachoroidal triamcinolone acetonide (SCTA) for achieving reduction/resolution of serous choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD). Methods: This was a prospective, noncomparative, interventional pilot study. All consecutive patients presenting with RD and coexisting CD underwent transconjunctival injection of SCTA before proceeding with vitrectomy/scleral buckle surgery. Sequential ultrasound B scans were performed for assessing the change in height of the CD. Results: The mean age of the cohort was 53.8 ± 10.8 years (range: 39–72 years). The CD was present in a median of 3 quadrants; the cumulative mean CD height was 5.59 mm (range: 2.02–9.42 mm). Following SCTA, a successful response (>50% reduction) was seen in five eyes by day 3 and in two eyes by day 5. Three eyes failed to respond to SCTA and required surgical drainage before proceeding with vitrectomy. No intraprocedural injection-related complications were noted. A transient rise in the intraocular pressure (30 mmHg) was seen in one eye following vitrectomy and was managed successfully with topical antiglaucoma medications. Conclusion: Suprachoroidal administration of triamcinolone appears to be a safe and effective technique to achieve CD resolution in eyes with RRD.

Purpose: To study the safety and efficacy of pre-operative suprachoroidal triamcinolone acetonide (SCTA) for achieving reduction/resolution of serous choroidal detachment (CD) associated with rhegmatogenous retinal detachment (RRD).Methods: This was a prospective, noncomparative, interventional pilot study. All consecutive patients presenting with RD and coexisting CD underwent transconjunctival injection of SCTA before proceeding with vitrectomy/scleral buckle surgery. Sequential ultrasound B scans were performed for assessing the change in height of the CD.Results: The mean age of the cohort was 53.8 ± 10.8 years (range: 39-72 years). The CD was present in a median of 3 quadrants; the cumulative mean CD height was 5.59 mm (range: 2.02-9.42 mm). Following SCTA, a successful response (>50% reduction) was seen in five eyes by day 3 and in two eyes by day 5. Three eyes failed to respond to SCTA and required surgical drainage before proceeding with vitrectomy. No intraprocedural injection-related complications were noted. A transient rise in the intraocular pressure (30 mmHg) was seen in one eye following vitrectomy and was managed successfully with topical antiglaucoma medications.Conclusion: Suprachoroidal administration of triamcinolone appears to be a safe and effective technique to achieve CD resolution in eyes with RRD. [ABSTRACT FROM AUTHOR]

We present a case of persistent macular hole (MH) having an apical diameter of 140 microns and a basal diameter of 530 microns following a combined phacoemulsification and MH surgery. Considering post-operative cystoid macular edema (CME) as the possible reason for the failure of the initial surgery, a trial of IVTA was given. The synergistic effect of mechanical plugging of the hole by TA, coupled with resolution of cystoid changes and falling back of the macular hole resulted in the successful closure of the persistent macular hole with improvement in vision from 20/250 to 20/63.

Dear Editor, With the advent of newer cataract techniques, there has been significant improvement in patients' postoperative (PO) recovery. Precis Here we report a case series of three patients who developed acute central serous chorioretinopathy (CSCR) following cataract surgery using the less-drop approach. [Extracted from the article]

To determine the effect of commonly used intravitreal agents on immediate and long-term IOP elevations and their association, if any, with glaucoma. Literature searches in PubMed and the Cochrane databased in January 2020 yielded 407 individual articles. Of these, 87 were selected for review based on our inclusion criteria. Based on the evidence provided, 20 were assigned level I, 27 level II, and 22 level III. Eight articles were rejected because of poor quality, insufficient clarity, or irrelevance based on standardized protocols set out by the American Academy of Ophthalmology. The studies that reported on short-term IOP elevation (i.e., between 0 and 60 min) showed that an immediate increase in IOP is seen in all patients who receive anti-VEGF agents or triamcinolone acetonide when measured between 0 and 30 min of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection of anti-VEGF agents, while the position of the implant vis-à-vis, the anterior chamber was important for steroid therapy. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. However, some studies demonstrated RNFL thinning in patients receiving chronic anti-VEGF therapy. Most, if not all, intravitreal agents cause ocular hypertension, both in the short term and long term. The functional consequences of these observations are not very clear. [ABSTRACT FROM AUTHOR]

The management of uveitis is challenging for most treating ophthalmologists. The treatment of uveitis often requires the use of high dose of systemic corticosteroid and immunosuppressive agents, which are almost always associated with potential side effects. Intravitreal medications have become a popular mode of drug administration in uveitis patients as they provide high volume of drug to the target tissues, eliminating the risk of systemic toxicity. There has been tremendous development in the intravitreal therapeutics over the last few years. With the advent of sustained-release technique, increasing patient compliance, biodegradable nature of the implant, and introduction of newer agents with better safety profile, the intravitreal medications have become more popular in recent years. This review presents evidence in the scientific literature supporting the use of intravitreal medications for the management of uveitis and its complications.

We present a case of persistent macular hole (MH) having an apical diameter of 140 microns and a basal diameter of 530 microns following a combined phacoemulsification and MH surgery. Considering post-operative cystoid macular edema (CME) as the possible reason for the failure of the initial surgery, a trial of IVTA was given. The synergistic effect of mechanical plugging of the hole by TA, coupled with resolution of cystoid changes and falling back of the macular hole resulted in the successful closure of the persistent macular hole with improvement in vision from 20/250 to 20/63. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical outcome following intraoperative transzonular intravitreal injection of triamcinolone acetonide and moxifloxacin in patients undergoing phacoemulsification cataract extraction with intraocular lens (IOL) implantation.Methods: In this prospective, non-randomized, clinical, interventional study, a total of 200 eyes were enrolled. Patients who voluntarily gave their consent after being informed about dropless cataract surgery along with its pros and cons were included. Those who had glaucoma or were known steroid responders as well as those who were lost to follow-up were excluded. 0.1 ml each of moxifloxacin (500 mg) and triamcinolone acetonide (4 mg) were injected transzonularly following IOL implantation in phacoemulsification cataract surgery with the help of 27G curved cannula. Slit-lamp examination was done to detect cells, visual acuity was noted, and intraocular pressure was measured postoperatively on day 1, 7, 30, 60, and 90.Results: Uncorrected visual acuity (UCVA) greater than 6/9 was achieved in 96% of patients at the end of 3 months. The mean IOP was found to be normal in all the cases at every visit. Twenty patients complained of floaters on postoperative day 1 (D1), which decreased to zero after 60 days (D60). None of the patients needed any eye drop during the entire postoperative period.Conclusion: The study demonstrates that this procedure is advantageous and safe. [ABSTRACT FROM AUTHOR]

Purpose: Triamcinolone acetonide (TA) is an alternative option for diabetic macular edema thanks to its cost-benefit ratio and unique delivery route. We performed this study to compare vitrectomized with nonvitrectomized eyes treated with subtenon TA injection for diabetic macular edema. Materials and Methods: We retrospectively reviewed the medical records of patients who had undergone subtenon TA injection for diabetic macular edema treatment. The patients were divided into two groups: Vitrectomized and nonvitrectomized. Visual acuity and central subfield macular thickness (CSMT) were analyzed before injection, at 1 and 3 months after injection. Results: Visual acuity in vitrectomized group improved significantly at 1 month (P = 0.002), but this improvement regressed after 3 months. In the nonvitrectomized group, visual acuity did not improve significantly after 1 month, but it did after 3 months (P = 0.019). The CSMT decreased significantly in both groups at 1 and 3 months (P < 0.001). There were no significant differences between the groups at either 1 or 3 months with regard to either visual improvement or change in CSMT. Conclusion: Subtenon TA injection could be an alternative treatment option for diabetic macular edema, both in vitrectomized and in nonvitrectomized eyes. TA seems to take effect earlier and decay faster in vitrectomized eyes.

Purpose: To evaluate the eff ect of different aspiration flow rates (AFR) and bottle heights (BH) on vitreous face (AVF) during phacoemulsifi cation.Methods: Experimental study in 20 porcine eyes. Transzonular viscodissection was performed between the posterior capsule(PC) and AVF to dissect out the Berger's space. Triamcinolone acetonide was injected into this space to aid visualization with ultrasound B-Scan(USG). Realtime USG was performed during phacoemulsifi cation. Eyes were divided randomly into-Group I: Low parameters(AFR = 20 cc/min, BH = 90 cm, vacuum = 400 mmHg),and Group II: High parameters (AFR = 40 cc/min, BH = 110 cm, vacuum=650 mm Hg).Results: 15 eyes were analysed (8 in Group I; 7 in Group II). In all eyes, forward and backward movement of the PC was seen when going from foot position 0 to 1, or on occlusion break. Amplitude of these movements was much greater in Group II compared to Group I. There was no PC rupture in either group. In 2 of the 7 eyes in Group II, USG showed a sudden, spontaneous dispersion appearance of sono-opaque echoes in the vitreous cavity alongwith disappearance of the well-defi ned, crescentic stained space despite an intact PC. This suggests rupture of the AVF, leading to dispersion of the triamcinolone into the entire vitreous cavity. No AVF rupture was seen in Group I.Conclusion: We report a rarely described entity of AVF rupture with intact PC. The use of high AFR and BH may have clinically invisible detrimental consequences to the anterior vitreous face. [ABSTRACT FROM AUTHOR]

Pseudophakic cystoid macular edema (PCME) is one of the leading causes of reduced vision, after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drops are frequently used in the management; however, intravitreal injections may be required for chronic cases. Suprachoroidal injection of preservative free Triamcinolone acetonide is a recent addition to the therapeutic armamentarium of ophthalmologists for treatment of cystoid macular edema of varied etiology. Though the drug is commercially available at a reasonable cost, the microneedle is not commonly available. We modified a 26 G needle for safe and cost-effective delivery of preservative-free suprachoroidal triamcinolone acetonide (SCT). In the current series of three patients with non-resolving PCME, macular edema resolved and vision improved over 3 months. [ABSTRACT FROM AUTHOR]

A 68-year-old woman with end-stage Stevens-Johnson syndrome developed cystoid macular edema (CME) 3 months following Boston keratoprosthesis type II (KPro-II) implantation and treated with single-dose injection of triamcinolone acetonide (TA) in the inferior peribulbar region. After 14 days, CME resolved completely, and she regained 20/30 vision. Seven months later, she developed recurrent CME. She was again treated with a similar peribulbar injection of TA. CME was resolved completely after 2 weeks with full visual and anatomical recovery. Here, we present a case of recurrent CME following KPro-II implantation responsive to peribulbar injection of TA, which may be the only effective treatment option. [ABSTRACT FROM AUTHOR]

Keratoconus is a slowly progressive, noninflammatory ectatic corneal disease characterized by changes in corneal collagen structure and organization. Though the etiology remains unknown, novel techniques are continuously emerging for the diagnosis and management of the disease. Demographical parameters are known to affect the rate of progression of the disease. Common methods of vision correction for keratoconus range from spectacles and rigid gas-permeable contact lenses to other specialized lenses such as piggyback, Rose-K or Boston scleral lenses. Corneal collagen cross-linking is effective in stabilizing the progression of the disease. Intra-corneal ring segments can improve vision by flattening the cornea in patients with mild to moderate keratoconus. Topography-guided custom ablation treatment betters the quality of vision by correcting the refractive error and improving the contact lens fit. In advanced keratoconus with corneal scarring, lamellar or full thickness penetrating keratoplasty will be the treatment of choice. With such a wide spectrum of alternatives available, it is necessary to choose the best possible treatment option for each patient. Based on a brief review of the literature and our own studies we have designed a five-point management algorithm for the treatment of keratoconus.

Aims : To represent the effects of transpupillary thermotherapy (TTT) and intravitreal bevacizumab on choroidal metastases and review the literature. Settings and Design : A retrospective, interventional, noncomparative case series. Materials and Methods : A retrospective, interventional, noncomparative case series of five eyes in three patients with choroidal metastases was conducted. Fundus findings of choroidal metastases were divided into two types: Solitary or diffuse type. The size of the tumor was termed small (15 mm diameter). All eyes received one session of TTT followed by 3 weekly intravitreal bevacizumab injections as an adjuvant therapy. The parameters of treatment for TTT were 1.2-3 mm spot size, 150-300 mW, 60 s with the whole lesion covered confluently. The changes in preoperative and postoperative best-corrected visual acuity (BCVA) were recorded. Serial color fundus photography and optical coherent tomography were performed to measure the treatment efficacy. Results : All eight choroidal metastases were solitary type. The size of six tumors was small, the size of one tumor was medium, and the size of one tumor was large. All five eyes of the three patients had improvement of BCVA after treatment. Fundus photos revealed tumor shrinkage and the mean shrinkage percentage was 61.27 ± 21.71%. Optical coherence tomography revealed complete resolution of serous retinal detachment. There was no recurrence after 6 months follow-up. Conclusions : TTT combined with intravitreal bevacizumab injections brought about beneficial effects in reducing tumor size and improving vision in all five eyes of the three patients. Despite the retrospective nature of our study, the absence of control group and the size limitation that, of course, limit the statistical power, TTT combined with intravitreal bevacizumab seems to be efficient in providing another cost-reducing and time-saving treatment option for patients with choroidal metastases. The antineoplastic properties of bevacizumab make it a viable adjunctive therapy. Studies with more cases and a longer follow-up period are warranted.

The retinopathy in association with malaria fever described so far includes retinal hemorrhages, vessel changes, retinal discoloration/whitening and papilledema. Malaria retinopathy has been mostly described in severe cases, associated with Plasmodium falciparum, correlating the patho-physiology of retinal and cerebral manifestations. We report an unusual case of proliferative retinopathy as a manifestation of malaria fever, caused by P. falciparum with no cerebral involvement. The patient had features of unilateral retinal vascular occlusion with proliferative changes and vitreous hemorrhage. To the best of our knowledge, such a case has never been reported so far in the literature. This report highlights the possible occurrence of severe proliferative changes associated with malaria fever, which if diagnosed early can prevent possible blindness.

Purpose: The purpose was to measure the concentrations of various cytokines and growth factors (including vascular endothelial growth factor [VEGF] and pigment epithelium-derived factor [PEDF]) in the vitreous of patients with proliferative diabetic retinopathy (PDR) and to investigate interaction between inflammatory and proliferative factors in the genesis of PDR. Materials and Methods : Vitreous samples from 32 eyes with PDR and 25 eyes without diabetes mellitus and signs of DR (control) were collected. Vitreous concentrations of VEGF, PEDF, monocyte chemotactic protein-1 (MCP-1), interleukin-4 (IL-4), IL-6, IL-8, IL-10, IL-17A, and secretory immunoglobulin A (sIgA) were simultaneously measured using enzyme-linked immunoassay. Results : Vitreous levels of VEGF, PEDF, IL-17A, IL-6, IL-8, IL-4, and sIgA were significantly (Π < 0.05) higher in eyes with PDR compared to control. The concentration of VEGF was more than 17-times higher than in control, and the concentration of PEDF was not changed oppositely and was also higher (1.45-times) compared to control, that may indicate disturbances of compensatory mechanisms in angiogenesis regulation in PDR. Significant (Π < 0.05) positive correlations were observed between vitreous concentrations of VEGF and IL-17ΐ (r = 0.45), VEGF and IL-8 (r = 0.48), VEGF and IL-4 (r = 0.51), PEDF and IL-17ΐ (r = 0.48), PEDF and IL-8 (r = 0.59), MCP-1 and PEDF (r = 0.72), MCP-1 and IL-8 (r0 = 0.45), IL-4 and IL-17ΐ (r = 0.65), IL-4 and IL-8 (r = 0.71), IL-8 and IL-17ΐ (r = 0.59). Conclusions: Significantly raised levels of inflammatory and proliferative factors and numerous positive correlations between them may demonstrate a significant role of activation of vascular proliferation and local inflammation in the pathogenesis of PDR.

Aims: To evaluate the 1-month efficacy of intravitreal triamcinolone acetonide (TA) in treating macular edema secondary to retinal vein occlusion (RVO) that was refractory to intravitreal bevacizumab. Materials and Methods: This retrospective, observational study included 23 eyes from 23 patients with macular edema secondary to RVO. Macular edema that did not respond to two or more consecutive intravitreal bevacizumab injections was treated with intravitreal TA. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared before and one month after TA injection. Results: Fifteen eyes were diagnosed with central RVO, and eight eyes were diagnosed with branch RVO. All patients were previously treated with 2.4 ± 0.6 intravitreal bevacizumab injections. The TA injection was performed, on average, 5.8 ± 1.4 weeks after the last bevacizumab injection. The CFT before TA injection was 516.6 ± 112.4 μm and significantly decreased to 402.3 ± 159.7 μm after TA therapy (P < 0.001). The logarithm of the minimal angle of resolution BCVA was 0.72 ± 0.34 before TA therapy and was not significantly improved by the treatment (0.67 ± 0.35, P = 0.119), despite a decrease in CFT. However, seven eyes (30.4%) had a BCVA gain of one or more lines. Conclusions: Intravitreal TA therapy was beneficial in some patients with macular edema secondary to RVO that was refractory to intravitreal bevacizumab therapy. This study suggests that intravitreal TA should be considered as a treatment option for refractory macular edema.

Aim: To report the "do it yourself" method of converting an existing wired-halogen indirect ophthalmoscope (IO) to a wireless-light emitting diode (LED) IO and report the preferences of the patients and the ophthalmologists. Subjects and Methods: In this prospective observational study, a conventional IO was converted to wireless-LED IO using easily available, affordable electrical components. Conventional and the converted IO were then used to perform photo-stress test and take the feedback of subjects and the ophthalmologists regarding its handling and illumination characteristics. Results: The cost of conversion to wireless-LED was 815/- rupees. Twenty-nine subjects, mean age 34.3 ΁ 10 years with normal eyes were recruited in the study. Between the two illumination systems, there was no statistical difference in the magnitude of the visual acuity loss and the time to recovery of acuity and the bleached vision on photo-stress test, although the visual recovery was clinically faster with LED illumination. The heat sensation was more with halogen illumination than the LED (P = 0.009). The ophthalmologists rated wireless-LED IO higher than wired-halogen IO on the handling, examination comfort, patient′s visual comfort and quality of the image. Twenty-two (81%) ophthalmologists wanted to change over to wireless-LED IO. Conclusions: Converting to wireless-LED IO is easy, cost-effective and preferred over a wired-halogen indirect ophthalmoscope.

Aims: To track citation patterns in ophthalmic journals and contrast them with major medical and surgical journals from 1997 to 2009. In addition, we want to familiarize the ophthalmic community with bibliometrics indices. Materials and Methods: Data retrieved from Institute for Scientific Information and related websites include 2-year journal impact factor JIF, 5-year impact, Eigenfactor score, H-factor, Article Influence score, and SCImago factor. Results: JIF rose steadily around 10% annually in ophthalmic journals, and likewise for major medical and surgical journals. JIF correlated with recent bibliometric indicators like 5-year impact, H index, and SCImago factor but not with Eigenfactor. Ophthalmic journals publishing reviews, basic science, or large volume on broad range of topics ranked at the top for JIF, while subspecialty journals tended to have low JIF. JIF of subspecialty journal Retina rose from 0.740 (rank 23) in 2000 to 3.088 in 2007 (rank 6). Conclusions: JIF tends to rise annually by 10% in medical, surgical, and ophthalmic fields. Journals publishing reviews, basic science, or large volume on broad range of topics rank at the top for JIF. The rapid rise of JIF for Retina unlike other subspecialties that stayed status quo is multifactorial: Change in editorial policies (introduction of review articles and omission of case reports) and technological advances in the retinal field.

The aim of this study was to report a case of atypical toxoplasma retinochoroiditis following intravitreal triamcinolone acetonide (IVTA) injection and to review the literature pertaining to toxoplasma retinochoroiditis following intravitreal injection of corticosteroid. Clinical data were collected from a 64-year-old male who developed toxoplasma retinitis 2 months after IVTA. A review of the literature was conducted to identify additional reports on similar cases. A 64-year-old male, known diabetic with nonproliferative diabetic retinopathy in both the eyes and optic atrophy in the left eye, presented with atypical retinitis inferior to the disc following IVTA. Real-time polymerase chain reaction and serology confirmed the toxoplasma etiology, and the patient was started on anti-toxoplasma therapy along with oral corticosteroid leading to regression of the lesion by 3 months. A high index of suspicion and proper microbiological diagnosis with appropriate antimicrobial therapy can aid in the management of toxoplasma retinochoroiditis following intravitreal injection of corticosteroid. [ABSTRACT FROM AUTHOR]

The management of uveitis is challenging for most treating ophthalmologists. The treatment of uveitis often requires the use of high dose of systemic corticosteroid and immunosuppressive agents, which are almost always associated with potential side effects. Intravitreal medications have become a popular mode of drug administration in uveitis patients as they provide high volume of drug to the target tissues, eliminating the risk of systemic toxicity. There has been tremendous development in the intravitreal therapeutics over the last few years. With the advent of sustained-release technique, increasing patient compliance, biodegradable nature of the implant, and introduction of newer agents with better safety profile, the intravitreal medications have become more popular in recent years. This review presents evidence in the scientific literature supporting the use of intravitreal medications for the management of uveitis and its complications. [ABSTRACT FROM AUTHOR]

We conducted a retrospective review of 11 eyes undergoing eye wall resection between October 1998 and October 2009. The median age of 11 patients was 29 years. Decreased vision (eight) was the most common presenting symptom. Ciliary body medulloepithelioma was the most common clinical diagnosis (six). Medulloepithelioma was the most common histopathological diagnosis (four). The duration of follow-up ranged from 0.5 to 67 months (median 11 months). Three eyes needed to be enucleated in the postoperative period (margin involvement two eyes, recurrence one eye). Postoperative complications among others included retinal detachment (three), vitreous hemorrhage (three), cataract (two), and suprachoroidal hemorrhage (two). To conclude, prognosis of this procedure continues to be guarded needing close postoperative follow-up.

Purpose : To study the optical coherence tomography (OCT) patterns in optic disc pit maculopathy and retinal changes after vitreous surgery. Materials and Methods : Retrospective review of consecutive cases with optic disc pit maculopathy seen at two tertiary eye institutes from January 2005 to June 2009. Results : Twenty-four eyes of 23 patients are included. The presenting visual acuity ranged from 20/400 to 20/20 (median:20/80). The median age at presentation was 24 years (range, 6-57 years). Optical coherence tomography demonstrated a combination of retinoschisis and outer layer detachment (OLD) in 19 (79.17%) eyes, OLD only in 3 (12.5%) eyes and retinoschisis only in 2 (8.33%) eyes. An obvious communication (outer layer hole) between the schisis and OLD was seen in 14 (73.68%) of the 19 eyes with both features. Of the 21 eyes with retinoschisis, schisis was present in multiple layers in 15 (71.43%) and single layer in 6 (28.57%) eyes. Eleven eyes underwent pars plana vitrectomy including creation of posterior vitreous detachment (PVD), fluid-air exchange, low intensity laser photocoagulation at the temporal edge of the optic disc pit and non-expansile perfluoropropane gas (14%) injection. Five (45.45%) of 11 eyes undergoing vitrectomy had complete resolution and 4 (36.36%) eyes had partial resolution of maculopathy. Visual acuity improved in 8 (72.72%) of 11 eyes. Conclusion : Optical coherence tomography demonstrates multiple layer schisis and outer layer detachment as main features of optic disc pit maculopathy. Vitrectomy with PVD induction, laser photocoagulation and gas tamponade results in anatomical and visual improvement in most cases with optic disc pit maculopathy.

Purpose: The purpose of this study was to evaluate the incidence, risk factors, and impact of intraoperative floppy iris syndrome (IFIS) on surgical performance. Materials and Methods : Consecutive cataract surgeries from October 2010 to Feb 2011 (1003 eyes, 980 patients; 568 males, 412 females) were analyzed prospectively. Operating surgeon, masked about medication history, noted the intraoperative details. Cases were identified as IFIS or non-IFIS. Multivariate analysis was performed to find risk factors for IFIS. Results : Prevalence of tamsulosin use among men undergoing cataract surgery was 7.0% (41) with incidence of IFIS 4.78% (48). On multivariate analysis, hypertension (OR: 3.2, 95% confidence interval, 95% CI: 1.39-6.57; P = 0.005), use of tamsulosin (OR: 133.32, 95% CI: 50.43-352.48; P < 0.0001), or alfuzosin (OR: 9.36, 95% CI: 2.34-37.50; P = 0.002) were the factors associated with IFIS. Among men taking tamsulosin (n = 41) and alfuzosin (n = 28), 68.3% and 16.6% developed IFIS, respectively. In subgroup analysis of men on tamsulosin, no factor added to the risk posed by tamsulosin. Seventeen of 944 eyes not exposed to any drug had IFIS (0.018%). On subgroup analysis, only risk factor for IFIS was hypertension (OR: 4.67, 95% CI: 1.63-13.35; P = 0.002). Of 48 IFIS eyes, the surgeon observed increased difficulty in 57.1% (21) and additional measures were required in 9 eyes. Mean operative time was increased in IFIS eyes (11.68 ± 3.46 vs. 10.01 ± 0.22 min; P = 0.001). Surgical outcome was good in all cases. Conclusion : The prevalence of tamsulosin intake and IFIS incidence is higher in India. Current tamsulosin/alfuzosin use and hypertension are important risk factors. IFIS makes the surgery more difficult, significantly prolongs the operative time, and predisposes for other intraoperative complications. However, with appropriate management, final operative outcome is not affected.

Context: Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages. Aims: Evaluating the role of intracameral irrigating solution (0.5% lignocaine + 0.001% epinephrine) in initiating and maintaining the pupillary mydriasis during phacoemulsification. Secondary aims were to observe the effect of surgical time, nucleus density and ultrasound time on mydriasis during the procedure. Settings and Design: The study is a prospective interventional case series, conducted at tertiary care institution. Materials and Methods: Thirty patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. Pupillary diameter was measured serially during surgery and ultrasound time and total surgical time were noted. Statistical Analysis Used: Paired samples student-t test was done to compare means. Spearman correlation coefficient was used to study the effect of various parameters on mydriasis. Results: Thirty eyes completed the study. The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. Duration of surgery, grade of nucleus and ultrasound time had statistically insignificant effect on mydriasis. Conclusions: Intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provides rapid mydriasis which is adequate for safe phacoemulsification and is unaffected by other parameters.

Background: Regular follow up and amblyopia treatment are essential for good outcomes after pediatric cataract surgery. Aim: To study the regularity of follow-up after cataract surgery in children and to gauge the causes of poor compliance to follow up. Subjects: 262 children (393 cataracts) who underwent cataract surgery in 2004-8. Materials and Methods: The children were identified and examined in their homes and a "barriers to follow-up" questionnaire completed. Demographic data collected, visual acuity estimated, and ocular examination performed. Statistical Analysis: SPSS version 19. Results: Of the 262 children, only 53 (20.6%) had been regularly following up with any hospital, 209 (79.4%) had not. A total of 150 (57.3%) were boys and the average age was 13.23 years (Std Dev 5 yrs). Poor follow up was associated with the older age group ( P < 0.001), less education of mother ( P = 0.012), father′s occupation ( P = 0.031), how much money spent on travel ( P = 0.033) and was it paid or free surgery ( P = 0.001). It was not related to gender, numbers of children in family, ordinal status of child, and social strata. Distance and cost were major barriers, as was the inability of the eye care center to communicate the importance of follow up. A prospective follow-up visit showed that 93 children needed Nd: YAG LASER capsulotomy, 5 needed low vision aids, 4 contact lens, and 162 a change of spectacles. The average visual acuity improved in 150 (38.8%) eyes >1 line with regular follow-up. Conclusion: Regular follow-up is important and improves vision; eye care practitioners need to take special efforts to ensure better follow-up.

Aim of Study: To analyze the association between anterior chamber depth (ACD) and age, sex, and body height (BH). Materials and Methods: One thousand four hundred eighty eyes of 1480 adults 40 years of age and older receiving preoperative evaluation for cataract surgery were recruited consecutively from June 1, 2006, to December 31, 2010. ACD was measured with the Zeiss IOLMaster. Univariate and multivariate linear regression models were used to analyze the correlations, and receiving operator characteristic (ROC) curves and the area under the curve (AUC) were used for evaluating the predictability of an ACD less than 2.70 mm. Results: ACD was negatively correlated with age and positively correlated with BH in both univariate and multivariate regression analysis (P < 0.001). Sex was associated with ACD in univariate analysis, but not after adjustment with age and BH. In predicting an ACD less than 2.70 mm, the AUCs of ROC curves for ′age and sex′, ′age and BH′, and ′age, sex, and BH′ were 0.687, 0.689, and 0.689, respectively. Conclusion: Age and BH were independent associating factors of ACD; however, sex was not. Older people and shorter ones likely had shallower ACD, and therefore were predisposed to Primary angle closure glaucoma (PACG). The predictability of ACD by age and BH solely was low, and adding sex did not increase it.

Orbital complications due to ethmoiditis are rare in neonates. A case of orbital abscess due to acute ethmoiditis in a 28-day-old girl is presented. A Successful outcome was achieved following antimicrobial therapy alone; spontaneous drainage of the abscess occurred from the lower lid without the need for surgery. From this case report, we intend to emphasize on eyelid retraction as a sign of neonatal orbital abscess, and to review all the available literature of similar cases.

Many systemic antimicrobials have been implicated to cause ocular adverse effects. This is especially relevant in multidrug therapy where more than one drug can cause a similar ocular adverse effect. We describe a case of progressive loss of vision associated with linezolid therapy. A 45-year-old male patient who was on treatment with multiple second-line anti-tuberculous drugs including linezolid and ethambutol for extensively drug-resistant tuberculosis (XDR-TB) presented to us with painless progressive loss of vision in both eyes. Color vision was defective and fundus examination revealed optic disc edema in both eyes. Ethambutol-induced toxic optic neuropathy was suspected and tablet ethambutol was withdrawn. Deterioration of vision occurred despite withdrawal of ethambutol. Discontinuation of linezolid resulted in marked improvement of vision. Our report emphasizes the need for monitoring of visual function in patients on long-term linezolid treatment.

Context: Severe pediatric ocular injury remains a frequent and difficult problem. Vitrectomy is a major technique that has been used to manage severely damaged eyes. However, limited follow-up studies exist currently. Aims: To evaluate the clinical features and predictive factors of visual and anatomic outcomes in Eye Injury Vitrectomy Study (EIVS). Settings and Design: Retrospective, consecutive, interventional case series. Materials and Methods: Reviewing and analyzing records of children, aged 15 years or younger, who had undergone vitrectomy for eye injuries in EIVS database between January 1997 and December 2009. Statistical analysis used: Descriptive analyses and multiple Logistic regressions were employed for all variables using SPSS software (version 17.0, SPSS Inc.). Results: Eighty-seven children (89 eyes) with more than 6 months follow-up and complete records identified in EIVS were included in this study. Average follow-up was 12.7 months. The mean age was 9.4 ± 3.8 years. Seventy-seven eyes (86.5%) had open globe injuries, and 12 (13.5%) had closed globe injuries. Seventeen eyes (19.3%) presented with endophthalmitis. Seventy-five eyes (88.2%) presented with visual acuity of 4/200 or worse; however, 42 eyes (47.7%) achieved 4/200 or better vision with anatomical restoration after vitrectomy. Multiple analysis showed that choroidal damage, large scleral wound, and endophthalmitis were significantly associated with unfavorable outcome, the OR values were 16.7 (95% CI: 2.7-102.4, P = 0.002), 10.9 (95% CI: 1.7-71.6, P = 0.013), and 6.6 (95% CI: 1.0-42.4, P = 0.048), respectively. Conclusions: Vitrectomy intervention resulted in favorable visual and anatomic outcomes in almost half of the injured eyes. Choroidal damage, large scleral wound, and endophthalmitis were the prognostic indicators of unfavorable outcome.

Aims: To assess and compare the optical quality of the myopic and hyperopic implantable collamer lens (ICL) from its wavefront aberrations for different powers and pupil diameters. Settings and Design: Prospective study. Material and Methods: The wavefront aberrations of two myopic (−3 and −6 diopters (D)) and two hyperopic V4b ICLs (+3 and +6D) were measured in vitro. To assess and compare the optical quality of different powers of ICLs, we analyzed the root mean square (RMS) of total higher order aberrations (HOAs), trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration at 3- and 4.5-mm pupil. In addition, the point spread functions (PSFs) of each ICL evaluated were calculated from the wavefront aberrations at 3- and 4.5-mm pupil. Statistical Analysis: A Student′s t-test for unpaired data was used for comparison between myopic and hyperopic ICLs. Results: Myopic ICLs showed negative spherical aberration, in contrast hyperopic ICLs showed positive spherical aberration, which increases when the ICL power increases, due to the innate optical properties of the lens. All ICLs evaluated had negligible amounts of other aberrations. We did not find statistical significant differences in any Zernike coefficient RMS values analyzed between myopic and hyperopic ICLs at 3- and 4.5-mm pupil (P > 0.05). Conclusions: Myopic and hyperopic ICLs provide good and comparable optical quality for low to moderate refractive error. The ICLs evaluated showed values of wavefront aberrations clinically negligible to affect the visual quality after implantation.

Background: Studies done on the prevalence of glaucoma have reported a high proportion of undiagnosed patients. Late diagnosis is related to increased risk of glaucoma associated with visual disability. Lack of awareness and non-availability of appropriate screening procedures are among the major reasons for non-diagnosis or late diagnosis of glaucoma. The present study has been undertaken to evaluate the level of awareness about glaucoma among the North Indian rural population. Materials and Methods: A group-administered, questionnaire-based survey, involving 5000 rural residents (aged 20 and above) was conducted through random sampling. The questionnaire was structured to evaluate the level of awareness and knowledge about glaucoma and the effect of gender, education status, and glaucoma diagnosis was also studied. The source of awareness about glaucoma was also questioned. Results: Of the 5000 individuals enrolled for the survey, responses from 4927 (98.5%; 95% Confidence Interval (CI): 98.2 - 98.9) participants, including 3104 males (63%; 95% CI: 61.7 - 64.3) and 1823 females (37%; 95% CI: 35.7 - 38.3) were evaluated. A total of 409 (~8.3%; 95% CI: 7.6 - 9.14) respondents were aware about glaucoma and only 93 (1.89%; 95% CI: 1.55 - 2.31) were qualified as having knowledge about glaucoma as per the set questionnaire. Education was the only variable significantly correlated (P value < 0.001) with the awareness and knowledge of glaucoma out of the parameters included in this study. Close acquaintance with a glaucoma patient was the most common source of information. Conclusions: There is a lack of awareness about glaucoma among the rural residents of North India. The study findings stress the need to spread awareness about glaucoma for prevention of glaucoma-related blindness.

Objective: To investigate the correlations between aqueous concentrations of vascular endothelial growth factor (VEGF), monocyte chemoattractant protein-1 (MCP-1), soluble intracellular adhesion molecule-1 (sICAM-1) and diabetic macular edema (DME). Materials and Methods: VEGF, MCP-1 and sICAM-1 concentrations in aqueous humor samples of 22 patients with DME and 23 patients with cataract of a control group were measured with solid-phase chemiluminescence immunoassay. Results: Aqueous VEGF (89.2 ± 58.5 pg/ml versus 48.5 ± 27.8 pg/ml, P = 0.006), MCP-1 (684.2 ± 423.4 pg/ml versus 432.4 ± 230.4 pg/ml, P = 0.019) and sICAM-1 (3213.8 ± 2581.6 pg/ml versus 260.2 ± 212.2 pg/ml, P < 0.001) all vary significantly between DME group and control group. Maximum height of submacular fluid measured by Optical coherence tomography (OCT) was significantly associated with aqueous sICAM-1 (r = -0.45, P = 0.034). The maximum height of macular thickness measured by OCT was not significantly associated with either VEGF (P = 0.300), MCP-1 (P = 0.320) or sICAM-1 (P = 0.285). Conclusions: Our results suggest that sICAM-1 may majorly contribute to the formation of subretinal fluid in DME patients and imply that MCP-1 and sICAM-1 may be the potential therapy targets, besides VEGF.

Purpose: To evaluate corneal biomechanical properties in eyes that has undergone penetrating keratoplasty (PK). Materials and Methods: Retrospective observational study in a tertiary care centre. Data recorded included ocular response analyzer (ORA) values of normal and post-keratoplasty eyes [corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated intraocular pressure (IOPg), and cornea-compensated intraocular pressure (IOPcc)], corneal topography, and central corneal thickness (CCT). Wilcoxon signed rank test was used to analyze the difference in ORA parameter between post-PK eyes and normal eyes. Correlation between parameters was evaluated with Spearman′s rho correlation. Results: The ORA study of 100 eyes of 50 normal subjects and 54 post-keratoplasty eyes of 51 patients showed CH of 8.340 ± 1.85 and 9.923 ± 1.558, CRF of 8.846 ± 2.39 and 9.577 ± 1.631 in post-PK eyes and normal eyes, respectively. CH and CRF did not correlate with post-keratoplasty astigmatism (P = 0.311 and 0.276, respectively) while a significant correlation was observed with IOPg (P = 0.004) and IOPcc (P < 0.001). Conclusion: Biomechanical profiles were significantly decreased in post-keratoplasty eyes with significant correlation with higher IOP as compared with that in normal eyes.

Rhodotorula mucilaginosa rarely cause keratitis in immunocompromised individuals. A 30 year old male with history of minor trauma presented with cotton wool like stromal infiltration and hypopyon in left eye. Microbiological examination of corneal scraping showed fungal hyphae and yeast cells in direct smear. Molecular identification of the organism was performed which showed 100% homology with Rhodotorula mucilaginosa. Management of these cases is difficult often necessitating surgical procedures. However further reports are necessary to understand the disease and establish a treatment protocol.

Purpose: To determine the effect of a capsular tension ring (CTR) implantation in preventing posterior capsular opacification (PCO) after cataract surgery in patients with high myopia. Materials and Methods: In this prospective single-surgeon standardized-surgical-procedure fellow-eye comparison trial, 34 patients with high myopia had phacoemulsification surgery. Although one eye received an acrylic intraocular lens (IOL) and CTR, other eye received only an IOL as control. PCO, within the capsulorhexis overlap, was documented by standardized digital retroillumination images at least 2 years post-operatively, and the percentage area of PCO was scored (scale 0%-100%) using the POCOman software system. The PCO score and the incidence of neodymium-doped yttrium aluminum garnet (Nd: YAG) capsulotomy of groups, and correlations between PCO score and presence of CTR, age, phaco time, refraction, and axial length (AL) were determined. Results: The mean time interval from surgery to PCO measurement was 43.4 ± 11.2 months for the eyes with a CTR and 43.1 ± 11.6 months for the controls (P = 0.91). The PCO score of the eyes with a CTR was significantly lower than in the controls (5.9 ± 4.3 vs. 22.3 ± 12.2, respectively; P < 0.001). There were statistically insignificant correlations between PCO score and pre-operative refraction (r = 0.02; P = 0.90), AL (r = 0.03; P = 0.80), phaco time (r = 0.11; P = 0.53), and patient′s age (r = 0.23; P = 0.55). No patient with a CTR had a Nd: YAG laser capsulotomy, but it was six in controls (P = 0.025). Conclusions: CTR implantation seems to be effective in reducing the PCO and Nd: YAG laser capsulotomy rates in high myopic eyes.

Pellucid marginal degeneration (PMD) is an uncommon cause of inferior peripheral corneal thinning disorder, characterized by irregular astigmatism. We analyzed a case of bilateral PMD patient and treated one eye with corneal collagen cross-linking (CXL) therapy. Corneal topography was characteristic for PMD. Visual acuity, slitlamp examinations, tonometry, and corneal thickness were observed. Simulated keratometric and topographic index values were detected with corneal topography. Uncorrected, LogMAR visual acuity has improved from +0.8 to +0.55 during the 6 months and +0.3 during the 8 months follow-up after CXL. Pachymetry values and intraocular pressure showed no changes. Keratometric values and topografic indexes disclosed no progression of the disease. CXL may postpone or eliminate the need of corneal transplantation in cases with PMD.

Introduction : Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS) approach with a standard paralimbal strabismus surgery (SPSS) approach in terms of post-operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS), and drop intolerance (DI) on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS). Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon′s signed rank test. Results: On the first post-operative day, only FBS (P = 0.01) and TIS (P = 0.04) showed significant difference favoring MISS. At 2-3 weeks, redness (P = 0.04), congestion (P = 0.04), FBS (P = 0.02), and TIS (P = 0.04) were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04) and TIS (P = 0.05) were significantly less. Conclusion: MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period.

A 26-year-old male presented to us with defective vision in the left eye. He had best corrected visual acuity (BCVA) of hand movement (HM) in right eye and 6/9 in left eye. He had ptosis with ectropion in both eyes and relative afferent pupillary defect (RAPD) in right eye. Intraocular pressure (IOP) was 46 and 44 mmHg in right and left eye, respectively. Fundus showed glaucomatous optic atrophy (GOA) in right eye and cup disc ratio (CDR) of 0.75 with bipolar rim thinning in left eye. Systemic examination showed hyperextensible skin and joints, acrogeria, hypodontia, high arched palate, and varicose veins. He gave history of easy bruising and tendency to fall and history of intestinal rupture 5 years ago for which he had undergone surgery. He was diagnosed as a case of Type IV Ehler-Danlos syndrome (EDS) with open angle glaucoma. He underwent trabeculectomy in both eyes. This is a rare case that shows glaucoma in a patient of EDS Type IV. Very few such cases have been reported in literature.

Aim: To provide the normative data of macular and retinal nerve fiber layer (RNFL) thickness in Indians using spectral domain OCT (Spectralis OCT, Heidelberg Engineering, Germany) and to evaluate the effects of age, gender, and refraction on these parameters. Design: Observational, cross-sectional study. Materials and Methods: The eyes of 105 healthy patients aged between 20-75 years, with no ocular disease and best corrected visual acuity of 20/20, were scanned using standard scanning protocols by a single examiner. Exclusion criteria included glaucoma, retinal diseases, diabetes, history of prior intraocular surgery or laser treatment. The mean macular and RNFL thickness were recorded, and the effects of age, gender, and refraction on these parameters were evaluated. This data was compared with published literature on Caucasians to assess the ethnic variations of these parameters. Results: The normal central foveal thickness in healthy Indian eyes measured using Spectralis OCT was 260.1 ± 18.19 ΅m. The nasal inner quadrant showed maximum retinal thickness (338.88 ± 18.17 ΅m).The mean RNFL thickness was 101.43 ± 8.63 ΅m with maximum thickness in the inferior quadrant. The central foveal thickness showed a gender-based difference (P = 0.005) but did not correlate significantly with age (P = 0.134), whereas the parafoveal, perifoveal thickness, macular volume, and RNFL thickness showed significant negative correlation with age. Conclusions: Our study provides the normative database for Indians on Spectralis OCT. It also suggests that age should be considered while interpreting the macular thickness and RNFL, whereas gender should also be given consideration in central foveal thickness.

Fibrous histiocytomas (FHs) are mesenchymal tumors that may be benign or malignant. Ocular involvement by FHs is infrequent and primarily limited to the orbit. Rarely, FHs can also involve the conjunctiva and perilimbal area. We report the case of a 38-year-old male with lid, conjunctival, and neck FHs. The diagnosis was confirmed by histopathology.

Purpose: To investigate the effect of optic neuritis (ON), ischemic optic neuropathy (ION) and compressive optic neuropathy (CON) on multifocal visual evoked potential (mfVEP) amplitudes and latencies, and to compare the parameters among three optic nerve disorders. Materials and Methods: mfVEP was recorded for 71 eyes of controls and 48 eyes of optic nerve disorders with subgroups of optic neuritis (ON, n = 21 eyes), ischemic optic neuropathy (ION, n = 14 eyes), and compressive optic neuropathy (CON, n = 13 eyes). The size of defect in mfVEP amplitude probability plots and relative latency plots were analyzed. The pattern of the defect in amplitude probability plot was classified according to the visual field profile of optic neuritis treatment trail (ONTT). Results: Median of mfVEP amplitude (log SNR) averaged across 60 sectors were reduced in ON (0.17 (0.13-0.33)), ION (0.14 (0.12-0.21)) and CON (0.21 (0.14-0.30)) when compared to controls. The median mfVEP relative latencies compared to controls were significantly prolonged in ON and CON group of 10.53 (2.62-15.50) ms and 5.73 (2.67-14.14) ms respectively compared to ION group (2.06 (-4.09-13.02)). The common mfVEP amplitude defects observed in probability plots were diffuse pattern in ON, inferior altitudinal defect in ION and temporal hemianopia in CON eyes. Conclusions: Optic nerve disorders cause reduction in mfVEP amplitudes. The extent of delayed latency noted in ischemic optic neuropathy was significantly lesser compared to subjects with optic neuritis and compressive optic neuropathy. mfVEP amplitudes can be used to objectively assess the topography of the visual field defect.

We report a 32-year-old male who presented with blurring of vision in the right eye since 1.5 years. He had history of swelling over the extensor surfaces of large joints which were migratory in nature. Few of them spontaneously subsided following suppuration of chalky white discharges except over the gluteal region. Ophthalmological examination revealed visual acuity of counting fingers (CF) at 1 m in the right eye and perilimbal conjunctival calcific deposits and retinal angiod streaks in both eyes. There was choroidal neovascular membrane with subretinal hemorrhage in right eye, confirmed by fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). B scan ultrasonography and simultaneous vector A scan detected calcification of the subretinal neovascular membrane and the adjoining sclera.

Purpose: To compare the results of intracameral dexamethasone and intracameral triamcinolone acetonide injection in patients that underwent cataract surgery with phacoemulsification. Materials and Methods: Sixty eyes of 60 patients that underwent cataract surgery with phacoemulsification were randomized into two groups. Preoperative visual acuity of all patients was 0.5 or lower and intraocular pressures were under 21mmHg. After surgery, eyes in group 1 (30 eyes) were injected with 0.4 mg/0.1 ml dexamethasone into the anterior chamber, and eyes in group 2 (30 eyes) were injected with 2 mg/0.05 ml triamcinolone acetonide into the anterior chamber. All eyes received standard postoperative prednisolone acetate and moxifloxacin eye drops. The biomicroscopic evaluation, visual acuity, and intraocular pressure measurements were done at baseline (preoperatively) and on postoperative days 1, 7 and 30. Results: There were no statistically significant differences in mean visual acuity, the amount of anterior cells and flare between the two groups (P ≥ 0.05). Mean intraocular pressure values at postoperative first day were significantly higher in group 2 than in group 1 (P = 0.009). The mean intraocular pressures on days 7 and 30 after surgery were not statistically different between the two groups (P ≥ 0.05). Conclusions: Intracameral dexamethasone and intracameral triamcinolone acetonide were similarly effective in controlling postoperative inflammation following phacoemulsification. However, the intraocular pressures on postoperative first day were higher in patients receiving intracameral triamcinolone acetonide. The highest intraocular pressure in triamcinolone acetonide group was 24 mmHg, and stabilized in a few days, therefore using triamcinolone acetonide may impose a minimal risk to patients. Nevertheless, intracameral dexamethasone seems to be a better alternative to apply at the end of surgery to suppress the inflammation during the first 24 hours.

Purpose: To evaluate the efficacy of a sleeve technique during endoscopic dacryocystorhinostomy (DCR) in primary nasolacrimal duct obstruction (NLDO) patients with a high lacrimal sac. Materials and Methods: The medical records of 45 patients (49 cases) undergoing endoscopic DCR for primary NLDO with a high lacrimal sac were retrospectively reviewed. In 19 patients (21 cases), the thick maxilla covering the common canalicular opening was removed using a drill and a bicanalicular silicone tube was inserted (group 1). In 26 patients (28 cases), instead of removal of the thick maxilla, a sleeve was inserted into the bicanalicular silicone tube (group 2). At 6 months postoperatively, the success rate was evaluated and the size of the intranasal mucosal ostium was measured. Results: The success rates in group 1 and 2 was 90.5% and 96.4%, respectively (P = 0.400). The intranasal mucosal ostium in group 1 and 2 measured 1.7 ± 0.7 mm and 3.1 ± 1.0 mm, respectively, and the difference was significant (P = 0.042). Conclusions: In primary NLDO patients with a high lacrimal sac, DCR inserting a silicone tube and a sleeve together had a satisfactory success rate without using a drill. In comparison with traditional surgical methods, it helped enlarge the size of the intranasal mucosal ostium.