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Purpose: To assess the visual and clinical outcomes after bilateral implantation of the novel extended depth of focus (EDOF) (AcrySof IQ Vivity) intraocular lens (IOL) using a micromonovision strategy. Methods: This was a prospective interventional study at a tertiary care center. Twenty patients (40 eyes) underwent bilateral implantation of AcrySof IQ Vivity IOL. Twelve weeks postoperatively, both uncorrected vision and corrected vision were assessed. Uniocular and binocular defocus curves with and without correction were noted subjectively as well as objectively on I-trace. Contrast sensitivity was assessed with a FACT (Functional Acuity Contrast Testing) machine, and objective parameters like modulation transfer function and Strehl ratio were also measured on I-Trace. Subjective quality of vision using a subjective questionnaire was also evaluated. Results: The mean binocular postoperative uncorrected distance visual acuity in LogMAR was -0.03 ± 0.09, the uncorrected intermediate visual acuity was 0.03 ± 0.09, and the uncorrected near visual acuity was 0.28 ± 0.18. All defocus curves were smooth and broad with the uncorrected defocus curve (with the micromonovision strategy) better than the corrected defocus curve. The subjective depth of focus (DOF = 3.73) was more than objective DOF (1.93) (P < 0.05). Photopic contrast was better than mesopic at all frequencies. All aberrations increased at 5 mm pupil size compared to 3 mm pupil size and were statistically significant, except for the total eye spherical aberration, which shows no significant difference at 3 mm and 5 mm pupil size (P = 0.27). Spectacle independence for distance, intermediate, and near was achieved in 100%, 94.7%, and 94.7% cases in this study, respectively. Conclusions: Using the micromonovision strategy, the visual performance of this novel EDOF IOL was outstanding both subjectively and objectively. [ABSTRACT FROM AUTHOR]

Aim: To report clinical experience and the comparative value of axial and instantaneous topography data in fitting Rose-K design contact lenses in moderate and severe keratoconus. Materials and Methods: Thirty-eight eyes (of 23 patients) with keratoconus were fitted with Rose-K design contact lenses and followed up for at least six months or more. Visual acuity with habitual vision correction available was measured. Axial and instantaneous topography maps for each eye were recorded. Contact lens wear comfort was graded on a ten point rating scale every three months. Results: Fourteen (100%) moderate keratoconus eyes (average Sim K 48.61 ± 1.24D) and 23 of 24 (96%) of severe keratoconus eyes (average Sim K 60.88 ± 5.31D) were successfully fitted with the Rose-K lenses. Final fit contact lenses in severe keratoconus had statistically significant steeper base curves compared to average axial corneal curvature than in moderate keratoconus eyes. Average simulated corneal curvature on axial maps predicted final fit contact lens base curves significantly better than on instantaneous maps. Thirty-three of the 37 eyes fitted with contact lenses maintained wear comfort over average follow up period of 13 ± 3.5 months. Conclusions: Rose-K design rigid contact lenses are successful in visually rehabilitating 100% of moderate and 96% of severe keratoconus eyes. Most patients (90%) maintained contact lens wear comfort. Corneal curvature on axial maps is a better predictive of base curve of final fit contact lens.

Purpose: To evaluate and compare impression smear with the conventional mechanical corneal scraping by potassium hydroxide (KOH) method in the diagnosis of fungal keratitis. Materials and Methods: Fifty consecutive cases of clinically suspected fungal keratitis were included. Under topical anesthesia, impression smear was obtained from the lesion, followed by the conventional mechanical scraping and both were transferred to sterile glass slides. The slides were examined under direct microscopy with KOH 10% wet mount. Impression smear KOH was compared with the scraping KOH and culture. Results: The KOH smear was positive in 36 (72%) patients with impression smear technique and positive in 35 (70%) patients from corneal scrapings. Sensitivity of impression smear technique as compared to scraping was 97.14%, specificity 92.86%, positive predictive value 94.4%, negative predictive value 92.86%, false positive rate 5.56%, false negative rate 7.14% and accuracy was 94%. As compared to culture, the sensitivity was 100%, specificity 46.67%, positive predictive value 55.56%, negative predictive value 100%, false positive rate 53.33%, false negative rate 0% and accuracy was 68%. Conclusion: Impression smear KOH examination is comparable to conventional mechanical corneal scraping KOH examination in making a tentative diagnosis of fungal keratitis and can be accurately relied upon for initiating anti-fungal therapy.

Purpose: To study the efficacy and safety of low dose topical Mitomycin C (MMC) in severe Vernal keratoconjunctivitis (VKC). Design: Placebo controlled double masked randomized clinical trial. Materials and Methods: Twenty-eight patients with severe VKC were randomly assigned to receive either topical MMC (0.01%) (n=17) or distilled water (n=11) three times daily for a period of two weeks. Signs and symptoms were recorded on day of presentation and at the end of treatment period (2 weeks). Mann Whitney test was used to analyze the signs and symptoms in the two groups. Results: No statistically significant difference was observed in terms of severity of symptoms at presentation. At two weeks patients in the MMC group showed significant decrease in tearing, foreign body sensation, discharge, hyperemia, punctate keratitis, limbal edema and trantas spots. No adverse effect of MMC was observed. Conclusion: Short term low dose topical MMC is an effective and safe drug to control acute exacerbations in patients of severe VKC refractory to conventional treatment.

Purpose: To evaluate the measure of intraocular pressure (IOP) in patients with scarred corneas obtained from the affected and non-affected areas. Materials and Methods: Eighteen patients with small maculo-leucomatous corneal opacity following microbial keratitis were prospectively included in the study. Goldmann applanation tonometry was done first on the non-affected corneal surface. ProTon tonometry (PT) was then carried out on the same eye, to obtain IOP measurements from the non-affected (PT1) and the affected area (PT2) of the cornea. The IOP measurements were compared using a two-tail paired t test. Results: The mean of IOP measurements of PT 2 and PT1 was 22 mm of Hg (SD ± 5.2) and 14.8 mm of Hg (SD ± 5.4), respectively. The higher reading of PT2 was statistically significant ( P < 0.001). The mean Goldmann applanation tonometry was 14.6 mm of Hg (SD 5.4) and it did not differ significantly ( P = 0.86) from the PT1 readings of 14.8 mm of Hg (SD 5.4). Conclusion: In patients with maculo-leucomatous corneal opacity, determination of IOP by ProTon tonometer varies from the affected to the non-affected area. The ProTon tonometer overestimates the level of IOP when it is applied to a leucomatous corneal opacity.

PURPOSE: Clinical comparison of intraocular pressure (IOP) measured with the Goldmann applanation tonometer (GAT), the ProTon tonometer (PT), and the Schiotz tonometer (ST), in normal eyes, eyes with scarred corneas and postkeratoplasty eyes. MATERIAL AND METHODS: The IOP readings with GAT, PT, and ST were compared in 125 eyes with normal corneas (Group A), 17 eyes with scarred corneas (Group B), and in 21 postkeratoplasty eyes (Group C). The data were statistically analysed at 95% confidence interval; linear regression analysis and paired t-test were done. RESULTS: The mean differences and their standard deviation [SD] between GAT and PT readings, and GAT and ST readings respectively were: [1] in Group A: -0.23 [SD 2.75] mmHg and +0.24 [SD 3.18] mmHg respectively; [2] in Group B: -1.8 [SD 12.67] mmHg and -4.5 [SD 9.95 mmHg; and [3] in Group C: +0.24 [SD 8.72] mmHg and -0.12 [SD 8.7] mmHg. They were not statistically significant. In Group A the 95% confidence interval between GAT and PT readings was -5.27 mmHg to 5.73 mmHg, and between GAT and ST readings, -6.12 mmHg to 6.59 mmHg. Ninety six [77%] eyes with the PT and 84 [69%] eyes with ST measurements were within 3 mmHg of GAT pressure. The correlation coefficients [r] for PT and ST were 0.93 [P = 0.0000] and 0.88 [P = 0.0000] respectively. In Group B 95% confidence interval between GAT and PT readings was -27.17 mmHg to 23.51 mmHg, and between GAT and ST measurement, -24.37 mmHg to 15.44 mmHg. The correlation coefficients [r] for the PT and ST were 0.112 [P = 0.660] and 0.630 [P = 0.006] respectively. In group C, the 95% confidence interval between GAT and PT measurements was -17.20 mmHg to 17.67 mmHg, and between GAT and ST measurements, -17.51 mmHg to 17.27 mmHg. The correlation coefficients [r] for the PT and the ST were 0.780 [P = 0.0000] and 0.740 [P = 0.0001] respectively. CONCLUSIONS: In clinical practice PT appears to have a higher level of accuracy than ST in normal corneas. In scarred corneas and post-penetrating keratoplasty eyes, because of high SD for mean differences and wide confidence interval of 95%, both PT and ST are inaccurate in measuring IOP as compared to GAT in such eyes.

A case of destructive ocular myiasis resulting in complete loss of the globe in two days time is documented. To the best of our knowledge this is the first report of such a severe involvement in a healthy and non-compromised host. Mechanical removal and good local hygiene helped heal the wound. The larvae were isolated to be that of Chrysomyia bezziana (screwworm fly). This is possibly the first report of destructive ocular myiasis caused by Chrysomyia bezziana from the Indian subcontinent and the second in world literature. Infestation of human eyes with larvae of flies (myiasis) has been reported. Serious consequences of destructive myiasis are seen in emaciated and diseased patients. Only one report of total destruction of the globe by maggots of Chrysomyia bezziana exists in the literature. As in previous communications, the patient in this report had no predisposing factors both systemic and local. We here in document a case of orbital myiasis leading to rapid destruction of the globe within two days in a healthy and a non-compromised patient.

We examined 23 consecutive cases of unilateral aphakia reporting to the contact lens office for endothelial count and morphology, corneal thickness and toricity. The fellow eye served as a control in all the cases. It was found that there is a significant drop in the central endothelial cell density, and change in the size and shape of the cells. These observations indicate a thermodynamically unstable state. The aphakic corneas were thicker than the controls but not to a significant extent. The cell count and pachymetry had no statistical correlation. Toricity of the aphakic corneas make successful fitting of a lens difficult. Since prolonged use of extended wear gas permeable as well as hydrogel lenses have a deleterious effect on the endothelium it is suggested that a careful case selection be made and strict monitoting carried out at follow up. These corneas are liable for decompensation with only mild noxious stimuli. This article is intended to acquaint the ophthalmologist with the pitfalls in aphakic contact lens fitting so that a cautious follow up may be planned.

Seborrheic keratosis can simulate a malignant melanoma and should form the differential diagnosis of a malignant melanoma. Histopathology is confirmatory.

Purpose: To evaluate the patient demographics and morphological characteristics of corneal endothelium by in vivo confocal microscopy (IVCM), in patients with Iridocorneal Endothelial (ICE) Syndrome.Methods: In this retrospective observational series, IVCM acquired endothelial images of patients with ICE syndrome were evaluated. 'ICE cells' morphology was classified as "-" or "+" if they were larger or smaller than contralateral normal endothelium. It was correlated with patient demographics and clinical manifestations.Results: IVCM was performed on 41 eyes of 21 patients, with 13 males (62%) and 8 females (38%). The disease was unilateral in 19 (90.5%) and bilateral but asymmetric in two (9.5%) patients. Total ICE was seen in 91% eyes. Eighty percent patients (12 out of 15) with ICE-cells were males while 83.3% (5 out of 6) patients with ICE + cells were females. Mean age of patients with ICE- cell type and ICE + cell type was 45.8 ± 17.8 years and 40.3 ± 9.2 years respectively (P = 0.02). Both ICE - and ICE + eyes had similar incidence (33.3%) of corneal edema. ICE + eyes had more severe (grades 2/3) glaucoma (n = 5/6 eyes, 83.3%) compared to ICE - eyes (n = 8/15 eyes, 53.3%).Conclusion: A male preponderance, predilection of ICE - and + cell variants for male and female gender respectively, lack of association of the endothelial cell morphology with corneal edema, and apparent association of ICE + phenotype with more severe glaucoma occurring at a relatively younger age, are some novel findings of the present study. In the clinical setting correlation of patient demographics with these IVCM findings may help in better long-term prognostication of eyes with ICE syndrome. [ABSTRACT FROM AUTHOR]

The effects of long term wear of PMMA contact lenses on the corneal endothelium used on a daily wear basis were determined by examining 8 patients who had been prescribed lenses in one eye only. The patients excluded unilateral aphakes. It was found that a significant reduction in the cell density and a change in the cell size and shape was induced by PMMA lenses. These changes reflect an endothelial metabolic stress and emphasize the need to find newer lens materials that are more oxygen permeable and produce little interference with the corneal metabolism.