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Context: Chemical injury to eyes causes limbal stem cell deficiency (LSCD), which leads to conjunctival epithelium and underlying stromal changes. Simple limbal epithelial transplant helps to restore corneal epithelium and corneal stromal clarity. These changes are documented in this prospective eye study. Purpose: To report the changes in epithelial/stromal (E/S) reflectivity ratio and corneal stromal densitometry following simple limbal epithelial transplantation (SLET) in patients with unilateral chemical burn-induced LSCD. Methods and Material: It is a prospective imaging study of cornea before and after SLET. Corneal densitometry with Pentacam and epithelial and stromal reflectivity on anterior segment optical coherence tomography were analyzed for five patients (n = 5 eyes), who underwent autologous SLET for unilateral chemical burn-induced LSCD. Statistical Analysis Used: Mann–Whitney U-test and Pearson correlation. Results: A significant improvement in E/S reflectivity was noted at 1 month (P < 0.05) after SLET, and this was maintained until the end of 6 months. The densitometry measurements decreased in the entire cornea at every level, that is, anterior, central, and posterior cornea. However, the values did not normalize till the last follow-up at 6 months. Conclusions: A trend of normal corneal epithelization exists in eyes undergoing SLET. Densitometry at all the levels, the anterior, central, and posterior cornea, also decreases after SLET. SLET improves visual outcomes in LSCD eyes not only by epithelization but also by reducing stromal scarring. [ABSTRACT FROM AUTHOR]

Context: Chemical injury to eyes causes limbal stem cell deficiency (LSCD), which leads to conjunctival epithelium and underlying stromal changes. Simple limbal epithelial transplant helps to restore corneal epithelium and corneal stromal clarity. These changes are documented in this prospective eye study. Purpose: To report the changes in epithelial/stromal (E/S) reflectivity ratio and corneal stromal densitometry following simple limbal epithelial transplantation (SLET) in patients with unilateral chemical burn-induced LSCD. Methods and Material: It is a prospective imaging study of cornea before and after SLET. Corneal densitometry with Pentacam and epithelial and stromal reflectivity on anterior segment optical coherence tomography were analyzed for five patients (n = 5 eyes), who underwent autologous SLET for unilateral chemical burn-induced LSCD. Statistical Analysis Used: Mann–Whitney U-test and Pearson correlation. Results: A significant improvement in E/S reflectivity was noted at 1 month (P < 0.05) after SLET, and this was maintained until the end of 6 months. The densitometry measurements decreased in the entire cornea at every level, that is, anterior, central, and posterior cornea. However, the values did not normalize till the last follow-up at 6 months. Conclusions: A trend of normal corneal epithelization exists in eyes undergoing SLET. Densitometry at all the levels, the anterior, central, and posterior cornea, also decreases after SLET. SLET improves visual outcomes in LSCD eyes not only by epithelization but also by reducing stromal scarring.

Background: Secondary angle closure glaucoma (SACG) can be quite puzzling and can challenge even an experienced glaucoma surgeon. Unlike primary angle closure glaucoma, SACG can have various ocular and systemic associations. A careful review of the symptoms and past ocular and surgical history cannot be overemphasized. Some of the SACG can be refractory, requiring drainage devices. However, sometimes, all it takes is a prompt laser iridotomy. This can significantly reduce ocular morbidity and, in some situations, even blindness. Gonioscopy, often an underutilized technique, is critical in making the right diagnosis. With the advent of imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, one can easily pick up the etiology and treat early. Purpose: As many cases of SACG present acutely, it is critical that one makes a prompt diagnosis. We present here a video bouquet of illustrated examples of SACG and the steps to identify the cause by using different imaging techniques. Through this video, we aim to make the diagnosis of SACG a simpler, more streamlined, and logical process that will help in the accurate diagnosis and management. Synopsis: This video demonstrates various etiologies of secondary angle closure and methods to identify and treat the same. Highlights: Secondary angle closure can occur either with or without pupillary block. SACG with pupillary block involves mechanisms such as seclusio pupillae, aphakic/pseudophakic glaucoma, phacomorphic glaucoma, and silicon oil-induced glaucoma. In contrast, there are various other etiologies causing anterior pulling or posterior pushing mechanisms that contribute to non-pupillary block SACG. We discuss all of these, along with the imaging modalities needed to identify the same. Video link: https://youtu.be/N0bIw7Uknww.

Purpose: To compare the safety and efficacy of subconjunctival injection (MMC: 0.02%) to those with subconjunctival application of sponges soaked in Mitomycin C (MMC: 0.02%) intra-operatively in patients who underwent phacotrabeculectomy. Methods: A total of 68 patients undergoing phacotrabeculectomy were randomized into two groups; the sponge group received 0.02% MMC-soaked sponges (n = 38), and the injection group received subconjunctival injection of 0.02% MMC (n = 30). The primary outcome was post-operative mean intra-ocular pressure reduction (IOP). The secondary outcomes were bleb morphology using Indiana Bleb Appearance Grading Score (IBAGS) and anterior segment optical coherence tomography (AS-OCT), post-operative use of 5-fluorouracil, and complications rates. These were compared at 1 week and 1, 3, and 6 months post-operatively. Complete success was defined as ≥30% reduction in IOP without anti-glaucoma medications. Results: In sponge and injection groups, the mean pre-operative IOP was 29.1 ± 8.1 and 29.8 ± 8.8 mmHg, respectively. At 6 months, IOP in sponge and injection groups reduced by 52% (14 ± 3.6 mmHg, P < 0.001) and 50% (15.2 ± 4.1 mmHg, P < 0.001), respectively. Complete success was observed in 90.9% in the sponge group and 95.83% in the injection group. Both groups had diffuse, shallow, relatively avascular blebs at 6 months using IBAGS and AS-OCT. A few complications were seen in the sponge group during this period, which were not vision-threatening. Conclusion: Subconjunctival MMC injection is an effective, safe, convenient, and time-saving alternative to sponge-soaked delivery of MMC in phacotrabeculectomy. [ABSTRACT FROM AUTHOR]

Purpose: To compare the safety and efficacy of subconjunctival injection (MMC: 0.02%) to those with subconjunctival application of sponges soaked in Mitomycin C (MMC: 0.02%) intra-operatively in patients who underwent phacotrabeculectomy. Methods: A total of 68 patients undergoing phacotrabeculectomy were randomized into two groups; the sponge group received 0.02% MMC-soaked sponges (n = 38), and the injection group received subconjunctival injection of 0.02% MMC (n = 30). The primary outcome was post-operative mean intra-ocular pressure reduction (IOP). The secondary outcomes were bleb morphology using Indiana Bleb Appearance Grading Score (IBAGS) and anterior segment optical coherence tomography (AS-OCT), post-operative use of 5-fluorouracil, and complications rates. These were compared at 1 week and 1, 3, and 6 months post-operatively. Complete success was defined as ≥30% reduction in IOP without anti-glaucoma medications. Results: In sponge and injection groups, the mean pre-operative IOP was 29.1 ± 8.1 and 29.8 ± 8.8 mmHg, respectively. At 6 months, IOP in sponge and injection groups reduced by 52% (14 ± 3.6 mmHg, P < 0.001) and 50% (15.2 ± 4.1 mmHg, P < 0.001), respectively. Complete success was observed in 90.9% in the sponge group and 95.83% in the injection group. Both groups had diffuse, shallow, relatively avascular blebs at 6 months using IBAGS and AS-OCT. A few complications were seen in the sponge group during this period, which were not vision-threatening. Conclusion: Subconjunctival MMC injection is an effective, safe, convenient, and time-saving alternative to sponge-soaked delivery of MMC in phacotrabeculectomy.

Purpose: To establish normative data on anterior scleral thickness using the spectral domain anterior segment optical coherence tomography (AS-OCT). Methods: In total, 200 eyes of 100 healthy subjects underwent AS-OCT scans in the temporal and nasal quadrants. The scleral + conjunctival complex thickness (SCT) was measured by a single examiner. Mean SCT was analyzed for differences across age groups, gender, and location (nasal versus temporal). Results: Mean age was 46.4 ± 18.3 (21–84) years; male to female ratio was 54:46. Mean SCT (nasal + temporal) of the right eye (RE) was 682.3 ± 64.2 μm in males and 660.6 ± 57.1 μm in females. In the left eye (LE), it was 684.6 ± 64.9 μm in males and 661.8 ± 49.3 μm in females. These differences between male and female for both eyes were statistically significant (P = 0.006 and P = 0.002). The mean SCT of temporal and nasal quadrants in the RE was 678.54 ± 57.50 and 666 ± 66.2 μm, respectively. In the LE, the temporal mean SCT quadrant was 679.6 ± 55.8 μm, and the nasal was 668.6 ± 63.6 μm. Age had a negative correlation with SCT (−0.62 μm/year; P = 0.03), and males had a higher temporal SCT than females (22 μm higher; P = 0.03). After adjusting for age and gender in a multivariate analysis, temporal SCT was significantly (P < 0.001) higher than nasal SCT. Conclusion: In our study, mean SCT decreased with age and males had a higher temporal SCT. This is the first study to evaluate scleral thickness in the Indian population, and the data can be used as a baseline for comparing variations in scleral thickness in disease.

Purpose: To establish normative data on anterior scleral thickness using the spectral domain anterior segment optical coherence tomography (AS-OCT). Methods: In total, 200 eyes of 100 healthy subjects underwent AS-OCT scans in the temporal and nasal quadrants. The scleral + conjunctival complex thickness (SCT) was measured by a single examiner. Mean SCT was analyzed for differences across age groups, gender, and location (nasal versus temporal). Results: Mean age was 46.4 ± 18.3 (21--84) years; male to female ratio was 54:46. Mean SCT (nasal + temporal) of the right eye (RE) was 682.3 ± 64.2 µm in males and 660.6 ± 57.1 µm in females. In the left eye (LE), it was 684.6 ± 64.9 µm in males and 661.8 ± 49.3 µm in females. These differences between male and female for both eyes were statistically significant (P = 0.006 and P = 0.002). The mean SCT of temporal and nasal quadrants in the RE was 678.54 ± 57.50 and 666 ± 66.2 µm, respectively. In the LE, the temporal mean SCT quadrant was 679.6 ± 55.8 µm, and the nasal was 668.6 ± 63.6 µm. Age had a negative correlation with SCT (-0.62 µm/year; P = 0.03), and males had a higher temporal SCT than females (22 µm higher; P = 0.03). After adjusting for age and gender in a multivariate analysis, temporal SCT was significantly (P < 0.001) higher than nasal SCT. Conclusion: In our study, mean SCT decreased with age and males had a higher temporal SCT. This is the first study to evaluate scleral thickness in the Indian population, and the data can be used as a baseline for comparing variations in scleral thickness in disease. [ABSTRACT FROM AUTHOR]

Background: Secondary angle closure glaucoma (SACG) can be quite puzzling and can challenge even an experienced glaucoma surgeon. Unlike primary angle closure glaucoma, SACG can have various ocular and systemic associations. A careful review of the symptoms and past ocular and surgical history cannot be overemphasized. Some of the SACG can be refractory, requiring drainage devices. However, sometimes, all it takes is a prompt laser iridotomy. This can significantly reduce ocular morbidity and, in some situations, even blindness. Gonioscopy, often an underutilized technique, is critical in making the right diagnosis. With the advent of imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, one can easily pick up the etiology and treat early. Purpose: As many cases of SACG present acutely, it is critical that one makes a prompt diagnosis. We present here a video bouquet of illustrated examples of SACG and the steps to identify the cause by using different imaging techniques. Through this video, we aim to make the diagnosis of SACG a simpler, more streamlined, and logical process that will help in the accurate diagnosis and management. Synopsis: This video demonstrates various etiologies of secondary angle closure and methods to identify and treat the same. Highlights: Secondary angle closure can occur either with or without pupillary block. SACG with pupillary block involves mechanisms such as seclusio pupillae, aphakic/pseudophakic glaucoma, phacomorphic glaucoma, and silicon oil-induced glaucoma. In contrast, there are various other etiologies causing anterior pulling or posterior pushing mechanisms that contribute to non-pupillary block SACG. We discuss all of these, along with the imaging modalities needed to identify the same. Video link: https://youtu.be/N0bIw7Uknww. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the ocular biometric parameters of eyes with acute primary angle closure (APAC) as compared to fellow eyes. Methods: A cross-sectional study was conducted on 27 patients presenting with recent onset APAC to a tertiary eye institute in India. Anterior and posterior ocular biometric parameters were measured simultaneously by anterior segment optical coherence tomography (AS-OCT), A-scan, ultrasound biomicroscopy (UBM), and B-mode ultrasonogram (USG). The parameters measured were anterior chamber depth (ACD), anterior chamber angle (ACA), angle opening distance (AOD500, AOD750), lens vault (LV), axial length (AL), ciliary body thickness maximum (CBTmax) and at the point of scleral spur (CBT0), anterior placement of the ciliary body (APCB), and retinochoroidal thickness (RCS). Results: Mean age ± SD of patients with APAC was 55.66 ± 7.2 years with female preponderance (21:6 patients). Mean presenting IOP ± SD of the affected eye and fellow eye were 54.74 ± 11.67 mm Hg and 18.7 ± 11.67 mm Hg, respectively. Eyes with APAC had statistically significant narrower anterior ocular biometric parameters, higher LV, decreased ciliary body thickness, more APCB, and longer AL than the fellow eyes. CBTmax is the only variable that had significance (β = −0.421,95% CI: −0.806 to − 0.035, P = 0.034) in the univariate analysis with RCS thickness in APAC eyes. Further, there was a correlation between CBT0 and APCB with CBTmax both in univariate (β = 0.894, P < 0.0001 and β = −0.351, P = 0.039) and multivariable analysis (β = 0.911, P < 0.0001 and β = −0.416, P = 0.016). Conclusion: Compared to the fellow eyes, APAC eyes had different ocular biometric parameters. In addition to known biometric parameters associated with pupillary block (narrower anterior biometric parameters-ACA, ACD, and AOD), our study found multiple nonpupillary block factors such as higher lens vault and thinner and more anteriorly placed ciliary body to be associated with APAC.

Purpose: : To analyze the ocular biometric parameters of eyes with acute primary angle closure (APAC) as compared to fellow eyes.Methods: : A cross-sectional study was conducted on 27 patients presenting with recent onset APAC to a tertiary eye institute in India. Anterior and posterior ocular biometric parameters were measured simultaneously by anterior segment optical coherence tomography (AS-OCT), A-scan, ultrasound biomicroscopy (UBM), and B-mode ultrasonogram (USG). The parameters measured were anterior chamber depth (ACD), anterior chamber angle (ACA), angle opening distance (AOD500, AOD750), lens vault (LV), axial length (AL), ciliary body thickness maximum (CBTmax) and at the point of scleral spur (CBT0), anterior placement of the ciliary body (APCB), and retinochoroidal thickness (RCS).Results: Mean age ± SD of patients with APAC was 55.66 ± 7.2 years with female preponderance (21:6 patients). Mean presenting IOP ± SD of the affected eye and fellow eye were 54.74 ± 11.67 mm Hg and 18.7 ± 11.67 mm Hg, respectively. Eyes with APAC had statistically significant narrower anterior ocular biometric parameters, higher LV, decreased ciliary body thickness, more APCB, and longer AL than the fellow eyes. CBTmax is the only variable that had significance (β = -0.421,95% CI: -0.806 to - 0.035, P = 0.034) in the univariate analysis with RCS thickness in APAC eyes. Further, there was a correlation between CBT0 and APCB with CBTmax both in univariate (β = 0.894, P < 0.0001 and β = -0.351, P = 0.039) and multivariable analysis (β = 0.911, P < 0.0001 and β = -0.416, P = 0.016).Conclusion: Compared to the fellow eyes, APAC eyes had different ocular biometric parameters. In addition to known biometric parameters associated with pupillary block (narrower anterior biometric parameters-ACA, ACD, and AOD), our study found multiple nonpupillary block factors such as higher lens vault and thinner and more anteriorly placed ciliary body to be associated with APAC. [ABSTRACT FROM AUTHOR]

An 18-year-old girl who had undergone deep anterior lamellar keratoplasty in her left eye for keratoconus a year back presented with inferonasal graft dehiscence with intact host Descemet's membrane and intact anterior chamber after sustaining blunt injury a week prior. The graft was sutured to the host bed, and complete resolution of graft edema was seen in 4 weeks. One year later, she underwent cataract surgery with foldable intraocular lens implantation. At her final follow-up, the best-corrected visual acuity in her left eye was 20/40 with a clear corneal graft and a stable posterior chamber intraocular lens implantation.

Background: Posterior polar cataracts (PPC) pose a great surgical challenge to ophthalmic surgeons. Main intraoperative surgical concerns are increased risk of posterior capsular rupture (PCR), vitreous loss, and nuclear drop. Traditional assessment of posterior capsule integrity utilizing anterior segment- optical coherence tomography (AS-OCT) requires training, and it is a time-consuming process. Recent techniques of posterior capsule assessment need additional software installation, raising the cost of investigation for the patient. This video demonstrates a time-saving method to assess posterior capsular integrity using regular AS-OCT, which can be learnt and practiced easily in outpatient department (OPD). Purpose: Ultrasound and 20 D lens mounted on posterior segment optical coherence tomography (OCT) are some of the popular methods to assess the posterior capsule. Such techniques need training and are laborious. Our technique used to assess posterior capsule integrity in PPC using AS-OCT is simple, time saving, and can be easily practiced. Synopsis: The technique described requires AS-OCT lens to be mounted on the lens aperture. The console panel is set to scan on scleral mode. AS-OCT is advanced to capture the cornea, anterior capsule, and posterior capsule. Intact posterior capsule is visualized as a continuous well-defined hyper-reflective layer, and any break in the continuity of this hyper-reflective layer suggests posterior capsule dehiscence, which can further be studied based on literature classifications. Highlights: (1) Importance of proper preoperative assessment in cases of PPC. (2) Detailed technique of using anterior segment OCT module in acquiring scans of posterior capsule in PPC. (3) How to find whether the posterior capsule is intact versus dehiscent. (4) Clinical cases showing utility of this technique. (5) Uses and benefits Video link: https://youtu.be/AohMG4jT13M [ABSTRACT FROM AUTHOR]

Changes in the limbal microvasculature following a chemical eye injury are essential for prognosis and management. At the slit lamp, it can be difficult to assess, here using fluorescein and indocyanine green angiography we show that anterior segment angiography may be informative to assess objectively the limbal microvascular changes over the follow-up period.

An 18-year-old girl who had undergone deep anterior lamellar keratoplasty in her left eye for keratoconus a year back presented with inferonasal graft dehiscence with intact host Descemet's membrane and intact anterior chamber after sustaining blunt injury a week prior. The graft was sutured to the host bed, and complete resolution of graft edema was seen in 4 weeks. One year later, she underwent cataract surgery with foldable intraocular lens implantation. At her final follow-up, the best-corrected visual acuity in her left eye was 20/40 with a clear corneal graft and a stable posterior chamber intraocular lens implantation. [ABSTRACT FROM AUTHOR]

Changes in the limbal microvasculature following a chemical eye injury are essential for prognosis and management. At the slit lamp, it can be difficult to assess, here using fluorescein and indocyanine green angiography we show that anterior segment angiography may be informative to assess objectively the limbal microvascular changes over the follow-up period. [ABSTRACT FROM AUTHOR]

A 14-year-old female presented with complaint of nonprogressive whitish opacity over cornea of right eye since birth. Cycloplegic refraction found refractive error of -12.0 D sphere and -3.0 D cylinder @150° in right eye and +3.50 D sphere and +1.50 D cylinder @20° in left eye. We found localized defect in the posterior layers of cornea of right eye in anterior segment optical coherence tomography (OCT) [Figure 4]. [Extracted from the article]