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Purpose: We put forward a physical levitation method to hook and flip the chopped nuclear fragments that could not be solely drawn by vacuum during phacoemulsification, due to various reasons such as a non-rotating nuclei or posterior polar cataracts where hydrodissection was unsuccessful or contra-indicated, respectively. Method: A Sinskey hook is insinuated through the crack of the divided nuclei into a plane behind the nuclear pie to 'hook and flip' the chopped piece, heading it towards the phacoemulsification probe. This simple step disassembles the nuclear chunk, thereby creating space to facilitate the dismantling of the rest of the fragments. The remnant epinuclear cushion guards the posterior capsule, mitigating the chances of serious intra-operative complications. Result: We have employed this technique in 17 eyes during similar situations. No specific intra-operative complications were observed; all surgeries were uneventful. A Sinskey hook utilised for this step ensures safety and familiarity, none encountered posterior capsular rent. This technique not only eases the surgery, but also decreases the anticipated intra-operative and post-operative complications. Conclusion: 'Hook and flip technique' thus proves useful whenever dismantling difficulties are encountered during phacoemulsification. [ABSTRACT FROM AUTHOR]

Evaluation of brain cluster activation using the functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) was sought in strabismic amblyopes. In this hospital-based case-control cross-sectional study, fMRI and DTI were conducted in strabismic amblyopes before initiation of any therapy and after visual recovery following the administration of occlusion therapy. FMRI was performed in 10 strabismic amblyopic subjects (baseline group) and in 5 left strabismic amblyopic children post-occlusion therapy after two-line visual improvement. Ten age-matched healthy children with right ocular dominance formed control group. Structural and functional MRI was carried out on 1.5T MR scanner. The visual task consisted of 8 Hz flickering checkerboard with red dot and occasional green dot. Blood-oxygen-level-dependent (BOLD) fMRI was analyzed using statistical parametric mapping and DTI on NordicIce (NordicNeuroLab) softwares. Reduced occipital activation was elicited when viewing with the amblyopic eye in amblyopes. An 'ipsilateral to viewing eye' pattern of calcarine BOLD activation was observed in controls and left amblyopes. Activation of cortical areas associated with visual processing differed in relation to the viewing eye. Following visual recovery on occlusion therapy, enhanced activity in bilateral hemispheres in striate as well as extrastriate regions when viewing with either eye was seen. Improvement in visual acuity following occlusion therapy correlates with hemodynamic activity in amblyopes. [ABSTRACT FROM AUTHOR]

The purpose of the study was to identify the clinical and etiological profile of uveitis at the apex institute for eye care in India. This is a prospective, prevalence study. 980 consecutive patients with uveitis referred to uvea clinic, Dr. RP Centre for Ophthalmic Sciences (Ophthalmology division, All India Institute of Medical Sciences). Demographic data of each patient were noted and a thorough ocular examination including slit lamp examination and dilated fundus evaluation was carried out. OCT and fluorescein angiography were undertaken whenever indicated. Uveitis was classified based on the anatomic location of inflammation (IUSG classification). Relevant serological and radiological investigations were obtained based on systemic symptomatology, and if the uveitis was recurrent (even in the absence of systemic symptoms). The presence of a systemic disease was confirmed by obtaining an internist consultation. The main outcome measures include pattern of uveitis according to anatomical classification and the etiology. Out of 980 patients with uveitis, 413 (42.14 %) patients had anterior uveitis, 131 (13.36 %) had intermediate uveitis, 165 (16.83 %) had posterior uveitis, 91 (9.2 %) had panuveitis, 47 (4.7 %) had retinal vasculitis, 22 (2.24 %) had scleritis, 17 (1.7 %) had masquerade syndromes, 8 (0.8 %) had keratouveitis, 22 (2.24 %) had sclerokeratouveitis, 19 (1.9 %) had endophthalmitis and 45 (4.5 %) had other causes of inflammation including trauma and intraocular surgery. Out of all uveitic patients definite etiological correlation could be made out in 225 (23 %) patients; thus 77 % were categorised as idiopathic. Only 9 % of all patients were found to have uveitis with an infectious etiology. Amongst infectious causes of uveitis tuberculosis was the leading cause, accounting for sixty percent of all infectious uveitis (approximately 5 % of overall uveitis). Non-infectious uveitis etiology accounted for more than 90 % of all cases with ankylosing spondylitis being the most common followed by sarcoidosis and juvenile rheumatoid arthritis. Amongst known uveitic syndromes serpiginous like choroidopathy was the most common and was followed by acute posterior placoid pigmented epitheliopathy and Fuch's heterochromic iridocyclitis. Infection, including tuberculosis, is an infrequent cause of uveitis in the study population. Multicentric, collaborative efforts are required to improve levels of clinical evidence and evolve consensus in establishing stringent guidelines for labelling uveitis as being of infectious etiology. [ABSTRACT FROM AUTHOR]

To estimate agreement in diurnal variations of intraocular pressure (IOP) by Tono-Pen (TP) and Goldmann applanation tonometer (GAT) in glaucoma patients on topical anti-glaucoma medication(s). IOP was measured at every 3 h from 7 a.m. to 10 a.m. in 50 eyes of glaucoma patients on topical medication(s). Diurnal fluctuation of IOP by each method was calculated as maximum-minimum IOP in a day. Central corneal thickness (CCT) was measured by ultrasonic pachymeter. There was good correlation between TP and GAT at all times during a day, minimum, and maximum IOPs during a day (Correlation coefficient, 0.706 at 7 a.m., 0.624 at 10 a.m., 0.682 at 1 p.m., 0.814 at 4 p.m., 0.652 at 7 p.m., 0.572 at 10 p.m., 0.668 minimum IOP, 0.689 maximum IOP). Mean IOPs by TP were always higher than GAT at all times during a day. Bland-Altman plots suggested a close relationship between the two sets of readings, and that this relationship was consistent at different times in a day, in maximum IOPs, minimum IOPs and also in fluctuation of IOPs. Linear regression analysis between the differences of diurnal fluctuation (diurnal fluctuation by GAT-diurnal fluctuation by TP) and CCT showed strong association ( R = 0.857, p < 0.001). The mean change in difference of diurnal fluctuation (GAT-TP) for a 10-micron increase in CCT was 0.69 mmHg. TP can be considered a reliable alternative to GAT in glaucoma patients for knowing the diurnal control of IOP; however these two methods should not be used interchangeably. Difference of diurnal fluctuation between two methods is dependent on CCT. [ABSTRACT FROM AUTHOR]

To analyze correlation of intraocular pressure (IOP) measurement between new rebound tonometer (RBT) I-Care TA01 and Goldmann applanation tonometer (GAT). One hundred eighty-five eyes of 185 subjects presenting with glaucoma or cataract were enrolled in the study. In all patients, IOP was obtained by an ophthalmologist using I-Care TA01 and GAT. IOP between the two were compared at range of 8-15, 16-21, and >22 mmHg and difference was considered as significant at p < 0.05 ( t test). Bland-Altman analysis tested agreement between instruments overall and for each subgroup of patients with glaucoma or no glaucoma (cataract only). Of 185 patients, 86 had glaucoma; 99 did not. Mean age of patients was 55.77 ± 14.46 years; with no difference between the two subgroups ( p = 0.12). There was no significant difference in mean IOP between the two tonometers at IOP between 8-15 mmHg ( p = 0.097) and 16-21 mmHg ( p = 0.51). However, a significant difference was observed between the two at IOP > 22 mmHg ( p = 0.023) with mean GAT (24.8 mmHg) being higher than mean RBT (23.16 mmHg). Overall, there was no difference between the two ( p = 0.59) and they had a high correlation (Pearson correlation r = 0.815; p = 0.01). The mean difference between the two was 0.1 (95 % agreement limits: UL +6 (1.96SD), LL −5.8 (−1.96SD)), in patients with no glaucoma was 0.091 (95 % AL: UL +4.8 (1.96SD), LL −4.6 (−1.96SD)), and in patients with glaucoma was 0.151 (95 % AL: UL +7.25 (1.96SD), LL −6.9 (−1.96SD)). RBT I-Care TA01 and Goldmann tonometer cannot be used interchangeably due to large limits of agreement. [ABSTRACT FROM AUTHOR]

To study the epidemiological and clinical profile of patients with traumatic subluxated lenses at a tertiary care center in India. Ours was a non-comparative descriptive case series. Evaluation of 71 eyes of 71 consecutive patients presenting to the lens clinic over a period of 2 years with traumatic lenticular subluxation was done. Demographic and clinical profile of patients was acquired, followed by a biomicroscopic examination of the cornea, anterior chamber, iris, lens, angles, zonules, anterior vitreous and fundus. Most of the patients were adolescents and belonged to lower socioeconomic status. The mean time lag before presenting was 33.6 months (range 5 days to 40 years) and mean visual acuity in the affected eyes was 1.67 + 0.56 logMAR. Blunt trauma (63/71) was nine times more common than penetrating trauma in the etiology of manifest subluxation. Injury while playing accounted for the highest rate of injury; sports-related injury with a gulli danda or a cricket bat and ball were the most common mode of blunt trauma while bow and arrow injury was the commonest cause of injury in the penetrating trauma subgroup. Cataract was the most frequent ocular association (53.5 %). All eyes had broken zonules and most presented with inferior subluxation (46 %). Traumatic lenticular subluxation, a unilateral cause of zonulolysis usually occurs while playing with a gulli danda, bow and arrow, or cricket bat and ball in Northern India. It is a major cause of severe visual loss and a modification in risk factors is mandatory to decrease ocular morbidity from trauma. [ABSTRACT FROM AUTHOR]

Iridodialysis needs to be repaired if it is symptomatic. We describe a new bimanual technique for repair of iridodialysis where a bent 26 gauge (G) needle is used to lift the peripheral iris first. The bevel of the needle then acts as a platform for the 9-0 prolene suture with a straight needle to enable unfolding of the curled up iris by stroking before finally docking the suture needle into the bevel of the 26 G needle. This technique ensures precise scleral fixation. [ABSTRACT FROM AUTHOR]

We describe the use of anterior segment optical coherence tomography in the diagnosis of inadvertent retention of Descemet's membrane (DM) after penetrating keratoplasty, and a novel technique for its removal in a case of congenital hereditary endothelial dystrophy. In this technique, we use a modification of the shifting bubble technique, commonly used in deep anterior lamellar keratoplasty where a viscocohesive ophthalmic viscosurgical device is injected into the false anterior chamber which causes migration of the central air bubble placed in the anterior chamber peripherally and helps in confirming the correct space. The DM is then peeled in a circular fashion with the help of 23-G vitreoretinal micro forceps. [ABSTRACT FROM AUTHOR]

A novel technique for creation of a peripheral iridectomy is presented which in our series of cases yielded a 100 % success rate. Constriction of the pupil is achieved by intracameral carbachol instillation to achieve a taut peripheral iris. A 23G vitrector on aspiration mode is first used to engage the peripheral iris with high vacuum. On pressing the foot switch to position two (in suction only mode, the peripheral iris is engaged and on pressing the foot switch to position three (in the cut mode) full thickness iridectomy is achieved. As a full thickness iris defect is made, the iris tissue flutters and the corresponding pupillary margin peaks towards the iris base due to aqueous currents through the newly created conduit; indicating that a patent iridectomy has been achieved. [ABSTRACT FROM AUTHOR]

Hemorrhage into the crystalline lens is exceedingly rare but has been described following ocular trauma [, ], glaucoma surgery [-], laser iridotomy [], pediatric cataract surgery [], and also in the absence of an obvious pathology []. We describe a case of intra- and retro-lenticular organised bleed which presented 9 years following repair of open globe injury and which was treated using fugo blade-assisted lens aspiration. The fugo blade provided adequate endocoagulation of retrolenticular blood during posterior capsulotomy and prevented undue anterior segment hemorrhage. [ABSTRACT FROM AUTHOR]