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Introduction: Rhegmatogenous retinal detachment (RRD) is a vision-threatening complication of viral retinitis, at times compounded by proliferative vitreoretinopathy (PVR) at the junction of the necrotic and unaffected retina., Methods: Retrospective review of eyes with 'junctional PVR' in RRD after viral retinitis. We define junctional PVR as presence of stiffness, transverse traction, epiretinal membrane and/or pucker at the junction of normal and necrotic retina., Results: Five eyes of four patients with a mean age at presentation of 46.5 ± 10.96 years were included. Immunosuppression due to Human immunodeficiency virus (HIV) was the underlying condition in all the cases. Posterior hyaloid removal and epiretinal membrane removal at the junctional PVR was performed in all cases. Favourable outcomes were observed in seven sites where epiretinal membrane (ERM) removal with inner limiting membrane (ILM) peeling was performed; however, one site developed localised RRD requiring re-surgery. The mean logMAR best-corrected visual acuity (BCVA) improved from 1.84 before surgery to 0.64 during the last follow-up. All patients had undergone 23 G vitrectomy and silicone oil tamponade 1500 Centistokes (cSt) was used in all patients for a mean duration of 6.8 months., Conclusion: Management of posterior hyaloid coupled with ERM removal and localised ILM peeling may be used to address junctional PVR in the eyes with RRD after viral retinitis., Competing Interests: Declarations. Conflict of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (© 2025. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To describe the demographics, clinical characteristics, and management of corneal hydrops in patients presenting to a multi-tier ophthalmology hospital network in India., Design: Cross-sectional hospital-based study., Methods: Of the total of 3,140,941 new patients presenting between October 2010 and March 2022, patients with a clinical diagnosis of corneal hydrops in at least one eye were included in the study. All the data was collected using an electronic medical record system., Results: 1291 eyes of 1110 patients were diagnosed with corneal hydrops and included in the study and 961 patients (83.69%) had a unilateral affliction. Corneal hydrops was noted to be significantly more common in males (62.43%) and adults (62.7%). The most common age group at presentation was during the second decade of life with 472 (42.52%) patients. They were more commonly from the higher socio-economic status (77.3%) and from the urban geography (44.23%). In the 1291 eyes, 567 (43.92%) eyes had a visual impairment of blindness (> 20/400-20/1200) followed by moderate visual impairment (> 20/70-20/200) in 166 (12.86%) eyes. Overall, the most common etiology was keratoconus in 1,082 (83.81%) eyes followed by primary congenital glaucoma (PCG) in 91 (7.05%) eyes. Surgical intervention to hasten the recovery of hydrops was performed in 7.82% of eyes with ectasia and as a definite management in 7.05% eyes with PCG. Visual rehabilitation was with contact lenses in 29.1% eyes and keratoplasty in 13.94% eyes., Conclusion: Corneal hydrops is predominantly unilateral and is more common in males. Keratoconus was the commonest etiological condition; however, the risk of hydrops was highest in keratoglobus, followed by PMD. Most affected age was the second decade of life and visual impairment was severe in majority (60%). A surgical intervention was performed in a third of the cases., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To describe the clinical features, management, and long-term outcome of Infectious crystalline keratopathy (ICK)., Methods: The medical records of clinically diagnosed and microbiologically proven cases of ICK were reviewed from January 2011 to December 2022. Clinical characteristics include the presence of whitish needle-like projections with branching, limited to anterior-mid stroma. Keratoplasty being the most common risk factor, graft-related microbial keratitis during the same period was also studied. The demography, clinical profile, microbiology, treatment, and outcome were analyzed, and compared with secondary graft infiltrate(GI)., Results: Medical records of 24 cases with ICK were reviewed. The mean age was 49.3 ± 20.1 years, with 15(62.5%) males. Prior keratoplasty was done in 18 (75%) cases, with a mean graft size of 10.1 ± 1.5 mm, and mean interval between the last graft and presentation was 9.7 ± 6.2 (3-90) months. In comparison to GI (n = 24), ICK patients (n = 18,75%) were less symptomatic, presented late (7.3 ± 6.5 days vs 16.3 ± 19.4, p = 0.003), using frequent topical steroids (> 3 times/day, p =  0.006), smaller infiltrate size < 4 mm (p =  0.008), central (p =  0.02), less associated with epithelial defect (p =  0.0001), hypopyon (p =  of 0.0002), corneal perforation (p =  0.0006), and surgical management (p =  0.03). On microbiology, 22 (91.6%) ICK cases were culture positive, 14 (63.6%) gram-positive, 3 (13.6%) gram-negative, 2 (9%) mixed bacteria, and 3 (13.6%) fungus, comparable with GI., Conclusion: ICK affects poor ocular surfaces usually following keratoplasty with larger graft size, the use of steroids being the most common association, and it responds to medical management as compared to GI., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Microbial keratitis is a sight-threatening condition with a higher incidence in agrarian populations. In countries with a high indigent population, due to financial and other constraints, patients prefer to seek therapy locally rather than travel to advanced centres. The aim of this study is to describe the epidemiology, clinical characteristics, and outcomes of 60 consecutive patients with microbial keratitis managed at a rural centre., Methods: Descriptive case series. All patients clinically diagnosed with infectious keratitis were included. Corneal scrapings were obtained and microbiological identification was done by Gram stain. Anti-microbial therapy was commenced based on smear findings and the patients were followed up till disease resolution., Results: Sixty eyes of 60 patients were diagnosed with microbial keratitis in the study period. The mean age was 47.43 ± 18.69 years. Male:female ratio was 47:53. Risk factors included ocular trauma in the majority of patients (46/60; 76.7%). Microorganisms were identified on 75.6% of smears, with fungal filaments (65.4%) being the most common. Ulcers were central in over half (32/60; 53.3%), and > 3 mm in diameter in over three-fourths (81.6%) of patients. Forty-four patients (73.3%) achieved treatment success whereas 16/60 (26.6%) required referral to our tertiary-eye care facility for management. The median time to resolution was 14 days (IQR 10-26 days)., Conclusion: Our series demonstrates the feasibility of microbiology-guided therapy in microbial keratitis by ophthalmologists at the secondary rural eye-care level. Two-thirds of the patients could be successfully managed at the rural centre and only severe cases needed a referral to tertiary centres., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: This study introduces the Order of Magnitude (OM), a cost-effective, indigenous, virtual reality-based visual field analyzer designed for detecting glaucomatous visual field loss., Methods: The OM test employs a two-step supra-thresholding algorithm utilizing stimuli of 0.43°diameter (equivalent to Goldmann size III) at low and high thresholds. A comparative analysis was conducted against the Humphrey visual field (HVF) test, considered the gold standard in clinical practice. Participants, including those with glaucoma and normal individuals, underwent comprehensive eye examinations alongside the OM and HVF tests between April and October 2019. Diagnostic sensitivity and specificity of the OM test were assessed against clinical diagnoses made by specialists., Results: We studied 157 eyes (74 glaucomatous, 83 control) of 152 participants. Results demonstrated a high level of reliability for both OM and HVF tests, with no significant difference observed (P = 0.19, Chi-square test). The sensitivity and specificity of the OM test were found to be 93% (95% CI 86-100%) and 83% (95% CI 72.4-93%), respectively, while the HVF test showed sensitivity and specificity of 98% (95% CI 93.9-100%) and 83% (95% CI 73.9-92.8%), respectively., Conclusion: These findings suggest that the OM test is non-inferior to the reference standard HVF test in identifying glaucomatous visual field loss., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To describe the demographics and clinical profile of Herpes Simplex Virus (HSV) Keratitis in patients presenting to a multi-tier ophthalmology hospital network in South India., Methods: We have reviewed the medical records of all patients having a clinical diagnosis of any form of HSV keratitis, seen between May 2012 and August 2020 across the L V Prasad Eye Institute network. All the further analyses of the groups were performed using the keywords used for making the diagnosis of HSV keratitis and the data were collected from the electronic medical record system., Results: There were a total of 8308 (N = 8897 eyes) patients. Male: female ratio was 5368 (64.61%):2940 (35.39%). Unilateral involvement was in 7719 (92.91%) patients. The most common age group affected was between the third to fifth decades of life with 1544 (18.58%). 3708 (1.68%) eyes had mild visual impairment (< 20/70) while the rest of them had moderate to severe visual impairment as observed mainly (p ≤ 0.01) in Necrotizing stromal keratitis. 7314 (82.21%) eyes had normal intraocular pressure (10-21 mm Hg) while raised most commonly in keratouveitis (P ≤ 0.01). Epithelial Keratitis, Immune Stromal Keratitis, Endotheliitis, Neurotrophic keratopathy and Keratouveitis were observed in 1875 (17.22%) eyes, 5430 (61.03%) eyes, in 129(1.45%) eyes, 1188 (13.35%) eyes, 148 (1.66%) eyes and 256 (2.88%) eyes respectively., Conclusion: Based on our institute-based data, the most common type of HSV keratitis is Immune stromal keratitis followed by epithelial keratitis. Although not representative of the general population, this data provide useful insights related to HSV keratitis from India., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To determine the trends in the microbial spectrum and antibacterial susceptibility patterns of non-viral conjunctivitis over 16 years., Methods: Microbiology data were reviewed from 2006-2021 for all the patients with clinically and culture-proven infectious conjunctivitis. Conjunctival swabs and/or conjunctival scrapings were collected for microbiological workup, and the demographic and antibiotic susceptibility data were extracted from the EMR (Electronic Medical Record). For statistical analysis, χ 2 -test was performed., Results: Of the 1711 patients, 814 (47.57%) were culture positive and 897 (52.43%) were culture negative. Of the total culture-proven conjunctivitis cases, 775/814 (95.20%) were bacteria, and 39/814 (4.80%) were fungi. Among these bacterial isolates, 75.74% were gram-positive bacteria, while 24.26% were gram negative. The predominant gram-positive pathogens isolated were S. epidermidis (16.7%), S. aureus (17.9%) (p < 0.05), and S. pneumoniae (18.2%), while Haemophilus spp. (36.2%) (p < 0.05) was the most often isolated gram-negative bacteria (36.2%), and Aspergillus spp. was the most commonly isolated fungus (50%). The susceptibility of gram-positive bacteria to cefazoline increased from 90.46 to 98% (p = 0.01), whereas the susceptibility for gatifloxacin decreased in both gram-positive (81-41%; p < 0.0001) and gram-negative bacteria (73-58%; p = 0.02)., Conclusions: Increasing resistance of ocular isolates to mainstay antibiotics is a concern, and this data can assist healthcare practitioners in making informed choices regarding the treatment of ocular infections with ophthalmic antibiotics., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To describe the spectrum and demographic distribution of non-oncological retinal diseases in children and adolescents presenting to a multi-tier ophthalmic hospital network in India., Methods: This is a cross-sectional hospital-based retrospective study over nine years (March 2011-March 2020) from a pyramidal eye care network in India. The analysis included 477,954 new patients (0-21 years), collected from an International Classification of Diseases (ICD) coded electronic medical record (EMR) system. Patients with a clinical diagnosis of retinal disease (non-oncological) in at least one eye were included. Age-wise distribution of these diseases in children and adolescents was analysed., Results: In the study, 8.44% (n = 40,341) of new patients were diagnosed with non-oncological retinal pathology in at least one eye. The age group-specific distribution of retinal diseases was 47.4%, 11. 8%, 5.9%, 5.9%, 6.4%, 7.6% in infants (< 1 year), toddlers (1-2 years), early childhood (3-5 years), middle childhood (6-11 years), early adolescents (12-18 years) and late adolescents (18-21 years), respectively. 60% were male, and 70% had bilateral disease. The mean age was 9.46 ± 7.52 years. The common retinal disorders were retinopathy of prematurity (ROP, 30.5%), retinal dystrophy (19.5%; most commonly, retinitis pigmentosa), and retinal detachment (16.4%). Four-fifth of the eyes had moderate to severe visual impairment. Nearly one-sixth of patients needed low vision and rehabilitative services, and about 1 in 10 patients required surgical intervention (n = 5960, 8.6%)., Conclusion and Relevance: About 1 in 10 children and adolescents seeking eye care in our cohort had non-oncological retinal diseases; the common ones were ROP (in infants) and retinitis pigmentosa (in adolescents). This information would help future strategic planning of eye health care in the institution in pediatric and adolescent age groups., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Mucormycosis is a severe fungal infection caused by species of the order Mucorales. Early and accurate diagnosis is a prerequisite in the management of the disease. In the present study, we evaluated and compared two PCR-based techniques for the diagnosis and identification of mucormycosis in patients with rhino-orbital mucormycosis (ROM) post-COVID-19., Methods: Diagnosed clinically and radiologically, 25 patients of ROM were included in the study and endoscopically or blind collected nasal swabs or orbital tissues were submitted for microbiological evaluation (direct microscopy + culture) and PCR using primers targeting two different loci (ITS and 28S rDNA region) for diagnosis. All PCR products were further processed for species identification using Sanger sequencing whenever possible., Result: Of the 25 samples included in the study, 16 samples were positive for presence of fungal filaments by Smear suggestive of Mucorales sp., but only 7/25 grew in culture. ITS-based PCR was able to identify mucormycosis in 7/25 (28%) samples and 28S rDNA PCR showed positivity for 19/25 (76%) samples. Rhizopus oryzae was found to be the predominant species in our study. The sensitivity and specificity of 28S rDNA PCR compared to culture were found to be 85.71% and 27.78%, respectively, while for ITS-based PCR, they were 42.86% and 77.78%, respectively., Conclusions: 28S rDNA-based PCR is a reliable and sensitive method for early diagnosis of mucormycosis. Molecular techniques have shown a promising future to provide quick and effective treatment by accurately identifying the aetiologic agent., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To study the clinical profile, treatment, and visual outcome of patients with Coats disease in India., Methods: This was a cross-sectional, observational hospital-based study of patients diagnosed with Coats disease during a 10-year period using an electronic medical record system., Results: We identified 675 patients with Coats disease with a prevalence rate of 0.025%. The mean age of the patients was 16.8 years (median, 12 years). Majority were males (75%) with unilateral presentation (98%) in first decade of life (n = 309, 46%). The most common presentation was foveal exudation (stage 2B, n = 161, 23.3%), followed by exudative retinal detachment-extrafoveal (stage 3A1, n = 143, 20.7%), and extrafoveal exudation (stage 2A, n = 136, 19.7%). Treatment modalities included observation (48 eyes, 17%), laser photocoagulation ± intravitreal bevacizumab/triamcinolone acetonide (n = 82, 29%), cryotherapy ± intravitreal bevacizumab/triamcinolone acetonide (n = 64, 23%), and surgical intervention (n = 86, 31%). Despite appropriate treatment, at mean follow-up of 16 months, there was no significant difference between presenting and final visual acuity (48% vs. 48%, p > 0.05). Using multivariate regression analysis, factors associated with poor visual outcome were younger age (< 0.001; - 0.02 to - 0.1), unilateral disease (0.04; - 0.68 to - 0.01), cataract (0.004; 0.13 to 0.69), retinal detachment (< 0.001; 0.49 to 0.82), and glaucoma (< 0.001; 0.34 to 0.94)., Conclusion: The most common clinical presentation of Coats disease in India is foveal exudation in first and second decade. At initial presentation, about half of the affected eyes had blindness and one-third underwent surgical intervention., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To assess the clinical characteristics of comorbid retinal dystrophies and primary angle closure disease., Design: Retrospective study from January 1992 to June 2020., Methods: This descriptive study included 92 eyes of 46 patients with comorbid retinal dystrophies and primary angle closure disease (PACD) that included eyes with primary angle closure suspect, primary angle closure and primary angle closure glaucoma. Demographic profile, clinical characteristics of PACD and its association with retinal dystrophies are described., Results: The study included 46 patients (92 eyes). Males were majority, 63%. Mean (± standard deviation) age when retinal dystrophy was diagnosed was 29.6 ± 9.4 years and PACD was diagnosed at 32.23 ± 7.92 years. Mean BCVA at presentation was 1.07 ± 0.87 log MAR [95% confidence interval (CI) 0.87, 1.26]. Mean Intraocular pressure at diagnosis of glaucoma was 27 ± 16 mmHg (95% CI 23.5, 31.5 mmHg). The most common retinal dystrophy associated with PACD was retinitis pigmentosa (RP) followed by RP with retinoschisis. The hospital-based prevalence of PACD among all patients with RP and retinoschisis was 0.19% and 0.15% respectively. Laser peripheral iridotomy was performed in 74 eyes (80.5%). Glaucoma was managed medically in majority of the eyes (58 eyes, 63.04%) and minority required surgical management with trabeculectomy (11, 11.9%)., Conclusion: Retinitis pigmentosa is the most common retinal dystrophy associated with PACD. Comorbid PACD in eyes with retinal dystrophies was observed in second to third decade of life. This calls for screening for angle closure in eyes with retinal dystrophies from second decade onwards to identify the comorbid PACD and treat or refer them appropriately., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To describe the risk factors, clinical features, management, and outcomes in patients with metastatic conjunctival squamous cell carcinoma (mcSCC)., Methods: Retrospective comparative study., Results: Of the 1192 cases with ocular surface squamous neoplasia during the study period, 654 (55%) patients were biopsied and 223 (19%) had invasive squamous cell carcinoma (cSCC). Of these 223 patients with cSCC, locoregional metastasis developed in 4 (2%) and distant metastasis in 1 (0.4%) patient. Mean age at diagnosis of OSSN was 48 years (median, 40 years; range 35-74 years). Tumors belonged to T2 (n = 2; 40%) and T4a (n = 3; 60%) at presentation. Primary treatment modalities included topical and subconjunctival interferon α 2B immunotherapy (n = 2; 40%), extended enucleation (n = 1; 20%) and orbital exenteration (n = 2; 40%). Metastases were noted after a mean period of 22 months of onset of primary tumor (median, 18 months; range 2-46 months). Death from metastatic disease occurred in all patients over a mean follow-up period of 21 months (median, 11 months; range 1-46 months). Bivariate regression analysis revealed smoking (p = 0.037, Odds Ratio (OR) = 0.13), tumor thickness ≥ 5 mm (p = 0.015, OR = 17.78), orbital invasion (p = 0.018, OR = 1.00), and poor histopathological differentiation (p = 0.031, OR = 10.44) to be significant risk factors for mcSCC., Conclusion: Metastatic disease in cSCC is rare and risk factors for metastasis include smoking, thicker tumors, orbital tumor extension, and poor tumor differentiation. mcSCC is associated with high mortality., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: The aim of this study was to assess the efficacy of Ahmed glaucoma valve (AGV) in eyes with Descemet's stripping endothelial keratoplasty (DSEK) and glaucoma and evaluate the risk factors for failure., Methods: Retrospective interventional study included 27 eyes (27 subjects) that underwent AGV implantation following DSEK. The main outcome measure was AGV success, defined as IOP between 6 and 21 mmHg with or without topical antiglaucoma medications (AGMs). Secondary outcome measure was graft survival. Graft failure was defined as corneal edema for ≥ 1 month or irreversible graft opacity requiring intervention., Results: Eighteen eyes (66.7%) had anterior chamber tube and 9 eyes (33.3%) had sulcus tube placement. Median follow-up was 1.2 years (interquartile range, IQR, 0.5-2.5 years). Following AGV implantation, the median IOP decreased significantly (p < 0.0001), median number of AGMs reduced significantly (p < 0.001) and median visual acuity was maintained (p = 0.76). Cumulative success probability of AGV was 75.8 ± 10.6% at 1 year, and 75.8 ± 10.6% at 2 years. For 24 clear grafts before AGV, estimates of success post-AGV were 100% at 1 year, 77.8 ± 10% at 2 years and 51.9 ± 16.4% at 3 years. Postoperative tube intervention was a borderline significant risk factor for graft failure (p = 0.05) with hazards ratio of 7.2; however, tube location was not associated with failure., Conclusions: AGV can be considered an effective surgical option for IOP control in eyes with DSEK and glaucoma. However, high risk of long-term graft failure in these eyes needs to be considered specially those eyes needing tube intervention., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: Albinism is known to disrupt emmetropisation in animal models. However, it is not clear if the same effect is seen in humans. This study aimed to investigate the refractive profile in individuals diagnosed with ocular albinism (OA) and oculocutaneous albinism (OCA) based on a large dataset., Methods: Required data from 618 individuals (61% males and 39% females) diagnosed with albinism were exported from the eyeSmart electronic medical records of L V Prasad Eye Institute. Overall, there were 112 (18%) individuals diagnosed with OA and 506 (82%) with OCA. Based on the spherical equivalent refraction (SER), individuals were classified as emmetropes, myopes, and hyperopes., Results: The overall spherical equivalent refraction of the individuals ranged from -25.00D to + 12.00D with a median + 0.25D (-2.00 to + 2.25 D). The proportion of individuals with albinism (combined OA, OCA) having hyperopia and myopia (overall: N = 282;45.6% vs. N = 245;39.6%) were similar (p = 0.18), and the least were with emmetropia (overall: N = 91;14.7%). Across all the age groups (0-10, 11-20, 21-30, > 30 years), the frequency of hyperopes and myopes was significantly higher (p < 0.05) compared to emmetropes. Both high degrees of hyperopia and myopia were found in individuals diagnosed with OA and OCA. Irrespective of the albinism type, with-the-rule (70%) astigmatism was the most prevalent compared to other types of astigmatism. The frequency of with-the-rule astigmatism was significantly high in the presence of nystagmus compared to individuals with no nystagmus in both OA (75% vs 25%, p = 0.01) and OCA (77% vs 23%, p = 0.014) groups., Conclusion: The presence of both high hyperopia and high myopia and very few numbers with emmetropia across all age groups indicates disrupted normal refractive development in individuals with albinism. With-the-rule astigmatism and nystagmus may result in meridional degradation of the retinal image leading to impairment of normal emmetropisation process in individuals with albinism., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To describe the clinical features, histopathology, treatment, and outcomes of patients with ocular surface squamous neoplasia (OSSN) presenting to a referral centre in India., Methods: Retrospective interventional study., Results: Of 438 patients, the mean age at presentation was 49 years. Human immunodeficiency virus infection was noted in 72 (16%), xeroderma pigmentosum in 22 (5%), hepatitis B virus infection in 14 (3%), and systemic cancer in 8 (2%) patients. Tumor pigmentation was noted in 243 (54%) tumors with a mean percentage of tumor pigmentation of 44% (median, 40%; range, 1 to 100%). Intraocular tumor extension was noted in 12 (3%), and orbital tumor extension in 16 (4%) eyes. Of the 381 treated lesions, excisional biopsy (n = 247; 65%) was the most common treatment modality. Of the 311 lesions with histopathology diagnosis of OSSN, invasive squamous cell carcinoma (n = 92; 30%) was the most common. Over a mean follow-up period of 11 months (median, 5 months; range, 1 to 108 months) in 368 patients, tumor recurrence was noted in 16 (4%) eyes, globe salvage was achieved in 341 (90%) eyes, vision salvage in 338 (89%) eyes, regional lymph node metastasis occurred in 9 (2%), and metastasis-related death in 9 (2%) patients., Conclusion: Pigmented OSSN is common in Asian Indian population. Appropriate management of OSSN is associated with good vision, globe, and life salvage rates in India., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To describe the clinical profile and microbiology trends in patients undergoing therapeutic keratoplasty at a multi-tier ophthalmology hospital network in India., Methods: This cross-sectional hospital-based study included 3147 eyes undergoing therapeutic keratoplasty between Jan 2016 and Dec 2020 (5 years period) as cases. The demographic data, clinical profile and microbiological analysis were collected using an electronic medical record system., Results: Of a total of 13,625 eyes with microbial keratitis(non-viral), 3147 (23.1%) underwent therapeutic keratoplasty during the study duration. Majority of patients were males (68.35%), from a rural geography (49.89%) and in 51-60 years age bracket (23.74%). The mean age of the patients was 50.54 ± 15.83 years. Two-thirds of patients were from lower socio-economic strata (66.63%) with an agrarian background (36.51%). Of the 3,147 eyes, fungus (51.8%) was the most common indication of therapeutic keratoplasty followed by bacteria (16.87%) and parasite (1.27%). No organisms could be identified in about a third (29.33%) of the cases. Between 2016 and 2020, the trend of therapeutic keratoplasties for fungal infections steadily grew (39.9% vs 45.49%) while the bacterial infections showed a steady decline (23.15% vs 11.81%)., Conclusions: Medical cure rate was seen in majority of those with microbial keratitis, and 23.1% eventually required management with therapeutic keratoplasty. Fungal keratitis was the most common indication for therapeutic keratoplasty. Male gender, rural setting, low socio-economic background and agricultural occupation are common risk factors for patients undergoing therapeutic keratoplasty in India., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To study long-term visual and refractive outcomes and complications in eyes with anterior chamber intraocular lens (ACIOL) implantation., Methods: Data of patients who underwent primary and secondary ACIOL implantation at L V Prasad Eye Institute, Bhubaneswar between 2011 and 2020 was collected, including details of post-operative visits. For analysis, sample was divided into: group Ia (primary ACIOL in cases without risk factors, n = 104); group Ib (primary ACIOL in cases with pre-existing risk factors, n = 49); and group II (secondary ACIOL, n = 40)., Results: A total of 193 eyes of 192 patients were included. Mean post-operative follow-up in groups I and II were 8.6 and 11.51 months, respectively. Mean pre-operative and last visit corrected distance visual acuity were 1.73 ± 0.11 and 0.42 ± 0.05 logMAR units in group Ia (p < 0.001), and 1.53 ± 0.14 and 0.49 ± 0.10 logMAR units in group Ib (p < 0.001). The mean spherical equivalent (MSE) for last refraction was -0.37 ± 0.18 diopters (D) and -0.15 ± 0.51 D in groups I and II, respectively. Of 76 eyes in which addition of 2.5 D (over the near emmetropic posterior chamber intraocular lens power) was taken for ACIOL, 40 (52.6%) had MSE within ± 0.5 D. Most common complications were transient corneal edema and anterior chamber reaction. Eyes on anti-glaucoma medications at last visit were eight (7.7%), 15 (30.6%), and two (5.0%) in groups Ia, Ib, and II, respectively., Conclusion: We observed that ACIOLs have good visual and refractive outcomes. Raised IOP is a concern in eyes with pseudoexfoliation, but can be managed with close monitoring. Hence ACIOL can be a good option for managing aphakia after cataract surgery., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: A significant proportion of eyes with polypoidal choroidal vasculopathy (PCV) can be resistant to anti-vascular endothelial growth factor (VEGF) injections. We evaluated the efficacy of a combination of dexamethasone intravitreal implant (DXI) and anti-VEGF therapy in eyes resistant to anti-VEGF monotherapy., Methods: In this retrospective study, patients with PCV resistant to anti-VEGF injections were additionally injected with a DXI along with an anti-VEGF agent. Best-corrected visual acuity (BCVA), slit-lamp examination, fundus evaluation, and optical coherence tomography (OCT) data were analyzed. Anatomical response on OCT was the primary outcome measure. Change in visual acuity and injection-free interval after DXI were evaluated as secondary outcome measures., Results: Twelve eyes of 11 patients were included in the study. Mean age of patients at presentation was 64.7 ± 9.5 years (range, 49-78.8 years), and there were seven females (63.6%). Median number of anti-VEGF injections prior to DXI was 4 (interquartile range IQR, 3-7). Median follow-up duration after DXI was 32.2 months (IQR, 6.6-41.6 months). Median logMAR BCVA immediately prior to DXI was 0.41 (IQR, 0.30-0.88) and after injection was 0.40 (IQR, 0.30-1.05), which was not significantly different (p = 0.85). Median Central Retinal Thickness (CRT) after DXI was 305.5 µm (IQR, 249-409 µm), which was significantly (p = 0.003) lesser than pre-injection thickness of 547 µm (IQR, 431-771 µm). Median injection-free interval in these eyes after DXI was 5 months (IQR, 2.8-6.4 months). Kaplan-Meier estimates of first injection after DXI were 27.3% at 3 months, 67.3% at 6 months, and 89.1% at 12 months., Conclusions: Dexamethasone implant combined with anti-VEGF treatment can prolong the treatment-free interval in eyes with PCV resistant to anti-VEGF injection while maintaining visual acuity., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To study interocular asymmetry in distribution of leaks in central serous chorioretinopathy (CSC)., Material and Methods: Patients with unilateral CSC were included in this retrospective multicenter study. All patients received multimodal imaging. The prevalence of leaks within 1 disk diameter (DD) peripapillary area and the mean shortest distance between a leak and the optic disk edge was analyzed for the right and left eyes separately based on FA images. Clinical and morphological characteristics were collected and compared between eyes with a peripapillary leak and eyes with a leak elsewhere., Results: In total, 152 eyes (77 right eyes and 75 left eyes) of 152 patients (128 males and 24 females) with a mean age of 45.2 ± 9.8 years were included. The mean distance from the leak to the edge of the optic disk was statistically significantly lower (p = 0.0003), and the prevalence of the leaks within the 1 DD-peripapillary area was higher in the left eye than in the right eye (32.1% versus 10.7%, respectively, p = 0.0017). The eyes with a peripapillary leak had a longer duration of the disease (p < 0.05), a wider area of retinal pigment epithelium alteration (p < 0.001), and a higher prevalence of outer retinal atrophy (p < 0.001) compared to the eyes with a leak elsewhere., Conclusion: The left eye showed closer location of the leak to the optic disk edge and higher prevalence of leaks within the peripapillary area. The cases with peripapillary leak commonly demonstrated characteristics of chronic CSC despite relative preservation of visual acuity., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To study the correlation between retinoblastoma (RB) associated with orbital pseudocellulitis and high-risk histopathology features., Methods: Retrospective study of 32 patients who underwent primary enucleation for RB presenting with orbital pseudocellulitis., Results: All RB patients presented with orbital pseudocellulitis. The mean age at presentation of RB was 30 months (median, 24 months; range, 3-70 months). There were 14 (44%) males and 18 (56%) females. All patients were referred with a diagnosis of RB with orbital pseudocellulitis. Tumor was bilateral in 12 (38%) patients but orbital pseudocellulitis was unilateral in all cases. The pseudocellulitis features included proptosis (n = 9; 28%), eyelid edema (n = 22; 69%), conjunctival congestion (n = 23; 72%), and conjunctival chemosis (n = 15; 47%). Based on clinical features and orbital imaging, all patients were diagnosed to have group E intraocular RB. All patients received intravenous steroids prior to enucleation. On histopathology, tumor necrosis was present in all cases with a mean % necrosis of 60% (median, 60%; range, 10% to 90%). Most tumors (72%) were poorly differentiated. High-risk histopathology features were noted in 23 (72%) cases and adjuvant chemotherapy was advised for all these patients. The most common high-risk histopathology features included post-laminar optic nerve infiltration (34%) and scleral infiltration (22%). Over a mean follow-up period of 34 months (median, 9 months; range, < 1-188 months), there was no event of metastasis or death in any patient., Conclusion: RB presenting with orbital pseudocellulitis is associated with high incidence of high-risk histopathology features., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To compare the outcomes of phacoemulsification with phacotrabeculectomy in primary angle closure glaucoma (PACG) eyes with medically controlled intraocular pressure (IOP)., Methods: Prospective, randomized control trial including 33 eyes of 33 patients who underwent phacoemulsification (Phaco) and 37 eyes (37 patients) who underwent phacotrabeculectomy (PT). The primary outcome measure was survival defined as IOP control (IOP ≥ 6 and ≤ 21 mmHg without antiglaucoma medications (AGM) at different time points. Secondary outcome measures were the rate of visual recovery and complications., Results: The mean age in years (PT: 58.5 ± 9.8, Phaco:61.6 ± 8.9; p = 0.16), preoperative mean deviation in decibel (PT: -18.7 ± 9.3; Phaco: -16.6 ± 7.9; p = 0.32) and the mean follow up in years (PT: 2.5 ± 1.8; Phaco: 2.8 ± 2.0; p = 0.63) were similar in the two groups. The mean preoperative AGMs were more in the PT group (PT: 2.13 ± 0.97, Phaco: 1.60 ± 0.78; p = 0.01). In both the groups the survival was similar at all-time points (PT: 78% at 1-year and 52% at 5-years, Phaco: 80% at 1 year and 59% at 5 years (P = 0.82). The postoperative visual acuity in LogMAR was significantly better in the Phaco group at 1 month (PT: 0.22 ± 0.38, Phaco:0.06 ± 0.07; p = 0.02). Postoperative AGM (p = 0.68) and rate of visual field progression PT: -0.46 ± 0.41 dB/year; Phaco: -0.38 ± 0.73 dB/year; p = 0.67) were similar in both groups. One eye in PT group developed malignant glaucoma which resolved with laser hyaloidotomy and cycloplegic therapy., Conclusions: More rapid visual recovery with similar IOP control and similar visual field stability favor phacoemulsification to phacotrabeculectomy in medically controlled PACG eyes with cataract., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To assess the treatment benefit of eyes with diabetic macular edema (DME) in vitrectomized eyes for tractional complications of proliferative diabetic retinopathy (PDR)., Methods: In a retrospective multicentre observational study in India, the clinical outcomes of eyes with center-involving DME in vitrectomized eyes for tractional complications of PDR in people with type 2 diabetes with at least 12 months follow-up data were assessed. The DME status and visual acuity outcomes were compared between those who received treatment versus those observed., Results: In the 10-year study period, 45 eyes of 44 patients from 5 tertiary centers in India met the inclusion criteria. Center-involving DME was documented after a mean of 7 ± 7 months following pars plan vitrectomy (PPV) for tractional complications of PDR. More than half of the (n = 25) eyes were immediately treated for DME, and treatment was deferred for the rest. At one year, there was a statistically significant reduction in mean central subfield thickness in treated (467.9 ± 124.8 μm to 367.8 ± 143.7 μm; p < 0.001) as well as observed (405.2 ± 132.6 μm to 325.6 ± 149 μm; p < 0.001) eyes, and the change was comparable (p = 0.574). The change in vision was also comparable (0.12 ± 0.31 and 0.22 ± 0.54 Log MAR in the treated and observed group, respectively; p = 0.443)., Conclusion: Treatment for pre-existing or new-onset DME after PPV for tractional complications of PDR may be deferred for up to one year because the DME may resolve spontaneously with time., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To assess the correlation between clinical and anterior segment optical coherence tomographic (AS-OCT) details and histopathological changes in various ocular surface lesions., Methods: Prospective case series of 70 lesions in 65 patients., Results: AS-OCT revealed epithelial changes in OSSN (n = 19; 44%), squamous papilloma (n = 3; 60%), nevus (n = 1; 33%), epithelial hyperplasia (n = 1; 33%), granular dystrophy (n = 1; 100%) and granulation tissue (n = 1; 100%); subepithelial changes in chronic inflammation (n = 4, 100%), lymphoma (n = 3; 100%) and arteriovenous malformation (n = 1; 100%); combined epithelial and subepithelial changes in OSSN (n = 24; 56%), squamous papilloma (n = 2; 40%), PEH (n = 3; 100%), nevus (n = 2; 67%), epithelial hyperplasia (n = 2; 67%), solar elastosis (n = 1; 100%), lobular capillary hemangioma (n = 1; 100%) and sebaceous carcinoma (n = 1; 100%). Epithelial involvement on AS-OCT paralleled the histopathological findings in 98% (n = 69) and subepithelial involvement in 83% (n = 58). The correlation of clinico-tomographic diagnosis with histopathology diagnosis was seen in 77% (n = 54) lesions. Sensitivity and specificity of AS-OCT as a diagnostic tool for detection of epithelial involvement were 100% and 92% and for subepithelial involvement was 98% and 100%, respectively., Conclusion: The correlation between AS-OCT and histopathology features determining epithelial and subepithelial involvement is excellent. It is a useful adjunctive tool for the diagnosis of ocular surface lesions., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To describe the patient demographics and recent clinical indications of endothelial keratoplasty (EK) in patients presenting to a tertiary eye care center in India., Methods: This cross-sectional hospital-based study included 2,182 patients who underwent EK between Jan 2016 and Dec 2019 (4 years period). The data were collected using an electronic medical record system., Results: Overall, 2,632 eyes of 2,182 patients underwent EK during the study period. Median age was 62 (IQR: 48-70) years and adults (94.45%) comprised most of the cohort. More commonly, the patients were male (55.59%) and from the higher socioeconomic strata (67.51%). The corneal signs included corneal edema (70.93%), corneal scarring (29.60%), corneal vascularization (16%) and guttae (12.88%). The major indications of EK were post-cataract surgery corneal edema in 1331 (50.57%) patients, endothelial dystrophy in 537 (20.4%) patients, failed graft in 535 (20.33%) patients causing a vision impairment of > 20/400-20/1200 in about a half (45.55%) of the patients. Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK) were performed in 2075 (78.84%) and 557(21.16%) patients, respectively., Conclusion: EK is commonly performed during the sixth decade of life and in males. The most performed procedure is DSEK. The commonest indication was post-cataract surgery corneal edema., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Endophthalmitis is a potentially blinding intraocular infection following intraocular surgery or trauma. Prompt diagnosis and treatment are important in preventing devastating visual complications. Procalcitonin (PCT) is a promising biomarker for diagnosing bacterial infections. The aim of the study was to measure vitreous PCT in infectious endophthalmitis and assess its utility as a biomarker., Methods: In this prospective study, vitreous was collected from patients with non-infectious retinal disorders and infectious endophthalmitis. PCT was measured using the Human Procalcitonin ELISA Kit. The diagnostic performance of PCT was calculated via receiver operating characteristic curves., Results: The study included three groups: patients with non-infectious retinal conditions, culture-positive endophthalmitis, and culture-negative endophthalmitis. The average PCT was 75.74 ± 26.8 pg mL -1 , 100.24 ± 12.9 pg mL -1 , and 126.41 ± 26.47 pg mL -1 in control, culture-negative, and culture-positive endophthalmitis, respectively. There was a significant difference in the vitreous PCT in the study and control groups (p = 0.04), but not between culture-positive and culture-negative endophthalmitis (p = 0.65). The sensitivity (66.7%) and specificity (65%) for PCT with a cut-off of ≤ 54.88 pg mL -1 (p = 0.31) implied that its diagnostic accuracy was not significant. But there was a significant difference in gram-negative (68.2 ± 16.5 pg mL -1 ) and gram-positive (175.09 ± 45 pg mL -1 ) (p = 0.02) bacterial infections; the sensitivity and specificity were 70%, with a cut-off of ≤ 82.3 pg mL -1 ., Conclusions: This study showed that vitreous procalcitonin concentration might not be a suitable biomarker for diagnosing culture-negative endophthalmitis though it could help distinguish between gram-positive and gram-negative infections., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To describe the clinical features, risk factors and outcomes of Neisseria keratitis., Methods: This is a retrospective observational study wherein medical records of cases with microbiologically proven Neisseria keratitis were reviewed. Data pertaining to the underlying predisposing factors, clinical characteristics of the corneal ulcer, antibiotic susceptibility of the Neisseria species isolate from the corneal scraping, the treatment given, and outcomes were collected and analyzed., Results: Medical records of 60 patients (60 eyes) with Neisseria keratitis were reviewed. Among the causes of poor ocular surface as predisposing factor, vernal keratoconjunctivitis (n = 6 eyes), along with use of topical corticosteroids (n = 18 eyes) was the most common. The ulcer was characterized by a central infiltrate (31/60, 51.7%) involving up to the mid-stroma (43/60, 71.7%). Of the forty-four (73.3%) eyes with pure Neisseria keratitis, 31 eyes (72.1%) resolved with medical therapy alone while five eyes (11.6%) underwent therapeutic penetrating keratoplasty and in two (4.6%) eyes evisceration was performed. The other 5/44 (11.6%) patients were lost to follow-up. Resolution with medical therapy was found to be similar in cases with pure infection and mixed infection (p = 0.58)., Conclusions: Neisseria keratitis most commonly causes a mild form of keratitis and is often associated with the poor ocular surface or prior steroid use. In most cases medical therapy is sufficient for complete resolution of the keratitis., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To review the evidence supporting diabetic retinal neurodegeneration (DRN) as a form of diabetic retinopathy., Method: Review of literature., Results: DRN is recognized to be a part of retinopathy in patients with diabetes mellitus (DM), in addition to the well-established diabetic retinal vasculopathy (DRV). DRN has been noted in the early stages of DM, before the onset of clinically evident diabetic retinopathy. The occurrence of DRN has been confirmed in animal models of DM, histopathological examination of donor's eyes from diabetic individuals and assessment of neural structure and function in humans. DRN involves alterations in retinal ganglion cells, photoreceptors, amacrine cells and bipolar cells, and is thought to be driven by glutamate, oxidative stress and dysregulation of neuroprotective factors in the retina. Potential therapeutic options for DRN are under evaluation., Conclusions: Literature is divided on the temporal relation between DRN and DRV, with evidence of both precedence and simultaneous occurrence. The relationship between DRN and multi-system neuropathy in DM is yet to be evaluated critically., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To compare the disease characteristics and treatment outcomes of patients with neovascular glaucoma (NVG) presenting with visual acuity (VA) 6/60 or better in two different health systems., Methods: Retrospective chart review of consecutive patients with NVG who presented between January 2016 to January 2018 in 5 tertiary-centres in India and one eye-specialist centre in London (UK) was performed. The baseline characteristics, treatment provisions, and visual outcomes in the India and UK cohorts were compared., Results: At presentation, 18% (83 of 451) and 22% (59 of 270) of patients with NVG had VA 6/60 or better in India and the UK cohorts, respectively. The aetiologies of NVG were similar with proliferative diabetic retinopathy being the most common cause (60.9%, India; 64.4%, UK; p = 0.38). Previous panretinal photocoagulation was more prevalent in the UK cohort compared to the India cohort (94.9% versus 66.3%, respectively; p < 0.001). The mean number of intravitreal anti-VEGF injections per eye was higher in the Indian cohort (1.65 ± 0.97 versus 1.14 ± 1.02 injections; p < 0.001). The number of eyes with closed angles (36.9% India versus 30.5% UK; p = 0.45) and the number of eyes needing glaucoma interventions (52.1% India; 62.7% UK; p = 0.82) were similar in two cohorts. Among glaucoma surgeries, trabeculectomies were more commonly performed in the Indian cohort (23 vs 4; p < 0.001),while glaucoma drainage device surgeries were more prevalent in the UK cohort (18 vs 4 p < 0.001). After a median follow-up of 21 months (IQR 8.4-34.8 India; 24-36 months UK), favourable visual outcomes (vision stable or improved) were similar in both health systems (52.5% in the Indian cohort vs 43.4% in the UK cohort; p = 0.28). On multivariate regression analysis, the need for trans-scleral cyclophotocoagulation was associated with worse visual outcomes in both cohorts., Conclusions: The causes and clinical profile of neovascular glaucoma with presenting visual acuity 6/60 or better in India and the UK were similar. Only up to 50% of eyes achieved favourable visual outcomes with current management protocols in both health systems.

Purpose: To compare outcomes of cataract surgery performed by ophthalmic trainees and consultants in patients associated with pseudoexfoliation (PXF) METHODS: Retrospective review of medical records of all patients with PXF who had undergone cataract surgery from January 2016 to December 2018 at L V Prasad Eye Institute, Hyderabad, India, were analysed RESULTS: A total of 914 eyes were included in the study; surgeries on 501 (54.8%) eyes with PXF were performed by trainees, while 413 (45.2%) were performed by consultants. Posterior capsule rupture (PCR) with vitreous loss (VL) occurred in significantly fewer eyes operated on by consultants (n = 8, 1.9%) than those operated on by trainees (n = 23, 4.5%) (p = 0.002). Eyes that underwent small incision cataract surgery (n = 100, 21.2%) had a significantly greater number of complications than those that underwent phacoemulsification (n = 31, 7.1%) (p = 0.00001). Multivariate logistic regression analysis shows that chances of a complication are higher when operated on by a trainee (OR = 1.59, 95% CI: 1.09-2.34, p = 0.02).The mean logMAR corrected distance visual acuity of patients one month post-surgery was significantly higher for patients in the consultant group (0.15 ± 0.3) than for those in the trainee group (0.2 ± 0.4) (p = 0.003)., Conclusion: Patients with PXF operated on by trainees for cataract had a relatively higher risk of developing PCR with VL and had poorer visual outcomes than those operated on by consultants.

Purpose: To analyze the risk factors and estimate the risk period for tumor recurrence in intraocular retinoblastoma (RB)., Methods: Retrospective study of 60 RB patients., Results: The mean age at presentation with RB was 16 months (median 11 months; range 1-84 months). Tumor was unilateral in 13 (22%) and bilateral in 47 (78%) patients. Of 83 eyes with intraocular RB, group B (n = 27; 33%) tumors were more common based on International Classification of Intraocular Retinoblastoma. All cases received intravenous chemotherapy as a primary treatment. Over a mean follow-up period of 57 months (median 38 months; range 12-185 months) post-primary treatment, 44 (73%) patients developed tumor recurrence. The mean interval between the completion of primary treatment and first tumor recurrence was 5 months (median 3 months; range 1-24 months). The total duration of treatment for complete tumor control including treatment of tumor recurrences was 20 months (median 19 months; 2-58 months). By multivariate analysis, the factors predictive of tumor recurrence were multiple tumors (p = 0.008) and retinal detachment (p = 0.003) at presentation. Kaplan-Meier estimate of tumor recurrence at 6 months, 1 year, 3 years, and 5 years was 20%, 31%, 68%, and 73%, respectively. There was no tumor recurrence beyond 5 years since primary treatment., Conclusion: Multiple tumors and retinal detachment at presentation are risk factors for tumor recurrence in RB. Close follow-up is mandatory for at least 5 years since the initiation of treatment for RB.

Purpose: To evaluate the seropositivity of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis from blood samples of cornea donors and assess correlation between seropositivity for HIV and syphilis., Methods: Retrospective analysis of blood samples of 31,355 cornea donors for HIV, HBV, HCV, and syphilis was performed. Postmortem blood samples were analyzed by a rapid screening test for anti-HIV envelope antibodies against HIV 1 and 2, HBV surface antigen, antibody to HCV and anti-cardiolipin antibodies for syphilis by rapid plasma reagin test., Results: The overall seropositivity rate was 4.28% (1343/31,355 donors). All positive donors were reactive for a single serological test. The seropositivity rate for HIV was 0.93% (95% CI 0.83-1.04%), for HBsAg was 1.56% (95% CI 1.43-1.7%), for HCV was 1.19% (95% CI 1.08-1.33%) and for syphilis was 0.59% (95% CI 0.52-0.69%). The trends in seropositivity rates showed a decline for three viral markers: HIV (2010, 1.17% to 2018, 0.72%, p = 0.02), HBsAg (2010, 1.98% to 2018, 1.05%, p = 0.0006) and HCV (2010, 1.32% to 2018, 0.43%, p < 0.0001). The seropositivity rates for syphilis showed a progressive increase when compared to baseline (2010, 0.14% to 2018, 1.14%, p < 0.0001). There was no relationship between seropositivity for HIV and syphilis (p = 0.18)., Conclusions: The overall seropositivity for HIV, HBV, HCV and syphilis was 4.28%. Seropositivity was highest for HBV. The study did not find correlation between seropositivity of HIV and syphilis.

Purpose: To identify morphological parameters aiding clinical differentiation of conjunctival intraepithelial neoplasia (CIN) and invasive squamous cell carcinoma (iSCC) and to demonstrate the utility of image processing software to objectively assess ocular surface squamous neoplasia (OSSN)., Methods: This retrospective case series included all biopsy-proven cases of OSSN presenting as an ocular surface nodule. Based on histopathology, lesions were classified as CIN and iSCC. Clinical image analysis utilized 'Contour' and 'ImageJ' software. The effect of predictors demography, seropositivity, lesion dimensions, keratin, pigmentation, corneal involvement, vascularity and feeder vessels on the final histopathologic grade were assessed., Results: A total of 108 OSSN lesions (74 CIN and 33 iSCC) were included. Mean age was 46.1 ± 17.2 years in CIN and 47.2 ± 13.9 years in iSCC. By univariate logistic regression analysis, significant predictors of iSCC were HIV seropositivity (p < 0.0001), maximum diameter (p = 0.003), perpendicular to maximum diameter (p = 0.003), height (p = 0.003), nodular morphology (p = 0.006) and feeder vessels (p = 0.03), whereas gelatinous morphology (p = 0.02) was predictor of CIN. By multiple logistic regression, seropositivity was the predictor of iSCC (p < 0.0001, OR 13.33 ± 8.35, 95% CI 3.90-45.53)., Conclusion: HIV seropositivity is an important predictor of iSCC. Large, thick, nodular lesions with feeder vessels may favor the diagnosis of iSCC, whereas gelatinous, small, flatter lesions without feeder vessels may favor CIN. In a first of its kind study, simple and objective analysis of OSSN with image processing software was demonstrated.

Purpose: To describe anterior segment optical coherence tomography (AS-OCT) features of pseudoepitheliomatous hyperplasia (PEH) of the ocular surface., Methods: This is a retrospective study of 9 lesions of 8 patients with histopathologically proven PEH RESULTS: Mean age at diagnosis of PEH was 31 years (median 31 years; range 12 to 62 years). The lesion was unilateral in 7 (88%) patients and bilateral in one (12%). Two patients (25%) had xeroderma pigmentosum, who also had a history of prior surgical intervention in the same eye for conjunctival tumor excision. Referral diagnosis was ocular surface squamous neoplasia (OSSN) in all cases. Ocular surface mass (n = 4, 44%) was the most common presenting complaint. The mean duration of symptoms was 18 months (median 3 months; range < 1 to 84 months). All lesions were perilimbal, and the mean basal diameter of the tumor was 7 mm (median 6 mm; range 4 to 12 mm). Clinical diagnosis included OSSN (n = 5; 56%), PEH (n = 3; 33%), or leiomyosarcoma (n = 1; 11%). AS-OCT features included irregular hyperreflective epithelium, epithelial dipping, and subepithelial hyperreflective lesion with posterior shadowing in all cases. Histopathology confirmed the diagnosis of PEH in all cases. The underlying cause of PEH in these cases included vernal keratoconjunctivitis (n = 4; 44%), idiopathic severe blepharitis (n = 2; 22%), or prior surgical intervention (n = 2; 22%). No apparent cause could be determined in one eye (11%)., Conclusion: Ocular surface PEH is a close mimicker of OSSN. Careful history-taking, clinical examination, and characteristic AS-OCT features aid in accurate diagnosis.

Purpose: To assess the incidence, types, and outcomes of second primary tumors (SPT) in cases of retinoblastoma (RB) from a referral Tertiary eye care center METHODS: Retrospective chart review of 7 cases RESULTS: All 7 (100%) cases had bilateral RB at presentation. The mean age at diagnosis of RB was 16 months (median 7 months; range 5-72 months). Treatment of RB with intravenous chemotherapy was noted in 3 (43%) patients, 1 (14%) patient had received external beam radiotherapy (EBRT) to the orbit, 1 (14%) patient had received a combination of chemotherapy and orbital EBRT, while 4 (57%) patients had undergone primary enucleation of the worse eye and focal treatment of the better eye. The mean age at detection of SPT was 15 years (median 8 years; range 6-46 years). The mean time interval between diagnosis of RB and SPT was 13 years (median 7 years; range 1-41 years). The SPT's included osteosarcoma of long bone (n = 2), eyelid sebaceous gland carcinoma (n = 2), ventricular ependymoma (n = 1), orbital neuroblastoma (n = 1), and acute lymphoblastic leukemia (n = 1). All patients received treatment for the SPT with either surgical excision (n = 2), intravenous chemotherapy (n = 1), or a combination of surgery/chemotherapy/radiotherapy (n = 4). Over a mean follow-up period of 8 years (median 8 years; range 4-11 years), one (14%) patient died, while other 6 (86%) patients are alive and well., Conclusion: Though the incidence of SPT's in cases of RB is rare, life-long follow-up is mandatory in at-risk patients.

Purpose: To evaluate, in a combined treatment strategy for treatment-warranted retinopathy of prematurity (ROP), which of the two is a better treatment sequence, peripheral laser photocoagulation (LPC-IVB) first or intravitreal bevacizumab (IVB-LPC) first., Methods: Twenty-two babies (44 eyes) with ROP were recruited from 1 July 2014 to 30 March 2016. All the right eyes received LPC on day one followed by IVB on day four (LPC-IVB group). In all left eyes, IVB was injected on day one followed by LPC on day four (IVB-LPC group). The primary outcome measure was the proportion of eyes that had complete ROP regression with no additional treatment within 2 weeks of the onset of therapy. Retinal photography and drawings were used at each visit to document disease course., Results: In LPC-IVB group, 72.7% (16/22) eyes had complete ROP regression with no additional treatment within 2 weeks of the onset of therapy. In the IVB-LPC group, 95.5% (21/22 eyes) had complete regression within 2 weeks. Additional laser had complete regression in all eyes in each group. One baby (two eyes, one from each group) had late recurrence at 5 months., Conclusion: The combined therapy strategy was successful for ROP management. Administration of anti-vascular endothelial growth factor injection before the peripheral laser was better than the reverse strategy of laser first. Late recurrences and adverse events were low.

Purpose: To evaluate the presenting features, treatment, and outcomes of posterior uveal melanoma (PUM) in Asian Indians based on the 8th edition of American Joint Committee on Cancer (AJCC) classification., Methods: Retrospective interventional case series of 321 Asian Indian patients with PUM., Results: Based on AJCC, PUM was classified into categories T1 (n = 36; 11%), T2 (n = 74; 23%), T3 (n = 126; 39%), and T4 (n = 85; 27%). Regarding tumor features, T4 was more likely to have pre-equatorial epicenter (vs T1 and T2; p ≤ 0.011), iris abnormalities (vs T2 and T3; p ≤ 0.002), and extraocular tumor extension (vs T3; p = 0.001), whereas T1 was more likely to have macular epicenter (vs T2, T3, T4; p ≤ 0.013), lipofuscin deposits (vs T3 and T4; p ≤ 0.008), and amelanotic tumors (vs. T4; p = 0.003). On multivariate analysis, factors predictive of systemic metastasis were increasing tumor thickness (p = 0.002) and extraocular tumor extension (p = 0.009). The 5-, 10-, and 15-year melanoma-related metastases rates were 0%, 0%, and 0% in T1, 0%, 60%, and 60% in T2, 7%, 40%, and 70% in T3 and 13%, 36%, and 76% in T4, respectively. Risk for metastasis was 1.23 times more for every 1-mm increase in tumor thickness and 9 times more with extraocular tumor extension., Conclusion: The AJCC 8th edition provides prognostic classification for PUM in Asian Indian patients. The significant risk factors for metastasis were increasing tumor thickness and extraocular tumor extension.

Aim: To compare the outcomes of Ahmed glaucoma valve (AGV) pediatric FP8 versus the large-sized adult FP7 implants in an adult secondary glaucoma., Methods: Patients who underwent AGV implantation from January 2011 to December 2016 for adult secondary glaucoma (due to causes other than post-vitreoretinal/buckle surgery glaucoma) with a follow-up of 6 months were included for this retrospective study. Success was defined as IOP > 6 mm Hg and < 21 mm Hg without any loss of vision, with or without the need of anti-glaucoma medications or additional procedures for control of IOP. Hypertensive phase was defined as IOP > 21 mmHg at any visit in the first 6 months of postoperative follow-up period, while failure was defined as IOP > 21 mm Hg even after medications or additional procedures, need of removal of implant or loss of light perception. Cumulative survival rates and intraoperative or postoperative complications along with IOP profiles were compared between the implants., Results: Of 43 patients, 19 patients underwent FP7 and 24 patients underwent FP8 Ahmed Glaucoma valve implantation. The IOP significantly reduced in both groups from baseline (31 ± 8.2 mm Hg in FP7 eyes and 37 ± 13.1 mm Hg in FP8 eyes) by a mean of 64 ± 23.5% in FP8 and 64 ± 21.5% in FP7 group, respectively, p = 0.8 with comparable final IOP of 16.5 mm Hg and 16.9 mm Hg, respectively, p = 0.9. Both groups had 75% qualified success rates at 20 months after surgery with similar rates of need for postoperative medications or incidence of hypertensive phase. The FP8 eyes had more frequent conjunctiva-related complications in eyes with prior surgeries and preoperative conjunctival scarring while the other complications were similar in the two groups., Conclusion: Surgical outcomes of adult FP7 and pediatric FP8 AGV in adult secondary glaucoma seem to achieve similar IOP control and success rates. This suggests that smaller-sized FP8 can be used in adult glaucoma with good surgical outcomes albeit with careful case selection in eyes with extensive preoperative scarring to avoid conjunctival thinning-related complications postoperatively.

Objective: To describe the clinical profile of pterygium in patients presenting to a multi-tier ophthalmology hospital network in India., Methods: This cross-sectional hospital-based study included 1,610,843 new patients presenting between 2010 and 2019. Patients with a clinical diagnosis of pterygium in at least one eye were included as cases. The data were collected using an electronic medical record system. Multiple logistic regression analysis with odds ratios (OR) was performed to identify the associated risk factors., Results: Overall, 168,807 (10.5%) new patients were diagnosed with pterygium, of which 43,692 (26%) patients complained about the lesion. The prevalence rates were 0.7% in children and 12.6% in adults. Majority of patients were female (54.5%) and had unilateral (57%) affliction. Among the 241,631 affected eyes, the pterygia were primary in 99.6%, nasally located in 94%, and were grade I-II in 84.8%. Four in 5 eyes did not have any cylindrical refractive error, and 44% had coexistent cataract. Pterygium surgery was indicated in 10.3% eyes. Female sex (OR 1.37), increasing age (OR 19.5), rural residence (OR 1.21), agriculture work (OR 2.19), manual labor (OR 2.05), low socioeconomic status (OR 2.14) and geographical location closer to the equator (OR 3.4) were identified as the risk factors for developing pterygium., Conclusion: About one-tenth of individuals seeking eye care in India have pterygium in at least one eye. It rarely impacts vision, is commonly unilateral and nasal and usually does not require surgery. It is associated with increasing age, females, outdoor work, low income and geographical location closer to the equator.

Purpose: To study the prevalence, antibiotic susceptibility profile, clinical outcomes and plasmid-mediated transfer of colistin resistance (CLR) among Gram-negative bacilli (GNB) isolates from different ocular infections., Design: Prospective case-control study in eastern India., Methods: Consecutive ocular samples with GNB isolates from clinically diagnosed cases of microbial keratitis, infectious endophthalmitis and orbital infections were included. Inclusion criteria were significant GNB growth from ocular samples and > 6 weeks follow-up. Clinical outcomes were determined by disease-specific criteria for each clinical group. Antibiotic susceptibility was tested by broth microdilution for colistin and Kirby-Bauer disc diffusion method for others. Plasmid detection for CLR genes mcr-1 and mcr-2 genes was done by standard protocols., Results: Sixty GNB isolates were studied. Overall prevalence of CLR (intrinsic plus acquired) was 40% (n = 24), acquired being 37.5% of CLR isolates (n = 9). The prevalence varied from 45.5% (10/22) and 45% (9/20) in microbial keratitis and infectious endophthalmitis, respectively, to 26.3% (5/19) in orbital infections. Clinical outcomes in CLR patients were significantly worse in microbial keratitis (p = 0.018) and orbital infections (p = 0.018), and comparable to colistin-susceptible ones (p = 0.77) in infectious endophthalmitis. CLR isolates had significantly higher resistance to Amikacin, Gentamicin and Ceftazidime but were susceptible to Piperacillin, Carbapenems and fluoroquinolones. Plasmids mcr-1 and mcr-2 were detected in 6.25% (n = 1) and 25%(n = 4), respectively, of the 16 tested isolates., Conclusions: CLR is highly prevalent in ocular isolates and affects clinical outcomes. CLR isolates may still remain susceptible to Carbapenems, Piperacillin and fluoroquinolones. Plasmid mcr-1- and mcr-2-mediated CLR remains low in ocular infections.

Purpose: To study the demographic features, treatment, histopathology, and outcomes in patients of xeroderma pigmentosum (XP) with conjunctival melanoma., Methods: Retrospective case series., Results: The median age at presentation was 18 years (range 9-30 years). There were three females and one male patient presenting with a median duration of symptoms of 3 months (range 1-60 months). The tumor was located in the bulbar conjunctiva in all 4 patients. All patients had corneal involvement by the tumor. The median tumor basal diameter was 7 mm (range 4-15 mm). Wide tumor excisional biopsy with alcohol keratoepithelectomy, cryotherapy to the free margins, and amniotic membrane grafting was done in three patients. One patient underwent orbital exenteration for extensive tumor. One patient also received adjuvant plaque brachytherapy for microscopic residual tumor. Over a median follow-up of 22 months (range 2-101 months), there were no recurrences, metastasis, or death., Conclusion: Conjunctival melanoma in XP is rare and manifests at a younger age.

Purpose: The global survey of eye banking and corneal transplantation reveals differences in eye banking trajectories in various countries. There is a need to encourage and lay down foundations of successful eye banking practices in many nations across the world map. The study evaluates demographics, trends in donor cornea retrieval, utilization and eye banking practices in over 30 years at a single eye bank in India., Methods: A longitudinal descriptive analysis of eye banking practices from 1989 to 2018 at Ramayamma International Eye Bank, Hyderabad, India, was performed. Data on eye donations, practice patterns and various types of keratoplasty were collected. Data were analysed focusing on practices and historical development of the eye bank., Results: Over the years, the eye bank has made use of several advances in its practice patterns and evolved to a stage of self-sustainability. With the fulfilment of internal demand for corneal transplantation, 50% of retrieved corneas could be distributed for community needs outside the institute. Number of transplants increased from 20 in 1987 to 4738 in 2018. Total number of transplants touched 27,746 in 2018 which might be the highest numbers for a single centre anywhere in the world., Conclusions: The study reveals a dynamic development of the eye bank over the last 30 years and emphasizes the importance of an active quality management in coping with the challenges of modern eye banking. The increasing trend of cornea collection and transplantation is a reflection of the needs and efforts towards treating and eliminating corneal blindness.

Purpose: To compare the efficacy and safety of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection versus dexamethasone implant (Ozurdex) for the treatment of center-involved DME (CiDME)., Method: This prospective randomized comparative study included 40 eyes (38 patients) of CiDME. They were randomized into two groups. Patients in group A received the intravitreal anti-VEGF injection (bevacizumab 1.25 mg or ranibizumab 0.5 mg) and those in group B received dexamethasone implant (0.7 mg) pro-re-nata after 4 weeks and 3 months, respectively. The primary outcome was measured at 3 months from the baseline that included improvement in BCVA, reduction in CFT, and adverse effects during the follow-up period., Results: Mean best-corrected visual acuity (BCVA) improved from 0.51 ± 0.275 LogMAR units (20/63) to 0.20 ± 0.185 LogMAR units (20/32) in group A and from 0.56 ± 0.213 LogMAR units (20/80) to 0.141 ± 0.177 LogMAR units (20/32) in group B at 3 months. There was no significant difference in mean BCVA between both the groups (p = .27). The mean central foveal thickness (CFT) improved from 443.55 ± 131.536 µ to 277.66 ± 76.184 µ and from 460.95 ± 125.462 µ to 233.25 ± 37.552 µ at 3 months in group B (p = .02)., Conclusion: Both the groups had the similar visual outcome. However, the superior anatomical result was observed in dexamethasone implant group during this short follow-up.

Purpose: To compare the clinical presentation and outcomes of retinoblastoma (RB) based on age at presentation., Methods: Retrospective comparative study of 1940 eyes of 1450 children with RB., Results: Presentation of RB with enlarged eyeball and eyelid swelling (2% and < 1% in ≤ 1 year, 4% and 2% in > 1-2 years, 7% and 2% in > 2-3 years, and 12% and 4% in > 3 years; p < 0.0001 and p = 0.05, respectively) is more common with increasing age. Based on the 8th edition of American Joint Committee Classification, T1 is more common in children younger than 1 year (27%), while T4 is more common in children > 3 years of age (20%) (p < 0.0001). Kaplan-Meier (KM) estimate at 1 and 5 years for globe salvage was 64% and 58% in children ≤ 1 year of age versus 30% and 20% in children > 3 years, respectively [Hazard ratio (HR) = 2.48; p < 0.0001], and KM estimate at 1 and 5 years for life salvage was 99% and 97% in children ≤ 1 year of age versus 89% and 78% in children older than 3 years, respectively (HR = 7.65; p < 0.0001)., Conclusion: Uncommon clinical features of RB including enlarged eyeball and eyelid swelling are more common with increasing age. Younger age at presentation with RB is associated with better prognosis including higher chances of life and globe salvage.

Purpose: The objective of this study was to investigate the efficacy and safety of phaco-endocycloplasty in an exclusive cohort of primary angle closure disease/glaucoma., Methods: The study was interventional and non-comparative, carried out at a tertiary level eye care Institute. All adult patients (> 18 years) with angle closure disease, who had controlled or uncontrolled intra-ocular pressure (IOP) and had visually significant cataract, requiring surgery, and had undergone phaco-endocycloplasty, performed for 180°-210° simultaneously with cataract surgery, were included., Main Outcome Measures: Primary outcome measure includes IOP, and secondary outcome measures include best corrected logMAR visual acuity (BCVA), anti-glaucoma medication (AGM) and complications., Results: Thirty-two eyes of 28 patients were included. Median follow-up was 15 months (range 3-42 months, Q1 7.5, Q3 18, IQR 10.5). Median IOP pre-procedure (20.5 mmHg, range 11-46, Q1 16.75, Q3 31, IQR 14.25) decreased significantly post-procedure at last follow-up (IOP 16 mmHg, range 10-20, Q1 12, Q3 17.5, IQR 5.5) (p < 0.001). There was significant decrease in use of AGM (median 3 pre-procedure, range 1-5, Q1 2, Q3 3.25, IQR 1.25) at last follow-up (median 0) (p < 0.001) post-procedure. Median logMAR BCVA improved from 0.4 (Q1 0.3, Q3 0.625, IQR 0.325) to 0.05 (Q1 0, Q3 0.3, IQR 0.3) at last follow-up (p < 0.001). None of the patients had serious sight-threatening complications., Conclusions: This study indicates that phaco-endocycloplasty can effectively control IOP, significantly reducing need for AGM, without compromising safety, in angle closure glaucoma. When combined surgery is indicated, this conjunctiva-sparing procedure may be employed in the management of coexisting cataract and glaucoma prior to bleb-forming surgery.

Purpose: To study the concordance between intra-operative rapid frozen section and permanent section diagnoses of surgical margins following wide surgical excisional biopsy of malignant eyelid tumors., Methods: This is a retrospective study of 120 cases and 429 frozen section slides., Results: Of 120 cases, 75 (63%) had sebaceous gland carcinoma, 34 (28%) had basal cell carcinoma, and 11 (9%) had squamous cell carcinoma. All cases with these malignant eyelid tumors underwent wide surgical excisional biopsy under frozen section control of surgical margins. A total of 429 frozen section slides were reviewed for rapid frozen section diagnosis. Eyelid reconstruction was performed in all cases after clearance was obtained by rapid frozen section diagnosis of surgical margins as negative for tumor infiltration. Permanent section diagnosis of surgical margins was positive for tumor infiltration in 5 (1%) slides, which were reported as negative on rapid frozen section diagnosis of surgical margins, and was negative for tumor infiltration in 3 (< 1%), which were reported as positive on initial rapid frozen section diagnosis of surgical margins. The sensitivity, specificity, and accuracy of intra-operative rapid frozen section diagnosis of surgical margins for malignant eyelid tumors were 89%, 99%, and 98%, respectively., Conclusion: The concordance between the intra-operative rapid frozen section and permanent section diagnoses of surgical margins following wide surgical excisional biopsy of malignant eyelid tumors is excellent at 98%.

Purpose: To report the clinical course, microbiological spectrum and visual outcomes of three cases of post-operative endophthalmitis caused by unusual combination of micro-organisms., Methods: Retrospective review of medical charts at a tertiary eye care centre over a period of 1 year, of subjects with post-operative endophthalmitis and more than one microbiological isolate., Results: We report 3 cases with unusual combination of microorganisms. In case 1, two organisms (Burkholderia cepacia and Aeromonas veronii, from the vitreous cavity and capsular bag, respectively) with an identical antibiotic sensitivity pattern were found, while in case 2, the organisms (Streptococcus pneumoniae and Sphingomonas paucimobilis, from cornea and vitreous cavity, respectively) isolated had different sensitivity patterns. In case 3, two different strains of the same organism (Enterococcus faecalis) were found. Cases 1 and 2 achieved good anatomical and visual outcomes, while in case 3, vision remained poor despite a good anatomical outcome., Conclusion: Unusual combinations of organisms in post-operative endophthalmitis can introduce unique clinical characteristics and should specifically be considered in atypical clinical presentations, poor response to standard therapy and unusual recurrence patterns.

Purpose: To evaluate outcomes of ocular surface squamous neoplasia (OSSN) based on American Joint Committee on Cancer (AJCC), 8th edition classification., Methods: Retrospective, non-randomized interventional case series of 127 patients (136 eyes) with OSSN., Results: On the basis of the AJCC (eighth edition), OSSN was classified as per T category as Tis (n = 14, 10%), T1 (n = 0), T2 (n = 4, 3%), T3 (n = 113, 83%), and T4 (n = 5, 4%). The following parameters increased with increasing T category: mean age at presentation at 37 years for Tis, 43 years for T2, 46 years for T3, and 55 years for T4 (p = 0.04); mean tumor basal diameter of 4 mm for Tis, not applicable (na) for T1, 6 mm for T2, 7 mm for T3, 20 mm for T4 (p = 0.001); extent of clock hours of corneal involvement (0, na, 0, 4, 8; p = 0.02), and conjunctival involvement (1, na, 2, 3, 9; p = 0.0005); involvement of adjacent structures including fornix (0%, na, 0, 9, 80%; p < 0.001), and caruncle (0%, na, 0, 3, 60%; p < 0.001) for Tis, T1, T2, T3, and T4, respectively. Overall, of the 136 eyes, 19 (14%) had tumor recurrence, and all tumor recurrences were seen in T3. Regional lymph node metastasis was noted in 4 (3%) patients. No systemic metastasis or death occurred in any patient during the mean follow-up period of 15 months (median, 11 months; range 6-55 months)., Conclusion: Increasing T category based on AJCC 8th edition classification is associated with increasing severity of disease, tumor recurrence rate, and the rate of regional lymph node metastasis.

Purpose: To review and summarize the newest update on ocular sebaceous gland carcinoma (SGC) focusing on diagnosis and treatment., Methods: A PubMed search was carried out using the terms "Sebaceous Carcinoma", "Meibomian Gland Carcinoma", "Sebaceous Cell Carcinoma", and "Sebaceous Gland Carcinoma". All studies published in English up to October 2017 were included in this review., Results: Globally, the overall incidence of SGC is increasing making it the third most common eyelid malignancy after basal cell carcinoma (BCC) and squamous cell carcinoma. The mainstay of treatment of ocular SGC is wide surgical resection under frozen section or Moh's micrographic surgery control followed by eyelid reconstruction. Based on histopathological features, SGC can be classified according to growth pattern, cell type, and cytoarchitecture. Based on the growth pattern, they can be classified as trabecular, lobular, papillary, and BCC-like. The cell type can be classified as basaloid, basosquamous, and epidermoid. The SGC cytoarchitecture presents either as a nodular or as an infiltrative lesion. Based on immunohistochemistry, the overexpression of ZEB2, BAG3, androgen receptor, and C-erbB-2 oncoprotein is associated with poor prognosis. The tumor is associated with systemic metastasis in 8-14% and death in 10-30%., Conclusion: Ocular SGC is an aggressive tumor associated with poor prognosis. Early identification and appropriate treatment may help improve the prognosis. New insight into its pathogenesis and the immunohistochemical profile may lead to the development of new effective treatment strategies, along with traditional therapies.

A 22-year-old male presented to us with complaints of sudden painful loss of vision in left eye 10 days ago along with inward deviation of the left eye. Best-corrected visual acuity (BCVA) in right eye was 20/20 and 20/50 in left eye. Left eye showed limitation of abduction, a relative afferent pupillary defect, normal anterior segment with optic disc oedema. Contrast-enhanced MRI of the brain and orbit showed thickening of left optic nerve along with a cystic lesion near the orbital apex with a central iso- to hyperintense spot resembling a scolex. A diagnosis of left orbital apex syndrome secondary to optic nerve cysticercosis was made. Patient was treated with oral albendazole and intravenous corticosteroids for 3 days followed by oral corticosteroids. Ten weeks post-treatment, his BCVA in the left eye improved to 20/20 and colour vision and visual fields improved. Pallor of the left optic disc was noted, and ocular motility improved completely. MRI after treatment showed a decreased thickness of left optic nerve with disappearance of the cystic lesion.

Aim: To assess patient perceptions regarding medical photography and the use of smart devices, namely mobile phones and tablets for medical photography., Methods: A questionnaire-based survey was conducted among 280 consecutive adult patients who presented to the oculoplastics clinic at a tertiary eye care centre. The responses were tabulated and analysed., Results: Of the 280 patients surveyed, 68% felt that medical photography had a positive impact on their understanding of their illnesses and 72% felt that the use of smartphones for medical photography was acceptable. Respondents below the age of 40 years were more likely to approve of the use of mobile phones for photography as compared to those over 40. Most patients (74%) preferred a doctor to be the person photographing them. While a majority approved of doctors and trainee physicians having access to their photographs, they felt non-physician healthcare personnel should not have access to clinical photographs. Also, 72% of the respondents felt that the patient's consent should be taken before using their photographs. It was noted that patient identification and breach of confidentiality could be some of the potential issues with using smart devices as cameras in the clinic., Conclusions: Clinical photography in general and, specifically, using smart devices for clinical photographs have gained acceptance among patients. The outcomes of this study may be utilized to create policy guidelines for the use of smart devices as photography tools in the clinics. The findings of this survey can also help to create standardized, uniform patient consent forms for clinical photography.