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To evaluate whether pediatric eyes that deviate from age-adjusted normative biometry parameters predict variation in myopic shift after cataract surgery.This is a single institution longitudinal cohort study combining prospectively collected biometry data from normal eyes of children10 years old with biometry data from eyes undergoing cataract surgery. Refractive data from patients with a minimum of 5 visits over ≥5 years of follow-up were used to calculate myopic shift and rate of refractive growth. Cataractous eyes that deviated from the middle quartiles of the age-adjusted normative values for axial length and keratometry were studied for variation in myopic shift and rate of refractive growth to 5 years and last follow-up visit. Multivariable analysis was performed to determine the association between myopic shift and rate of refractive growth and factors of age, sex, laterality, keratometry, axial length, intraocular lens power, and follow-up length.Normative values were derived from 100 eyes; there were 162 eyes in the cataract group with a median follow-up of 9.6 years (interquartile range: 7.3-12.2 years). The mean myopic shift ranged from 5.5 D (interquartile range: 6.3-3.5 D) for 0- to 2-year-olds to 1.0 D (interquartile range: 1.5-0.6 D) for 8- to 10-year-olds. Multivariable analysis showed that more myopic shift was associated with younger age (P.001), lower keratometry (P = .01), and male gender (P = .027); greater rate of refractive growth was only associated with lower keratometry measures (P = .001).Age-based tables for intraocular lens power selection are useful, and modest adjustments can be considered for eyes with lower keratometry values than expected for age.

Supplemental material, sj-docx-2-ejo-10.1177_11206721231167643 for Axial length and corneal curvature of normal eyes in the first decade of life by Isdin Oke, Bharti R Nihalani and Deborah K VanderVeen in European Journal of Ophthalmology

Supplemental material, sj-docx-1-ejo-10.1177_11206721231167643 for Axial length and corneal curvature of normal eyes in the first decade of life by Isdin Oke, Bharti R Nihalani and Deborah K VanderVeen in European Journal of Ophthalmology

PURPOSE This study aims to report long-term outcomes of secondary intraocular lens (IOL) implantation after early cataract surgery in children. METHODS This is a retrospective case series that included children undergoing secondary IOL implantation. The patients had either in-the-bag (ITB) or sulcus implantation; alternative methods of IOL fixation were excluded. Single-piece acrylic IOL was used for ITB and 3-piece acrylic or PMMA IOL for sulcus implantation. The visual acuity outcomes and rate of complications at the last follow-up visit were evaluated. RESULTS One hundred six eyes (70 patients) were analyzed. The mean follow-up was 5.5 ± 3.8 years. Sixty-two eyes (58.5%) had ITB; 44 eyes (41.5%) had sulcus IOL. All but 3 eyes (97.2%) showed stable or improvement in visual acuity. Early inflammation > grade 2 + was noted with sulcus IOL (84% vs 34%, p = 0.01); late inflammation requiring vitrectomy occurred in one eye with sulcus IOL. Mild decentration was seen in 2 eyes with sulcus IOL; one additional subluxed sulcus IOL was exchanged. Sixteen out of 106 eyes (16%) had glaucoma. Eyes that developed glaucoma had early primary surgery (mean, 0.2 years, p

Stroke is abrupt onset of neurologic deficit, referable to a focal vascular cause. The study was undertaken to analyse treatment strategies adopted for patients with ischemic/haemorrhagic stroke, and associated short-term and long-term outcomes of management protocols. Single-centre, observational study, conducted in 200 stroke patients admitted in medicine department at tertiary care hospital with diagnosis of haemorrhagic/ischemic stroke. Data was collected over 18 months. Patient related information was documented into Case Report Form and analysed for a) Ddescriptive statistics regarding drugs used in patients b) Descriptive analysis of outcome in patients in form of death/survival as also improvement in the stroke specific scores i.e., NIH, Modified Rankin, Barthel c) Odds ratio for studying association between use of various drugs and outcome. Among ischemic stroke patients, most commonly prescribed drug was hypolipidemic agent atorvastatin and anti-platelet drug aspirin, followed by anti-hypertensive amlodipine and anti-coagulant enoxaparin sodium. Among hemorrhagic stroke patients, most commonly prescribed drug was atorvastatin, followed by amlodipine. 94% of ischemic stroke patients survived, 6% died while 88% of hemorrhagic stroke patients survived and 12% died. On the basis of stroke-specific scores, prognostic outcome among ischemic stroke patients showed improvement with use of atorvastatin, aspirin and clopidogrel whereas the hemorrhagic stroke patients showed improvement with use of atorvastatin and amlodipine primarily. In Ischemic stroke patient’s hypolipidemic and anti-platelets were apparently associated with better prognostic outcomes. In Hemorrhagic stroke patient’s better prognostic outcomes were seen in patients receiving hypolipidemic and anti-hypertensive primarily.

Background/Aims To establish normative curves for axial length and corneal curvature in the first decade of life. Methods This is a cross-sectional study from a single institution in the United States. Children from 0- to 10-years of age with no underlying ocular pathology were prospectively enrolled to obtain ultrasound biometry and hand-held keratometry while under anaesthesia for an unrelated procedure. Older cooperative children had optical biometry obtained in-office. Logarithmic quantile regression models were used to determine the change in axial length and average keratometry as a function of age. Results Single-eye measurements from 100 children were included. 75% of children were White and 49% female. Median axial length ranged from 20.6 mm (IQR, 20.2 to 21.1 mm) at age one year to 23.1 mm (IQR, 22.5 to 23.8 mm) at age ten years. Median average keratometry ranged from 44.1 D (IQR, 42.6 to 45.4 D) at age one year to 43.5 (IQR, 42.2 to 44.0 D) at age ten years. As age increased, there was a significant increase in axial length (0.74 mm per doubling of age; 95% CI, 0.62 to 0.82 mm), and a non-significant trend towards lower average keratometry (−0.21 D per doubling of age; 95% CI, −0.62 to 0.08 D). Conclusions We provide a set of normative charts for axial length and corneal curvature which may facilitate the identification of eyes outside the normal range and assist in the management of ocular conditions such as glaucoma or cataract.

The Employee Satisfaction Survey is part of the Strategic Framework, and will be one of several measures used to indicate overall organizational performance. Organizations spend an inordinate amount of time and energy focusing on service output, or the customer experience, often without giving thought to what the employees are experiencing along the way. The best way to realign the customer service strategy is to consider shifting your primary focus from the customer experience, to the employee experience. Employee Success and Satisfaction is an important indicator in companys success and continuous growth. This study finds out various factors underlying employee satisfaction. To achieve the aim of the study questionnaire survey was used. The results show that there is direct impact of all the factors in the organization. Job satisfaction is related to different Socioeconomic and personal factors, such as: Age, Sex, Incentives, Working Environment, Education, duration of work etc. The present paper will highlight different factors affecting job satisfaction in retails such as India retail employee such as IndiaBulls mart, Apna Bhanadar, Purti Superbazar, Big Bazar, Pyramid, and Day To Day in the Nagpur region Bulls mart, Apna Bhandar, Purti Superbazar, Big Bazar, Pyramid, and Day To Day in the Nagpur region, India. &nbsp

Evaluation for systemic diagnosis is an important part of pediatric cataract management. While there are reports on associated systemic and ocular associations in children with infantile cataracts, reports specifying associations in large cohorts of children undergoing cataract surgery are lacking.Retrospective chart review of consecutive patients undergoing cataract surgery at a pediatric tertiary referral center during 30-year period was performed. Associated systemic and ocular associations were recorded. The etiologies were analyzed depending on laterality, age, and gender.Seven-hundred twenty-seven patients (1135 eyes) were included for analysis: 408 (56%) with bilateral and 319 (44%) with unilateral cataract. An identifiable cause for cataract was identified in 66% (270/408) bilateral and 55% (176/319) unilateral cataract patients. Hereditary cataract accounted for 22% of bilateral cataracts. An underlying syndrome or genetic diagnosis was found in 24% bilateral (97/408, 86 genetic/syndromic, 11 metabolic) but only in 2% of unilateral cases (5/319). Cataracts were the result of treatment for cancer, or other systemic conditions requiring steroids, in 60/408 bilateral (15%) and 15/319 (5%) unilateral cataract patients. In contrast, unilateral cataracts had higher ocular associations (49%, 156/319) than bilateral cataracts (6%, 23/408) primarily ocular trauma (20%, 64/319) and persistent fetal vasculature (20%, 62/319).Clinicians should be aware of potential systemic and ocular associations among children with visually significant cataracts. Those with no family history of juvenile cataract should be evaluated for systemic associations, and referral to genetics may be warranted in select cases.

Orbital myositis is a rare, commonly idiopathic, inflammatory condition that affects one or more extraocular muscles. We present a case of unilateral orbital myositis affecting the lateral rectus muscle presenting with gaze-evoked amaurosis, pain, and diplopia, with restrictive limitation of adduction. With improvement in adduction after initiating treatment, we noted narrowing of the palpebral fissure on attempted adduction, mimicking Duane retraction syndrome (DRS). Reported cases of “pseudo-DRS” are associated with multiple etiologies and are characterized by retraction on attempted abduction rather than adduction, as occurs in true DRS. In this case, pseudo-DRS occurred in the setting of idiopathic orbital inflammatory syndrome (orbital myositis) with a motility pattern more consistent with true DRS.

To evaluate the efficacy of immunomodulatory therapy (IMT) in paediatric anterior uveitis.Chart review of all patients ≤ 18 years treated for anterior uveitis using a stepladder approach during a 10-year period. The type and duration of IMT were noted. The data were analysed depending on chronicity, aetiology, and type of IMT using appropriate statistical tests. The outcome measures included ocular complications, the need for surgical intervention, and visual outcomes.One hundred and thirty-four patients (191 eyes) were analyzed. The median age at diagnosis was 7 years (interquartile range (IQR): 7.5 years). The median follow-up was 4 years (IQR: 6 years). The most common causes of anterior uveitis were Juvenile idiopathic arthritis (64 patients, 47.8%) and undifferentiated (33 patients, 24.6%). All patients were started on topical steroids and cycloplegics. 94 (70%) patients required IMT. 92 (68.6%) were started on Methotrexate as the first agent, of which 21 (22%) were switched to a different agent owing to side effects. Biologic agent was added in 55 (41%) patients. 21 (16%) required switch to a second biologic agent, 5 (3.7%) to third, and 1 (0.8%) to fourth biologic agent. At the last exam, 11 (8%) had persistent inflammation. 55 (41%) had ocular complications, and 113 (84%) had a best corrected visual acuity ≥ 20/40.Early introduction of IMT and switch to different agents may be required to control anterior uveitis and reduce the complications in children. IMT is safe and effective in treating paediatric anterior uveitis.

Intraocular lens (IOL) power calculation is challenging in pediatric eyes. These eyes have short axial length, steep cornea and shallow anterior chamber. The measurements are performed under general anesthesia in infants and young children where it is difficult to ensure central fixation. There are no IOL calculation formulae designed for pediatric eyes. Most surgeons undercorrect the IOL power to account for ocular growth and to prevent large myopic shifts by adulthood. In this chapter, we discuss the biometry techniques, IOL power formulas and principles for IOL power selection in pediatric eyes. There is a need to better understand the pediatric eye growth and to develop IOL power calculation formula specifically designed for pediatric eyes that are tailored for each eye to achieve best refractive outcomes. Residual refractive correction and amblyopia management are additional measures needed to promote good visual outcomes.

This study aims to report long-term outcomes of secondary intraocular lens (IOL) implantation after early cataract surgery in children.This is a retrospective case series that included children undergoing secondary IOL implantation. The patients had either in-the-bag (ITB) or sulcus implantation; alternative methods of IOL fixation were excluded. Single-piece acrylic IOL was used for ITB and 3-piece acrylic or PMMA IOL for sulcus implantation. The visual acuity outcomes and rate of complications at the last follow-up visit were evaluated.One hundred six eyes (70 patients) were analyzed. The mean follow-up was 5.5 ± 3.8 years. Sixty-two eyes (58.5%) had ITB; 44 eyes (41.5%) had sulcus IOL. All but 3 eyes (97.2%) showed stable or improvement in visual acuity. Early inflammation grade 2 + was noted with sulcus IOL (84% vs 34%, p = 0.01); late inflammation requiring vitrectomy occurred in one eye with sulcus IOL. Mild decentration was seen in 2 eyes with sulcus IOL; one additional subluxed sulcus IOL was exchanged. Sixteen out of 106 eyes (16%) had glaucoma. Eyes that developed glaucoma had early primary surgery (mean, 0.2 years, p 0.001, significant); there was no difference in glaucoma rates based on implantation site.Early postoperative inflammation is higher in eyes with sulcus implantation, but good visual acuity outcomes are noted after secondary IOL implantation in children. Glaucoma is the main complication that requires close monitoring and is associated with early age at primary surgery.

Unilateral congenital cataracts are believed to result from localized ocular dysgenesis. Approximately 80–90% of unilateral cataracts are idiopathic. They are rarely associated with systemic anomalies and hence do not require systemic workup. Nuclear cataracts are common. Posterior capsule plaques are frequently encountered with unilateral congenital cataracts. Persistent fetal vasculature (PFV) poses special challenges in management. Early diagnosis and prompt treatment are critical for visually significant unilateral congenital cataracts owing to competition from the dominant normal eye. Preoperative counselling should stress the importance of full-time optical correction and amblyopia management. The visual outcomes are limited by early onset of deprivation amblyopia.

Disposal of chemical waste and discharges of process wastewater over long period results in contamination of soil, ground water and surface water. The release or potential release of contaminant from such sites may endanger human health, welfare & the environment. Human health could be at a risk due to inhalation of air borne contaminants, direct contact with soil /sediment and ingestion of contaminated ground water. It is, therefore, necessary to remediate contaminated soil by adopting suitable measures. The objective of study is to determine the efficacy of soil washing technology in the removal of Technical Lindane (T-HCH) adsorbed on soils. In this paper we are giving our experimental work on remediation of soil which comprises of soil washing technique, Extraction process and Gas chromatography. Keyword:Soil,Washing ,Solvent,Lindane ,Extraction ,Pesticide ,Chromatography

Background: To investigate the effects of metformin sustained-release (MSR) compared with metformin immediate-release (MIR) on glycaemic control, blood pressure, lipid profile and metabolic parameters like weight, waist circumference in type 2 diabetes. Methods: A prospective, randomized, double blind study was conducted at tertiary healthcare and teaching hospital at Pune, Maharashtra. After obtaining institutional ethical committee approval and written informed consent, 40 newly diagnosed type 2 diabetic patient were randomly assigned to receive metformin immediate release formulation (MIR) 500 mg once 1 week and then twice daily and metformin sustained release formulation (MSR) 500 mg once 1 week and then 1000mg once daily for 18 weeks. Fasting and post prandial blood glucose level (BGL), HbA1c, blood pressure, lipid profile, weight and waist circumference, were recorded at the start and end of study. Results: Both MIR and MSR significantly decreased fasting; post prandial BGL and HbA1c at 18 weeks. But no significant difference was seen between two groups. Study did not show any effect on blood pressure and on lipid profile. Both formulations decreased obesity as evident by significant reduction in weight and waist circumference. All patients tolerated both formulations of metformin. Though overall incidences of adverse effects are less with sustained release formulation, difference was not significant between two groups. Conclusions: To conclude, both metformin immediate release and sustained release formulations achieved comparable glycaemic control and sustained release formulation would be as effective as immediate release formulation with advantage of being reduce daily intake of tablets.

Background: Metformin is a first-line therapy for type 2 diabetes mellitus. However, the glycaemic response to metformin is likely to be affected by polymorphisms of transporter genes. Therefore, the study was done with the aim to assess demographic distribution of transporter genotypes involved in disposition and action of metformin.Methods: This cross-sectional, observational, single centre, clinical study was conducted in 80 diabetic patients recruited from medicine OPD. Descriptive analysis was done for distribution of the four transporter genotypes viz. SLC47A1 (rs2289669), ATM (rs11212617), SLC22A2 (rs316019) and SLC22A1 (rs622342). Genotyping was determined by DNA extraction, agarose gel electrophoresis, estimation of DNA concentration, polymerase chain reaction, DNA sequencing, sequencing analysis.Results: Transporter genotype analysis showed that for SLC47A1 (rs2289669) transporter, 31.25% and 26.25% were homozygous for AA and GG allele respectively, while 42.5% were heterozygous (AG). For ATM (rs11212617), SLC22A2 (rs316019) and SLC22A1 (rs622342) transporter, 45% and 10%, 1.25% and 80%, 58.75% and 7.50% were homozygous for AA and CC allele respectively; while 45%, 18.75%, 33.75% were heterozygous (AC) respectively. Interethnic differences in the genotype and allele frequencies of SLC22A1 (rs622342) and ATM (rs11212617) gene polymorphism were observed when compared with other major populations.Conclusions: In the genotypic distribution of four transporter genotype study showed that there was an ethnic variation in allelic distribution of allele A and C of ATM (rs11212617) and SLC22A1 (rs622342) while AA genotype of SLC22A2 (rs316019) was rare genotype and allele ‘A’ was major allele found in our study. The study data observed would justify further pharmacogenetic studies to evaluate the role of gene polymorphism in the therapeutic efficacy of metformin.

Introduction: Considering the cost of Anti-Snake Venom (ASV) and irregularity in its supply, there is often a need to curtail doses of ASV, despite guidelines for management of snake bite. During June 2013 to September 2013, when ASV was in short supply, our institutional committee reviewed the overall hospital statistics of snake bite cases as well as scientific literature and formulated a working modified protocol that used low dose of ASV in snake bite cases. Aim: To retrospectively analyse and compare the modified ASV protocol versus conventional ASV protocol with respect to outcome, number of ASV vials required, duration of stay in the hospital/ ICU, and additional supportive interventions needed. Materials and Methods: This was a retrospective study conducted at a tertiary care teaching hospital, Maharashtra, India. Hospital records of inpatients admitted for snake bite during June 2013 to September 2013 (since introduction of the modified protocol) as well as during June 2012 to September 2012, (when patients received conventional protocol-historical controls) were retrospectively analysed to assess the number of ASV vials received by the patients during the stay, need for supportive therapy, duration of stay and outcome of the patients. Results: There was a significant reduction in average number of ASV vials per patient, required vide the modified protocol compared to their historical controls (10.74±0.95 vs 28.17±2.75 p

Introduction: The indoor hospital use of antibiotic irrationally has been a growing concern in the recent past. For the patients and providers of health care services this kind of drug consumption account for a major chunk of the budget. Aim: To assess the outcome of restriction on the use of parenteral antibiotics with respect to their utilization and monetary benefits, in a tertiary care hospital in India. Materials and Methods: Data details were collected regarding drug utilization two months before and after restriction respectively. A total 1605 patient records assessed. Drug utilization was expressed as DDD/100 patient bed days. Use of Carbapenems were restricted to culture positive cases only. Antibiotics started for patients as per clinical judgment were issued for only five days. Culture sensitivity reports verified physically on a special indent form, before every antibiotic issued thereafter. Results: Piperacillin-tazobactum (DDD/100 BD 1.72 before and 1.29 after restrictions) was the commonly used antibiotic. Considering values expressed in DDD/100 BD before and after restriction respectively, substantial decrease in consumption of antibiotics like Imipenem- Cilastin (0.22 to 0.16), meropenem (0.30 to 0.09), piperacillin-tazobactum (1.72 to 1.29), teicoplanin (0.24 to 0.05) and vancomycin (0.69 to 0.40) was observed. An increase in consumption of amoxicillin-clavulanic acid (0.90 to 1.04) and clarithromycin (0.44 to 0.55) noted, pointing to a shift in antibiotic use. Restriction decreased expenditure burden on these antibiotics by INR 1,45,911 (17.31%). Conclusion: Restriction of antibiotics cuts down consumption and benefits hospital budget immensely.

Resistance to inhibitors of cholinesterase (Ric-8)A and Ric-8B are essential genes that encode positive regulators of heterotrimeric G protein α subunits. Controversy persists surrounding the precise way(s) that Ric-8 proteins affect G protein biology and signaling. Ric-8 proteins chaperone nucleotide-free Gα-subunit states during biosynthetic protein folding prior to G protein heterotrimer assembly. In organisms spanning the evolutionary window of Ric-8 expression, experimental perturbation of Ric-8 genes results in reduced functional abundances of G proteins because G protein α subunits are misfolded and degraded rapidly. Ric-8 proteins also act as Gα-subunit guanine nucleotide exchange factors (GEFs) in vitro. However, Ric-8 GEF activity could strictly be an in vitro phenomenon stemming from the ability of Ric-8 to induce partial Gα unfolding, thereby enhancing GDP release. Ric-8 GEF activity clearly differs from the GEF activity of G protein–coupled receptors (GPCRs). G protein βγ is inhibitory to Ric-8 action but obligate for receptors. It remains an open question whether Ric-8 has dual functions in cells and regulates G proteins as both a molecular chaperone and GEF. Clearly, Ric-8 has a profound influence on heterotrimeric G protein function. For this reason, we propose that Ric-8 proteins are as yet untested therapeutic targets in which pharmacological inhibition of the Ric-8/Gα protein–protein interface could serve to attenuate the effects of disease-causing G proteins (constitutively active mutants) and/or GPCR signaling. This minireview will chronicle the understanding of Ric-8 function, provide a comparative discussion of the Ric-8 molecular chaperoning and GEF activities, and support the case for why Ric-8 proteins should be considered potential targets for development of new therapies.

Pediatric genetic disorders of lens include various cataractous and non-cataractous anomalies. The purpose of this review is to help determine the genetic cause based on the lens appearance, ocular and systemic associations. Children with bilateral cataracts require a comprehensive history, ophthalmic and systemic examination to guide further genetic evaluation. With advancements in genetics, it is possible to determine the genetic mutations and assess phenotype genotype correlation in different lens disorders. The genetic diagnosis helps the families to better understand the disorder and develop realistic expectations as to the course of their child's disorder.

Purpose To describe our technique for secondary intraocular lens (IOL) implantation in aphakic children and report patient outcomes. Patients and Methods In our technique for in-the-bag IOL implantion, we used a microvitreoretinal (MVR) blade to separate the capsular leaflets for aspiration of reproliferated lens material within Soemmering's ring. When sufficient capsular opening was not possible or capsular support deemed inadequate, an IOL was implanted in the sulcus. Records of patients with secondary IOL implantation between 1999 and 2009 were retrospectively reviewed with regard to intra- and postoperative complications and visual and refractive outcomes. Results A total of 50 consecutive eyes of 32 patients were evaluated. Mean age at secondary IOL implantation was 9.1 years. Of these, 26 eyes had in-the-bag IOLs and 24 had sulcus IOLs. Forty-four eyes (88%) had an AcrySof IOL (Alcon Inc, Ft. Worth, TX). The prevalence of any corneal edema (54% vs 19%, P = 0.04) and uveal inflammation >2+ (92% vs 31%, P Conclusions Eyes achieving secondary in-the-bag IOL showed less inflammation and corneal edema in the early postoperative period partly as the result of greater surgical and anatomic challenges in some eyes receiving sulcus IOL. Visual and refractive outcomes were satisfactory in eyes with secondary IOL implantation. Mean prediction error was similar for in-the-bag and sulcus IOLs.

It is being realized that identification of subgroups within normal controls corresponding to contrasting disease susceptibility is likely to lead to more effective predictive marker discovery. We have previously used the Ayurvedic concept of Prakriti , which relates to phenotypic differences in normal individuals, including response to external environment as well as susceptibility to diseases, to explore molecular differences between three contrasting Prakriti types: Vata, Pitta, and Kapha . EGLN1 was one among 251 differentially expressed genes between the Prakriti types. In the present study, we report a link between high-altitude adaptation and common variations rs479200 (C/T) and rs480902 (T/C) in the EGLN1 gene. Furthermore, the TT genotype of rs479200, which was more frequent in Kapha types and correlated with higher expression of EGLN1 , was associated with patients suffering from high-altitude pulmonary edema, whereas it was present at a significantly lower frequency in Pitta and nearly absent in natives of high altitude. Analysis of Human Genome Diversity Panel-Centre d’Etude du Polymorphisme Humain (HGDP-CEPH) and Indian Genome Variation Consortium panels showed that disparate genetic lineages at high altitudes share the same ancestral allele (T) of rs480902 that is overrepresented in Pitta and positively correlated with altitude globally ( P < 0.001), including in India. Thus, EGLN1 polymorphisms are associated with high-altitude adaptation, and a genotype rare in highlanders but overrepresented in a subgroup of normal lowlanders discernable by Ayurveda may confer increased risk for high-altitude pulmonary edema.

To evaluate the effect of anterior capsule polishing on the development of anterior capsule opacification (ACO) in patients undergoing cataract surgery. This prospective randomized observational double-masked clinical trial comprised 120 eyes of 60 consecutive patients with bilateral age-related cataract who underwent phacoemulsification. The patients were randomly assigned to one of the two groups: One eye received a 360 degree anterior capsule polishing (group 1 (cases)) and the fellow eye was without anterior capsule polishing (group 2 (controls)) The primary observation was to observe the development of ACO between the 2 groups, whereas the secondary observation was to measure uveal inflammation. ACO was evaluated at 1 week, 1 month, and 6 months. At the 1-week follow-up, there was no significant difference in the development of ACO between the two groups. At 1 month, 54 (90%) eyes developed ACO in controls and 26 (43.3%) eyes in cases (P

Purpose To evaluate surgical outcomes of 1-piece AcrySof SA30AL intraocular lens (IOL) (Alcon Laboratories) implantation in children having surgery for congenital and developmental cataracts. Setting Iladevi Cataract & IOL Research Centre, Raghudeep Eye Clinic, Ahmedabad, India. Methods This prospective observational study comprised 134 consecutive eyes of 84 children from 2 to 15 years old who had surgery for congenital and developmental cataract. Two groups were formed depending on the age of the child at surgery. Primary posterior continuous curvilinear capsulorhexis (PCCC) was performed in children younger than 6 years (Group 1, 66 eyes), and no PCCC was performed in children older than 6 years (Group 2, 68 eyes). Vitrectomy was not performed. An AcrySof IOL was implanted in the bag in all eyes except 1 in Group 1, which received a sulcus-fixated IOL. The study's primary outcome measures were the incidence of visual axis obscuration and the need for a secondary procedure to clear the axis. Secondary observations included the incidence of posterior synechias, cell deposits, and haptic compression. A test of proportion was applied to determine whether age was a risk factor for the development of visual axis obscuration. Results The mean age at surgery was 6.0 years ± 3.2 (SD). The mean follow-up was 2.6 ± 0.6 years. In Group 1, 20 eyes (30.3%) developed visual axis obscuration but only 6 (9.1%) required a secondary procedure. In Group 2, 20 eyes (29.4%) developed visual axis obscuration and 10 (14.7%) required secondary procedures. Posterior synechias were observed in 2 eyes (3.0%) in Group 1 and none in Group 2. Cell deposits were seen in 8 eyes (12.1%) in Group 1 and 8 eyes (11.8%) in Group 2. Haptic compression was noted in 1 eye in Group 2. Mild IOL decentration was observed in the 1 eye with a sulcus-fixated IOL. Conclusion The 1-piece AcrySof IOL provided satisfactory visual axis clarity, produced an acceptable inflammatory response, and maintained centration in pediatric eyes.

Purpose: We sought to document the completion rate of primary posterior continuous curvilinear capsulorhexis during congenital cataract surgery and determine the incidence of disruption of vitreous face during this procedure. Methods: One hundred six consecutive eyes of patients undergoing posterior continuous curvilinear capsulorhexis (PCCC) during congenital cataract surgery were evaluated prospectively for completion of PCCC and disruption of vitreous face. PCCC was performed under high-viscosity sodium hyaluronate (Healon GV 1.4%) initiated with 26 g of cystotome and later completed with Kraff–Uttrata forceps by frequent grasping and regrasping of the flap. Completion of PCCC and disruption of vitreous face during the procedure was noted. Even in cases of disrupted vitreous face, PCCC was performed and completed with forceps and, later, disruption of vitreous face was managed with 2-port automated limbal anterior vitrectomy. The size of PCCC was measured. An Alcon AcrySof SA30AL™ was implanted in-the-bag if the PCCC was 4 mm or smaller and in the sulcus when the PCCC was larger than 4 mm. Results: The mean age of the 106 pediatric patients was 17 ± 26 months (median, 6 months; range, 1 month to 8 years). PCCC was completed in all the eyes. Disruption of vitreous face during PCCC was noted in 5 of 106 (4.7%) eyes. The mean size of PCCC was 3.6 ± 0.7 mm. A total of 98 (92.5%) had in-the-bag, and 8 (7.5%) eyes had sulcus implantation of IOL. Conclusion: PCCC was completed in all eyes with minimal disruption of vitreous face in a well-controlled manner under high-viscosity viscoelastics.

Purpose of review Pediatric cataract surgery remains a very important and difficult problem to manage. While dramatic advances have occurred in this field over the past 10 years, some technical aspects of surgery, changing refraction and functional outcome continue to pose significant problems. The aim of the present review is to update the reader on advances reported on the topic during the past year. Recent findings Manual capsulorhexis still remains a gold standard for the successful outcome of pediatric cataract surgery. Primary management of the posterior capsule is mandatory depending on the age of the child at surgery. Primary implantation of the intraocular lens after cataract removal is gaining popularity even in infants and young children. Short-term results of single-piece Acrysof in pediatric eyes are encouraging. Predicting axial growth and the refractive change that accompanies it is one of the major challenges for long-term care of children after surgery. The evaluation of rate of axial growth and its correlation with age at surgery, laterality, aphakia/pseudophakia and visual-axis obscuration is a positive step in the right direction. Despite satisfactory technical outcomes, the functional outcomes remain unpredictable. Summary With refinements in surgical techniques, improvisation of intraocular lenses and better understanding of growth of the pediatric eye, in the coming years intraocular lens implantation is likely to become an established mode of treatment of children even in the youngest age group.

To evaluate the rate of axial growth after congenital cataract surgery.Prospective observational case series.Rate of axial growth of 158 eyes (79 children10 years) undergoing surgery was correlated with age at surgery, laterality, and visual axis obscuration. After measuring axial length (AL) at each follow-up, the mean AL was calculated, adding the AL of all eyes divided by their total number. Rate of axial growth is the percentage difference between preoperative mean AL and mean AL at last follow up. The temporal profile of RAG is the difference between two consecutive mean ALs with respect to the previous reading. The follow-up period was 58.96 +/- 2.02 months. The student' paired t test and independent sample t test were applied. The main outcome measure was RAG.Rate of axial growth in children operated ator = 1 year (23.5%) was significantly higher than in those ator = 3 years (4.8%; P = .0001, confidence interval [CI] 1.05-3.2) and ator = 10 years (4.3%; P = .0001, CI 1.3-3.1). In children operated ator = 1 year, temporal profile of RAG was higher in the first 2 years after surgery. Rate of axial growth was higher in patients with unilateral pseudophakia ator = 1 year (25.53%) than in age-matched patients with bilateral pseudophakia (18.50%; P = .001, CI -13 to -0.2). Rate of axial growth was negligible in children with visual axis obscuration in any group.Rate of axial growth is higher in childrenor = 1 year and increases until the second year after surgery. Unilateral pseudophakia revealed accelerated growth compared with bilateral pseudophakia. Visual axis obscuration does not influence rate of axial growth.

Response to: ’Unmet needs of cataract blind children in special schools in Southeast Nigeria’

When a patient is brought to the emergency department with profound coma, absent brain stem reflexes, and apnea, the possibility of brain death should be considered. If this condition is irreversible, the patient meets the clinical criteria and may be declared dead. Prompt confirmation is important: valuable resources can be redirected to living patients, the decedent’s family can be given ministry, and transplantation of donor organs to needy patients can be facilitated. Although brain death is a clinical diagnosis, confirmation by additional testing is often required by local practice standards or local law. This article discusses the role of the radiologist in this situation and the examinations used for this purpose.

In their PNAS article, Kataria et al. conclude that “…Dictyostelium resistant to inhibitors of cholinesterase 8 (Ric-8), in contrast to mammalian Ric-8, does not play a role in the expression or folding of G proteins.” (1) We contend that the experimental evidence presented to support this claim is not sufficient. Figure 5A reported similar steady-state whole cell Gα2 levels in a ric-8-null organism vs. a WT control. This experiment reveals no information about the functionality or folded state of Gα2 or any other Gα subunit in ric-8-null Dictyostelia. In Ric-8A-null mouse embryonic stem (ES) cell whole cell lysates, we reported slight reductions of particular Gα subunits (e.g., Gαo and Gα13) and dramatic reductions of others (e.g., Gαq and Gαi1/2) (2). However, Gαo and Gα13 were reduced dramatically in a subcellular membrane fraction prepared from Ric-8A-null cells because these G proteins were not folded properly during biosynthesis (2, 3). The individual stabilities of misfolded Gα subunits differ depending on subtype. Gα subunit misfolded status in Ric-8 absence may not always be revealed by immunoblotting Gα subunits from whole cell lysates.

Purpose To report uncorrected distance and near visual acuity in pediatric eyes treated with primary monofocal intraocular lens (IOL) implantation. Setting Boston Children's Hospital, Boston, Massachusetts, USA. Design Retrospective chart review. Methods Records of children older than 5 years who had uneventful monofocal IOL implantation targeted for emmetropia within ±1.00 diopter (D) spherical equivalent were reviewed. Eyes with secondary IOL placement and sulcus-fixated IOLs were excluded. Vision was tested using the Mentor BVAT or M&S system for distance and the standard Jaeger near card for near visual acuity. Keratometry, axial length, type of IOL, and preoperative and postoperative refractions were recorded. The main outcome measure was uncorrected visual acuity at distance and near. Good visual acuity was defined as 20/40 or better. Results Forty-one eyes of 25 children had uncorrected distance and near visual acuity recorded in the early postoperative period. The mean age was 11.2 years ± 3.6 (SD). Twenty eyes (49%) had good visual acuity at distance and near, 11 had good visual acuity at distance only, 6 had good visual acuity at near only, and 4 had worse than 20/40 at distance and near. Thirty eyes (70%) had with-the-rule astigmatism. All but 2 eyes (95%) had 20/70 or better uncorrected acuity at distance and near. In children with bilateral pseudophakia, 12 (75%) of 16 had 20/40 or better uncorrected acuity at distance and near. Conclusion Monofocal IOL placement resulted in good uncorrected distance and near visual acuity in almost 50% of pediatric eyes and in 75% of patients when targeted within ±1.00 D of emmetropia. Financial Disclosure Neither author has a financial or proprietary interest in any material or method mentioned.

Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of 'no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach.

Managing pediatric cataracts is often challenging. It is technically difficult to perform surgery in these small complaint eyes and there is higher prevalence of postoperative complications. The outcomes of surgery depend on technique and technology. The purpose of this study is to review the current literature on technological advances in pediatric cataract surgery.Review of literature on management of pediatric cataract surgery.The advent of vitrectomy machines and intraocular lenses (IOLs) has revolutionized pediatric cataract surgery. "Vitrectorhexis" has become a good alternative to manual capsulorhexis. Primary management of posterior capsule and limited anterior vitrectomy has reduced the incidence of visual axis opacification. Primary IOL implantation is becoming a standard of care in the youngest children. Single piece Acrysof® is preferred for in-the-bag implantation and 3-piece Acrysof® for sulcus implantation. Newer IOLs are being evaluated in pediatric eyes. Precise measurement of intraocular lens power and predicting refractive change are major challenges in long term care of children after surgery.New technology and surgical techniques have refined pediatric cataract surgery. It is critical to focus our efforts on precise biometry measurements, IOL power calculation, and designing IOLs that may address refractive changes in the growing pediatric eye.