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Byline: S. Kaliaperumal, S. Tiroumal, V. Rao Orbital rhabdomyosarcoma is the most common orbital malignancy of childhood with the common presentation of rapidly evolving unilateral proptosis. We studied six patients [...]

PurposeTo investigate the efficacy of a standardised wick soaked in a mydriatic cocktail regimen and compare it with the pre-existing regimen of topical dilating drops.DesignProspective, two armed, randomised, double blind, parallel assignment efficacy studyParticipantsIn all, 150 eyes of 150 patients were dilated using the dilating cocktail regimen by using a Weck cell sponge. The control group comprised of 75 eyes of 75 patients dilated using the conventional mydriatic regimen.InterventionsA specially prepared mydriatic cocktail regimen consisting of 1 : 1 : 1 : 1 ratio of 2.5% phenylephrine, 0.5% moxifloxacin, 1% cyclopentolate, and 0.03% flurbiprofen eye drops was prepared. A standard sized wick (1 cm × 2 mm) made of Weck cell sponge was soaked in the cocktail for a minute and placed in the lower fornix with sterile forceps. In the control group, eyes were dilated with the above drops using topical instillation in every 15 min. The mydriasis was measured at 15, 30, and 45 min after instillation using the Procyon pupillometer under scotopic conditions (0.04 lux). The intraoperative maintenance of mydriasis was measured with calipers after nucleus delivery and after intraocular lens implantation.Main outcome measuresPupillary diameters at the end of 15, 30, and 45 min, and intraoperative maintenance of mydriasis in the two groups were compared using unpaired t-test.ResultsThere was a statistically significant difference (P<0.001) in dilation achieved at the end of 45 min in both groups. There was also a significant difference of 1-mm dilation between the two groups after nucleus delivery (P< 0.001), and a difference of 1.41 mm after intraocular lens implantation, which was statistically significant (P<0.001).ConclusionsThese results show that the mydriatic cocktail regimen delivered with a wick is a useful, economical, and timesaving regimen compared with the conventional method of preoperative mydriasis using topical drops. [ABSTRACT FROM AUTHOR]

Purpose: To study the efficacy of adding vancomycin in irrigating solutions, in comparison to topical antibiotic given preoperatively for a day, during phacoemulsification, in reducing the anterior chamber (AC) contamination.Settings and Design: This was a prospective, interventional, hospital-based study.Materials and Methods: This was a study involving 400 eyes of 400 paitens, undergoing routine phacoemulsification between January 2004 and June 2006. The patients were non-randomly assigned to two groups: Group 1 included 180 patients, who received topical ciprofloxacin eye-drops (four-hourly) for a day preoperatively and Group 2 included 220 patients, who underwent phacoemulsification with vancomycin (20 microg/ml) in the irrigating solution. Anterior chamber aspirate obtained at the end of the surgery was sent for microbial workup. The number of positive cultures in both the groups was determined.Statistical Analysis: This was performed using Chi-square test.Results: Aqueous samples showed microbial growth in 38 (21.1%) out of 180 eyes in Group 1 and in 17 (7.7%) out of 220 eyes in Group 2 ( P = 0.001). Coagulase-negative staphylococcus was the most common organism in both the groups. Aqueous samples from four eyes in group 1 showed multiple organisms, while none of the sample from group 2 showed more than one organism. None of the eyes in either group showed fungal contamination. One patient in Group 1 developed endophthalmitis, and the causative organism was Alcaligenes faecalis. All patients were followed up for a minimum of six months (range: 6 to 14 months and mean: 9.3 months).Conclusion: Addition of vancomycin in irrigating solutions is more efficacious in reducing AC contamination in comparison to topical antibiotic administered a day preoperatively. [ABSTRACT FROM AUTHOR]

PurposeTo study the incidence, clinical presentation, and the response of anti-fungals in cases of fungal endophthalmitis following open globe injury.MethodsThis is a prospective study of eight cases of post-traumatic fungal endophthalmitis among 110 patients who presented to us with open globe injury between August 2003 and January 2005. Patients with panophthalmitis were eviscerated and rest received intravitreal amphotericin B. Pars plana vitrectomy along with intravitreal miconazole was given in patients with inadequate response to intravitreal amphotericin.ResultsTwo patients had panophthalmitis at the time of presentation and were eviscerated. Six different organisms were isolated from the culture of intraocular specimen of eight patients. The yield of vitreous aspirate was 87.5% and that of aqueous aspirate was 66.6%. Aspergillussp. and Fusariumsp. were isolated in 62.5% of cases. Minimum inhibitory concentration of amphotericin B and miconazole was less than 3 μg/ml for all organisms except for Paecilomyces lilacinusand Fusarium solani, respectively. In total, 37.5% of patient had final visual acuity of 20/400 or better.ConclusionsFungal endophthalmitis is a relatively rare complication of open globe injury. The final visual outcome after fungal endophthalmitis is dismal. Aspergillus fumigatuswas found to be the most virulent organism. All organisms were found to be sensitive to amphotericin B, except P. lilacinus, which was sensitive to miconazole. Repeated intravitreal injection may be required to control the infection. The virulence of the organism and the site of injury are the main determinants of final visual outcome.Eye (2008) 22, 13–17; doi:10.1038/sj.eye.6702463; published online 2 June 2006 [ABSTRACT FROM AUTHOR]

This study reports a novel method for preparation of water soluble CdS nanoparticles using leaf extract of a plant, Asparagus racemosus. The extract of the leaf tissue which worked as a stabilizing and capping agent, assisted the formation of nanoparticles. Nanoparticles were characterized using a UV–vis spectrophotometer, Photoluminescence, TEM, EDAX, XRD and FT-IR. Transmission electron microscopy followed by selected area electron diffraction pattern analysis indicated the formation of spherical, polydispersed, crystalline, CdS of diameter ranging from 2 to 8 nm. X-ray diffraction studies showed the formation of 111, 220 and 311 planes of face-centered cubic (fcc) CdS. EDAX analysis confirmed the presence of Cd and S in nanosphere. The cytotoxicity test using MTT assay as well as DNA damage analysis using comet assay revealed that synthesized nano CdS quantum dots (QDs) caused less DNA damage and cell death of lymphocytes than pure CdS nanoparticles.

A novel, lamellar type Vanadium n-propylamino phosphate catalyst is synthesized and characterized by using various physicochemical techniques such as Powder X-ray diffraction, Scanning electron microscopy/Energy dispersive X-ray analysis, Thermogravimetry/Differential thermal analysis, Fourier transform Infrared analysis, Electron spin resonance spectroscopy, Ultraviolet - Visible Diffuse reflectance spectroscopy, X-ray Photoelectron spectroscopy, 31P Magic angle spinning Nuclear Magnetic Resonance spectroscopy and Catalytic applications toward Octahydroquinazolinone synthesis. It is found that the n-propylamine is present as sandwich between Vanadyl phosphate layers. Most of the Vanadium is present as V4+ ions in tetrahedral co-ordination. Vanadium n-propylamino phosphate catalyses Octahydroquinazolinone synthesis more effeciently and the optimum conditions required for Octahydroquinazolinone synthesis are, Benzaldehyde (2 mmol), Dimedone (2 mmol), Urea (4 mmol), Methanol + Water (1:1, 5 mL) and Catalyst (0.05 g). A plausible mechanism is also proposed.

Neuroretinitis is a less-known clinical entity, which can be funduscopically confused with papillitis or papilledema and with hypertensive, renal and infiltrative retinopathies as well as with retinal vein occlusion or anterior ischemic optic neuropathy. Report: Two young patients presented with sudden onset of blurring of vision. Ophthalmic evaluation revealed a characteristic picture of neuroretinitis. Detailed study of the cases failed to indicate any specific etiology, thereby suggesting the diagnosis of idiopathic neuroretinitis. Although funduscopy showed marked inflammatory changes in the retina and optic nerve head, the recovery following medical treatment was remarkable. Comment: Familiarity with the fundus picture and awareness of the specific causes of neuroretinitis among neurologists and physicians may enable a prompt clinical diagnosis, avoidance of expensive brain imaging studies and early referral for appropriate and effective therapy. A brief review of the literature is presented suggesting a need for further studies to establish specific environmentally determined etiological factors such as infections and the effectiveness of the current modalities of treatment.

A letter to the editor on alcaligenes faecalis is presented.

A novel, lamellar type Vanadium n-propylamino phosphate catalyst is synthesized and characterized by using various physicochemical techniques such as Powder X-ray diffraction, Scanning electron microscopy/Energy dispersive X-ray analysis, Thermogravimetry/Differential thermal analysis, Fourier transform Infrared analysis, Electron spin resonance spectroscopy, Ultraviolet - Visible Diffuse reflectance spectroscopy, X-ray Photoelectron spectroscopy, 31P Magic angle spinning Nuclear Magnetic Resonance spectroscopy and Catalytic applications toward Octahydroquinazolinone synthesis. It is found that the n-propylamine is present as sandwich between Vanadyl phosphate layers. Most of the Vanadium is present as V4+ ions in tetrahedral co-ordination. Vanadium n-propylamino phosphate catalyses Octahydroquinazolinone synthesis more effeciently and the optimum conditions required for Octahydroquinazolinone synthesis are, Benzaldehyde (2 mmol), Dimedone (2 mmol), Urea (4 mmol), Methanol + Water (1:1, 5 mL) and Catalyst (0.05 g). A plausible mechanism is also proposed.

Purpose: To study the clinical spectrum and recovery patterns in patients of acquired isolated ocular motor nerve palsies (OMNPs). Methods: Patients above 5 years of age with various etiologies of OMNPs were included. Demographic and ocular details were recorded, and a squint assessment was performed. Recovery patterns at 3 and 6 months were noted. Results: OMNP was more common in adults, in the order VI > III > IV nerve. Ischemic cause (35%) was followed by idiopathic (26.3%). III nerve palsies were all unilateral, of which all ischemic palsies were pupil-sparing. By 6 months, >50 patients showing complete recovery had ischemic and idiopathic palsies. Smaller baseline deviation correlated with better recovery. Conclusion: Acquired isolated OMNPs are mostly ischemia-related, with >80% of cases fully recovering by 6 months. VI nerve palsy of ischemic or idiopathic etiology and small baseline deviation were associated with self-recovery.

Introduction: Human mastadenovirus (HAdV) types 8, 37, 64 have been considered the major contributors in Epidemic keratoconjunctivitis (EKC) epidemics, but recent surveillance data have shown the involvement of emerging recombinants, including HAdV-53, HAdV-54, and HAdV-56. In our initial work, positive samples for adenovirus revealed that our strains were closer to HAdV-54 than HAdV-8. Hence, the current study aimed to use whole genome technology to identify the HAdV strain correctly., Methodology: Oxford Nanopore technique was used, wherein a Targeted sequencing approach using long-range PCR amplification was performed. Primers were designed using HAdV-54 (AB448770.2) and HAdV-8 (AB897885.1) as reference sequences. Amplicons were sequenced on the GridION sequencer. Sequences were annotated using Gatu software, and similarities with standard reference sequence was calculated using Bioedit software. The phylogenetic tree was built after alignment in MEGA v7.0 using Neighbour joining method for each of the genes: Penton, Hexon, and Fiber. The effect of novel amino acid changes was evaluated using the PROVEAN tool. The Recombination Detection Program (RDP) package Beta 4.1 was used to identify recombinant sequences., Results: Of the five samples sequenced, OL450401, OL540403, and OL540406 showed nucleotide similarity to HAdV-54 in the penton region. Additionally, OL450401 showed a statistically significant recombination event with HAdV-54 as minor and HAdV-8 as major parents. This was further supported by phylogenetic analysis as well., Conclusions: In the present study, we have found evidence of a shift from HAdV-8 towards HAdV-54, thus stressing the need for surveillance of HAdVs and to stay updated on the rise of new recombinants., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Ferdinamarie Sharmila P, Mini Pritam, Jayanthi Shastri, Anil Chandra Phukan, Muruganandam Nagarajan, Subashini Kaliaperumal, Radha Kanta Ratho, Jagat Ram, Madhav Jagannath Sathe, Avinash Ingole, Darshana Babubhai Rathod, Benjamin Nongrum, Rehnuma Parvez, Vineeta Malik, Rahul Dhodapkar.)

Purpose: Conjunctivitis is one of the most common ocular conditions in clinical practice. Human adenoviruses have been the common causative agents known to cause epidemic kerato-conjunctivitis (EKC) in India from 1996 to 2019 with a positivity range of 13.8%-65.2%. The current study was initiated to throw light on the distribution of keratoconjunctivitis causing agents across India covering a span of 3 years., Methods: A total of 709 swabs were collected from patients in viral transport medium (VTM), and real-time PCR was done to identify agents including Adenovirus (HAdV), Enterovirus, HSV, and Chlamydia., Results: 47.8% of the samples were positive for HAdV followed by HSV (3.4%), Enterovirus (2.7%), and Chlamydia (0.6%). Overall, 386 people (54.4%) tested positive for one of these infections, with Chandigarh (88.4%) and Port Blair (71.7%) showing higher positivity rate. Pre-auricular lymphadenopathy and follicles were significantly associated with increased risk of conjunctivitis., Conclusion: Epidemiology of keratoconjunctivitis in the current study revealed HAdV to be predominant causative agent. Knowledge gained in such epidemiological studies guide us in outbreak expectations, limit antibiotic over-prescription, and enhance disease prevention.

Purpose: The purpose of this study was to assess the retinal nerve fiber layer (RNFL) thickness in patients with pseudoexfoliation (PXF) and to correlate it with anterior segment parameters such as intraocular pressure (IOP), central corneal thickness (CCT), pigments in angle structures, and grades of PXF., Methodology: This was a cross-sectional comparative study in a tertiary care center. Patients having unilateral PXF were categorized as group 1. Age- and sex-matched healthy controls were categorized as group 2. All subjects underwent IOP measurement, CCT measurement, and retinal nerve fiber thickness measurement. Subjects in group 1 also underwent gonioscopy and perimetry. Data were entered and analyzed using the IBM-SPSS program (version 20.0); Chicago, IL., Results: Mean RNFL thickness in group 1 was 85.91 ± 22.237 μ and in group 2 was 106.65 ± 6.1 μ. The mean RNFL thickness in patients with PXF syndrome was 103.38 ± 5.815 μ and in patients with PXF glaucoma was 67.82 ± 17.984 μ. The mean CCT in patients with PXF syndrome was 516.41 ± 23.03 μ and in patients with PXF glaucoma was 507 ± 33.05 μ and control group was 526.6 m. The mean IOP in patients with PXF syndrome was 8 ± 6.01 mmHg; in patients with PXF glaucoma was 17.21 ± 7.33 mmHg; and in the control group was 14.12 ± 2.693 mmHg. There was a negative correlation between IOP and RNFL thickness, and a positive correlation between CCT and RNFL thickness, but it was not statistically significant. A statistically significant correlation was found between grades of PXF and RNFL thinning with a correlation coefficient of 0.437 ( P = 0.001)., Conclusion: Patients with PXF have a lower CCT, higher mean IOP, and RNFL thinning compared to normal subjects. The presence of grade 3 PXF (on the lens surface edge) showed a statistically significant correlation with RNFL thinning., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Oman Ophthalmic Society.)

Significance: On comparing the Humphrey Field Analyzer (HFA) 24-2C Faster, which tests 10 additional points in the central field, with the 24-2 Swedish Interactive Thresholding Algorithm (SITA) Standard for detecting central field defects, we found that the HFA 24-2C Faster may be used for the initial field evaluation in glaucoma with the advantage of a shorter testing time., Purpose: This study aimed to compare the HFA 24-2C Faster with the 24-2 SITA Standard and 10-2 among patients with glaucoma for the number of defective central points, global indices, and testing time., Methods: Sixty eyes of 60 patients with glaucoma and glaucomatous visual field defects on the 24-2 SITA Standard algorithm underwent the 24-2C Faster and 10-2 field tests. The number of central points detected, global indices, and reliability indices were compared between the 24-2C Faster and the 24-2 SITA Standard and 10-2 field tests., Results: The 24-2C Faster, on average, detected 5.5 defective points more on the total deviation plot and 2 defective points more on the pattern deviation plot than the 24-2 SITA Standard in central 10°. The 10-2 algorithm detected 2.5 times more points on the total deviation plot than the 24-2C Faster. There was excellent consistency by an intraclass correlation coefficient of 0.95 for the mean deviation and 0.93 for the pattern standard deviation between the 24-2C Faster and the 24-2 SITA Standard. There was good consistency by an intraclass correlation coefficient of 0.80 for both mean deviation and pattern standard deviation between the 24-2C Faster and the 10-2. The testing time was significantly lower with the 24-2C Faster compared with the 24-2 SITA Standard and 10-2 test., Conclusions: Our study demonstrates that the HFA 24-2C Faster may be used for the initial evaluation of the visual field in glaucoma with the added advantage of a shorter testing time compared with the 24-2 SITA Standard program., Competing Interests: Conflict of Interest Disclosure: GB is a Principal Investigator of a Sponsored Clinical Trial; registration number CTRI/2022/08/044944 (M/s Appasamy Associates for INR 393,875)., (Copyright © 2023 American Academy of Optometry.)

Carotid cavernous fistulas (CCFs) can present with varied ophthalmic manifestations. The most important vision-threatening complications of CCF include glaucoma and retinal vascular occlusions. We report a case of a man in his early 30s who developed a post-traumatic direct CCF. The patient denied undergoing embolisation therapy. This resulted in aggravation of his condition with onset of combined retinal venous and artery occlusion leading to neovascular glaucoma and severe vision loss. He was treated with medical management followed by diode laser photocoagulation to control intraocular pressure. Diagnostic cerebral angiography done 3 months later showed complete closure of the fistula; hence, no further intervention was advocated. Combined vascular occlusion is a rare vision-threatening occurrence in cases of CCF. Timely intervention with closure of the fistula can prevent the development of vision-threatening complications., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To assess the morphological changes in the anterior segment following laser peripheral iridotomy (LPI) in primary angle-closure disease (PACD) using Sirius Scheimpflug-Placido disk corneal topographer., Methods: This was a prospective observational study. A total of 52 eyes of 27 patients with PACD who underwent LPI were analyzed for iridocorneal angle (ICA), anterior chamber depth (ACD), anterior chamber volume (ACV), horizontal visible iris diameter (HVID), corneal volume (CV), central corneal thickness (CCT), and horizontal anterior chamber diameter (HACD) 1 week following LPI, using Sirius Scheimpflug-Placido disk corneal topographer. Data analysis was done using Statistical Package for the Social Sciences (SPSS) software version 19.0, and paired t-test was used to assess the statistical significance., Results: Laser peripheral iridotomy was performed in 43 eyes with primary angle-closure suspect (PACS), six eyes with primary angle closure (PAC), and three eyes with primary angle-closure glaucoma (PACG). The analysis of the data showed statistically significant changes in anterior segment parameters of ICA, ACD, and ACV. Post-laser increase in ICA from 34.13° ± 2.64° to 34.75° ± 2.84° (P < 0.041), mean ACD increase from 2.21 ± 0.25 to 2.35 ± 0.27 mm (P = 0.01), and mean ACV increase from 98.19 ± 12.13 to 104.15 ± 11.16 mm 3 (P = 0.001) were noted., Conclusion: Significantly quantifiable short-term changes in the anterior chamber parameters of ICA, ACD, and AC volume were seen after LPI in patients with PACD on Sirius Scheimpflug-Placido disc corneal topographer., Competing Interests: None

Competing Interests: None

Competing Interests: None

Purpose: The purpose of the study was to analyze the outcomes of patients with toxic anterior segment syndrome (TASS) and Urrets-Zavalia (UZ) syndrome., Materials and Methods: The records of all patients with TASS and UZ syndrome were studied. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), and the details of surgeries performed were recorded at 1 and 3 months. We studied the changes in CDVA and IOP using repeated-measure ANOVA and paired t -test, respectively., Results: Four patients (44.4%) developed refractory UZ syndrome, and five (55.6%) patients had TASS. At the end of 3 months of follow-up, all nine patients had concentric rings of iris atrophy and corneal edema. None of the cases had hypopyon or vitritis. Peripheral anterior synechiae (PAS) with secondary glaucoma was present only in cases of UZ syndrome. Among the four cases of UZ syndrome, goniosynechialysis was performed for 2 cases and trabeculectomy for one case. Despite these interventions, IOP could not be controlled. Patients in the TASS group did not exhibit PAS formation, and IOP was normal, but corneal edema and concentric rings of iris atrophy persisted. Descemet's stripping endothelial keratoplasty was performed for all the TASS cases. There was a statistically significant drop in CDVA ( P = 0.028) and an increase in IOP ( P = 0.029) at 3-month postcataract surgery., Conclusion: TASS and UZ syndrome could result in sight-threatening complications. They may be considered diseases of the same entity as both the conditions were found in the same cluster. TASS could be considered as an abortive attack of UZ syndrome., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Oman Ophthalmic Society.)

Purpose: This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non-valved glaucoma drainage device (GDD) surgery in refractory glaucoma., Methods: This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM)., Results: Thirty-four eyes were analyzed and the mean follow-up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively., Conclusion: AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long-term follow-up studies are needed to assess long-term IOP control and cost-effectiveness., Competing Interests: None

Competing Interests: None

Purpose: To compare the anxiety levels related to visual field testing and optical coherence tomography (OCT) in patients with glaucoma., Methods: This prospective, comparative study was conducted on patients with glaucoma. The participants' anxiety traits were assessed using the State-Trait Anxiety Inventory [STAI]. Before visual field testing on Humphrey visual field analyzer (HVF) and retinal nerve fiber analysis on OCT, the participants completed Form Y1 to measure the current pretest level or 'State' anxiety [pretest anxiety]. Immediately after testing, participants were administered the Form Y1 questionnaire to assess the induced anxiety level during the testing [Intratest anxiety]., Results: A total of 228 patients were enrolled with 152 participants in the HVF group and 76 in the OCT group. The mean age of the participants in the HVF group was 57.2 ± 20.8 years and in the OCT group was 56.8 ± 20 years. There was no significant difference in trait and pretest anxiety between the HVF group and the OCT group (P = 0.971 and P = 0.716). Intratest test anxiety score was slightly higher in the HVF group (HVF: 42.13 ± 10.63, OCT: 40.71 ± 9.76; P = 0.33). The anxiety scores were higher when the experience of previous HVF tests was <2 and least when the number of tests exceeded five., Conclusion: Automated perimetry induces slightly more anxiety than OCT, which may affect test performance. The measured anxiety reduces as patients gain familiarity with the test with experience. This adds credence to the recommendation of more frequent visual field testing in newly diagnosed glaucoma patients., Competing Interests: None

Purpose: Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology, clinical features, treatment outcome, and the factors associated with outcome in ROCM., Methods: Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings, treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures were evaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identify factors associated with treatment outcome., Results: On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea, diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relative afferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconal invasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatment outcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation (aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferent pupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two or more sinus involvement (aOR, 4.90; p = 0.009)., Conclusions: The current study identified newer factors in the form of presenting ocular and radiological features as predictors for aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiate these associations.

Competing Interests: None

Competing Interests: None

Competing Interests: None

Purpose: To assess the rapid antigen test (RAT) against the gold standard reverse transcription-polymerase chain reaction (RT-PCR) to screen COVID-19 infection in asymptomatic patients undergoing ophthalmic procedures., Methods: This was a retrospective hospital-based study. Point-of-care (PoC) RAT was performed using nasopharyngeal swab, while RT-PCR for SARS-CoV-2 viral RNA was performed using both nasopharyngeal and throat swabs., Results: A total of 629 patients were tested for SARS-CoV-2 by using both RAT and RT-PCR. Only one patient had tested positive for SARS-CoV-2 with both RAT and RT-PCR, while two patients had tested positive with RT-PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT-PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen's kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT-PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%., Conclusion: The sensitivity and Cohen's kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT-PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID-19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients., Competing Interests: None

Competing Interests: None

Introduction: Primitive neuroectodermal tumors arise from the progenitor cells of the neural crest, in the central nervous system or other peripheral locations., Case Presentation: We report a rare case of a congenital malignant tumor, diagnosed as a primary orbital primitive neuroectodermal tumor on histopathological examination., Conclusion: Multidisciplinary management with adjuvant chemotherapy needed for the management of these cases.

Competing Interests: None

Purpose: To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram-negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc)., Methods: Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day-care wards to localize the source., Results: Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48-60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia., Conclusion: Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow-up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection., Competing Interests: None

Phacomatosis pigmentovascularis (PPV) is a rare congenital disease characterized by the co-existence of cutaneous vascular malformation and pigmentary nevi with or without extracutaneous systemic involvement. Here, we present a 2-month old child diagnosed with phacomatosis cesioflammea type of PPV with Sturge-Weber syndrome and secondary congenital glaucoma of the left eye. She underwent combined trabeculotomy and trabeculectomy in the left eye for glaucoma and was started on anti-epileptics for seizure control following pediatric evaluation. Early screening and treatment initiation can prevent blindness and other systemic complications associated with PPV.

Purpose: To study the prevalence of glaucoma among adults with migraine and the effect of migraine on peripapillary retinal nerve fiber layer (pRNFL) and central macular thickness (CMT) using optical coherence tomography (OCT) compared to those without migraine headache, i.e. in tension-type headache (TTH) and normal group., Methods: One hundred and eleven patients (222 eyes) were recruited in three groups. migraine, TTH, and normal subjects visiting hospital outpatient services. After noting demographic details and pertinent history, ophthalmological evaluation including optic disc for glaucomatous changes along with computerized visual field testing and OCT for pRNFL thickness and CMT was performed in all eyes. Continuous variables were compared using ANOVA or Kruskal-Wallis test, while categorical variables including the association of glaucoma with migraine were analyzed using Chi-square or Fisher's exact test., Results: Prevalence of glaucoma in migraine group (12.2%) was more than in comparison groups (6.8% in TTH, 4.1% in normal) which was however not significant (Fisher's exact P = 0.207). Average pRNFL thickness (103.59 ± 12.82 μm) and thickness in nasal (90.49 ± 19.19 μm) and temporal quadrants (70.58 ± 16.13 μm) and CMT (213.78 ± 19.81 μm) were significantly reduced (ANOVA P < 0.05) in migraine patients when compared to the other groups and this was independent of the presence of glaucoma., Conclusion: Prevalence of glaucoma is not significantly higher in migraine patients. However, migraine causes thinning of retinal layers on OCT that is statistically significant., Competing Interests: None

A 50-year-old female patient presented with protrusion of the left eye for 1 month. Examination showed abaxial proptosis, restriction of extraocular movements, and elevated intraocular pressure. Computed tomography of the orbits showed soft tissue enhancing lesion in the superolateral aspect of the left orbit with lytic lesions in calvarium. Fine needle aspiration cytology of the lesion revealed a diagnosis of plasmacytoma with positive CD138 and CD38 immunohistochemical stains. Erythrocyte sedimentation rate, C-reactive protein and serum lactate dehydrogenase were elevated. Serum protein electrophoresis revealed hypergammaglobulinemia, and bone marrow biopsy revealed 6% plasma cells. The patient was started on chemotherapy with bortezomib, dexamethasone and lenalidomide by the medical oncologist. Significant improvement in proptosis and extraocular movements noted on follow-up. Orbital myeloma may be the first manifestation of systemic disease.

Using the periodic density functional theory-based methodology, we propose a potential catalytic system for dinitrogen activation, viz., single metal atoms (Mo, Fe, and V) supported on graphene-based sheets. Graphene-based sheets show an excellent potential toward the anchoring of single atoms on them (Mo, Fe, and V) with adsorption energies ranging between 1.048 and 10.893 eV. Factors such as defects and BN doping are noted to enhance the adsorption energies of single metal atoms on the support. The adsorption of a dinitrogen molecule on metal atom-anchored graphene-based supports is seen to be highly favorable, ranging between 0.620 and 2.278 eV. The adsorption is driven through a direct hybridization between the d orbitals of the metal atom (Mo, Fe, and V) on the support and the p orbital of the molecular nitrogen. Noticeably, BN-doped graphene supporting a single metal atom (Mo, Fe, and V) activates the N 2 molecule with a red shift in the N-N stretching frequency (1,597 cm -1 as compared to 2,330 cm -1 in the free N 2 molecule). This red shift is corroborated by an increase in the N-N bond length (1.23 Å from 1.09 Å) and charge transfer to an N 2 molecule from the catalyst., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Senthamaraikannan, Kaliaperumal and Krishnamurty.)

Purpose: The objective of the study was to evaluate the type of conjunctival microbial flora in intensive care unit patients and their antimicrobial sensitivity pattern., Methods: A total of 272 samples (conjunctival swabs) were taken from patients in various intensive care units and sent for culture and sensitivity. An ocular examination was done to look for lagophthalmos, conjunctival discharge, exposure keratitis, and corneal perforation., Results: Majority (82.1%) of the samples showed at least one microbial isolate while 29 (10.7%) samples showed multiple microbial growth. The most common microbes were coagulase negative Staphylococcus spp. (41.5% of isolates), diphtheroids (11.0% of isolates), and Staphylococcus aureus (9.6% of isolates) which are the usual commensals of the ocular surface. Of the other microbes isolated, Pseudomonas aeruginosa (4.0%) was the most common. Eighty-four percent isolates of coagulase negative Staphylococcus sp., 81.8% isolates of diphtheroids and 100% isolates of Staphylococcus aureus were penicillin resistant. All isolates of Enterococcus fecalis were sensitive only to vancomycin. Two hundred and twenty eyes (80.9%) had varying degrees of lagophthalmos. Nineteen (7.0%) had severe corneal exposure changes leading to infectious corneal ulcer and perforation in all of them., Conclusions: The isolates in patients of intensive care units were no different from the normal conjunctival flora though few pathogenic organisms such as Pseudomonas aeruginosa and Acinetobacter sp. were also isolated. Most of the isolates were penicillin resistant. This knowledge will help take appropriate prophylactic measures to contain ocular infections in the intensive care units.

Background: There is a paucity of data from India on ophthalmological complications in children on long-term oral corticosteroids for idiopathic nephrotic syndrome., Methods: All children aged 4-18 years with idiopathic nephrotic syndrome who had received long-term oral steroids for >6 months  and who attended the paediatric nephrology clinic between January 2019 and January 2021 were included. The majority of them (95/110) were being followed up in the paediatric nephrology clinic which was functioning from 2010.   The children were screened for ophthalmological complications at 6-month intervals., Results: Overall, 110 children with nephrotic syndrome  were enrolled. Their median (IQR) age was 9.4 (7.0-12.8) years, and the median (range) duration of follow-up following onset of nephrotic syndrome was 5 years (1.0-16). The incidence of cataract was 18.1% (20 of 110 cases).  Visual acuity was impaired in seven (35%) of the children with cataract.  Children with cataract were younger as compared to those without cataract [Median (IQR) age at onset of nephrotic syndrome [2.5 (2.0-4.0) yrs vs 4 (2.1-6.0) yrs] ( p =0.03)]. Children with cataract also had higher cumulative dose of prednisolone intake (mg/m 2 ) [28,669 (21,329-33,500) vs 14,995 (10,492-19,687)] ( p <0.01)] and greater cumulative duration of prednisolone intake [4.3 (3.1-5.2) vs 2.25 (1.3-3.7) yrs] ( p <0.01). The incidence of raised IOP was 9.1% (10 of 110 cases)., Conclusions: The incidence of cataract and raised IOP was high. The risk factors for the development of cataract were age at onset of nephrotic syndrome, cumulative dose and cumulative duration of steroid intake.