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This paper describes a novel approach to treat migrated orbital implants post socket surgery. Implant migration may hinder the final aesthetic outcome of a custom ocular prosthesis. Once an implant migrates within the orbit there tends to be fibrosis around the implant. This fibrosis does not allow for centeration of the implant during repeat surgery. Hence treatment of a migrated implant traditionally involves implant removal with dermis fat grafting. Dermis fat graft though an option, needs a second site surgery that may be unacceptable to many patients. Also the rate of graft necrosis is as high as 40%. This paper describes a technique to create a custom orbital implant that allows recenteration of the migrated implant centrally, using 3-dimension (3D) printing and rapid prototyping to construct the patients affected orbit. This orbit is used as a mould to create the custom orbital implant that aids in volume augmentation as well as recenteration of the migrated orbital implant. Keywords: Orbital implant, 3D printing, Migration, Custom designed, Secondary implant, Computer assisted, Patient specific implants

Ocular pain is a common complaint which forces the patient to seek immediate medical attention. It is the primeval first response of the body to any severe condition of the eye such as trauma, infections and inflammation. The pain can be due to conditions directly affecting the eye and ocular adnexa; or indirect which would manifest as referred pain from other organ structures such as the central nervous system. Paradoxically, there are several minor and non-sight threatening conditions, which also leads to ocular pain and does not merit urgent hospital visits. In this perspective, we intend to provide guidelines to the practising ophthalmologist for teleconsultation when a patient complains of pain with focus on how to differentiate the various diagnoses that can be managed over teleconsultation and those requiring emergency care in the clinic. These guidelines can decrease unnecessary hospital visits, which is the need of the hour in the pandemic era and also beyond. Patients who are under quarantine and those who are unable to travel would be benefitted, and at the same time, the burden of increased patient load in busy hospital systems can be reduced.

Sebaceous gland carcinoma (SGC) of the eyelid is one of the leading peri-ocular eyelid malignancies in Asian-Indians. It usually affects elderly women and has a high rate of local recurrence, regional and distant metastasis. This is partly attributable to a delay in clinical diagnosis since it mimics more benign conditions of the eyelid like chalazia. To the best of our knowledge, this is the first case report of a peri-punctal SGC. Atypical location and the young age of the patient resulted in a relatively conservative excisional biopsy under frozen section control and eyelid reconstruction with a favorable outcome.

Purpose: To describe the outcomes of a patient-specific implant (PSI), fabricated using a three-dimensional (3D) printed orbital template and placed in the basin of the inferior orbital fissure to correct inferotemporally migrated spherical orbital implant. Methods: This is a single-center, prospective, consecutive, interventional, case series of six patients, with non-porous, spherical, orbital implant migration that underwent implant recentration surgically with a novel technique. Migration was subclassified either as decentration that did not affect the prosthetic retention or as displacement that affected the prosthetic retention in the eye socket. Only implant displacements were treated. The primary outcome measure was centration of the implant clinically and radiologically, with ability to retain the prosthesis. Results: At a mean follow-up of 21 months, all six orbital spherical implants remained centered. There were no cases of extrusion, exposure, or migration of either implants. There were no cases of PSI displacement. Additional procedures to optimize the aesthetic outcome of the customized ocular prosthesis (COP) required were simultaneous fornix formation suture in three patients, subsequent fornix formation with mucus membrane graft in two patients, and levator resection and sulcus hyaluronic acid gel injection in one patient each. The mean PSI implant weight was 2.66 ± 0.53 g. The mean COP weight was 2.2 ± 0.88 g postoperatively. The median patient satisfaction with the procedure was 9 on 10. Conclusion: A 3D printing-assisted PSI placed in the basin of the inferior orbital fissure allows recentration of the migrated implant over a follow-up of 21 months without complications.

Purpose: The aims of this study were to determine the acceptability levels of different styles of the doctors’ dress and the expectations from the initial phases of physician-patient encounter. Methods: The study design was a cross-sectional descriptive type using the survey methodology. A survey based on a five-point questionnaire was performed on all consecutive patients or their caregivers, aged ≥15, visiting the ophthalmic plastics outpatient clinics at a tertiary eye care institute. The participants were shown three sets of photographs and were required to answer a questionnaire which consisted of five questions. Data collected include participant demographics and their preferences with regards to the physician's attire and initial communications. Results: A total of 300 consecutive responses were analyzed. The mean age of the participants was 37.2 years. Among the participants, 87.6% (263/300) and 90.3% (271/300) preferred a white coat for the male and female physicians, respectively (P < 0.001). The most common second preference was scrubs for both the males and female physicians. 92.3% (277/300) preferred the attire to have an identification display. The overwhelming majority of respondents (95.6%, 287/300) preferred the physicians to address them by their name and 98.6% (296/300) liked if their physicians smiled while addressing them. Conclusions: White coat was the main preferred attire among respondents. Increased awareness of the patient's expectations plays a crucial role in enhancing their satisfaction.