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To identify risk-factors for developing endophthalmitis following open globe injury (OGI) in children.Retrospective, single-center, case-control study of children aged18 years who sustained OGI.Our cohort of 93 eyes consisted of 30 cases (Group A- endophthalmitis) and 63 controls (Group B- no endophthalmitis). Twenty-four eyes (80%) diagnosed with endophthalmitis presented after 24 hours of injury. The presence of central corneal zone-1 injuries (Odd ratio [OR]: 6.64, p= 0.001) and vitreous in wound (OR: 3.53) were associated with the risk of developing endophthalmitis. (p=0.05) Additionally the presence of iris prolapse (OR: 4.76) and posterior capsular rupture (PCR) (OR: 5.80) increased the risk of developing endophthalmitis.(p0.05) . Streptococci was isolated in 15 eyes, Pseudomonas in 3 eyes, and Candida in 1 eye. The visual outcomes at three months were significantly worse in Group A (LogMAR 1.77±1.06) compared to Group B (LogMAR 0.65±0.68)(p0.05).Central corneal involvement, vitreous/ iris incarceration and PCR were important risk factors for development of PTE in children.

Extra time of sitting in front of a digital device is required for e-learning by children during Corona virus (COVID-19) pandemic which can lead to many ocular problems including digital eye strain (DES). In view of increased incidence of DES in children, multiple studies had been conducted in central India to assess the eye strain in children due to excessive online classes as a research project named "Digital eye strain among kids (DESK) study." This study DESK-3 aimed to report series of cases of acute acquired comitant esotropia (AACE) in children attending online classes during COVID-19 pandemic. Children aged 6-18 years with recent onset of esotropia of1-month duration without any similar history in past presented in month of July-August 2020 at a tertiary children eye care hospital were evaluated. Data collection included age and gender of child, presence or absence of diplopia, visual acuity, duration of smartphone use, duration of online classes, angle of deviation for near and distance and cycloplegic refraction. Total eight children of AACE were included in the study. The mean age of children was 12.5 ± 4.2 years. All eight were males. The mean duration of smartphone use was 4.6 + 0.7 hours per day. All children were attending online classes4 hours per day on smartphone of average size 5.5 inches. Five children were emmetropic, one myopic, one pseudomyopic and one hyperopic. The angle of deviation for near and distance were 48.1 ± 16.4 PD and 49.3 ± 15.9 PD respectively with normal ocular motility. Seven children complained of horizontal diplopia in all gazes. Neurological examination and CT scan of brain and orbit was normal in all patients. Two months before the lockdown only one case was identified as compared to eight during the lockdown. Prolonged near work during smart phone use for e-learning might lead to the development of AACE in children.

Purpose: To subjectively evaluate the degree of visual fatigue in children attending online classes during the coronavirus 2019 (COVID-19) pandemic and objectively evaluate accommodation and vergence dysfunction in these children. Methods: Children aged between 10 and 17 years with recent onset of asthenopia symptoms were included. Symptoms were evaluated using the Convergence Insufficiency Symptom Survey (CISS) questionnaire. A CISS score of 16 or greater was considered symptomatic. Binocular vergence and accommodation parameters were objectively evaluated. For ease of comparison, children were divided into two groups: children using digital devices for less than 4 hours/day and children using digital devices for 4 hours/day or more. Results: A total of 46 children with a mean age of 14.47 ± 1.95 years were evaluated. The mean duration of online classes during the COVID-19 pandemic was 3.08 ± 1.68 hours/day, which is higher than before the COVID-19 pandemic (0.58 ± 0.71 hours/day, P < .00001). The mean CISS scores were 21.73 ± 12.81 for children using digital devices less than 4 hours/day and 30.34 ± 13.0 for children using digital devices for 4 hours/day or more ( P = .019). Mean near exophoria ( P = .03), negative fusional vergence ( P = .02), negative relative accommodation ( P = .057), and accommodation amplitude ( P = .002) were different between the two groups. The Spearman correlation between the symptomatic CISS score and the duration of online classes showed a linear association (coefficient r s = 0.39; P = .007). In the multivariate analysis, only the duration of online classes longer than 4 hours was a significant risk factor ( P = .07) for the symptomatic CISS score. Conclusions: Online classes longer than 4 hours were more detrimental to abnormal binocular vergence and accommodation parameters than online classes shorter than 4 hours. [ J Pediatr Ophthalmol Strabismus . 2021;58(4):224–231.]

To study the impact of prophylactic intracameral (IC) moxifloxacin on the incidence, clinical profile and outcomes in eyes developing post-cataract surgery endophthalmitis (PCE). This was a single-centre, retrospective, comparative, observational study in which all eyes with PCE between June 2013 and May 2014 without IC moxifloxacin prophylaxis (group A) and June 2015–May 2016 with IC moxifloxacin prophylaxis (group B) were analysed. A total of 101,815 cataract surgeries were performed in group A and 112,967 in group B. PCE was diagnosed in 179 eyes (0.18%) in group A and 92 eyes (0.08%) in group B (p

Purpose: To determine the surgical outcomes of bleb needling and the risk factors of failure of needling after failed filtration surgeries in patients with pediatric glaucoma. Methods: The medical records of patients who underwent needling with 5-fluorouracil following filtering surgeries (trabeculectomy, combined trabeculectomy, and trabeculotomy) between January 2012 and December 2016 were retrospectively reviewed. At the 1-year follow-up visit, complete success and qualified success were defined as an intraocular pressure (IOP) of less than 18 mm Hg with and without antiglaucoma medication, respectively. Results: Forty-five eyes that underwent needling and fulfilled the study criteria were included in the analysis. The mean age at needling was 9.6 years. The mean time interval between filtration surgery and the first needling procedure was 57.3 days. Thirty-eight of 45 eyes (84.4%) had undergone needling within 3 months after the primary surgery. Cumulative success was achieved in 35 eyes (77.7%) after needling (complete success in 22 eyes and qualified success in 13 eyes). Mean follow-up after needling was 18.9 months. The mean IOP before and after needling was 31.7 ± 9.45 and 16.6 ± 5.68 mm Hg, respectively ( P < .00001). Steroid-induced glaucoma ( P = .01), high IOP prior to the first filtration surgery ( P = .01), and an inability to achieve low IOP (< 9 mm Hg, P = .04) immediately after needling were significant risk factors associated with failure. Conclusions: Bleb needling is an efficient method for lowering IOP after a failed trabeculectomy or combined trabeculectomy and trabeculotomy in the pediatric population. [ J Pediatr Ophthalmol Strabismus . 2021;58(2):118–125.]

Purpose: The aim of this study was to determine prevalence, symptoms frequency and associated risk factors of digital eye strain (DES) among children attending online classes during COVID-19 pandemic. Methods: The online electronic survey form was prepared on the Google app. Children/parents were asked to indicate the total duration of digital device use before and during COVID era. The symptoms of DES, its severity and frequency were recorded & measured with the Computer Vision Syndrome Questionnaire. Results: Two hundred and sixty one parents responded to the questionnaire, of these 217 were complete. Mean age of children was 13 ± 2.45 years. Mean duration of digital device used during COVID era was 3.9 ± 1.9 h which is more than pre COVID era (1.9 ± 1.1 h, P = 5 h in COVID era as compared to 1.8% (n = 4) before COVID era. The most common digital device used were smartphones (n = 134, 61.7%). One hundred and eight children (49.8%) were attending online classes for >2 h per day. Prevalence of DES in our cohort is 50.23% (109/217). Of these 26.3% were mild, 12.9% moderate and 11.1% of severe grade. Most common symptoms were itching and headache (n = 117, 53.9%). Multivariate analysis revealed age >14 years (P = 0.04), male gender (P = 0.0004), smartphone use (P = 0.003), use of device >5 h (P = 0.0007) and mobile games >1 h/day (P = 0.0001) as independent risk factors for DES in children. Conclusion: There is an increased prevalence of DES among children in COVID era. Parents should be considerate about duration, type and distance of digital device use to avoid DES symptoms in children.

Purpose: To compare the post-cataract endophthalmitis (PCE) rates among eyes undergoing syringing or regurgitation on pressure over the lacrimal sac (ROPLAS) test prior to cataract surgery. Methods: We performed a single-center, retrospective, comparative analysis of eyes developing PCE who underwent syringing prior to cataract surgery (group A) in the pre-COVID-19 era between November 1 2019 and January 31, 2020 and the eyes that underwent ROPLAS test prior to cataract surgery (group B) in the COVID-19 era between November 1, 2020 and January 31, 2021. Results: A total of 87,144 eyes underwent cataract surgery during the two time periods of the study. Syringing was performed in 48,071 eyes, whereas ROPLAS was performed in 39,073 eyes. In group A, 19 eyes (0.039%) developed PCE, whereas 20 eyes (0.051%) developed PCE in group B (P = 0.517). Between the two groups, the grade of anterior chamber cellular reaction (P = 0.675), hypopyon (P = 0.738), and vitreous haze (P = 0.664) were comparable. Gram-positive organisms were detected in 4 eyes in group A and 6 eyes in group B; 2 eyes in group A had gram-negative bacilli. The presenting visual acuity (Group A: LogMAR 1.42 and Group B: LogMAR 1.30) and final visual acuity (Group A: LogMAR 0.52 and Group B: LogMAR 0.5) were comparable between the two groups. (P = 0.544 and 0.384, respectively). Conclusion: The rates of PCE were comparable among the eyes undergoing either syringing test or ROPLAS prior to cataract surgery.

Purpose: To evaluate demographic data, clinical profile, and factors responsible for the success of anatomical and functional outcomes of canalicular laceration repair with the Mini Monoka stent (FCI Ophthalmics) in children younger than 10 years. Methods: This was a retrospective cohort observational study involving children younger than 10 years who underwent canalicular tear repair with the Mini Monoka stent with a minimum follow-up of 6 months. Results: A total of 18 patients (9 boys and 9 girls) with a mean age of 5.39 ± 3.05 years were included. Twelve and 6 patients had lower and upper canalicular tear, respectively. Six (33.4%) patients had associated ocular comorbidity. The common mode of trauma was direct injury in 77.8% of the patients. The blouse hook of the mother was noted as the most common object causing canalicular laceration. Early repair (< 48 hours) and delayed repair were done in 7 (38.9%) and 11 (61.1%) patients, respectively. Anatomical and functional success was achieved in 88.9% and 94.4% of patients, respectively. The odds ratio (95% CI) for anatomical and functional success with the time since injury was 0.6 (CI: 0.03 to 11.47) and 0.19 (CI: 0.01 to 5.33), respectively. There was no significant difference between the early and delayed repair groups in terms of the distribution of anatomical ( P = 1.000) and functional ( P = .389) success. There was no significant difference between the various groups in terms of the distribution of complications ( P = .224). Conclusions: Canalicular laceration repair with the Mini Monoka stent in children younger than 10 years has shown good outcomes in terms of anatomical and functional success irrespective of time lag since injury to repair. [ J Pediatr Ophthalmol Strabismus . 2021;58(1):42–47.]

Purpose: To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods: It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results: Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion: Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.

Purpose: To find the accuracy of Scheimpflug imaging for the evaluation of posterior lens capsule and to assess the incidence of pre-existing posterior capsular tear (PCT) in pediatric traumatic cataracts. Methods: It was a prospective, non-randomized, and interventional study. Scheimpflug imaging was done preoperatively to detect pre-existing PCT in pediatric traumatic cataracts after blunt trauma. All patients underwent cataract extraction with intraocular lens implantation. Intraoperatively, the posterior capsule status was noted and compared with the preoperative Scheimpflug images. Results: Forty-seven eyes of 47 children having traumatic cataracts following closed-globe injury were included. There were 32 males and 15 females with a mean age of 10.91 ± 2.75 years. The mean duration of performing the Scheimpflug imaging from injury was 41.7 ± 7.78 days. Preoperative Scheimpflug imaging showed intact posterior lens capsule in 36 eyes and PCT in 11 eyes. Intraoperative, 37 eyes had an intact posterior lens capsule and 10 eyes had PCT. The Scheimpflug imaging did not detect the PCT in three eyes (false-negative), and in four eyes, PCT was detected falsely on Scheimpflug imaging (false-positive). The sensitivity and specificity of the Scheimpflug imaging were 70 and 89.18%, respectively. The accuracy of the technique was 85.11%. Conclusion: Scheimpflug imaging is a useful modality for the detection of PCT preoperatively in cases with doubtful posterior lens capsule integrity.

Purpose: To compare the safety, feasibility, and outcomes of clear corneal cataract surgery with or without sutures in children (2 to 8 years old) with congenital or developmental cataracts. Methods: One hundred seventy consecutive eligible eyes with pediatric cataracts were randomized into treatment groups depending on closure of clear corneal incisions: suture group and sutureless hydroclosure group (sutureless group). Patients were evaluated on days 1, 7, 30, and 90 postoperatively, with an emphasis on wound leakage from incisions and complications. Results: Wound leakage from any corneal incisions was not observed in both groups. Shallow anterior chamber on the first postoperative day was observed in 2 and 3 eyes in the suture and sutureless groups, respectively ( P = .48). Hypotony was not observed in any patients. Intraocular pressure measurements were comparable on follow-up visits ( P > .05). Mean cylindrical error was significantly greater ( P = .03) in the suture group than the sutureless group (1.01 and 0.74 diopters, respectively) after 1 month. One patient developed endophthalmitis after suture removal in the suture group. Conclusions: Sutureless hydroclosure of incisions is not inferior compared to suturing in pediatric cataracts. This avoids suture-related complications while reducing the astigmatic error and is thus potentially less amblyogenic. However, sutures must be used whenever the incision architecture is compromised. [ J Pediatr Ophthalmol Strabismus . 2021;58(4):246–253.]

Scleroderma, "en coup de sabre" is a rare disorder, characterized by linear depressed scarring at frontoparietal area of the face, seldom associated with ophthalmological findings. Extraocular muscle involvement and paralytic strabismus are rarely associated with linear scleroderma. Here we are reporting a case of unilateral linear scleroderma in an 8-year-old child, with features of strabismus fixus secondary to fibrosed medial rectus (MR) muscle, enophthalmos and en coup de saber (sword-like scar) on the eyebrow. MRI orbit was suggestive of the bulky MR and the inferior rectus muscle. MR recession along with partial loop myopexy resulted in cosmetically acceptable ocular alignment in this case. Histopathology of the portion of muscle and intermuscular septum showed diffuse fibrosis of the muscle. Linear scleroderma may be the causative etiology of strabismus fixus in our case, never reported before in literature.

Purpose: To assess the success rate of external dacryocystorhinostomy (DCR) with silicone intubation for recurrent lacrimal abscess in children younger than 6 years. Methods: A single-center retrospective analysis of 46 eyes of 40 children who underwent DCR with silicone tube intubation for recurrent lacrimal abscess was done. Probing done previously in these cases was unsuccessful. Only those children who underwent incision and drainage of the abscess at least once with antibiotic treatment were included in the study. In all cases, silicone tube removal was done after 3 months. A successful outcome was defined as the absence of subjective complaints of pain and swelling over the medial canthal area and watering and discharge at 6 months postoperatively. Objective assessment of patency of the lacrimal apparatus was done by sac syringing at 6 months postoperatively. Results: The mean age at surgery was 4.93 ± 0.93 years (range: 3 to 6 years) and the mean follow-up duration was 11.80 ± 11.87 months (range: 6 to 84 months). Intra-operative difficulties encountered were excessive perisac adhesion (n = 28) and severe bleeding/hemorrhage (n = 24). A total of 82.61% cases had a successful outcome after DCR with silicon tube intubation. One child had granuloma formation at the wound. Spontaneous tube extrusion occurred in three children. Conclusions: DCR with silicone tube intubation is a safe and effective surgical approach with satisfactory outcomes for treating recurrent lacrimal abscess with congenital nasolacrimal duct obstruction in children younger than 6 years. [ J Pediatr Ophthalmol Strabismus . 2019;56(3):188–193.]

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA

To determine the efficacy of Smartphone-based exercises in conjunction with modified glasses prescription in the treatment of convergence insufficiency and fusion weakness.A total of 150 patients using glasses and having asthenopia between 15 and 30 years of age were subjected to thorough eye examination including binocular vision testing and refraction. Of them 26 individuals were found to have convergence insufficiency with fusion weakness and exophoria6 pd. Subjects with amblyopia, manifest strabismus and other ocular diseases were excluded from the study. Modified glasses (overcorrection of myopia by -0.5 D Sphunder correction of hypermetropia by +0.5 D Sph) were given along with newly designed Smartphone-based fusion exercises.Near point of convergence improved by 2.89 ± 1.08 cm, positive fusion vergence by -10.2 ± 3.25 pd and near phoria by 3.13 ± 0.32 pd (p 0.001).The current study demonstrates the efficacy of Smartphone-based fusion exercises, in conjunction with modified glasses prescriptions, in the management of symptomatic convergence and fusion insufficiency. Indeed, this novel, newly designed approach for convergence insufficiency improves symptoms by reducing near point of convergence and degree of exophoria and increasing fusional vergence.

Purpose To compare the rate of posterior capsule opacification (PCO) of hydrophilic acrylic intraocular lenses (IOLs) and hydrophobic acrylic IOLs in pediatric cataract surgery. Setting Sadguru Netra Chikitsalaya, Chitrakoot, India. Design Retrospective case series. Methods The medical records of children who had uneventful cataract surgery with acrylic IOL implantation from 2010 to 2016 and a follow-up of at least 1-year were reviewed. The patients had implantation of a hydrophilic IOL (Ocuflex ANU6 IOL) or a hydrophobic IOL (AcrySof SA60AT). The main outcome measure was the PCO rate at the last follow-up. Results The study comprised 103 eyes (80 children). The mean age was 8.2 years ± 4 (SD) in the hydrophilic group (51 eyes) and 6.9 ± 4 years in the (52 eyes) hydrophobic group (P = .1). The mean follow-up was 38.8 months and 39.4 months, respectively. When the posterior capsule was left intact, 39.3% of eyes in the hydrophilic group and 13.4% of eyes in the hydrophobic group developed PCO (P = .03). When primary posterior capsulotomy (PPC) and anterior vitrectomy were performed, 4.3% and 6.8%, respectively, developed PCO (P = .69). Kaplan-Meier survival plots with stratification for type of procedure (ie, PPC and anterior vitrectomy) showed a survival (ie, no PCO formation at 5-year follow-up) rate of 95.4% in the hydrophobic group and 88.8% in the hydrophilic group. Conclusion Hydrophilic acrylic IOLs and hydrophobic acrylic IOLs implanted in the bag had comparable visual and surgical outcome and an equal rate of PCO formation when PPC and anterior vitrectomy were performed.

This study aimed to evaluate the intra- and postoperative complications of intraocular lens (IOL) implantation with posterior optic buttonholing (POBH) in children that had undergone phacoemulsification irrigation/aspiration for congenital/developmental cataract and experienced complication of anterior capsulorrhexis extension (ACE). A total of 25 eyes of 21 patients were included in the study. A foldable three-piece IOL was implanted into the bag/ciliary sulcus with primary posterior capsulorrhexis and POBH. The visual acuity improved from 2.12 ± 0.69 log MAR to 1.38 ± 0.49 log MAR at 6 months follow-up. Postoperative complications included heightened postoperative inflammation in three patients and temporary corneal edema in two patients. Only one patient had developed posterior capsular opacification (PCO) at 6 months follow-up with mild tilt, while the rest 24 eyes had no PCO formation and adequate IOL centration. The results of this study indicate that a three-piece foldable IOL implantation with POBH is a feasible option for children who experienced ACE during pediatric cataract surgery, as it results in satisfactory surgical outcomes and very few ocular complications.

Purpose: The aim of this study was to report the outcome of cataract surgery with different surgical techniques in eyes with coexisting coloboma and to define factors of prognostic importance. Methods: Retrospective case sheet review of patients presenting between January 2016 and December 2018, who underwent cataract surgery in eyes with coexisting coloboma. Results: Of the 3,30,231 cases operated during the study period, 280 eyes of 276 patients had associated colobomatous malformation. The prevalence of coloboma in eyes undergoing cataract surgery was 0.085%. The mean age of the patients was 46.4 years (range 19 - 88 years). Phacoemulsification (PE) was performed in 130 eyes (46.4%), manual small incision cataract surgery (M-SICS) was done in 115 eyes (41.1%), and 35 eyes (12.5%) underwent intra capsular cataract extraction. Intra-operative complications were noted in 26 (9%) eyes. Incidence of intra-operative and post-operative complications was comparable between PE and M-SICS groups (p = 0.94). The mean corrected distance visual acuity (CDVA) improved from logMAR 1.71 ± 0.62 to 0.87 ± 0.61 (p = 0.00009). On multivariate analysis, microcornea (p = 0.002), type 1 and 2 coloboma (p < 0.001), and intraoperative complications (p = 0.001) were associated with poor visual outcome. Conclusion: Favorable functional outcomes can be achieved with phacoemulsification in eyes with softer cataract and corneal diameter >8 mm and with M-SICS in eyes with hard cataracts and corneal diameter of 6–8 mm. PE should be considered as the primary choice whenever permissible by the corneal diameter and severity of nuclear sclerosis. Poor functional outcomes were seen in eyes with smaller corneal diameter, extensive chorioretinal coloboma, and intraoperative complications.

Megalocornea and megalophthalmos are bilateral developmental anomaly of the anterior segment of the eye. Either of these conditions has a high risk of developing glaucoma. We report the rare case in a 9-year-old child with simple megalocornea in one eye and megalophthalmos in other eye. He has increased corneal diameter in both the eyes and iris stromal hypotrophy exposing the radial vessels, raised intraocular pressure (IOP), and optic nerve head cupping in the left eye (LE). LE trabeculectomy with Ologen was performed. Postoperative IOP was well controlled at 1-year follow-up with favorable bleb morphology.

Purpose: To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome. Methods: A prospective interview-based analytical cohort study was conducted on 156 children aged 0–16 years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome. Results: The mean age of presentation was 7.78 ± 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1–6 months, 11 (7%) had delay of 6–12 months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes. Conclusion: Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.

The authors report a rare case of slipped medial rectus muscle with stretched scar in the left eye of a 45-year-old woman following pterygium surgery. There was total limitation of adduction in her left eye with complaints of diplopia in all gazes with maximum separation of images in dextroversion on diplopia charting. Hess charting showed underaction of the medial rectus muscle of the left eye and overaction of the lateral rectus muscle of the right eye. Based on the history and findings, a diagnosis of medial rectus muscle disinsertion of the left eye during pterygium surgery was made. Medial rectus muscle exploration was done and the slipped medial rectus muscle was found attached to its original insertion site via pseudotendon/stretched scar. The capsule was dissected, the scar tissue was excised, and the slipped medial rectus muscle was identified, hooked, and secured with sutures. The muscle was reattached with advancement. Postoperatively, the patient was orthotropic and there was no diplopia. Accidental medial rectus muscle disinsertion during pterygium surgery is a rare but serious complication. Proper care should be taken intraoperatively during pterygium surgery to avoid this complication. However, meticulous surgical exploration and reattachment of the muscle yields satisfactory results. [ J Pediatr Ophthalmol Strabismus . 2019;56:e34–e37.]

We report a case of an Angiostrongylus parasite in the corneal stroma in an 8-year-old boy and our technique for its removal. The parasite was identified on slit-lamp examination. Its location was confirmed on anterior segment optical coherence topography (AS-OCT). The parasite was found on the superficial corneal stroma in the periphery and was removed after lamellar dissection of the cornea following marking with trephine.

To compare the visual and refractive outcomes and complications of primary and secondary intraocular lens (IOL) implantation after open-globe injury in pediatric patients.Sadguru Netra Chikitsalaya, Madhya Pradesh, India.Retrospective case series.Patients had primary cataract extraction with IOL implantation with globe repair (Group A) or repair followed by secondary IOL implantation (Group B). Preoperative and surgery data, visual outcomes, and postoperative complications were recorded.The study included 139 patients. Thirty (49%) of 61 patients in Group A and 47 (60%) of 78 patients in Group B achieved a corrected distance visual acuity (CDVA) of 20/40 or better. In both groups, a central corneal scar and amblyopia were the main reasons for not achieving a CDVA better than 20/40. The mean spherical equivalent (SE) was 1.81 diopters (D) in Group A and 1.55 D in Group B. Forty patients (66%) in Group A and in 60 patients (77%) in Group B achieved a desirable refractive outcome (SE2.00 D). A large wound was the greatest risk factor for not obtaining desirable refractive outcomes. Fibrinous uveitis was the most common postoperative complication in both groups. Pupillary optic capture and IOL decentration were significantly more common in Group A than in Group B (P = .02), while strabismus was significantly more common in Group B (P = .04).Both approaches had satisfactory and comparable visual and refractive outcomes. However, primary IOL implantation can be considered in cases with small peripheral corneal lacerations with the goal of providing early visual rehabilitation and avoiding repeat general anesthesia.

Aim: To analyze surgical outcome of pterygium excision with conjunctival autografting in pediatric population ≤16 years. Settings and Design: Retrospective case series. Materials and Methods: A case sheet review of 145 patients (167 eyes) aged ≤16 years consecutively presented with pterygium from April 2008 to August 2014 in the single center was done. Twenty-six eyes of 25 children who underwent pterygium excision with conjunctival autograft were analyzed. Different techniques used to secure conjunctival autograft in a position were multiple interrupted 8-0 vicryl sutures, single 8-0 vicryl suture in the center of graft and sutureless glue free. Outcome measures were a failure of surgery and recurrence. Results: Of the total 167 eyes, 26 eyes of 25 children, mean age 13.07 ± 3.08 years (range 7-16 years) were managed surgically with pterygium excision and conjunctival autograft. The rest of the patients were managed conservatively. In 18 eyes, the graft was secured with multiple sutures, in 6 eyes with a single suture, whereas in 2 eyes, sutureless glue-free graft opposition was done. Mean follow-up was 8.03 months. No case of graft retraction, graft dehiscence or graft displacement was found. Recurrence occurred in 6 eyes and managed surgically. Conclusions: Occurrence of pterygium is not uncommon in the pediatric population. A single suture or sutureless glue-free technique may be good alternative for securing conjunctival autograft after pterygium excision in children.

Purpose: The purpose of the study is to compare the efficiency as well as the rate and type of suture-related complications between 10-0 monofilament nylon (Aurolab Nylon Sutures, double arm, Aurolab) and 10-0 polyglactin 910 sutures (Vicryl, single arm, Aurolab) for pediatric cataract surgery. Methods: It is a prospective, comparative study performed in children who underwent surgery for congenital or developmental cataract from March 2013 to February 2016. Patients underwent suturing with either nylon or Vicryl in unilateral cases, but in most bilateral surgeries, one eye received Vicryl sutures while the other eye received nylon. The sutures were compared for their complications and the need for suture removal. Results: Forty-one children (72 eyes) were included in the study, of which 31 children (62 eyes) underwent bilateral surgery while 10 (10 eyes) underwent unilateral surgery. Sixty-four nylon sutures were placed in 32 children (34 eyes), of which 22 (34.4%) were removed due to suture-related complications, whereas 14 (19.7%) (P = 0.03) of the 71 Vicryl sutures placed in 32 children (38 eyes) needed suture removal at an average of 2.9 weeks with the earliest at 6 days postoperatively. The odds of Vicryl suture being removed was 0.42 times with respect to nylon. The most common reason encountered for suture removal in both the materials was sutures becoming loose (16.3%), followed by vascularization (14.1%), infiltration (1.5%), and opacification (4.4%). Conclusion: Absorbable suture such as 10-0 Vicryl is preferred over nonabsorbable suture 10-0 nylon for suturing incisions in pediatric cataract surgery, to avoid subjecting the child to repeated anesthesia.

Sir, We read with interest article by Arda, et al.[1] We put forth following observations: The study did not mention about detail age subgroup. How many children were below 4 years age? Indication of surgery in the patients below 4 years of age? Is there any amblyopia or fusion loss with augmented surgical amounts in X (T) in this age? There is a controversy about surgical management in X (T) in children