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Aggressive fibromatosis is a locally invasive tumor that does not metastasize. Only few cases of scapulectomy for fibromatosis of scapular muscles are reported in the world literature. We present two consecutive cases of scapulectomy done for fibromatosis of periscapular muscles at the Department of Surgical Oncology in our centre between 2014 and 2019. One patient underwent subtotal scapulectomy by posterior approach and the other patient underwent scapulectomy below spine of scapula by combined anterior and posterior approach. The follow-up period of both the patients was 5 years. One patient developed recurrence after 9 months of surgery dealt by re-resection followed by adjuvant radiation. The modified Musculoskeletal Tumor Society (MSTS) score for scapular surgery was 20 in the first patient and 22 in the second patient. Both of them are able to carry out normal regular activities with the compensation from the opposite upper limb. Scapulectomy for symptomatic fibromatosis of the scapular muscles gives acceptable functional results and good disease-free interval. Scapulectomy should be considered as part of resection for better tumor clearance in fibromatosis involving muscles around the scapula. Further studies are needed to evaluate and validate the need for radical surgery in this setting.

AIM: To analyse the changes in magnitude and orientation of astigmatism after suture removal (SR) in keratoplasty eyes as measured by refraction, tomography, and aberrometry. METHODS: Twenty-six eyes of 25 patients after optical keratoplasty requiring SR to reduce the astigmatism during the follow-up period were prospectively included. Eyes with poor quality topography scans or if there were no sutures in the steepest semi meridian were excluded. Corrected distance visual acuity (CDVA), manifest refraction, corneal tomography and aberrometry were performed on all patients before and after SR. RESULTS: The mean age of the patients was 40.8±14.4y. Penetrating keratoplasty was performed in 23 eyes (89%) and deep anterior lamellar keratoplasty was done in 3 eyes (11%). There was a statistically significant reduction in the magnitude of refractive, tomographic and aberrometry astigmatism after SR (P

BACKGROUND Endometrial carcinoma is a leading malignancy among females. Pre-operative imaging and biopsy are necessary to identify the disease. Clinicopathological analysis determines the extent of the disease. Complete surgical staging is advised for high-risk patients. The purpose of this study was to analyze the different clinical endpoints, prognostic factors and demographic details that will influence the survival patterns of the cases of carcinoma of endometrium who underwent surgery during the period from 2014 to 2017 at a tertiary care centre, Chennai, India. METHODS Patients diagnosed with operable endometrial carcinoma were surgically staged based on the surgical procedures performed namely, total abdominal hysterectomy (TAH) with bilateral salphingo-oophorectomy (BSO), bilateral pelvic lymph node dissection, and para-aortic lymphadenectomy (patients with high-risk features). Post-surgical staging specimens were histopathologically examined in the Department of Pathology. Adjuvant radiation was given to patients with stage IA grade II and above. Patients with stage III disease received adjuvant chemotherapy. Descriptive analysis was done to show the distributions of patients accordingly. Kaplan-Meier survival analysis was performed for the overall median survival of the patients. RESULTS The study consisted of a total of 35 patients with a mean age of 56 ± 8.64. Parameters such as age, clinicopathological features, stage (FIGO staging), tumor size, grade, lymphovascular invasion (LVI), myometrial invasion, cervical involvement, involvement of margins, lymph node ratio (LNR) and survival were studied. Tumor size and grade were found to be significant factors affecting the survival. Overall median survival period of patients who underwent surgery was found to be 31 months. CONCLUSIONS Tumor size and grade of the tumor are significant prognostic factors affecting the survival of the patients with carcinoma of endometrium. Lymph node ratio is a new concept in carcinoma endometrium to be pondered upon as a factor predicting survival in future studies thereby defining the role of lymph node dissection in surgical staging. KEYWORDS Endometrial Cancer, FIGO Staging, Lymph Node Ratio, Prognosis, Survival Analysis

Purpose: To compare the total keratometry (TK) and astigmatism measurements in eyes with cataract using automated keratometry of swept-source optical coherence tomography (ss-OCT), optical low-coherence reflectometry (OLCR), simulated keratometry (SimK), and total corneal power (TCP) of combined placido-dual Scheimpflug imaging system. Setting: The study was conducted at LV Prasad Eye Institute, Hyderabad, India. Design: Retrospective evaluation of electronic medical records of patients who were evaluated for cataract surgery Methods: Twenty-eight eyes of 28 patients were included in the study. All patients evaluated for cataract surgery underwent corneal power measurements using three devices: ssOCT, OLCR, and combined placido-dual Scheimpflug imaging were included in the study. Vector analysis was performed to evaluate corneal astigmatism and Bland-Altman analysis was conducted to evaluate the limits of agreement of similar parameters among devices. Results: The mean TK was statistically significantly different from the keratometry obtained from optical biometers and values measured by the Scheimpflug imaging system. The magnitude of mean difference was greater between TK and TCP (0.75 ± 0.25) compared to other variables. The mean difference in astigmatism between TK, ss-OCT-K (0.09 ± 0.12, p = 0.48), OCLR-K (0.10 ± 0.48, p = 0.91), and TCP (0.09 ± 0.47, p = 0.31) was not statistically significant but was statistically significant between TK and SimK values (0.23D ± 0.49D). The axis of orientation (Conclusion: There appears to be a greater correlation of automated keratometry, and TK values obtained from ss-OCT compared to other variables studied. The measurements from TK, Simk, and TCP cannot be used interchangeably.

Janu Sandhigata vata is one such Vatavyadhi presenting with Sandhi shula, Sandhi shotha, Sandhi atopa and Prasarana Akunchana Vedana, resulting in limited range of movements, there by restricting daily activities of the individual. Janu Sandhigatavata is commonly identified with Osteoarthritis of Knee Joint characterized by pain, swelling & impaired movements. The prevalence of Osteoarthritis rises progressively with age and it has been estimated that that 45% of all people develop Knee Osteoarthritis in life. Osteoarthritis is more common in women than men. The existent line of treatment in contemporary field of medicine includes the administration of analgesics, NSAIDS, Intra articular steroids and surgical intervention in the form of Knee replacement, which all has their own limitation and meanwhile may have deleterious adverse effect. In this regard, there is a need for exploring the safe, effective and affordable line of treatment. Basti karma is a supreme treatment for Vata Vyadhi and also known as Ardha Chikitsa because of its multifaceted actions. Many Basti formulations are mentioned in classics among which Erandamooladi Bati was selected for the study because its dual action, does Vataghna and also relives Kapha Avarana. The results were statistically highly significant within the group.

Introduction: Angular deformities around the knee in children is a common finding, these deformities are from diverse group of etiologies. Most of these deformities are physiological in nature corresponding to the changes in the alignment of tibio-femoral angle from birth to adolescence. Angular deformities can also be developed due to pathological causes like skeletal dysplasias, metabolic bone disorders, Blount’s disease and trauma. Osteotomies were the mainstay of treatment for correcting deformities in both adults and children been replaced by Hemiepiphysiodesis using 8 plates having less complication rate. Materials and Methods: A total of 49 knees (35 genu valgum, 14 genu varum) of 30 patients were studied. 8 -plates were used for correction of coronal plane deformities around the knee. All cases were followed for minimum period of 12 months. Preoperative clinical and radiological measurements were compared to post-operative measurements. Results: There was statistically significant improvement in clinical and radiological outcome measures. In genu valgum group preoperative mean Tibio-femoral angle (TFA) improved from 24.16 to 8.36. Mean Mechanical axis deviation (MAD) improved from 4.26 to 1.09. Rate of correction of TFA is 1.1/month, rate of correction of MAD is 0.22/month. In genu varum group preoperative mean TFA improved from 34.58 to 21.47. Mean MAD improved from 4.92 to 0.63. Rate of correction of TFA is 0.77/ month, rate of correction of MAD is 0.12/month. Conclusion: Hemi-epiphysiodesis using 8-plate systemin the correction of coronal plane deformities around the knee is a safe and effective procedure. Keywords: Hemiepiphysiodesis, Guided growth modulation, Genu varum, Genu valgum.

Introduction: Foot deformities caused by altered or abnormal muscle forces are common in patients with cerebral palsy. The incidence of foot deformities in cerebral palsy is approximately 70% to 90%. The most common deformity is ankle equinus, with equinovarus and equinovalgus deformities being equally common. A foot deformity can have significant effects on the patient's overall ambulatory level. The purpose of this study was to assess the functional outcome of batchelor’s extra-articular subtalar arthrodesis in spastic planovalgus foot in cerebral palsy children. Materials and Methods: This is a prospective study of 40 patients (68 feet) with spastic planovalgus foot deformity presenting to BIRRD (T) Hospital from October 2015 to October 2017. Children with spastic planovalgus foot between 6 yrs-14 yrs were included in study. There were 24 male and 16 female children. The mean age at the time of surgery was 10 yrs. Both feet were involved in 28 children, 8 had right foot involvement and 4 had left foot involvement. In our study we had 12 hemiplegics and 28 diplegics. Children with mental retardation, extra pyramidal type of cerebral palsy, rigid plano-valgus foot, spastic quadriplegia were excluded from the study. All patients underwent batchelor’s arthrodesis with fibular graft and were immobilized in below knee POP cast for 8 weeks. 24 patients underwent gastrosoleus lengthening along with batchelor’s arthrodesis. Clinical and functional outcome was assessed based on AOFAS (American orthopaedic foot and ankle score) clinical rating system. Radiological assessment was done by measuring Lateral talocalcaneal angle and Talar declination angle. The results of batchelor’s arthrodesis are stated as satisfactory and unsatisfactory. Satisfactory: Clinical and roentgenographic stabilization of the hind foot and no recurrence of planovalgus deformity. Unsatisfactory: Clinical and roentogenographic evidence of failure of stabilization. Results and Discussion: All children had spastic type of cerebral palsy. Post-operatively children were followed-up for an average period of 14 months, with range from 4 to 24 months. Among 40 patients (68 feet), 8 feet (12 percent) had residual valgus, 12 feet (18 percent) had graft absorption, 4 feet (6 percent) had fracture of the graft and none had varus deformity after an average follow-up of 14 months. Out of 68 feet, 44 feet had “satisfactory” result (65 percent) and 24 feet had “unsatisfactory” result (35 percent). Conclusion: Our experience concludes that batchelor’s extra-articular arthrodesis of sub-talar joint is a good procedure for correction of plano-valgus foot deformity in cerebral palsy patients. Advantages of the procedure are simplicity of the technique, immediate firm fixation and early weight bearing. Keywords: Cerebral palsy, Batchelor’s subtalar arthrodesis, Planovalgus foot, AOFAS clinical rating system.

Introduction: Patients with Developmental dysplasia of hip many a times present later in the age due to missed or delayed diagnosis. The treatment of DDH is mainly dependent upon the age of the child at the time of presentation and varies according to it. In the late presenting cases it is mostly surgical with open reduction alone or in combination with pelvic and femoral osteotomies. Materials and Methods: This study between October 2012 and October 2014 includes 21 patients with unilateral dysplastic hips, surgically treated with a single stage procedure of open reduction and Acetabuloplasty of Pemberton, along with Varus derotation osteotomy and femoral shortening when necessary. Preoperatively they were classified according to Tonnis grade. Clinical assessment was done using Modified McKay’s criteria; Radiological evaluation was done using Severin’s radiographic criteria. Results: The mean follow up period was 15.14 months and the mean age at surgery was 66.86 months. McKay’s grades were excellent in 8 hips, good in 11 hips, fair in 1 hip and poor in 1 hip. Severin’s score was excellent in 4 hips, good in 15 hips, fair in 1 hip and poor in 1 hip. Conclusions: Every case of DDH is unique. The type of surgery chosen depends on the clear understanding of each hip after using the available resources. The combination of open reduction with pelvic and/ or femoral osteotomy when needed gives good immediate stability and promotes remodelling. This surgery is a technically demanding procedure but when performed properly by an experienced surgeon, it does give satisfactory results. Keywords: Developmental dysplasia of hip, Late presentation, Open reduction, Pelvic and/ or femoral osteotomy.

Materials and Methods: A total of 263 knees, (150 patients), males 65, females 85 with early OA were divided randomly into two groups. Group A 75 patients (134 knees) received a single injection of PRP, group B 75 patients (129 knees) received 2 injections of PRP 3 weeks apart. PRP with a platelet count 5 times that of baseline was administered in all. Clinical outcome was evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire before treatment and at 1 month, 3 month, and 6 months post injection. A reduction in WOMAC score is suggestive of improvement in patient condition. Results: significant improvement in all WOMAC parameters was noted in groups A and B within 3 to 4 weeks and lasting until the final follow-up at 6 months. The mean WOMAC scores (pain, stiffness, physical function, and total score) for group A at baseline were 15.8, 6.22, 43.09, and 65.11, respectively, and at final follow-up were 4.83, 1.00, 14.12, and 19.95, respectively, showing significant improvement. Similar improvement was noted in group B (mean WOMAC scores at baseline: 16.51, 6.91, 41.98, and 65.38, respectively; mean WOMAC scores at final follow up: 5.50, 1.12, 13.69, and 20.37, respectively. The 2 groups were compared with each other, and no improvement was noted in group B as compared with groups A (P, value 0.77). Conclusion: Autologous PRP infiltration in early Osteoarthritis of Ahlback’s radiological grading does give relief from pain, stiffness and improves functionality without any major side effects. Double dose doesn’t offer any additional advantage. Keywords: Platelet rich plasma, Early osteoarthritis knee.

Introduction: One of the most common fractures an orthopaedic surgeon encounters is Malleolar fractures. As with all intra articular fractures accurate reduction and stable internal fixation of malleolar fractures is desirable. The present study aimed at analyzing the factors influencing the outcome of operative management of malleolar fractures. Materials and Methods: In this prospective study 25 patients with Malleolar fractures who were surgically treated between 2014 to 2016 were included. All patients were treated in accordance with A.O. principles. Patients aged above 18 years, with unstable fractures were included in this study. Post op protocol was below knee POP cast with a dorsal window for ankle mobilization and non-weight bearing walking with walker for 4 weeks post operatively. Baird and Jackson ankle scoring system was used to analyze the results. The follow up period for all patients was 60 weeks. Results: In this series of fixation of malleolar fractures with various techniques had Fair results in 84% and poor results in 16% as per Baird and Jackson Score. The average time to union was 12 weeks. The complications leading poor result were instability, Pain at rest, arthritic changes. Conclusion: Open reduction and internal fixation guaranty high standard of reduction besides eliminating the chances of loss of reduction. In our study, the Extent of anatomical reduction achieved in the surgery and Post-operative ankle mobilization and patients’ compliance influenced the outcome. Restoration of fibular length and rotation is critical in re-establishing a stable ankle mortise and perfect talar alignment. We conclude tension band wiring is the preferred method for small fracture fragments and osteoporotic bones of both medial and lateral malleolus. Keywords: Malleolar fractures, Anatomical reduction, Baird and Jackson score.

Askin tumor (a Ewing sarcoma variant) is the most common tumor of the chest wall in the pediatric age group. Multimodal treatment is required, with complete resection being the cornerstone of effective management. We describe the case of a 13-year boy with a left paraspinal Ewing sarcoma with intraspinal extension and spinal cord compression with neurological weakness. He underwent complex surgical resection using thoracoscopic resection of multiple ribs along with vertebral resection and reconstruction, after neoadjuvant therapy.

Purpose: To estimate the time taken for topometric indices to stabilize in keratoconic corneas following cessation of habitual RGP contact lens wear. Methods: A total of 29 eyes of 20 patients, diagnosed with mild to severe keratoconus were included in this prospective observational study. All patients were experienced RGP contact lens wearers (either conventional RGP or Rose K2 lens) with each patient having used these lenses for at least a year. Corneal topography was performed immediately following discontinuation of habitual contact lens wear at baseline and each of four consecutive visits, 1-week apart. Results: An overall reduction in the keratometry and thickness values were noted on tomography immediately following cessation of contact lens wear and these indices increased significantly in the 1st week (P < 0.001). Consecutive visits following the first visit did not show any significant change in the topometric parameters (P > 0.05). Subgroup analysis revealed a similar trend in eyes with “severe” keratoconus and in eyes fitted with the “three-point touch” philosophy. However, eyes with “mild-moderate” keratoconus and those fitted with “apical clearance” fitting philosophy showed marginal differences even within the 1-week period of lens cessation. Conclusion: Maximum changes in keratometry and pachymetry values following discontinuation of RGP lens wear stabilize within the 1st week of cessation of rigid lens wear in a keratoconic cornea. These changes were more pronounced in patients with severe keratoconus and those with an apical bearing fit. This information would be useful for practitioners to assess the progression of keratoconus in RGP lens users before collagen cross-linking.

Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.

Cutaneous Leishmaniasis (CL) is the most prevalent form of Leishmaniasis and is widely endemic in the Americas. Several species of Leishmania are responsible for CL, a severely neglected tropical disease and the treatment of CL vary according to the different species of Leishmania. We proposed to map the distribution of the Leishmania species reported in French Guiana (FG) using a biogeographic approach based on environmental predictors. We also measured species endemism i.e., the uniqueness of species to a defined geographic location. Our results show that the distribution patterns varied between Leishmania spp. and were spatially dependent on climatic covariates. The species distribution modelling of the eco-epidemiological spatial patterns of Leishmania spp. is the first to measure endemism based on bioclimatic factors in FG. The study also emphasizes the impact of tree cover loss and climate on the increasing distribution of L. (Viannia) braziliensis in the most anthropized regions. Detection of high-risk regions for the different between Leishmania spp. is essential for monitoring and active surveillance of the vector. As climate plays a major role in the spatial distribution of the vector and reservoir and the survival of the pathogen, climatic covariates should be included in the analysis and mapping of vector-borne diseases. This study underscores the significance of local land management and the urgency of considering the impact of climate change in the development of vector-borne disease management strategies at the global scale., Graphical abstract Unlabelled Image

Chikungunya fever (CHIKF) is an arbovirus disease caused by chikungunya virus (CHIKV), an alphavirus of Togaviridae family. Transmission follows a human-mosquito-human cycle starting with a mosquito bite. Subsequently, symptoms develop after 2–6 days of incubation, including high fever and severe arthralgia. The disease is self-limiting and usually resolve within 2 weeks. However, chronic disease can last up to several years with persistent polyarthralgia. Overlapping symptoms and common vector with dengue and malaria present many challenges for diagnosis and treatment of this disease. CHIKF was reported in India in 1963 for the first time. After a period of quiescence lasting up to 32 years, CHIKV re-emerged in India in 2005. Currently, every part of the country has become endemic for the disease with outbreaks resulting in huge economic and productivity losses. Several mutations have been identified in circulating strains of the virus resulting in better adaptations or increased fitness in the vector(s), effective transmission, and disease severity. CHIKV evolution has been a significant driver of epidemics in India, hence, the need to focus on proper surveillance, and implementation of prevention and control measure in the country. Presently, there are no licensed vaccines or antivirals available; however, India has initiated several efforts in this direction including traditional medicines. In this review, we present the current status of CHIKF in India.

Propylene glycol is a viscous, colorless liquid that has been approved by the US Food and Drug Administration for use as a preservative in foods and as a solvent in pharmaceuticals. Compared with methanol and ethylene glycol, it is regarded as a relatively safe alcohol. There have been several reports of severe lactic acidosis in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam. The laboratory findings may include high metabolic acidosis and high osmolal gap. Propylene glycol is also one of the ingredients used in Fireball Whiskey. We present two cases of severe lactic acidosis in the setting of Fireball Whiskey use.

Vascular endothelial growth factor (VEGF) inhibitors are used in the treatment of various cancers as well as diabetic retinopathy. The systemic use of these drugs has been associated with adverse effects such as worsening hypertension, proteinuria, and renal function. There have been some reported cases of worsening hypertension, thrombotic microangiopathy, or glomerular disease after intravitreal injections of bevacizumab, aflibercept, and ranibizumab. We present a case of a patient who was taking intravitreal bevacizumab injections for diabetic retinopathy and was hospitalized with worsening renal function, high blood pressure, and nephrotic-range proteinuria in the setting of tight glycemic control.

Introduction: Reconstruction of the anterior cruciate ligament (ACL) is a common procedure. Injury is the predisposing risk factor for developing heterotopic ossification(HO). We like to report a case of HO of the knee following arthroscopic ACL reconstruction. Case Report: A29-year-old patient was admitted with complaints of painful instability of the left knee after a fall from bike. MRI study con?rmed a complete ACL rupture along with tear of the body and posterior horns of the medial meniscus. ACL reconstruction was carried out using ipsilateral hamstring tendon graft by knee arthroscopy. Eight months after the procedure, the patient complained of pain in the lateral side of the knee joint evidencing a slight prominence of hard consistency. The radiological study confirmed it to be a case of HO. The patient was managed conservatively. Conclusion: Bone is the only tissue that has an incredible property as such that it can differentiate and develop into its mature form outside its native locations. Numerous studies have suggested ways of preventing and treating this complication. One has to be aware that even these simple surgical procedures can lead on to HO. Keywords: Heterotopic ossification in arthroscopy, unusual complication in arthroscopy, heterotopic ossification, knee arthroscopy complication.

Primary hyperparathyroidism is rare in pregnancy, with an incidence of 1%. It is associated with maternal, fetal, and neonatal complications. Herein, we present two patients with gestational primary hyperparathyroidism who failed medical management and underwent successful parathyroidectomy. Based on our experience and review of the literature, gestational hyperparathyroidism appears to be a clear indication for early parathyroidectomy in both symptomatic and asymptomatic patients.

Retrograde hysterectomy is indicated when adhesion around the uterus is strong and the usual surgical method is not possible. We describe a technique of retrograde retroperitoneal type B1 radical hysterectomy in patients with distorted pelvic anatomy. We performed the retrograde retroperitoneal type B1 radical hysterectomy in 17 patients during the period 2017–2019 in the department of surgical oncology at our centre. Eleven patients underwent this procedure for ovarian tumour as part of primary or interval cytoreduction, three patients for Grade IV endometriosis, one patient for locally advanced carcinoma rectum as part of posterior pelvic exenteration, and one patient for advanced carcinoma endometrium and as part of cytoreductive surgery (peritonectomy with HIPEC) in one patient with pseudomyxoma peritonei. Out of the 17 patients, only one patient had prolonged bladder morbidity which settled with conservative management. The patient who underwent the procedure as part of cytoreductive surgery had persistent increased frequency of stools for 1 month following the ileorectal anastomosis. She settled with conservative management and frequency of stools decreased. Two patients had wound morbidity. Retrograde retroperitoneal type B1 radical hysterectomy with preservation of pelvic nerves is technically feasible thereby decreasing the postoperative morbidity in patients with distorted pelvic anatomy. The technique described by us is a boon to the surgeon on encountering a difficult pelvic anatomy during the surgery.

Obesity with its devastating consequences is a global health problem of this era. Presently Obesity in India has reached epidemic proportions in the 21st century, with morbid Obesity affecting 5% of the country’s population. The characteristic features of Obesity have close resemblance with Sthoulya in Ayurveda. Sthoulya is one among Santharpanottha Vyadhi, one among the Ashta Nindita Purushas, Kapha Nanatmaja Vyadhi and Dushta Medo Roga. Sthoulya being Bahudoshavasta and Mamsala, Medhura and Bhuri Sleshma Vyadhi. Hence, considering the condition, a comparative study was planned to compare the efficacy of Rookshana Poorvaka Vamana and Virechana Karma. The objective criteria were assessed before and after treatment. The results was statistically highly significant within the group, at the level of P value less than 0.001. Between the groups, Rookshana Poorvaka Vamana Karma group showed better results in comparision of mean difference to that of Rookshana Poorvaka Virechana Karma group.

Background/AimTo report visual outcomes and factors associated with good visual outcomes after cataract surgery among the elderly residents in ‘homes for the aged’ in Hyderabad, India.MethodsIndividuals aged ≥60 years were recruited from 41 ‘homes for the aged’. All participants had a detailed eye examinations including visual acuity (VA) assessment , refraction, slit-lamp examination and fundus imaging by trained professionals. A detailed history of cataract surgery was recorded. Multivariate logistic regression was used to determine the factors associated with good visual outcomes after cataract surgery which was defined as presenting VA of 6/18 or better in the operated eye. Visual impairment (VI) is defined as presenting VA worse than 6/18 in the operated eye.Results1215 eyes of 703 individuals had cataract surgery. The mean age of these participants was 77.5 years (SD: 8.2 years; range: 60–108 years), 66.8% were women, 29.9% reported diabetes and 61% reported hypertension. 406/1215 (33.4%; 95% CI 30.8 to 36.1) eyes had VI after cataract surgery. Posterior capsular opacification (31.8%; n=129) was the leading cause of VI followed by uncorrected refractive error (24.1%; n=98). The prevalence of good outcomes was 66.6% (95% CI 63.8 to 69.2). On applying multivariable analysis, younger age, self-reported hypertension, independent mobility, surgery in a non-government (as opposed to private) hospital and undergoing paid surgery were associated with good outcomes.ConclusionsOne-third of the eyes of elderly individuals living in homes for the aged that had previously undergone cataract surgery had VI. Regular eye examinations with the provision of laser capsulotomy and appropriate refractive correction can substantially improve their vision.

Background and Aims Cancer is now increasingly recognized as a major cause of death among patients especially after kidney transplantation. Malignancy represent a major burden in transplantation medicine. The Incidence is about 12 fold higher for PTLD and 3.5 fold higher for non-cutaneous malignancy compare to age-matched population. The increased risk is multifactorial and attributed to oncogenic viruses, immunosuppression and altered T cell immunity. In the era of longer graft survival and with the introduction of more potent immunosuppressive medication, malignancy represents a major burden. The incidence of malignancy after renal transplantation is 3 to 5 times higher. Incidence is higher in transplant patients even when compared to patients on hemodialysis. Aim: We attempted to assess the incidence of post-transplant malignancies in patients who underwent renal transplantation at our centre, along with studying the presentation, type and other factors affecting their development. Method We analysed data retrospectively from 626patients who underwent renal transplantation atour centre from January 2003 to September 2018.Pre transplant history, post transplant course including duration on hemodialysis, immunosuppression details and duration till diagnosis of malignancies were collected. Details regarding type of malignancy, histopathology, staging and treatment given and outcome were collected. Results Number of transplant recipient-626. The total number of patients with malignancy is 12. Incidence of malignancy posttransplant is 1.9%.Male-7 and female-6.One patient was detected with 2 malignanciesduring her post transplant period. The types of malignancies encountered were Conclusion The incidence of malignancy – 1.9%.Probable reason for decreased incidence of malignancy is the decreased immunosuppression needed by South Asian people. The most common malignancy was solid organ tumour; tongue being the most common organ. Most common histological variant is squamous cell carcinoma.Non-Hodgkin is more common than Hodgkin. Incidence of malignancy is low. Decision regarding cancer screening should be made on individual basis.

SIGNIFICANCE Laser refractive surgery procedures are efficacious at correcting myopia, but they result in long-term deterioration of optical quality that affects monocular and binocular visual performance. The study shows that the optical quality of the two eyes needs to be similar to optimize binocular visual performance after surgery. PURPOSE This study aimed to systematically analyze longitudinal changes in optical quality, high- and low-contrast logMAR acuity and random-dot stereoacuity before and after three refractive surgery procedures for correcting myopia. METHODS A total of 106 subjects (laser-assisted in situ keratomileusis, 40; photorefractive keratectomy, 26; small-incision lenticule extraction, 40) with myopia and astigmatism ≤1.5 D participated in this prospective cohort-based study. All aforementioned outcome variables were measured in both eyes pre-operatively and 1 week and 1, 3, and 6 months post-operatively. RESULTS Pre-operative myopic spherical equivalent of refraction (median [25th to 75th interquartile range], -6.4 D [-8.0 to -4.2 D] for laser-assisted in situ keratomileusis, -4.3 D [-5.0 to -3.5 D] for photorefractive keratectomy, -5.5 D [-6.5 to -4.3 D] for small-incision lenticule extraction) was corrected to within ±0.75 D of emmetropia in all cohorts up to 6 months post-operatively (P < .001). Higher-order wavefront aberrations, uncorrected high- and low-contrast logMAR acuity, and stereoacuity all worsened and remained so up to 6 months post-operatively, relative to pre-operative values (P < .001). Stereoacuity worsened with both interocular average and difference in the magnitude of higher-order aberrations, whereas logMAR acuities worsened only with interocular average of these aberrations (r ≥ 0.40; P < .01 for all). CONCLUSIONS Although the refractive surgery procedures tested here correct myopia, they result in a sustained (up to 6 months) loss of optical quality and spatial and depth-related visual functions post-operatively. Both interocular average and difference in the eye's optical quality seem to impair binocular visual functions after refractive surgery for myopia.

Background: Anthropization of natural habitats including climate change along with overpopulation and global travel have been contributing to EIDs outbreaks. The ongoing COVID-19 outbreak highlights the threats to human health, social stability and global trade and economy. The Blueprint Priority Diseases (BPDs) is a list established by the World Health Organization, which are in urgent need of research. We proposed mapping the predictive risk of the BPDs, identifying the environmental drivers and validating the use of disease biogeography as a tool for identifying the potential hotspots for Disease X. Methods: We used environmental predictor variables from satellite imagery such as landscape, deforestation, climatic covariates, and species distribution modelling by classical regression and Support Vector Machine (SVM) to model BPD occurrences from 2000 to 2019. The models were evaluated using AUC (>0.9) and a weighed mean was used to map the predictive risk of the BPDs and identify potential sites of Disease X. Results: We generated predictive risk maps for Ebola, Marburg, Nipah, Rift Valley Fever and coronavirus diseases using glm and SVM models. Elevation, tree cover loss and climatic covariates were found to significant triggers for disease emergence of BPD outbreaks. We identified regions in China and Uganda to be potential hotspots for Disease X. Conclusions: Using a biogeographic approach, existing disease databases and freely accessible environmental data, we were able to identify Wuhan as a potential hotspot of disease emergence in the absence of COVID-19 data. We confirm that distribution of disease emergence in humans is spatially dependent on environmental factors. Funding Statement: None to declare Declaration of Interests: None to declare Ethical Approval: Not needed

BackgroundUrban disadvantaged neighborhoods have higher HIV risk behavior and higher levels of AIDS-related mortality. Studies demonstrate that interventions at the community level focusing on risk groups have increased success rates than individual patient-based based management in the context of HIV/AIDS. We tested a novel approach to identify population groups in need of greater public health efforts to achieve UNAIDS 90-90-90.MethodsWe extracted retrospective data on 2141 HIV/AIDS patients, recruited from 1997-2017 in the regional hospitals in French Guiana. Self-organizing maps were constructed and clusters were identified based on demographic and socioeconomic variables such as age, sex, CD4 counts at Nadir, type of neighborhood, unemployment rate, and presence of opportunistic illness such as Histoplasmosis and Hepatitis B in the sample population.ResultsNeighborhood unemployment rates were identified to have a large impact in the distribution of HIV/AIDS. Also, the risk of disseminated histoplasmosis, the most common AIDS-defining illness in French Guiana, was not associated to any particular neighborhood suggesting that urban socioeconomic features are not the primary drivers of exposure risk.ConclusionSocioeconomically disadvantaged neighborhoods remain hotspots for HIV/AIDS. We conclude that SOM is an effective tool in the identification of risk clusters that may guide public health efforts to optimize HIV prevention and testing in French Guiana and other developing countries.

Objective: Tendon transfers are indicated when dynamic muscle imbalance results in a deformity that interferes with ambulation or function of the extremities. Foot and ankle are the most dependent parts of the body and are subjected to greater strain than other parts. Calcaneo-valgus deformity is one of the common deformities seen in Post-Polio Residual Paralysis. A host of operative procedures have been described in the management of this deformity. We report the results of the study conducted in our institute where Achilles tendon plication and transfer of Peroneus Longus tendon to Achilles tendon has been done for dynamic calcaneo-valgus deformity of the foot in patients of post-polio residual paralysis. Methods: This is a prospective study of 37 patients with Calcaneovalgus deformity having Post-Polio Residual Paralysis presenting to Balaji Institute of Surgery, Research and Rehabilitation for the Disabled Hospital from December 2009 to December 2012. Informed consent was taken from the parents of all the patients. Ethical committee approval was also taken. Patients with age more than 7 years, ability to walk without support and Peroneal tendon having minimum motor power of grade 4 or 5 as per MRC classification are included in our study. Patients with fixed deformity at ankle joint or subtalar joint are excluded from the study. Pre-operative evaluation included detailed motor examination of the involved lower limbs as per MRC (Medical research council) classification, evaluation of deformity in the hip and knee and range of motion at ankle. AOFAS (American Orthopaedic Foot and Ankle Society) clinical rating system was used to assess the patient pre-operatively and post-operatively. The aggregate score of the AOFAS ankle-hind foot clinical rating scale pre and post operatively were analyzed with use of chi-square analysis. The level of significance of < 0.05 was considered to be significant. The surgical procedure was done under spinal anesthesia with the patient in lateral position under pneumatic tourniquet. A longitudinal incision is made starting from the tip of lateral malleolus midway between the posterior border of lateral malleolus & Achilles tendon to about 8-10cm proximally. Skin flaps are mobilized without dissecting the subcutaneous fat. The two peroneal tendons are identified as they pass down the leg and around the back of the lateral malleolus. The peroneus longus tendon is divided as distally as possible and mobilized. Similarly the Achilles tendon is identified. Plication of the Achilles tendon is done in its middle third with nylon sutures and the peroneus longus tendon is transferred through it using Fish-Mouth (Pulvertaft) tendon suturing technique and is secured over itself proximally under tension providing the tenodesis effect. While this is done the ankle is kept in plantar flexion. The deep fascia is closed over the tendon. Pneumatic tourniquet was released, and the incision was closed in layers after hemostasis was achieved. Below knee cast is applied with the foot in plantar flexion. Movements of the toes are encouraged after recovery from anesthesia. Active toe movements were encouraged in the cast. After six weeks sutures are removed and ankle foot orthoses are provided for another six weeks. During this period supervised active exercises for strengthening the Tendoachilles (static cycling exercise) are started. Patient is reassessed after six weeks and the orthoses is discarded at this stage. Conclusion: Our experience concludes that Achilles tendon plication and transfer of peroneus longus tendon to Achilles tendon is an excellent procedure which improves the dynamic calcaneo-valgus deformity of foot in patients with post-polio residual paralysis. The advantage of the procedure being easy to do with very low complication rate and improves the quality of life in patients with post-polio residual paralysis. 37 patients with the dynamic calcaneo-valgus deformity of foot in patients with post-polio residual paralysis were analyzed with average follow up period of 12.5 months. Dynamic calcaneo-valgus deformity of the foot was corrected in 89.18% of patients. The study fared with 89 percent patients satisfied with the results. The patients showed improvement in their activity limitation, maximum walking distance, gait and stability.

Dysplastic Gangliocytoma of the Cerebellum, also called as Lhermitte-Duclos Disease (LDD), is a rare condition. The importance of diagnosing it is to rule out co-existant Cowden’s syndrome by thorough clinical examination in view of increased risk of visceral malignancy associated with the latter. Though considered as hamartomatous lesion by some, it is mentioned as a tumour of central nervous system by WHO (Grade I). A lesion, seen in young adults usually, presents with signs & symptoms of raised intracranial tension. We herein describe a case that came with the symptoms of obstructive hydrocephalus five years back and diagnosed as having some tiny cerebellar lesion on imaging. As the patient was not willing to have biopsy done for definitive diagnosis at that time, it remained undiscovered till present. This time, classical MRI finding (tiger stripes appearance) & diagnostic histopathological features were seen leading to the diagnosis. Association with Cowden’s syndrome was not found in this case. DOI: 10.21276/APALM.1665

Key Clinical Message Myxoinflammatory fibroblastic sarcoma is a rare sarcoma which typically presents in the extremities and is treated by definitive surgery. In recurrent disease, the reported utilization of radiotherapy is increasing, and more modern techniques such as intensity‐modulated radiotherapy may be improving long‐term outcomes.

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue malignancy which is locally aggressive, slow growing. It has a very low metastatic potential and has high risk of local recurrence. We report a 65-year-old man with recurrent DFSP of thigh with pancreatic metastasis. Apart from our patient, only four other cases of pancreatic metastasis of DFSP have been reported. Our patient had a solitary metastasis to pancreas and was treated with distal pancreaticosplenectomy. Outcome of the patient was good. We present this case report to emphasise that resection may be considered for solitary metastasis of DFSP and can be managed successfully.

The commonest disease in Indian women is breast cancer (BC). The Mammography Screening is the best solution to predict breast cancer in early stages. Though more research is going to predict BC in the early stages, the death rate is increasing year by year. So, we proposed a method for efficient classification to identify BC in the early stage. Our system uses efficient shape descriptors and is segmented by using Thresholding. Classification is done by using K-Nearest Neighbor (KNN). Our system classified the mammography images into Normal, Benign or Malignant.

Suprachoroidal hemorrhage is one of the most dreaded intraoperative complications that can lead to loss of vision, and is usually associated with certain ocular and systemic risk factors and is rarely reported with phacoemulsification. We present a case of bilateral recurrent intraoperative suprachoroidal hemorrhage during phacoemulsification and secondary intraocular lens implantation in a patient with no known risk factors. Our patient had a history of surgery for a lower facial arteriovenous malformation and no external ocular vascular anomalies. However, postoperatively after the resolution of the complication, enhanced-depth imaging optical coherence tomography showed bilateral marked thickening of the choroid, suggestive of subclinical choroidal hemangioma in both eyes. This abnormally thickened choroid was the possible risk factor causing recurrent suprachoroidal hemorrhage in our case. We suggest performing choroidal thickness measurements in patients with facial vascular malformations or when suprachoroidal hemorrhage occurs in the absence of known risk factors.

Syndrome of inappropriate anti-diuretic hormone (SIADH) secretion is uncommon in small cell lung cancer (SCLC), but even more rare in cases of non-small cell lung cancer (NSCLC). We report a case of a 59-year-old male who presented with superior vena cava (SVC) syndrome. After further investigation, he was diagnosed with adenocarcinoma of the lung. He delayed his medical care and his condition worsened. He was diagnosed with SIADH as an incidental finding on routine lab draw. Radiotherapy was subsequently initiated, and after one week of treatment, the patient showed marked clinical improvement. In this article, we also review the current indications for radiotherapy in various lung cancers and the management of SIADH.

Purpose: To describe the impact of lockdown and unlock phases of the COVID-19 pandemic on cataract surgery at a multitier ophthalmology network. Methods: This cross-sectional hospital-based study included 106,279 eyes operated between March 23, 2019 and March 31, 2021. The data of patients who underwent cataract surgery presenting during the lockdown and unlock phases were compared with the respective periods in the previous year before COVID-19. Results: The cataract surgeries performed decreased to 5.6% (839/14,994) of pre-COVID-19 volumes during the lockdown phase. There was a gradual recovery of the cataract surgeries performed to 86.7% of pre-COVID-19 volumes by May 2020 and exceeded by 17.9% by September 2020. There was a decrease in the number of women who underwent cataract surgery during the lockdown phase (49.11%) compared to the pre-COVID-19 (52.59%) or unlock phase (52.29%, P < 0.001). Patients operated during the lockdown phase were younger when compared to other groups (P < 0.001). The mean LogMAR presenting visual acuity at the time of surgery was worse in patients operated during the lockdown phase (1.84 ± 1.16) as compared to pre-COVID-19 (1.39 ± 1.05) and unlock phases (1.51 ± 1.08, P =

Laser-assisted in situ keratomileusis (LASIK) is one of the most commonly performed kerato-refractive surgery globally. Since its introduction in 1990, there has been a constant evolution in its technology to improve the visual outcome. The safety, efficacy, and predictability of LASIK are well known, but complications with this procedure, although rare, are not unknown. Literature review suggests that intraoperative complications include suction loss, free cap, flap tear, buttonhole flap, decentered ablation, central island, interface debris, femtosecond laser-related complications, and others. The postoperative complications include flap striae, flap dislocation, residual refractive error, diffuse lamellar keratitis, microbial keratitis, epithelial ingrowth, refractive regression, corneal ectasia, and others. This review aims to provide a comprehensive knowledge of risk factors, clinical features, and management protocol of all the reported complications of LASIK. This knowledge will help in prevention as well as early identification and timely intervention with the appropriate strategy for achieving optimal visual outcome even in the face of complications.

A 28-year-old lady with a refractive error of -11.0 D sphere/-1.50 D cylinder at 160 degrees in the right eye underwent an uneventful Implantable Collamer Lens surgery (ICL) with a V4c model, which uses a central Aquaport. This ICL does not require preoperative laser iridotomy or surgical iridectomy, as the centraflow opening is designed to prevent pupillary block. At postoperative day 1, her visual acuity in the right eye was 20/400, with diffuse microcystic corneal edema with fixed, dilated pupil and high intraocular pressure. Following intravenous mannitol, the corneal edema resolved. It was then noted that the ICL was anteriorly displaced, creating acute pupillary block, presumably due to obstruction of the central Aquaport with viscoelastic and inflammatory debris. She underwent AC wash the same day that helped in IOP control; however, the pupil remained permanently dilated and fixed because of extensive sphincter atrophy as a result of acute pupillary block. By 1 month, the visual acuity was 20/30 with an IOP of 14 mm Hg, which was maintained at 1-year follow-up. We report the first case of pupillary block glaucoma with this particular ICL design, suggesting the need for careful attention to complete removal of viscoelastic in the anterior chamber and behind the ICL, to prevent such complications and their cosmetically unacceptable sequelae.

Background: Despite improvements in the techniques of surgery and internal fixation devices, non-union is still reported in one-third of cases of femoral neck fracture with displacement. Valgus intertrochanteric osteotomy alters the biomechanical environment of the fracture site and restores limb length.Methods: This was a prospective study on functional outcome of valgus osteotomy and fixation with dynamic hip screw (DHS) in neglected fracture neck of femur in Balaji Institute of Surgery, Research and Rehabilitation for the Disabled (BIRRD), Tirupati. 28 patients were enrolled between December 2017 to December 2019. Patients less than 60 years of age with fracture neck of femur of more than or equal to 3 weeks since injury and with failed primary fixation were included. Patients >60 years of age, patients with avascular necrosis (AVN), and with resorption of femoral neck were excluded.Results: Among 28 patients 12 had union within 6 months and another 12 within 12 months. 4 patients were lost for follow-up hence considered as non-union. Osteotomy site united by 6 months in 22 patients and by 12 months in 2. Harris hip score was fair to excellent in 24 patients and poor in 4.Conclusions: Valgus osteotomy and DHS fixation is often a definitive one-time surgical procedure to achieve union in neglected and ununited fracture neck femur in young patients. It is simple and biological. In this study because of the delay in presentation and the young age of patients, Pauwels’ osteotomy was performed as the head-salvaging procedure. Union was achieved in 86% of this study patients.

Chemotherapy induced cardiotoxicity leads to development of hypertension, conduction abnormalities, and congestive heart failure. However, there is no simple test to detect and assess cardiovascular risk in a chemotherapy treated cancer patient. The aim of the present study on cancer patients treated with (n = 66) and without (n = 66) chemotherapy is to identify indicators from plasma for vascular injury. The levels of plasma nitrite, asymmetric dimethyl arginine (ADMA), von Willebrand factor (vWF), cardiac troponins, lipid peroxidation (MDA), and lactate dehydrogenase (LDH) were estimated. An R package, namely, Optimal Cutpoints, and a machine learning method—support vector machine (SVM) were applied for identifying the indicators for cardiovascular damage. We observed a significant increase in nitrite (p

Granulomatous interstitial nephritis (GIN) is a rare histological diagnosis seen in less than 1% of native renal biopsies. This case report describes a 37-year-old male with chronic kidney disease (CKD) and mediastinal lymphadenopathy. The kidney biopsy showed granulomatous interstitial nephritis with mild interstitial fibrosis and variable tubular atrophy, as well as a lymph node biopsy with non-caseating granulomas. All the etiologies for non-caseating granulomas, such as infections (mycobacterial, fungal, bacterial, viral infections), hypersensitivity reactions, autoimmune disorders, and granulomatosis with polyangiitis), were initially considered and later excluded as the workup was negative. The patient was unresponsive to a trial of steroids and continued to be on dialysis. This case highlights the importance of obtaining a kidney biopsy in patients with progressive renal dysfunction without traditional risk factors such as hypertension and diabetes.

A 23-year old male of South-Asian ethnicity, presented with fever and cough of one month duration. Examination revealed pansystolic murmur in tricuspid area, ejection systolic murmur in pulmonary area and a normal second heart sound. Echocardiogram showed tricuspid valve vegetations with mild to moderate Pulmonary artery hypertension (PAH) with non dilated right atrium and right ventricle. Blood Cultures for typical and atypical organisms of endocarditis were sterile. Anti-nuclear antibody (ANA) turned out to be positive but ds-DNA and anti-sm were negative. Lupus anticoagulant and anti cardiolipin antibody were positive in high titers. CECT thorax revealed thrombotic occlusion of left main pulmonary artery (LMPA). Criteria for Systemic lupus erythematosus (SLE), was not met initially, developed subsequently during the course of the disease. He was finally diagnosed as Anti-Phospholipid Antibody Syndrome (APS) secondary to SLE. This is a rare case of APS presenting as right sided endocarditis in a young male. Initially confused for Infective Endocarditis but finally diagnosed as APS secondary to SLE.

Purpose The aim of this study was to compare visual acuity, clinical outcomes, complications, and risk factors for graft failure after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for macular corneal dystrophy. Methods Retrospective comparative case series. Results The PK group consisted of 109 eyes of 84 patients and the DALK group consisted of 21 eyes of 20 patients. The mean logarithm of the minimum angle of resolution best-corrected visual acuity at 3 and 12 months was 0.5 versus 0.5 (P = 0.285) and 0.4 versus 0.4 (P = 0.67) in the DALK and PK groups, respectively. There was no significant statistical difference in astigmatism and spherical equivalent between the 2 groups at 12 months. In the PK group, graft rejection that was the most common cause of graft failure was seen in 27 eyes (25%), of which 55% occurred within 1 year. In the DALK group, Descemet membrane microperforation occurred in 5 eyes (24%) intraoperatively, and early postoperative Descemet membrane detachment with double anterior chamber occurred in 9 eyes (43%). Kaplan-Meier estimate of graft survival in PK versus DALK groups were 93% versus 80% at 1 year and 78% versus 70% at 4 years, respectively. Conclusions Visual and refractive outcomes are comparable between DALK and PK groups. DALK was superior to PK in its safety against postoperative complications such as endothelial rejection and secondary glaucoma. Graft failure in DALK was mostly associated with either intraoperative or early postoperative complications. DALK is a viable surgical option in cases with macular corneal dystrophy.

Electrical storm refers to a state of cardiac electrical instability characterized by multiple episodes of ventricular tachycardia (vt storm) or ventricular fibrillation (vf storm) over a short period of time, typically 24 hrs. Patients with acute myocardial infarction are particularly at a higher risk. The disease has a very high mortality and hence an early recognition with prompt treatment is warranted. We report a case of a 47 year old male who had a vt storm following extensive anterolateral wall myocardial infarction. He initially had an unstable vt and was cardioverted by dc shock. However, he continued to have multiple episodes of monomorphic vt within the next 24 hours. He was initially treated with dc shock (under sedation) and amiodarone. He continued to have stable monomorphic vt for which intravenous amiodarone and metoprolol was administered. He still continued to have a dysrhythmia and intravenous lidocaine was tried which finally controlled his arrhythmia. Later, he was later put on icd for secondary prevention and had no further episodes. Key words: Electrical storm, Vt storm, Implantable cardioverter-defibrillator, Iignocaine, Amiodarone, MI.

We report a case series of patients who developed post-laser-assisted in situ keratomileusis (LASIK) ectasia or had a progression of keractesia during pregnancy. We reviewed the medical records of 12 patients (20 eyes) who had reported deterioration of vision during their pregnancy and were diagnosed with keractesia. All 12 patients had experienced symptoms of deterioration of vision between 2 months to 1 year of onset of their pregnancies. A total of 17 eyes of 10 patients had developed post-refractive surgery keractesia. Sixteen of these had undergone LASIK and one had undergone femtosecond lenticule extraction (FLEX). Three eyes of two patients had an exacerbation of keratoconus during pregnancy while one patient had associated hypothyroidism. The results indicate that the hormonal changes that take place in pregnant women can affect the biomechanical stability of the cornea and may trigger the onset of keractesia.

Phototherapeutic keratectomy (PTK) involves treating anterior corneal lesions by superficial corneal ablation using an excimer laser (193 nm). Some of the commonly treated conditions include recurrent corneal erosions (RCE), corneal dystrophies, spheroidal degeneration, keratoconus, and corneal scars. We discuss various techniques of PTK including large area PTK, focal PTK, and multifocal PTK and alternatives to PTK. Masking agents like hyaluronate, methylcellulose, and dextran are recommended to help achieve a better outcome when ablating irregular corneal surfaces. Antifibrotic agents like mitomycin C reduce the chances of recurrence of the disease, apart from minimizing the postoperative scarring. Some of the complications include induced hyperopia and irregular astigmatism, haze, recurrence, and corneal thinning. However, earlier postoperative recovery, possibility of a repeat procedure, and ability to control the depth of ablation make PTK a promising, minimally invasive alternative to keratoplasty in cases with anterior corneal pathologies.