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The organoid nevus syndrome is a rare neurocutaneous syndrome typified by cutaneous sebaceous nevus, seizures and epibulbar choristomas. The condition is associated with multiple ocular abnormalities. Herein, the authors aim to study and report the ophthalmic features of cases diagnosed with organoid nevus syndrome. The authors retrospectively evaluated the records of patients with the organoid nevus syndrome who had presented to a tertiary care eye hospital in northern India. The ocular features were studied and entered in MS excel and the data were evaluated. Data of 13 patients with the organoid nevus syndrome were found. All 13 patients had cutaneous features in the form of Sebaceous nevus of Jadasson, 8 patients had alopecia of the scalp area, 2 had history seizures and 10 had arachnoid cysts on neuroimaging of the head. All 13 patients had a complex choristoma involving the ocular surface. We conclude that the most common ophthalmologic features associated with organoid nevus are complex choristoma of the bulbar surface, scleral coat calcification and upper eyelid coloboma. [ABSTRACT FROM AUTHOR]

Background: Bandage contact lenses are important aids for aftercare following ocular surgery and for a wide variety of ocular surface conditions. However, bandage contact lenses also bear the risk of fostering microbial infections of the cornea. We herein report the safety profile of bandage contact lenses from a comprehensive review of medical records in a tertiary care eye hospital in Germany. Methods: We identified 638 consecutive patients who had been prescribed at least one bandage lens during the past 10 years. For these, we performed a computerized search for the following adverse events: (1) endophthalmitis, (2) emergency keratoplasty and (3) vision loss of at least 2 lines according to the Early Treatment Diabetic Retinopathy Study (ETDRS). We manually assessed the relatedness of each event to the bandage lens. Events later than 100 days following the bandage lens prescription were not considered to be related to bandage contact lenses. Results: We observed 267 adverse events, with 120 occurring within 100 days after bandage lens prescription. This left a total of 18 endophthalmitis events, 21 penetrating keratoplasties and 81 eyes with vision loss of at least 2 ETDRS lines (for individual review of relatedness). Only two episodes of endophthalmitis could be linked to bandage lens wear. All other adverse events were due to causative conditions that had already been present prior to bandage contact lens insertion. Conclusions: Severe adverse events after bandage contact lens wear are not uncommon because lenses are used in patients suffering from preexisting ocular conditions. However, severe adverse events were almost never caused by the bandage contact lenses directly in our hands. We therefore conclude that bandage contact lenses are safe given proper ophthalmological supervision. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the spectrum of uveitis occurring after 60 years of age in elderly patients who presented to a tertiary care eye center in India. Methods: Retrospective study of patients who visited a tertiary eye care institute between January 2010 and July 2020. Result: Eighty-seven patients developed uveitis after 60 years, with only 44.8% having sufficient follow-up documentation and were included in the final analysis. The median age of these patients was 64 (IQR: 62-70) years, and 69% of them were male. Among the identifiable causes of uveitis, infectious uveitis (36%) was the most common and noninfectious uveitis was noted in 23% of patients. The most common subtype of uveitis was anterior uveitis (52%), followed by intermediate uveitis (32%), panuveitis (11%), and posterior uveitis (7%). Tuberculosis (28%) was the most common cause in our cohort, followed by HLA B27 (10%), sarcoid (8%), and Vogt-Koyanagi-Harada disease (5%). In 41% of patients, a definitive diagnosis of uveitis could not be achieved, and the anterior uveitis group had the highest number of undifferentiated uveitis cases. There were no undifferentiated cases of uveitis in the posterior and panuveitis category. The median follow-up period of these patients was 52 (15-91) months and 66% of eyes had recurrence. A statistically significant improvement in vision was seen in anterior uveitis and panuveitis groups, whereas the median visual acuity of the intermediate uveitis group remained stable throughout the follow-up period. Conclusion: Uveitis in the elderly can have a higher recurrence rate; however, the lack of follow-up in these groups of patients is a major challenge. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the medical management of primary open‑angle glaucoma (POAG) and ocular hypertension (OHT) and the placement of fixed‑drug combination drugs (FDC) in the treatment paradigm at a tertiary eye care center in South India. Methods: Retrospective study (January 2011–December 2015) of newly diagnosed POAG and OHT patients (≥18 years) with ≥5 years follow‑up. Primary outcome included percentage use of different antiglaucoma drugs (at initiation) and FDCs at the first, second, and third progression (sequencing). Secondary outcomes: Percentage discontinuation for different FDCs, efficacy parameters (decrease in intraocular pressure (IOP)/visual field), adverse events, and the median number of antiglaucoma medications (AGMs) after 5 years. Results: Three hundred and seventy eyes (198 patients) were analyzed; 84% of them had POAG. Prostaglandin analogs (PGAs) were the most common (66.2%). FDCs were started in 48 eyes (12.9%), with brimonidine + timolol combination being the most common. FDC usage at subsequent modifications was 10.1%, 24.04%, and 30.0%. Beta‑blockers and PGAs were the most frequently prescribed AGMs in our practice pattern, with β‑blockers being the most consistent one. Conclusion: This study is a fairly large study with a minimum of a 5‑year follow‑up of patients with POAG and OHT and gives insights into the treatment patterns, use of FDCs, and the need for multiple medications over time. [ABSTRACT FROM AUTHOR]

Objectives: To report ocular manifestations in patients with Fabry disease (FD) from a tertiary eye care center in Türkiye. Materials and Methods: This prospective, cross-sectional study included 30 eyes of 15 patients with FD. The diagnosis of FD was made based on a combination of clinical findings, genetic analysis, and biochemical evaluation. All participants underwent a detailed ophthalmic examination with special focus on the typical ocular features of FD (cornea verticillata, conjunctival aneurysms, cataract, retinal vessel tortuosity). Results: The mean age was 45±17 years (range: 22-75 years), with a female/male ratio of 2:3. All patients had tortuous conjunctival vessels and 12 patients (80%) had conjunctival aneurysms. Cornea verticillata was present in 10 patients (66.6%), lens opacification in 4 patients (26.6%), and retinal vascular tortuosity in 8 patients (53.3%). All patients had at least two different ocular findings; most (3 heterozygotes/7 hemizygotes) had a combination of corneal verticillata and conjunctival vessel abnormality. The conjunctiva, cornea, and retina were affected together in 5 hemizygous patients (33.3%). One hemizygous patient had all FD-related ocular manifestations in both eyes. Conclusion: To our knowledge, this study is the first to describe the ocular manifestations of FD in the Turkish population. Although cornea verticillata is considered a hallmark of FD, it was absent in approximately one-third of patients. Moreover, cataract, another well-known feature of FD, was present in only 26.6% of the patients. Conjunctival vascular abnormality alone seems to be quite rare in FD, although it often accompanies other ocular manifestations. Therefore, recognition of other mild findings and special consideration of their associations may increase the diagnostic value of ocular findings in FD. [ABSTRACT FROM AUTHOR]

Aim: To investigate the barriers to the uptake of referral services from secondary care centers (SC) to a higher-level tertiary care center (TC) in Southern India. Methods: A cross-sectional study was conducted in the Mahabubnagar district of Telangana, India, between February 1, 2018 to January 31, 2019 and all those referred from SC to TC between January 1, 2013 to December 30, 2016 were identified for interview. Based on inclusion criteria, of the 960 participants identified, 681 (70.9%) participated in the study. A validated study questionnaire was administered to all participants. Information collected were the demographic details, details related to their referral and barriers to referral. The participants that presented at TC were considered compliant and who did not, were non-compliant. Reasons for non-compliance was also collected. Results: The mean age those interviewed was 46.1 years (SD: 17.3 years) and 429 (63%) were males and 252 (37%) were females. Overall, 516 (75.8%) were compliant, and 165 (24.2%) were non-compliant. The major factors for non-compliance were economic (16.4%) and attitudinal (44.2%) barriers. Within the attitudinal barrier category, the most prevalent individual attitudinal barriers were 'too busy to go to the eye center for treatment (16.4%)'and 'able to manage routine daily activities with current vision (12.1%)'. The multivariable analysis showed that the non-compliant participants had only visited the SC once prior to the referral (odds ratio: 2.82; 95% CI: 1.43–5.57) (p = 0.003). Conclusions: Participants with only one SC visit, were less likely to comply with referrals and the major barriers to compliance were economical and attitudinal. It is important to address these specific barriers to provide proper counseling to participants during referrals. [ABSTRACT FROM AUTHOR]

Aim: To compare the demographics, clinical features, and changes in the management pattern of acute dacryocystitis at a tertiary care eye institute. Methods: A retrospective review was performed of electronic medical records of all patients diagnosed with acute dacryocystitis from January 2013 to January 2023. Data retrieved include demographics, history, presenting symptoms, duration of symptoms, surgical interventions, associated systemic conditions, management, complications, and outcomes. A successful anatomical outcome was defined as patency on lacrimal irrigation, and a successful functional outcome was defined as the resolution of infection and epiphora. The data parameters obtained were compared with the historical published data of the earlier two decades from the same Institute. Results: A total of 363 eyes of 349 patients were enrolled in this retrospective study. The median age was 45 years (range: 19–94 years). There were 216 (62%) females and 133 (38%) males. Surgery was performed in 320 (88%) patients. Needle aspiration or incision and drainage were performed in 102(32%) patients with lacrimal abscesses. Of the 320 patients, an endoscopic DCR was performed in 138 (43%) patients and an external DCR in 182 (57%). Of the 320 patients who underwent DCR surgery, 308 (96%) demonstrated anatomical and functional success at 1-year follow-up. Conclusion: There is a changing trend towards endoscopic DCR being incorporated as the primary procedure for managing acute dacryocystitis with the advantages of quicker resolution and reduced morbidity. There is a trend for choosing needle aspiration over the traditional incision and drainage in the initial management of lacrimal abscess. [ABSTRACT FROM AUTHOR]

Background:Near-term follow-up for minor ophthalmic emergencies is important to ensure positive patient outcomes but can impose logistical challenges for patients and ophthalmology practices. While ophthalmic telemedicine has been used for screening and triage, its feasibility and safety for follow-up care for minor ophthalmic emergencies have not been reported. The objective of this study was to report initial results of a novel virtual emergency department (ED) follow-up clinic. Methods:Retrospective cross-sectional study of patients discharged from the ophthalmic ED who required near-term follow-up and carried diagnoses suitable for virtual evaluation, between December 6, 2021, and June 26, 2022, at a single tertiary eye care center. Main outcome measures included missed appointment rate, time interval between ED encounter and virtual follow-up, clinical diagnoses, and referrals after telemedicine follow-up (including for urgent ambulatory and ED evaluation). Results:A total of 145 virtual visits were scheduled with 99 (68.3%) completed appointments, yielding a no-show rate of 31.7%. Of the completed visits, the mean time interval between ED evaluation and virtual follow-up was 8.3 days (standard deviation ±3.9). Eighty-four (84.9%) visits were video-based and 15 (15.1%) were audio-only. Seventy-nine (94%) had at least one aspect of the ophthalmic examination documented. The most common diagnoses were chalazion (18), conjunctivitis (13), corneal abrasion (12), and encounter after corneal foreign body removal (7). After virtual follow-up, 23 patients (23.2%) had subsequent referrals, and no patients re-presented to the ophthalmic ED. Conclusions:Ophthalmic telemedicine may be a safe and feasible modality for providing timely post-acute near-term follow-up care for patients with appropriate ophthalmic diagnoses. [ABSTRACT FROM AUTHOR]

Purpose: To study the epidemiological profile of various pediatric orbital tumors and determine their clinicopathological correlation over 20 years. Methods: A retrospective analysis of all pediatric patients with orbital tumors from the medical records between 1995 and 2015 was done. Tumors were categorized based on their cellular origin. Demographic details, clinical and histopathological diagnoses, frequency, and clinicopathological correlation were studied. Results: A total of 265 pediatric patients with orbital tumors were analyzed, of which 145 (54.7%) patients were males and 120 (45.3%) were females. The mean age was 7 years (median: 6 years; range: 10 days–16 years). The distribution of lesions in each group was as follows: vasculogenic, 76 (28.7%); lipogenic and myxoid, 66 (25%); myogenic, 31 (11.7%); optic nerve and meningeal, 22 (8.3%); lymphoid and lymphoproliferative, 18 (6.8%); secondary orbital tumors, 14 (5.2%); histiocytic, 9 (3.4%); miscellaneous, 9 (3.4%), lacrimal gland, 8 (3%); mesenchymal with neural differentiation, 6 (2%); osseous, 4 (1.5%), and fibrocystic, 2 (0.8%). The most common benign and malignant pediatric orbital tumors were dermoid cysts (65, 24.5%) and rhabdomyosarcoma (31, 11.7%). A statistically significant (P < 0.0001) clinicopathological correlation was observed in 208 (83.2%) out of 250 biopsy-proven cases. Conclusion: Pediatric orbital neoplasms include a broad spectrum of benign and malignant lesions. Vasculogenic tumors constitute the majority of them, followed by lipogenic and myxoid tumors. A thorough knowledge of the incidence, clinical profile, imaging features, and histopathology of specific orbital tumors aids in accurate diagnosis and their successful management. [ABSTRACT FROM AUTHOR]

Purpose: Visual snow syndrome is a debilitating neurological condition. A comprehensive eye examination may not detect any abnormalities in this condition. Presently the condition is recognized only through the history elicited. Hence, it becomes important to understand the presenting complaints and profile of these patients. A retrospective study at a tertiary eye care center was undertaken to achieve this goal. Methods: Electronic medical records of patients presenting to a Binocular Vision and Orthoptics clinic were reviewed. Records of the patients containing keywords such as "light sensitivity, shadowing, visual snow, multiple images, and night vision" were retrieved and inspected. Those matching the diagnostic criteria of visual snow syndrome were included in the study. Results: A total of 33 patients (average age ± standard deviation: 29.7 ± 9.8 years) were identified. Majority of the patients were males (69%). All the patients had logMAR visual acuity 0 or better in each eye. The most prominent (84.4%) presenting symptom was palinopsia (or afterimage or trailing). About 34.4% complained of floaters (including snow-like appearance). More than half (54.6%) of the patients also had binocular dysfunction. Conclusion: Visual snow syndrome is a relatively new condition on the rise, with unclear pathology. The symptoms of this condition can easily be confused with regular floaters or black spots seen in vitreous and retinal pathologies. In the absence of such pathology, an elaborate history should be elicited, and the distress of the patient should be acknowledged. The patient should also be reassured that this is not a blinding condition. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate factors associated with the occurrence of ROCM in COVID-19 patients and to compare its related parameters and outcomes between active and recovered COVID-19 groups. Methods: A total of 35 patients of ROCM associated with COVID-19 (active and post-COVID-19) were included. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessments of ROCM-associated COVID-19 during the second wave of the COVID-19 pandemic. The demographic data, clinical parameters, and outcome were recorded on MS excel sheet, and various parameters were compared between active and recovered COVID-19 groups. Results: ROCM in recovered COVID-19 group was higher (57.1%) as compared to active COVID-19 (42.9%) (P = 1.00). High occurrence of ROCM was seen in those who had a history of hospitalization due to severity of COVID-19 (n 33, 94.28%), oxygen support (77.14), and received systemic steroids (82.9%). The most common comorbidity was diabetes mellitus (82.9%), and new-onset hyperglycemia was noticed in 17.1% of patients. Exenteration (28.6%) was performed in severe cases who had stage IV ROCM, bilateral, and CNS involvement (RR = 7.2, 95% CI: 2.91 to 18.00). The risk of globe exenteration was 1.35 (0.7-2.29) times higher in recovered COVID-19 group, and mortality was 1.76 (0.72-3.36) times higher in active COVID-19 group. Conclusion: Monitored use of systemic steroids and the prompt management of hyperglycemia in COVID-19 patients are important factors for favorable outcomes with reference to globe salvage and life-saving in ROCM associated with COVID-19. Even recovered COVID-19 patients should be observed for persistent hyperglycemia and occurrence of ROCM. [ABSTRACT FROM AUTHOR]

Purpose: To identify different types of exotropia in children less than 16 years and their clinical presentation. The secondary objective is to identify the age of onset, age of presentation, birth history, and ocular and systemic associations as well as to evaluate their motor and sensory status. Methods: This hospital-based descriptive observational study was conducted from September 2018 to December 2019. Patients with a clinical diagnosis of exotropia of age less than 16 years, and exotropia of ≥10 PD were included in the study. Data were collected using a structured proforma. All statistical calculations were performed using Microsoft Excel Office version 2016 and R version 4.0.2. Results: Two hundred eighty-six (286) consecutive children with exotropia were analyzed. Intermittent exotropia (72%) was the most common form of exotropia, followed by exotropia with a neurological association (11%), infantile (8%), sensory (6%), restrictive (2%), and paralytic (1%) types. Exotropia with neurological association had a significantly earlier age of presentation (median = 42months) as compared to other types (P = 0.039). Conclusion: We recorded a huge amount of cases of exotropia associated with neurological abnormalities and this group of patients had significantly more number of preterm and low birth weight children. This study has its limitations as it is not a population-based study and prevalence rates could not be calculated. [ABSTRACT FROM AUTHOR]

CONTEXT: This study aimed to know the clinical and demographic profile of pediatric cataracts in Oman. AIMS: The aim of this study was to describe the demographic and clinical profile of pediatric cataracts in a tertiary care hospital, Oman. SETTINGS AND DESIGN: This was a hospital-based, retrospective observational study. SUBJECTS AND METHODS: A retrospective cross-sectional study of all Omani children presented to ophthalmology outpatient at a tertiary hospital, between January 2012 and December 2016. All patients aged <18 years presented with lens opacity were included in the study. Traumatic cataract cases were excluded from the study. STATISTICAL ANALYSIS USED: SPSS version 22.0 International Business Machines, (Armonk, New York, Unites States of America, dated 8/13/13) used for statistical analysis. RESULTS: Among 379 eyes of 239 patients, 58.6% (140 patients) had bilateral cataracts. Male-to-female ratio was 1.38:1. We arrived at prevalence of 4.32 with 95% confidence interval (3.85, 4.77) of congenital cataract cases/10,000 Omani Children. Most patients (54%) were from either Muscat (28.9%) or A'Sharqiyah (25.1%). The median age of cataracts first noticed by parents was 3 months and the median age of presentation to the eye care unit was 15 months. Patients with positive family history significantly (P = 0.007) presented with bilateral cataracts (75%). About 22.2% of the patients had associated systemic diseases. Among those with systemic association, 77.4% of cases had bilateral cataracts. About 35.4% of eyes had another ocular association. The most common ocular association was squint (11.1%). The most common cataract morphologies at presentation were 20.1% presenting with total lens opacities and 19.8% with posterior subcapsular/posterior lenticonus. CONCLUSIONS: A higher demographic distribution of pediatric cataracts was found in Muscat governorate. There was a significant median delay in presentation to the pediatric ophthalmology clinic by 12 months since lens opacity was first noticed by parents. [ABSTRACT FROM AUTHOR]

Purpose: Optic nerve avulsion (ONA) is a rare but serious presentation of ocular trauma. This study investigates the presenting characteristics and etiologies of all cases of ONA over an 8-year-period at a tertiary eye care center in the Middle East.Methods: The medical records of patients diagnosed with ONA at an Ophthalmic Emergency Department between November 2014 and November 2022 were analyzed in this retrospective cohort study. Data were collected on patient age, sex, affected eye, cause of injury and imaging studies. The best-corrected visual acuity (BCVA) at presentation and at the last follow-up visit, and the duration of follow-up were documented.Results: The study sample was comprised of 44 eyes of 43 patients with ONA with median age of 16.5 (9.3– 26.8) years ranging from 2 years old to 70 years old. There were (35;79.5%) males and (9; 20.5%) females. Most cases presented with an affected left eye (27; 61.4%) followed by the right eye (16; 36.4%) and only one patient (2.3%) had bilateral ONA. The most common cause of trauma resulting in ONA was a metallic object (8;18.2%). This study demonstrates the value of multi-sequence Magnetic resonance imaging (MRI) in the setting of unexplained vision loss when other modalities are inadequate or inconclusive.Conclusion: Ophthalmic morbidity resulting from ONA can be devastating. Metallic object injuries were the most prevalent cause of ONA. The presence of associated media opacities challenges the initial diagnosis of ONA. In the vast majority of cases, the vision ended as no light perception (NLP), indicating permanent vision impairment. [ABSTRACT FROM AUTHOR]

Purpose: To determine the factors affecting the visual outcome after surgical repair of limbal corneal lacerations at a tertiary eye care center in South India. Methods: A retrospective analysis of patients diagnosed with limbal tears between 2011 and 2021 was conducted. Demographic information such as age, gender, cause of injury, and size of the laceration was recorded. Comprehensive ocular examination was performed, including gentle B scan evaluation whenever not contraindicated for detailed posterior segment evaluation. Only those cases with a minimum follow up of one year were included. Postoperative best corrected visual acuity, intraocular pressure (IOP), cornea clarity, and integrity of the wound at last follow up were noted. Results: Out of the 20 patients, 15 (75%) were males and 5 (25%) were females. The mean age was 42.6 ± 22.4 years. All 20 patients had a penetrating injury, with four (20%) injured by a stick, two (10%) by an iron rod, three (15%) due to road traffic accident (RTA), three (15%) by glass, and eight (40%) with other nonspecific objects [two (10%) with needle, two (10%) with elastic rope, two (10%) with bangle, and two (10%) with metal]. The average time between the injury and the surgery was 48 hours (2 days). Four (20%) patients underwent a second surgery within a week of repair. After limbal tear repair, at final follow up at 3 years, 7 (35%) had VA worse than 20/800, 3 (15%) had VA between 20/100 and 20/800, and 10 (50%) achieved VA better than 20/80. Conclusion: Preoperative visual acuity (VA), mode of injury, and size of wound affect the final visual outcome after surgical repair of limbal corneal laceration. Preoperative VA and mode of injury were statistically significant even in the multivariate analysis. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to review the demographics, clinical characteristics, and long term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital. Methods: Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes. Results: The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6 month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three year follow up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty. Conclusion: Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome. [ABSTRACT FROM AUTHOR]

Introduction: Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision and can lead to severe complications such as panophthalmitis. The prevalence of endophthalmitis varies from one place to another. Aim: To identify the various aetiological and predisposing factors that contribute to endophthalmitis and to assess the visual outcomes following medical intervention (intravitreal antibiotics only) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy). Materials and Methods: The present study was conducted in the Department of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India between January 2023 and February 2023. Demographic and clinical data of patients diagnosed with endophthalmitis over a two year period from October 2020 to September 2022 were collected from the Medical Records Department of the Institution for analysis. A total of 50 case records were selected using convenience sampling. Demographic details such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the present study. Quantitative data was presented as Mean and Standard Deviation (SD), while qualitative data was presented as frequencies and percentages. Summary statistics were analysed using Microsoft Excel version 2018. Results: In present study, 29 (58%) were males and 21 (42%) were females, with the majority falling within the age group of 50-70 years. The mean age of the sample was 53.8±16.1 years. Postoperative causes accounted for 39 (78%) of the cases, with phacoemulsification surgery with foldable intraocular lens implantation being the leading cause in 23 (58.7%) cases. Culture positivity was observed in only 22 (44%) cases, with Staphylococcus (Staph) epidermidis as the major causative organism. The best visual acuity achieved was 6/12 for two patients. Conclusion: Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who presented with better visual acuity had a better visual outcome after treatment. Therefore, patients should be educated about the early signs of endophthalmitis to ensure prompt medical attention and improve visual recovery. [ABSTRACT FROM AUTHOR]

Background: Fungal keratitis is an important cause of ocular morbidity in developing countries. Aims and Objectives: To study fungal keratitis in detail along with its outcome. Materials and Methods: This is a retrospective study of fungal keratitis that had presented between October 2013 and March 2015. Results: 168 fungal ulcers were enrolled. 145 had fungus isolated in the culture; 23 had fungal elements seen only in potassium hydroxide mount examination. The average age of patients was 46.7 years. 55.3% were male. 75% were farmers. Patients presented at an average of 23.6 days since the onset of symptoms. In 85 cases (50.6%), trauma was the risk factor followed by steroid use (12.5%, n=21) and diabetes mellitus (7.7%, n=13). 72 out of 85 cases of trauma were due to vegetative matter. 94 (55.9%) ulcers had hypopyon. 56 (33.3%) ulcers had infiltrate size of ≥¼ of corneal surface. 12 (7.1%) ulcers were perforated at presentation. Out of 145 fungal isolates, Aspergillus species and Fusarium species were isolated in equal numbers (n=41, 28.3% each), followed by unidentified hyaline fungus (14.4%, n=21). The ulcers were treated with combination of topical natamycin 5% and fluconazole 0.3% with or without oral fluconazole. 111 (66.1%) fungal ulcers improved with medical treatment, 37 (n=22.0%) underwent therapeutic penetrating keratoplasty, 6 (3.6%) were eviscerated and outcome unknown in 14 (8.3%). Smaller-sized ulcers, ulcers without hypopyon and those presenting within 7 days had better prognosis (>80% healing with medical treatment) with statistical significance. Conclusion: Farmers were constantly at risk of fungal keratitis due to work-related trauma. Fungal ulcers presented late with large sized ulcers and with complications, thus making treatment challenging and necessitating surgical intervention. Timely treatment had better prognosis. [ABSTRACT FROM AUTHOR]

We present frequency of ocular symptoms in COVID-19 patients in Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of 333 admitted patients with laboratory-confirmed SARS-CoV-2 infection were included. Patients were enquired and examined for any ocular symptoms that developed along with COVID-19. The results were stratified by sex, age, comorbidities, High Resolution CT (HRCT) and condition of conjunctiva. Data was analyzed using SPSS 28.0.1.1. Chi square test was performed to measure the p value of the reported eye symptoms. Out of the 333, 81 subjects fulfilled the inclusion criteria. Forty-six patients (56%) were females and 52 patients out of 81 (64.2%) reported redness of conjunctiva. A positive relationship between the COVID-19 and the frequency of eye symptoms was observed with p value of 0.001. A weak positive correlation between HRCT and conjunctiva was found through bivariate analysis (0.132). [ABSTRACT FROM AUTHOR]

Background: Lack of eyecare protective measures especially in unconscious and sedated critically ill patients, make them prone to ocular surface diseases (OSDs), e.g., exposure keratopathy. This study is aimed to frame an algorithm-based approach to eyecare via eyecare bundle to bring down the burden of OSDs in critically ill patients especially in resource-limited settings. Materials and methods: After clearance from institutional ethical committee, a quasi-experimental single center study was conducted over a period of 6 months. Incidence of exposure keratopathy was calculated before and after induction of eyecare bundle and was compared. Statistical analysis was done using SPSS software v20. p-value of less than 0.05 was considered significant. Results: A total of 218 patients were enrolled in the study after obtaining informed written consent and after fulfilling inclusion criteria. Patients were divided into control and experimental groups, with baseline characteristics similar in both the groups, respectively, in terms of gender, age (40 years), APACHE II score, and specialty distribution except predominantly medical patients in experimental group. In control group (n = 99), total 69 patients (41 medical and 28 surgical) developed exposure keratopathy, while in experimental group (n = 109) only 15 patients (6 medical and 9 surgical) developed exposure keratopathy, hence a significant reduction was observed. Further follow-up of patients in the experimental group was also done on Days 5 and 7, respectively. Conclusion: The proposed protocolized algorithm-based eyecare bundle significantly reduced the incidence of exposure keratopathy in sedated, mechanically ventilated, and vulnerable critically ill patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: The World Health Organization (WHO) was notified by China on December 31, 2019, of a pneumonia outbreak severe acute respiratory syndrome-associated coronavirus-19 virus infection in Wuhan. This outbreak was declared by the WHO from the Public Health Emergency of International Concern to formal declaration as a pandemic on March 11, 2020. Because the public health measures like lockdown, the eye care delivery system was markedly impacted. The aim of this study was to find out if any pattern change of red eye cases among patients who attended eye accident and emergency (A and E) in a tertiary care hospital during COVID-19 pandemic in 2020 compared to 2019 and 2018. MATERIALS AND METHODS: This was a cohort retrospective study which included all patients who presented to eye A and E clinic with red eye from March 1 to July 31 in 2018, 2019, and 2020. Data were analyzed using statistical tools in the SPSS software. Furthermore, the clinical records of 578 inpatients with proven COVID-19 were reviewed for any red eye problem. RESULTS: Out of 7895 eye patients attended eye A and E clinic during March-July of 2018, 2019, and 2020, 1573 (19.9%) patients had red eye. Males were slightly dominant with 59%, and unilateral cases were the majority among them. The most common causes of red eye in 2018 and 2019 were injury, conjunctivitis, and keratitis; whereas in 2020, a clear dominance of injury and keratitis cases was found. Only 10 (2.03%) patients out of the 493 outpatients with red eye during the 5-month period in 2020 reported a prior contact to a COVID-19 positive case; of whom nine patients had conjunctivitis, and one had a right eye open globe injury. Of the 578 inpatients with proven COVID-19, only 1 (0.17%) patient had red eye with the diagnosis of conjunctivitis. CONCLUSION: There was relatively increased number of adults reporting with red eye in 2020. Eye injuries were the most common among all years, followed by conjunctivitis and keratitis. Ocular problems, however, might be a primary or secondary COVID-19 complaint and seem to be relatively uncommon in COVID-19 individuals. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on compliance to amblyopia therapy from the perspective of parents of amblyopic children. Methods: The participants for the qualitative study were enrolled from the medical records of a tertiary eye care center during the COVID-19 pandemic. The trained researcher conducted telephonic interviews consisting of validated 15 open-ended questions for 15 min. The questions were related to patients' compliance toward amblyopia treatment and the date of follow-up with their practitioners. The data collected were entered on Excel sheets in the participant's own words and later converted to a transcript for analysis. Results: A total of 217 parents of children with amblyopia who were due for follow-up were contacted through telephone. The response rate for willingness to participate was only 36% (n = 78). Of these, 76% (n = 59) of parents reported that their child was compliant toward the treatment during the therapy period and 69% reported that their child was currently not on treatment for amblyopia. Conclusion: In the current study, we have observed that although reported compliance by parents during the therapy period was good, around 69% of patients had discontinued amblyopia therapy. The main reason for the discontinuation of therapy was the failure to visit the hospital during the scheduled follow-up with the eye care practitioner. [ABSTRACT FROM AUTHOR]

Purpose: To report the clinical profile of Behcet's disease and its management with immunosuppressants and biologics in a cohort of 25 patients from a tertiary eye care center in South India. Methods: This was a retrospective, observational study. Records of 45 eyes of 25 patients between January 2016 and December 2021 were retrieved from the hospital database. Complete ophthalmic evaluation and systemic examination by the rheumatologist with appropriate investigations had been done. Results were analyzed using Statistical Package for the Social Sciences (SPSS) software. Results: Males (19, 76%) were found to be more affected than females (6, 24%). Mean age of presentation was 27.68 ± 11.08 years. Twenty patients had bilateral involvement (80%), and unilateral involvement was seen in five patients (20%). Seven eyes of four patients (16%) had isolated anterior uveitis, out of which one patient had unilateral and three patients had bilateral involvement. Twenty-six eyes of 16 patients (64%) had posterior uveitis, out of which six patients had unilateral and 10 had bilateral involvement. Twelve eyes of seven patients (28%) had panuveitis, out of which two patients had unilateral and five had bilateral involvement. Hypopyon was seen in five eyes (11.1%) and posterior synechiae in seven eyes (15.55%). Posterior segment findings included vitritis (24.44%), vasculitis (17.78%), retinitis (17.78%), disc hyperemia (11.11%), and disc pallor (8.89%). Steroids alone were given in five patients (20%) and intravenous methylprednisolone (IVMP) was given in four patients (16%). Immunosuppressive agents along with steroids were given in 20 patients (80%), of which azathioprine alone was given in seven patients (28%), cyclosporin alone was given in two patients (8%), mycophenolate mofetil alone was given in three patients (12%), combination of azathioprine and cyclosporin was given in six patients (24%), and combination of methotrexate and mycophenolate mofetil was given in one patient (4%). Biologics were given in 10 patients (40%) -- adalimumab in seven patients (28%) and infliximab in three patients (12%). Conclusion: Behcet's disease is an uncommon uveitis in India. Addition of immunosuppressants and biologics to conventional steroid therapy gives better visual outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Coping strategy is the mechanism by which patients adjust to the condition they face. It can be adaptive or maladaptive. A maladaptive coping strategy is a harmful and ineffective way of dealing with stress or anxiety. It is common among patients with chronic illnesses. Despite Ethiopia having a greater glaucoma prevalence, there was no evidence of patients with glaucoma using maladaptive coping mechanisms. Objective: The main goal of this study was to evaluate the magnitude of maladaptive coping strategy use and the factors that associate with it among adult glaucoma patients enrolled in the Tertiary Eye Care and Training Center at the University of Gondar in Northwest Ethiopia in 2022. Methods and Materials: At the University of Gondar, Tertiary Eye Care and Training Center, a facility-based cross-sectional study was carried out on a sample of 423 glaucoma patients chosen by a systematic random sampling technique from May 15 to June 30, 2022. Optometrists conducted an interview with the study subject and reviewed the medical record, and administered a pretested, structured questionnaire of the brief cope inventory assessment. In the multivariable logistic regression, binary logistic regression was performed to identify the related factors, and significance was taken into account when the p-value was less than 0.05 at the 95% confidence interval. Results: The study found that among study participants 50.1% (95% CI: 45.1– 54.5%) had a maladaptive coping strategy. Female sex (AOR=2.031, 95% CI:1.185– 3.480), chronic medical illness (AOR=1.760, 95% CI:1.036– 2.989), bilateral glaucoma (AOR=2.321, 95% CI: 1.328– 4.055), receiving both drug and surgery treatment (AOR=1.895, 95% CI: 1.002– 3.585), severe visual impairment (AOR=2.758, 95% CI:1.110– 6.852), absolute glaucoma (AOR=2.543, 95% CI:1.048– 6.169), duration of diagnosis > 12 months (AOR=3.886, 95% CI: 2.295– 6.580) were significantly associated with a maladaptive coping strategy. Conclusion and Recommendation: Half of the participants had a maladaptive coping strategy. It is better to set and plan strategies that enable the integration of coping strategy care into the current treatment of patients with glaucoma to encourage positive coping strategies instead of maladaptive ones. [ABSTRACT FROM AUTHOR]

Purpose: The study intends to evaluate the demographic and clinical profile of pediatric patients (0–18 years) attending six vision centers (VCs) of a tertiary eye care facility in south India. Methods: This is a cross-sectional observation study conducted at six major peripheral VCs of a tertiary eye care facility in South India from June 20 to Dec 20. All children presenting at the VCs under a base hospital (BH) in Pondicherry, whose parents gave consent were included. Data were entered by the ophthalmic assistants in the VC and cross checked by the principal investigator at the BH. Results: A total of 250 pediatric patients were brought to the VCs during the study period, predominantly males (60.8%), with a mean age of 8.2 ± 4.5 years (0–18 years). Half of them were staying within 5 km from the VCs. Most children were escorted by their parents (88%), and the expenditure of travel to the VC was affordable for most of the parents (75%). Also, 53.6% of patients were in their primary school, while schooling had not started for 28% of children. Visual acuity (VA) could be assessed only for school-going children and older children due to lack of age-matched VA assessment tools. Most children (91.3%) had uncorrected VA better than or equal to 6/18 in the better eye, and approximately 3% had VA worse than 6/60. All patients had best corrected VA of 6/6–6/18 after cycloplegic refraction. Most children reported to the VC for allergic conjunctivitis (25%), followed by refractive error (13%) and squint (10.4%). Urgent referral to the BH was made for 47 children. Conclusion: Primary eye care in pediatric population-I (PREPP-I) showed that most children can be treated at the VCs and only one-fifth of the children require active intervention at higher referral centers. Further study on satisfaction of services provided for pediatric patients in these VCs and barriers of not reporting to the BH when referred are considered for the PREPP-II study. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to determine the demographic profile and clinical characteristics in patients with Fuchs' endothelial corneal dystrophy (FECD) reporting to a tertiary eye care center in India. It is a retrospective, single-center, observational study. Methods: The study included 280 patients (559 eyes) diagnosed with FECD presenting between January 2013 and December 2020. The data was collected from the electronic medical record system of the institute. Patient data included demographic features, clinical characteristics, investigations, and surgical interventions. Results: The mean age of the patients was 62 years. Late-onset FECD (95.7%) was more common than early-onset FECD (4.3%). Male: female ratio for late-onset FECD and early-onset FECD was 1:1.65 and 3:1, respectively. More than one-third of the patients had associated systemic history. Preexisting ocular diseases were seen in 5.9% of eyes. Blurring of vision was seen in 383 eyes (68.5%), 13 eyes (2.1%) had glare, and 163 eyes (29.2%) were asymptomatic. A total of 113 surgical interventions were done in 108 eyes (including repeat transplants). Only cataract surgery was done in 40 (7.2%) eyes, whereas penetrating keratoplasty, Descemet stripping endothelial keratoplasty, and Descemet membrane endothelial keratoplasty without or with cataract surgery (sequential or triple procedure) were done in 12 (2.1%), 47 (8.4%), and 14 (2.5%) eyes, respectively. Conclusion: Patients with FECD present mostly during the sixth decade. Posterior lamellar keratoplasty is the most common transplant procedure being performed on FECD patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the level of awareness and knowledge about glaucoma surgery and post-surgery counseling amongst paramedical staff at a tertiary eye-care hospital. Methods: This observational cross-sectional study included a random sample of 94 hospital personnel: 37 general nurse midwives, 47 ophthalmic assistants, and 10 patient caretakers (PCTs). Participants were administered a questionnaire about glaucoma surgery and post-surgery counseling of patients. Results: The study included 41 (43.6%) females and 53 (56.4%) males. The mean age of the participants was 24.85 ± 4.54 years. All participants were aware of trabeculectomy surgery in glaucoma (100%). A total of 95.7% knew that surgery helps in controlling IOP, of whom 57 (60.6%) participants got information during their course of learning. Overall 53 (56.4%) believed that surgery is done when medication failure occurs, and 58 (61.7%) knew that surgery helps in preserving vision. A total of 63 (67.0%) participants knew to counsel patients to visit an ophthalmologist when called for and take the treatment as advised, whereas 74 (78.7%) correctly said to visit an ophthalmologist immediately if pain/diminution of vision/discharge occurs. Overall, PCTs were found to be having significantly better knowledge (P = 0.01) compared to others and they also reported ophthalmologists as the chief source of information. Conclusion: This study revealed that paramedical staff had an excellent awareness of trabeculectomy surgery. However, the knowledge and counseling parts of the questionnaire revealed less than satisfactory responses. So, there is a need to continuously educate paramedical staff members so that they can help in propagating information about the role of glaucoma surgery and the importance of proper follow-up. [ABSTRACT FROM AUTHOR]

Purpose: While there are a few studies that show the prevalence of blindness and ocular morbidity in children, studies on socioeconomic factors in childhood cataracts are scarce. We aimed to study the socioeconomic status, education and occupation of the parents, consanguinity, and gender inequality among children presenting with cataracts. Methods: This was a hospital-based, prospective, descriptive study of 68 children with cataracts (aged 0–18 years). In addition to the data on clinical parameters and surgical management, we also collected data on age, gender, age at which the chief complaint was noticed, consanguinity of parents, socioeconomic class, and occupation and education of parents. All statistical analyses were performed using MedCalc statistical software (MedCalc Software 2019, Ostend, Belgium). Results: Sixty-eight children with pediatric cataract, out of which 36 were bilateral, were studied. Thirty children (44%) were in the age group of 1–5 years. Out of the 36 bilateral cataracts, 25 (69.44%) were males and 11 (30.56%) were females. Thirty (44.1%) had a delayed presentation. Also, 31% belonged to middle class and 28% belonged to lower middle class. Moreover, 65% of the mothers had an undergraduate education. Conclusion: There is a gender-based inequality and late presentation of childhood cataracts. To improve early detection, red reflex screening should be mandatorily done. Further studies are required to identify barriers to access of eye care specific to girls, in order to plan interventions to improve uptake of treatment. The lower socioeconomic status of the patients should be taken into account in the management of this disease. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor commenting on a study titled "Peripapillary nerve fiber layer in patients with iron-deficiency anemia: A cross-sectional study in a tertiary eye care center in Central India." The letter raises several queries and concerns about the study's methodology and sample size. It suggests that the study should have excluded confounding factors such as hypertension, diabetes, and cigarette smoking, and should have collected information about the duration of anemia and history of blood transfusion. The letter also notes that the study's retrospective nature limits its findings. Overall, the letter provides constructive criticism and highlights areas for improvement in the original study. [Extracted from the article]

The article titled "Peripapillary nerve fiber layer in patients with iron-deficiency anemia: A cross-sectional study at a tertiary eye care center in Central India" discusses a study conducted on patients with iron-deficiency anemia (IDA) and its potential correlation with the thickness of the retinal nerve fiber layer (RNFL). The study, categorized as a hospital-based cross-sectional study, included 58 anemia patients, and the findings suggest a potential correlation between IDA and RNFL thickness. The authors acknowledge the limitations of the study, such as the challenge of determining the exact duration of anemia, and express their appreciation for feedback and suggestions for future research, including exploring diverse populations and considering additional factors like nutritional status and comorbidities. [Extracted from the article]

Purpose: To describe the clinical features and management of patients with scleritis associated with granulomatosis with polyangiitis (GPA) at a tertiary eye care center in South India. Methods: The clinical profile and management of patients presenting to a tertiary eye care center in South India with scleritis secondary to GPA from 2003 to 2021 were analyzed retrospectively. Scleritis was classified into anterior diffuse, nodular, and necrotizing scleritis with inflammation according to Watson and Hayreh's classification. Demographic characteristics, clinical features, anti-neutrophil cytoplasmic antibody (ANCA) positivity, treatment response, ocular complications, and status at the last follow-up were analyzed. Statistical analysis of data was performed using Microsoft Excel 2019. Results: Nineteen eyes of 17 patients (15 cytoplasmic staining ANCA [c-ANCA], two p-ANCA positive) were included. Fifteen eyes had necrotizing scleritis, two had diffuse anterior scleritis, and two had nodular scleritis. Remission was induced using a combination of steroids and cyclophosphamide or rituximab. Maintenance therapy was instituted using tapering steroids and immunosuppressants like cyclophosphamide, mycophenolate mofetil, methotrexate, or rituximab. Three eyes required a scleral patch graft. Fourteen patients had good anatomical and visual outcomes, and three were lost to follow-up. Conclusion: GPA is a rare disease, while it is the most common ANCA-associated vasculitis with scleritis. As scleritis may be the presenting sign of the disease, ophthalmologists must be aware of the various features suggestive of GPA. GPA-associated scleritis can have a good prognosis when diagnosed promptly and managed aggressively in the acute stage, and remission is maintained with adequate systemic immunosuppression. [ABSTRACT FROM AUTHOR]

Purpose: The epidemiological, clinical, and microbiological profiles of patients with infectious endophthalmitis comparing the traumatic and non-traumatic etiologies presented to a Tertiary Eye Care Center in the rural tribal areas of Gujarat. Methods: A retrospective review of the electronic medical records of 114 patients between January 2008 and December 2019 was carried out. All patients were diagnosed with clinical endophthalmitis, treated with Endophthalmitis Vitrectomy Study first intravitreal injection, and then undergone pars plana vitrectomy with intraocular antibiotics. Results: 61/114(53.5%) patients had non-traumatic postoperative (PO) and 53/114 (46.3%) had posttraumatic (PT) endophthalmitis. Males were predominant in all types of endophthalmitis. Significantly younger individuals constituted the PT group. Best-corrected visual acuity (BCVA) at presentation was <1/60 in the majority (94.2%) of patients, while the treatment outcome was variable in the etiology with respect to BCVA that improved to 6/60 in 27 (23.68%) eyes and >6/24 in 17 (15.7%) eyes. In addition, 23 (20.2%) did not have any perception of light, and no significant change was detected in the visual outcome (p=0.278) according to etiologies. Conclusion: Infectious endophthalmitis is a rare but serious sight-threatening complication. Aggressive and prompt treatment causes significant improvement in vision. Etiology does not have a significant impact on the outcome of EVS in PT cases. [ABSTRACT FROM AUTHOR]

Purpose: To access knowledge, attitude, and practices of Eye care practitioners (ECPs) towards COVID-19 guidelines and to determine their knowledge about use of Personal Protective Equipment (PPE). Methods: A cross-sectional study was conducted in Tertiary Eye Hospitals of Rawalpindi and Islamabad from October 2020 to March 2021. A total of 270 Eye care practitioners currently working in public and private hospitals were included in this study. Non-probability convenient sampling technique was used. Data was collected from individuals through an interview-based questionnaire after taking consent. Data was coded and analyzed by using SPSS version 26. The Chi-square test was used for further analysis. Results: Mean age of participants was 29.85 ± 7.482 years, ranging from 18 to 65 years. Females (67%) were slightly out-numbered than males of the total sample. Moreover, 50% of the respondents had adequate knowledge about COVID-19 while only 39.3% had a positive attitude towards COVID-19. Hours of practice and years of experience had an association with knowledge. Good practices were observed by only 43.3% of the total sample. Practices had an association with the department of work of ECPs. Conclusion: There is scarcity of knowledge among ECPs about COVID-19 and its preventive measures. Less than 50% ECPs with positive attitude and good practices towards COVID-19 indicate a dire need to train them for use of PPEs. [ABSTRACT FROM AUTHOR]

Context: Considerable evidence of gender, ethnicity, thyroid dysfunction, and environmental factors including smoking influencing the development and progression of thyroid eye disease (TED). Settings and Design: Cross-sectional study of the clinical characteristics of 136 patients with TED who presented to the Orbit and Oculoplasty services at a tertiary eye care center in south India between October 2018 and June 2020. Results: Among the 136 patients (M: 61, F: 75), the mean age was 47.04 (SD ± 13.24) years. Hyperthyroid disease was present in 53%, hypothyroid disease in 40%, and 7.3% were euthyroid. Active disease was noted in 25% and inactive disease in 75% of patients. Active disease was present in 25% of hyperthyroid, 18.5% of hypothyroid, and 15% of euthyroid patients. Active TED showed statistically significant association toward development of greater severity of proptosis (P = 0.001), optic neuropathy (P = 0.004), and extraocular movement restriction (P < 0.001) as compared to inactive disease. Mild, moderate to severe, and sight-threatening TED was noted in 34.6%, 59.6%, and 6% of patients, respectively. Nine eyes had dysthyroid optic neuropathy, of which eight had either mild or no proptosis while one had moderate to severe proptosis. Conclusion: Prevalence of active as well as severe thyroid eye disease is common in our population. Recommendation for ophthalmological examination of patients even with milder disease especially when associated with decreased vision and signs of inflammation. Active disease is less common in euthyroid patients, thus necessitating maintaining the euthyroid status toward reducing disease activity and progression. [ABSTRACT FROM AUTHOR]

This study described the clinical presentations and proposed a diagnostic algorithm of fungal orbital infections based on 20 years of experience in a tertiary eye care center in Egypt. Medical Records of cases with orbital fungal infection from January 2000 to December 2019 were reviewed. The study included 45 patients. Mucormycosis was proven in 32 (71.1%) and aspergillosis in 13 (28.9%) patients. Thirty-five (77.8%) patients had predisposing factors mainly uncontrolled diabetes. Twenty-seven (60%) patients presented with orbital apex syndrome, 10 (22.2%) with orbital cellulitis and 8 (17.7%) with proptosis. The prognosis was generally poor (31.1% mortality, 8.88% exenteration and 11.1% self-evisceration). The proposed algorithm composed of six atypical clinical presentations mainly acute orbital apex and fulminating orbital cellulitis plus any radiological or microbiological findings. The proposed algorithm markedly reduced the complications after 5 years of the study. Once fungal orbital infection is suspected, treatment should start immediately. [ABSTRACT FROM AUTHOR]

Purpose: To compare the clinical outcomes of femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification (CP) in terms of refractive outcomes, cumulative dissipated energy, and intraoperative complications.Methods: In this retrospective study performed in a tertiary care ophthalmic hospital, we reviewed 2124 eyes that underwent FLACS or CP. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), cumulative dissipated energy (CDE), and intraoperative complications were analyzed in the study.Results: Out of 2124 eyes, 873 underwent FLACS and 1251 underwent CP. The postoperative mean UCVA after one month was 0.05 ± 0.11 logMAR and 0.14 ± 0.23 logMAR for FLACS and CP, respectively (P < 0.00001). Mean CDVA one month post operation was 0.02 ± 0.07 logMAR and 0.06 ± 0.19 logMAR for FLACS and CP, respectively (P < 0.0001). The CDE for the FLACS group was 6.17 ± 3.86 (P < 0.00001) and it was 9.74 ± 6.02 for the CP group. The intraoperative complication for the FLACS group was 1.60% and the CP group was 2.39% (P < 0.00001).Conclusion: The visual outcomes were better in FLACS compared to CP. The CDE was lower for the FLACS group and FLACS had significantly less intraoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: To study the clinical and demographic profile of patients less than 40 years of age presenting to glaucoma services including the reasons for referral.Methods: Patients in the age group of 5 to 39 years, visiting the glaucoma clinic, who were either suspected to have glaucoma or who had been newly/previously diagnosed with glaucoma were included in the study. After informed written consent, basic demographic details of the participants including age, gender, education, socioeconomic status, and family history were obtained. A comprehensive ophthalmological evaluation was performed by glaucoma specialists.Results: The proportion of glaucoma in the study population (n = 384) was found to be 31.25%, and the incidence of glaucoma among new patients was found to be 11.9%. Among all glaucomas (n = 120), 44.2% of patients had secondary glaucomas, 27.5% had primary glaucomas, and 28.3% had congenital glaucomas. Also, 67.3% of all glaucoma patients were males. Newly diagnosed glaucoma patients presented with a mean intraocular pressure (IOP) of 32.9 mmHg and mild-moderate disc damage with a mean cup-disc ratio of 0.65. Nearly one-third of them had a presenting visual acuity worse than 5/60. The most common reason for referral was raised IOP. Univariate and multivariate analysis revealed that the odds of developing glaucoma were less in females (P = 0.04) and in patients with a higher standard of living index (P < 0.001).Conclusion: One-third of the patients had glaucoma and another one-third were suspects. Secondary glaucomas are more common than primary/congenital glaucomas. A comprehensive eye evaluation is a must, especially in those with predisposing factors. [ABSTRACT FROM AUTHOR]

To study the clinical, microbiological profile and management outcomes of orbital abscess at a tertiary care center in South India. In a retrospective interventional case series, we reviewed all patients diagnosed with orbital cellulitis from 2000–2020. The data analyzed included demographic profile, clinical and radiological features, microbiological profile, and management outcome. A total of 921 cases of orbital and periorbital infections were reviewed. Seventy-two cases were diagnosed as orbital cellulitis. Thirty-four cases (47.22%) had radiological evidence of orbital abscess. The median age was 20.63 years. Three patients (8.82%) were neonates. A male preponderance was noted (23, 67.65%). Sinusitis (10, 29.41%) and diabetes (5, 14.7%), were the most common predisposing factors. Optic neuropathy was seen in 15 (44.11%) patients, cavernous sinus thrombosis in two patients (5.88%), and septicemia in one patient (2.94%) Multiple orbital abscesses were noted in 7 (20.59%) cases. All patients underwent surgical drainage. Methicillin-sensitive Staphylococcus aureus was the most common organism isolated in 14 patients (41.18%). Vision improvement or stabilization was seen in all except 3 (8.82%) Orbital abscess is a potential sight-threatening orbital infection. The infective process can spread and ascend up to involve cavernous sinus thereby becoming life-threatening. A timely diagnosis and intervention can halt the disease process and help restore vision in many cases. [ABSTRACT FROM AUTHOR]

To describe the socioeconomic profile, awareness level and reasons for the delay in accessing timely eye care for cataract surgery in patients of lens-induced glaucoma (LIG). This cross-sectional observational study included all patients with LIG who presented to a tertiary eye care centre in central rural India between March 2019 to February 2020. Data were collected through a questionnaire. Out of the 731 patients included in the study, the majority were females (69.36%). The mean age of the patients at presentation was 62.66 ± 10.37 years. Only a few participants, 193 (26.40%) were aware of LIG. Lower socioeconomic profile, older age, female gender and illiteracy were found to be strongly associated with awareness about LIG (p <.001). Patients waiting for the winter season (58.27%) to get operated was the major reason for delayed presentation to the hospital. Other reasons for the delayed presentation were – need not felt (feeling that intervention was not necessary) due to good vision in other eye (14.36%), financial issues (11.63%), long travelling distance (7.11%), no caretaker (6.89%), medical illness (1.78%) and fear of surgery (0.55%). Delayed reporting for eye healthcare in patients of LIG is found to be multifactorial. Most patients preferred waiting for the winter season to get their eyes operated, which throws light on the mindset and ignorance of the patients in this part of central rural India. We further emphasize on strengthening the education and counseling efforts in the community to enable patients to access services in a timely fashion. [ABSTRACT FROM AUTHOR]

Introduction: Visual impairment has a profound impact on loss of economy and productivity, which can impair health-related quality of life. Objective: The purpose of this study was to determine productivity loss and its predictive factors among adults with visual impairment in Addis Ababa tertiary eye care centers, Ethiopia. Methods: An institution-based cross-sectional study was conducted between February and July 30, 2021. A total of 425 samples were retrieved using systematic random sampling. Data collection included socio-demographic information, employment status, job absenteeism, presenteeism and reduced work participation. Analysis was done by SPSS version 23, and binary logistic regression was employed for statistical analysis. P-values less than 0.05 were used to state significant associations between dependent and outcome variables. Results: A total of 416 study participants were involved in the study, with a response rate of 97.88%. The mean age was 48 ± 14.3 years. The total productivity loss was $775,325.51, with a median of $358.02. Maximum productivity loss was contributed by reduced workforce participation, which was about $746,337.45, with a median of $1,432.10. Regarding predictor factors, gender, monthly income, degree and duration of visual impairment and support of family to get job were statistically associated with high productivity loss. Conclusion: In general, the current study revealed that there is a profound annual loss of productivity due to visual impairment. The predictor factors for higher productivity loss were gender, monthly income, degree of visual impairment, duration of visual impairment and presence of support from family to get job or achieve better performance on job activities. Rehabilitation for visually impaired adults is recommended to enhance their quality of life by increasing their workplace participation to the maximum potential. [ABSTRACT FROM AUTHOR]

Objective: To describe the demographics and outcomes of sports‐related ocular injuries in an Australian tertiary eye hospital setting. Methods: Retrospective descriptive study from the Royal Victorian Eye and Ear Hospital from 2015 to 2020. Patient demographics, diagnosis and injury causation were recorded from baseline and follow‐up. Outcomes included visual acuity (VA), intraocular pressure (IOP), ocular injury diagnosis, investigations and management performed. Results: A total of 1793 individuals (mean age 28.67 ± 15.65 years; 80.42% males and 19.58% females) presented with sports‐related ocular trauma. The top three injury‐causing sports were soccer (n = 327, 18.24%), Australian rules football (AFL) (n = 306, 17.07%) and basketball (n = 215, 11.99%). The top injury mechanisms were projectile (n = 976, 54.43%) and incidental body contact (n = 506, 28.22%). The most frequent diagnosis was traumatic hyphaema (n = 725). Best documented VA was ≥6/12 at baseline in 84.8% and at follow‐up in 95.0% of cases. The greatest risk of globe rupture/penetration was associated with martial arts (odds ratio [OR] 16.22); orbital blow‐out fracture with skiing (OR 14.42); and hyphaema with squash (OR 4.18): P < 0.05 for all. Topical steroids were the most common treatment (n = 693, 38.7%). Computed tomography orbits/facial bones were the most common investigation (n = 184, 10.3%). The mean IOP was 16.1 mmHg; 103 (5.7%) cases required topical anti‐ocular hypertensives. Twenty‐six individuals (1.45%) required surgery with AFL contributing the most surgical cases (n = 5, 19.23%). Conclusion: The top three ocular injury causing sports were soccer, AFL and basketball. The most frequent injury was traumatic hyphaema. Projectiles posed the greatest risk. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the clinical presentations of uveitis at the University of Gondar Tertiary Eye Care and Training Center, North-West Ethiopia. A cross sectional study was performed at the center from August 2017 to July 2018. Study patients underwent complete ophthalmic evaluation and relevant ancillary tests. Data was gathered using a data extraction format and analyzed. A total of 105 eyes of 82 patients were studied. The mean age was 33.8 ± 14.8 years,53 (65%) were male and uveitis was unilateral in 72%. Anterior uveitis was the commonest, 57%, followed by Intermediate uveitis 21.7%. Sixty-six of the 105 (63%) of eyes were blind. Cataract was the commonest complication identified. This study showed that uveitis is prevalent in the working age group with a significant number of blindness. Anterior uveitis was the commonest type of Uveitis and cataract was the commonest complication. [ABSTRACT FROM AUTHOR]

To report the pattern of noninfectious scleritis across a tertiary eye-care network. A three-year retrospective review of patients diagnosed with noninfectious scleritis was performed. Data were retrieved using diagnostic terms assigned to scleritis through the in-house eyeSmart-electronic medical record system. 1103 patients, with a mean age of 44.33 ± 14.38 years and a median follow-up of 199.5 days (range 32–685) were enrolled. Unilateral disease was noted in 85%. Diffuse anterior scleritis (n = 542, 42.51%) and nodular scleritis (n = 482, 38.12%) were the commonest subtypes. Systemic immune disease association was present in 65 (5.89%). Treatment at onset was topical corticosteroids (n = 372, 36.54%) followed by oral non-steroidal anti-inflammatory drugs (n = 351, 34.45%), oral corticosteroids in 184 (19.04%), and immunomodulators in 32 patients (3.54%). This study depicts the pattern of various noninfectious scleritis in a large cohort of patients. The present study helped to further customize the electronic medical records to minimize several data capture limitations. [ABSTRACT FROM AUTHOR]

Congenital inferior rectus hypoplasia and aplasia is a rare abnormality of the extraocular muscles, and it is the second most common after superior oblique muscle aplasia. It has been reported either in isolation or with coexisting ocular or systemic associations. We describe here cases of inferior rectus hypoplasia/aplasia, their clinical features, and surgical approach to achieve satisfactory outcomes. We retrospectively reviewed medical records from January 2009 to December 2020 of patients with vertical strabismus due to inferior rectus hypoplasia/aplasia at a tertiary eye care center. Those who underwent surgical intervention with an adequate follow up postoperatively were included in the study. Three patients who presented with congenital hypertropia and diagnosed of inferior rectus aplasia/hypoplasia and who underwent strabismus surgery were identified. Diagnosis was based on clinical examination and orbital imaging. Coexisting horizontal deviation was present in two patients. None of the patients had any other ocular, cranial, or systemic anomalies. All patients had isolated inferior aplasia/hypoplasia with normal other extraocular muscles on orbital imaging. Intraoperatively, ipsilateral superior rectus was tight in all patients. All underwent ipsilateral superior rectus recession, whereas two patients with large vertical strabismus required additional inferior oblique anteronasal transposition in the same eye. Satisfactory outcomes were achieved in all three patients without the need for resurgery. Moderate to large vertical A pattern strabismus and limitation of infraduction are common clinical findings. Orbital imaging helps not only in diagnosis but also in surgical planning. Weakening of antagonist superior rectus with anteronasal transposition of inferior oblique not only gives good surgical outcomes but also avoids potential complications related to vertical transposition of either horizontal rectus muscle. [ABSTRACT FROM AUTHOR]

Purpose: To identify and describe the clinical profile at presentation in patients diagnosed as having Leber's hereditary optic neuropathy with primary and secondary mutations and correlate with treatment. Methods: A review of electronic medical records from January 2016 to December 2020 for proven cases of Leber's hereditary optic neuropathy was conducted. A total of 157 patients with clinically suspected Leber's hereditary optic neuropathy (143 males and 14 females) underwent genetic testing and 55 were found to have a mutation for Leber's hereditary optic neuropathy. Data of 55 consecutive patients were retrieved and analyzed for their clinical profile, investigations, mutations identified, treatment, and outcome. Results: All 55 patients were male, and the mean age was 23.80 ± 9.90 years (range: 9 to 53 years). The median duration of symptoms before the first physician examination was 6 months. The mean duration between the first hospital visit and genetically proven diagnosis of Leber's hereditary optic neuropathy was 9.03 ± 19.61 months (median: 2 months). More than half of the patients (n = 32; 58.2%) presented with severe to profound vision impairment in the better eye and 72.7% (n = 40) in the worse eye. Bilateral temporal disc pallor was more frequent in 38.2% (n = 21) and 36.4% (n = 20) had bilateral optic atrophy. Primary single mutations were detected in 61.81% (n = 34) and secondary mutations were detected in 38.2% (n = 21). The most common mutation was G11778A. One novel secondary mutation (A13615C) was identified in the cohort. Idebenone was used for treatment in 15 patients, and half of them (n = 8) showed an improvement in vision at 2 to 7 months of follow-up. Conclusions: The current cohort is the largest study to date in an Indian population that has analyzed the clinical presentations and mutations of Leber's hereditary optic neuropathy. G11778A was the most common primary mutation and several secondary mutations were identified. A delay in referral, inadequate compliance, and cost of care contributed to the outcomes. [J Pediatr Ophthalmol Strabismus. 2022;59(5):344–349.] [ABSTRACT FROM AUTHOR]

This article discusses the patterns of ophthalmic emergencies in a tertiary eye care hospital in India. The study found that the differences in ophthalmic emergencies between industrialized and developing countries can be attributed to factors such as financial coverage, economic status, educational level, child labor laws, and protective eyewear. The retrospective analysis of data from 405 patients revealed that the majority of patients presented with eye pain, redness, irritation, or defective vision. Trauma was the most common cause of emergencies, followed by infection and inflammation. Open globe injury was more common during late-night hours. The study emphasizes the need for expanded emergency eye care centers and improved access to well-trained eye care professionals, especially in developing countries. [Extracted from the article]

The free-living amebae of genus Acanthamoeba are an important cause of microbial keratitis. The clinical appearance of Acanthamoeba keratitis (AK) usually mimics viral or fungal keratitis. Thus, microbiological workup plays a significant role in the diagnosis and timely treatment of such cases. We report a retrospective case series of seven culture-confirmed AK cases from a tertiary eye care center in North India. Various risk factors and triggers of infection, clinical presentations, microbiological findings, and management of AK are elucidated. [ABSTRACT FROM AUTHOR]

Purpose: To construct a simple management algorithm for cases with orbital mucormycosis during the COVID-19 era. Methods: Retrospective study included records of 30 Egyptian patients with post COVID-19 orbital mucormycosis. They underwent full clinical examination, laboratory investigations, Computed tomography (CT)/magnetic resonance imaging (MRI) of the paranasal sinuses and pathological specimen examination. The proposed algorithm was based on all the available data of the included patients. Results: The mean age of the studied patients was 62.47± 11.13 years; 56.6% were females and 63.3% had uncontrolled diabetes mellitus. The main presentation was Orbital apex syndrome (OAS) in 43.3% of the cases. Twenty-six patients (86.6%) received systemic liposomal amphotericin B, while 4 patients (13.3%) received posaconazole. Orbital exenteration was done in 6 patients (20.0%), 4 of them died (66.7%). Twenty-four patients (80%) survived with clinical but not with visual improvement. Conclusion: Systemic antifungal treatment and functional endoscopic sinus surgery (FESS) with extensive debridement of involved necrotic tissues were the main steps to control ROCM. Orbital exenteration should be kept for cases with periorbital tissue affection as it did not increase the final cure rate. The proposed management algorithm is supposed to be simple and easy to follow. [ABSTRACT FROM AUTHOR]

Objective: To determine patient satisfaction with successful external dacryocystorhinostomy for one eye and patients' preference time for second eye dacryocystorhinostomy after the first surgery. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Ophthalmology, HBS General Hospital, Islamabad Pakistan, from Jan 2018 to Dec 2020. Methodology: A sample of 37 patients was calculated. All selected patients underwent bilateral external dacryocystorhinostomy and were followed for six months. Patient satisfaction was measured using a treatment satisfaction scale. Results: A total of 37 patients were included in the study. The mean age of patients was 33.5 ± 3.1 years. Satisfaction with 1st eye external DCR was extremely satisfied in 14 (37.8%), satisfied in 14 (37.8%), neutral in 2 (5.4%), dissatisfied in 6 (16.2%) and extremely dissatisfied 1 (2.6%). 31 (83.8%) prefer second eye surgery in =1 year after first eye DCR, while 6 (16.2%) prefer second eye surgery after more than one year of first eye DCR surgery. The majority of females prefer =1 year duration for second eye DCR surgery as compared to males 25 (67.7%) vs 6 (16.2%), (p=0.03). Anatomical success and functional success were insignificantly associated with satisfaction of first eye DCR surgery of patients (p=0.793 and p=0.482) Conclusions: High satisfaction with first eye dacryocystorhinostomy and greater preference for second eye dacryocystorhinostomy was found in patients coming to tertiary care hospital in Pakistan. [ABSTRACT FROM AUTHOR]