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Background: Morbidity and mortality due to oral cancer in India are exacerbated by a lack of access to effective treatments amongst medically underserved populations. We developed a user-friendly low-cost, portable fibre-coupled LED system for photodynamic therapy (PDT) of early oral lesions, using a smartphone fluorescence imaging device for treatment guidance, and 3D printed fibreoptic attachments for ergonomic intraoral light delivery., Methods: 30 patients with T 1 N 0 M 0 buccal mucosal cancer were recruited from the JN Medical College clinics, Aligarh, and rural screening camps. Tumour limits were defined by external ultrasound (US), white light photos and increased tumour fluorescence after oral administration of the photosensitising agent ALA (60 mg/kg, divided doses), monitored by a smartphone fluorescence imaging device. 100 J/cm 2 LED light (635 nm peak) was delivered followed by repeat fluorescence to assess photobleaching. US and biopsy were repeated after 7-17 days. This trial is registered with ClinicalTrials.gov, NCT03638622, and the study has been completed., Findings: There were no significant complications or discomfort. No sedation was required. No residual disease was detected in 22 out of 30 patients who completed the study (26 of 34 lesions, 76% complete tumour response, 50 weeks median follow-up) with up to 7.2 mm depth of necrosis. Treatment failures were attributed to large tumour size and/or inadequate light delivery (documented by limited photobleaching). Moderately differentiated lesions were more responsive than well-differentiated cancers., Interpretation: This simple and low-cost adaptation of fluorescenceguided PDT is effective for treatment of early-stage malignant oral lesions and may have implications in global health., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: To evaluate the efficacy of CXL in treating fungal keratitis as an adjuvant therapy., Methods: Detailed clinical examination microbiological investigation was performed. Twenty fungal keratitis patients were recruited and randomized into two groups: group 1 (n= 11, standard antifungal), group 2 (n=9, corneal collagen crosslinking with standard antifungal). Corneal scraping and tear samples collected were subjected to real-time PCR targeting ITS, TLR analysis and cytokine analysis., Results: The mean time for complete resolution of ulcer for group 2 was significantly shorter compared to group 1 and the final mean BCVA was better for group 2. Expression of IL-1β, IL-8, IFN-γ significantly decreased immediately post CXL in group 2 patients. Significant downregulation of TLR 6, TLR-3, TLR-4 was observed 3-days post CXL compared to group 1 patients., Conclusion: Adjuvant effect of CXL was significant in treating fungal keratitis compared to standalone antifungal treatment.

Purpose: The aim of this study was to assess the efficacy of corneal collagen cross-linking (CXL) with riboflavin using ultraviolet-A light in children with progressive keratoconus., Methods: Thirty-five eyes of 24 children with progressive keratoconus aged between 9 and 16 years were included in this retrospective study. Ocular examination included the best-corrected visual acuity (BCVA), dilated refraction, slit-lamp exam, and corneal topography (Orbscan II) at 6 and 12 months. All children were treated with riboflavin with ultraviolet-A light under topical anesthesia and all completed 1-year follow-up., Results: The mean age of the children was 13.65 years (range, 9-16 years). Follow-up was for a period of 1 year. The mean of preoperative keratometry (Kmax) was 55.11 ± 5.34 diopters (D), whereas the mean of postoperative Kmax was reduced to 53.87 ± 4.99 D. The mean preoperative pachymetry was 412.31 ± 36.54 μm, which changed to 361.31 ± 58.04 μm postoperatively. At 1 year, improvement in the BCVA was noted in 18 (51.42%) eyes, stabilization in 12 (34.28%), and worsening in 5 (14.28%) eyes. Overall, the BCVA improved by 1 line, which was statistically significant (P = 0.0368) at the end of 1 year. There was a reduction in both cylindrical and spherical equivalent, of which, the latter was not statistically significant (P = 0.77), whereas the former was of weak statistical significance (P = 0.061). No complications were reported., Conclusions: CXL with riboflavin is an effective procedure for children with progressive keratoconus. The results show stabilization, improvement, or both in keratoconus in terms of BCVA and corneal curvature after CXL in most children.

Purpose: To report the profile of microbial keratitis occurring after corneal collagen cross-linking (CXL) in keratoconus patients., Methods: A retrospective analysis of 2350 patients (1715 conventional CXL, 310 transepithelial CXL, and 325 accelerated CXL) over 7 years (from January 2007 to January 2014) of progressive keratoconus, who underwent CXL at a tertiary eye care centre, was performed. Clinical findings, treatment, and course of disease of four eyes that developed postprocedural moxifloxacin resistant Staphylococcus aureus (MXRSA) infectious keratitis are highlighted., Results: Four eyes that underwent CXL (0.0017%) had corneal infiltrates. All eyes that developed keratitis had conventional CXL. Corneal infiltrates were noted on the third postoperative day. Gram's stain as well as culture reported MXRSA as the causative agent in all cases. Polymerase chain reaction (PCR) in each case was positive for eubacterial genome. All patients were treated with fortified antibiotic eye drops, following which keratitis resolved over a 6-week period with scarring. All these patients were on long-term preoperative oral/topical steroids for chronic disorders (chronic vernal keratoconjunctivitis, bronchial asthma, and chronic eczema)., Conclusion: The incidence of infectious keratitis after CXL is a rare complication (0.0017%). MXRSA is a potential organism for causing post-CXL keratitis and should be identified early and treated aggressively with fortified antibiotics.

Psoralen + ultraviolet A (PUVA) therapy is an established modality for psoriasis. As India is a tropical country that has good availability of natural sunlight psoralen + sunlight (PUVAsol) may be a more convenient option. To compare the efficacy and cost-effectiveness of PUVA versus PUVAsol in chronic plaque psoriasis. Cases of chronic plaque psoriasis with body surface area ≥10% or Psoriasis Area and Severity Index (PASI) ≥10, excluding erythrodermic or pustular psoriasis, were randomized to receive either PUVA or PUVAsol, with endpoint being the achievement of PASI 90 or completion of 12 weeks treatment, whichever is earlier. Cost analysis was also undertaken. Thirty-six cases (16 in PUVA and 20 in PUVAsol group) completed treatment. In the PUVA group, 15 cases (93.75%) responded to therapy while in the PUVAsol group, 15 (75%) responded (P = 0.29). Mean baseline PASI in the PUVA and PUVAsol groups was 16 and 14.4, respectively, and at endpoint was 1.62 and 3.77. There was a significantly greater reduction in PASI in the PUVA group at 2 and 4 weeks but at 8 and 12 weeks and endpoint, it was comparable. Treatment failure occurred in 6.25% and 25% of cases respectively (P = 0.29). Side effects were higher with PUVA. Total cost of therapy was significantly higher in the PUVA group (P = 0.002). Cost-effectiveness ratio was US$0.72 with PUVA and US$0.37 with PUVAsol. Both PUVA and PUVAsol were equally efficacious, with PUVAsol being twice as cost effective. Hence, PUVAsol may be recommended as treatment for psoriasis in a developing economy such as India., (© 2013 The International Society of Dermatology.)

Aim: To assess the results of corneal collagen cross-linking with riboflavin using ultraviolet - A light for keratoconus at one year in Indian eyes., Materials and Methods: Sixty-eight eyes of 41 patients with progressive keratoconus were included in this retrospective study. All eyes completed was 12 months of follow-up and 37 eyes had a one-year follow-up. The maximum follow-up was 16 months. Ocular examinations including refraction, best corrected visual acuity (BCVA), corneal topography, were recorded at each visit., Results: The mean age was 16.9 +/- 3.5 years (range 12-39 years) and the mean follow-up was 10.05 +/- 3.55 months (range six to 16 months). Thirty seven eyes with a follow-up of at least 12 months were analyzed. The preoperative values on the day of treatment were compared with postoperative values of the 12-month examination. This showed that BCVA improved at least one line in 54% (20/37) of eyes and remained stable in 28% (10/37) of eyes ( P =0.006). Astigmatism decreased by a mean of 1.20 diopter (D) in 47% (17/37) of eyes ( P =0.005) and remained stable (within +/- 0.50 D) in 42% (15/37) of eyes. The K value of the apex decreased by a mean of 2.73 D in 66% (24/37) of eyes ( P =0.004) and remained stable (within +/- 0.50 D) in 22% (8/37) of eyes. The maximum K value decreased by a mean of 2.47 D in 54% (20/37) of eyes ( P =0.004) and remained stable (within +/- 0.50 D) in 38% (14/37) of eyes. Corneal Wavefront analysis revealed that spherical and higher-order aberrations did not show significant variations in the follow-up period. The coma component showed a very significant reduction at six months after treatment and persisted throughout the follow-up period ( P =0.003), Conclusion: The results show a stabilization and improvement in keratoconus after collagen cross-linking in Indian eyes. This suggests that it is an effective treatment for progressive keratoconus.

Purpose: To evaluate photodynamic therapy (PDT) with verteporfin along with intravitreal Ranibizumab in treatment of neovascular age related macular degeneration., Methods: This prospective interventional care series included 16 patients (17 eyes) of choroidal neovascularization secondary to neovascular AMD, who were treated with PDT with verteporfin followed by an injection of 0.5mg Ranibuzimab on the same day. The main outcome measures were best corrected visual acuity (VA) as recorded by both Snellen's and ETDRS charts (logMAR), contrast sensitivity (Pelli-Robson Chart), retreatment frequency and frequency of side effects., Results: Seventeen eyes underwent PDT with verteporfin and intravitreal 0.5mg Ranibizumab, following PDT. Patients were followed up every month for a total period of 6 months. Initial VA ranged from CF to 20/32 and final acuity ranged from CF to 20/20. VA stabilizes (gain/loss <2 lines) in 14 out of 17 eyes (82.24%) and improved in 3 out of 17 (17.65%). Contrast sensitivity improved in 15 out of 17 eyes (82.24%) Lesion type, patient age had no influence on the outcome. There were no cases of ocular/systematic adverse events. Retreatment was required in only 2 out of 17 cases (11.76%) with only a single injection of ranibizumab., Conclusion: The combination of PDT with intravitreal Ranibizumab improves contrast sensitivity and stabilizes vision and reduces the number of retreatments, without significant ocular and/or systematic risks.

Purpose: To evaluate photodynamic therapy (PDT) with verteporfin along with intravitreal triamcinolone acetonide (IVTA) in the treatment of neovascular age-related macular degeneration (AMD)., Materials and Methods: This prospective interventional case series included 23 patients (23 eyes) of choroidal neovascularization due to neovascular AMD who were treated with PDT with verteporfin followed by an injection of 4 mg IVTA. The main outcome measures were visual acuity (VA), contrast sensitivity, retreatment frequency with PDT (and triamcinolone) and frequency of side-effects., Results: Twenty-three eyes underwent PDT with verteporfin followed by IVTA one week later. All patients were followed up for one year. Initial VA ranged from 20/32 to 20/800 and final VA ranged from 20/40 to 20/500 at the end of 12 months. VA stabilized (that is loss/gain < 2 lines) in 19 (82%) eyes. Contrast sensitivity also improved in 16/23 eyes (70%). Lesion type and patient's age had no influence on the outcome, but baseline VA had a borderline statistically significant effect (P =0.059). Six eyes (27%) had an increase in intraocular pressure that required therapy. There were no cases of endophthalmitis, but four eyes (18%) developed significant cataract that required surgery during the follow-up period., Conclusion: The combination of PDT along with IVTA improves contrast sensitivity and stabilizes vision during one-year follow-up.