Search

The aim of this study was to assess the efficacy of Ahmed glaucoma valve (AGV) in eyes with Descemet's stripping endothelial keratoplasty (DSEK) and glaucoma and evaluate the risk factors for failure.Retrospective interventional study included 27 eyes (27 subjects) that underwent AGV implantation following DSEK. The main outcome measure was AGV success, defined as IOP between 6 and 21 mmHg with or without topical antiglaucoma medications (AGMs). Secondary outcome measure was graft survival. Graft failure was defined as corneal edema for ≥ 1 month or irreversible graft opacity requiring intervention.Eighteen eyes (66.7%) had anterior chamber tube and 9 eyes (33.3%) had sulcus tube placement. Median follow-up was 1.2 years (interquartile range, IQR, 0.5-2.5 years). Following AGV implantation, the median IOP decreased significantly (p 0.0001), median number of AGMs reduced significantly (p 0.001) and median visual acuity was maintained (p = 0.76). Cumulative success probability of AGV was 75.8 ± 10.6% at 1 year, and 75.8 ± 10.6% at 2 years. For 24 clear grafts before AGV, estimates of success post-AGV were 100% at 1 year, 77.8 ± 10% at 2 years and 51.9 ± 16.4% at 3 years. Postoperative tube intervention was a borderline significant risk factor for graft failure (p = 0.05) with hazards ratio of 7.2; however, tube location was not associated with failure.AGV can be considered an effective surgical option for IOP control in eyes with DSEK and glaucoma. However, high risk of long-term graft failure in these eyes needs to be considered specially those eyes needing tube intervention.

To report the clinical course and management of interface keratitis due to Enterococcus faecalis after Descemet membrane endothelial keratoplasty (DMEK). A 64-year-old man underwent DMEK, with unevenful immediate postoperative course, with a visual recovery of 20/30 at 2 weeks. At 3 months of clinical visit, interface keratitis was noted. DMEK graft removal with stromal bed scrapings was performed. A diagnosis of E. faecalis interface keratitis was made. The patient responded favourably to antibiotic susceptibility-guided intensive treatment with vancomycin 5% with complete resolution of infection. After 2 months of graft removal, Descemet stripping endothelial keratoplasty (DSEK) was performed. The corneal clarity was restored and the best corrected visual acuity was 20/40 at last follow-up of 1 year. E. faecalis should be kept as a differential in delayed onset interface keratitis after DMEK. After microbiological cure with antibiotic therapy, visual rehabilitation with DSEK restores corneal clarity and results in favourable visual outcome.

PURPOSE: To evaluate visual photosensitivity threshold and objective photosensitivity luminance in healthy eyes, thereby providing a normative dataset that will lead to a better understanding of diseases causing photophobia. METHODS: It was a prospective cross-sectional study. Emmetropes whose visual acuity was better than 0.18 logMAR (6/9) with no other ocular abnormality were included. Headache Impact Test-6 questionnaire and visual light sensitivity questionnaire were administered. Visual photosensitivity threshold was measured subjectively using ocular photosensitivity analyzer. Objective photosensitivity luminance was assessed manually by evaluating the videos recorded using infrared camera and noting down the intensity of light at the first squeezing reflex. RESULTS: A total of 75 normal subjects (age range, 7–71 years) were included. Median age was 32.7 years (inter-quartile range, 20.3–47.9 years). Forty subjects (53.3%) were males. Median Headache Impact Test score was 38 (inter-quartile range, 36–42) and visual light sensitivity questionnaire score was 11 (inter-quartile range, 8–15). Mean (standard deviation) right eye, left eye and binocular visual photosensitivity threshold was 3.34 (0.78), 3.33 (0.81) and 3.37 (0.78) loglux respectively. There was a significant negative correlation of visual light sensitivity questionnaire scores with right eye, left eye and binocular visual photosensitivity thresholds, and positive correlation of age with binocular visual photosensitivity thresholds. Mean (standard deviation) right eye, left eye and binocular objective photosensitivity luminance was 3.25 (0.55), 3.35 (0.47) and 3.15 (0.52) loglux respectively. Age was positively correlated with only binocular objective photosensitivity luminance and there was no correlation between age and right eye or left eye objective photosensitivity luminance. CONCLUSIONS: The study characterized, for the first time, objective photosensitivity luminance and established a normative data for both visual photosensitivity threshold and objective photosensitivity luminance. The data would help in understanding the pathophysiology of the diseases causing photophobia, monitoring the disease progression and thereby evaluating the treatment modalities.

Objective To describe the clinical profile and microbiology trends in patients undergoing therapeutic keratoplasty at a multi-tier ophthalmology hospital network in India. Methods This cross-sectional hospital-based study included 3147 eyes undergoing therapeutic keratoplasty between Jan 2016 and Dec 2020 (5 years period) as cases. The demographic data, clinical profile and microbiological analysis were collected using an electronic medical record system. Results Of a total of 13,625 eyes with microbial keratitis(non-viral), 3147 (23.1%) underwent therapeutic keratoplasty during the study duration. Majority of patients were males (68.35%), from a rural geography (49.89%) and in 51–60 years age bracket (23.74%). The mean age of the patients was 50.54 ± 15.83 years. Two-thirds of patients were from lower socio-economic strata (66.63%) with an agrarian background (36.51%). Of the 3,147 eyes, fungus (51.8%) was the most common indication of therapeutic keratoplasty followed by bacteria (16.87%) and parasite (1.27%). No organisms could be identified in about a third (29.33%) of the cases. Between 2016 and 2020, the trend of therapeutic keratoplasties for fungal infections steadily grew (39.9% vs 45.49%) while the bacterial infections showed a steady decline (23.15% vs 11.81%). Conclusions Medical cure rate was seen in majority of those with microbial keratitis, and 23.1% eventually required management with therapeutic keratoplasty. Fungal keratitis was the most common indication for therapeutic keratoplasty. Male gender, rural setting, low socio-economic background and agricultural occupation are common risk factors for patients undergoing therapeutic keratoplasty in India.

Purpose The purpose of this study was to evaluate the prevalence of SARS-CoV-2 in human postmortem ocular tissues of asymptomatic donors and its implications on our eye banking protocols. Methods The expression of SARS-CoV-2 RNA was assessed by reverse transcription-polymerase chain reaction in corneal rims and conjunctival tissues from 100 donors who were found suitable for transplantation as per the donor screening guidelines of the Global Alliance of Eye Bank Associations. The donor's clinical history and cause of death were assessed for secondary analysis. Results Of 200 ocular tissues (100 corneal and 100 conjunctival) from the same 1 eye of 100 surgical-intended donors, between September 2020 and April 2021, the overall positivity rate for SARS-CoV-2 was ~1% (2/200). Both the ocular samples that tested positive were conjunctival biopsies (2/100, 2%), whereas corneal samples were negative (0/100, 0%) in both donors. The causes of donor death were trauma in 51 donors, suicide in 33, cardiac arrest in 7, electric shock in 5, metabolic cause in 2, malignancy in 1, and snake bite in 1. None of the donors had a medical history suggestive of COVID infection or possible contact. None of the recipients from the donors were reported to have any systemic adverse event after keratoplasty until the follow-up of 6 weeks. Conclusions The overall prevalence of SARS-CoV-2 was 1% (2% for conjunctival and 0% for corneal samples, P value = 0.5) in the donors who were found suitable for cornea recovery and transplantation. The findings of exceptionally low positive rates in our samples validate the criticality of history-based donor screening and do not support the necessity of postmortem PCR testing as a criterion for procurement and subsequent use for corneal transplantation.

Our study aimed to evaluate the utility of the anterior segment morphometry for objectively assessing anterior segment architectural changes of corneal clouding in the mucopolysaccharidoses (MPS) cohort and to investigate whether these measurements correlate with the slit-lamp findings on the cornea and early diagnosis of glaucoma.This retrospective study involved 70 eyes of 35 children with cloudy cornea due to MPS variants. Anterior segment architectural alterations were measured using anterior segment imaging and biometry in MPS children and compared with controls.Mean age of the cohort at the time of assessment was 7.9 ± 4.5 years. Males constituted two-thirds of the cohort. Variants of MPS with cloudy cornea were as follows: Type I (62%), Type IV (11%), and Type VI (22%). Morphometric measurements were available in 22 eyes of 11 MPS children and an age-matched healthy control group. There were significant differences between MPS cohort and controls in refraction in Diopters (5.03 ± 0.39 and 0.01 ± 0.04; P0.0001), axial length (AXL) in mm (21.39 ± 0.28 and 23.04 ± 0.28; P = 0.0002), average keratometry in Diopters (40.67 ± 0.44 and 42.83 ± 0.44; P0.0001), anterior chamber depth (ACD) in mm (2.92 ± 0.07 and 3.65 ± 0.07; P0.0001), and intraocular pressure (IOP) in mmHg (25.2 ± 2.0 and 14.1 ± 2.3; P = 0.0003). Secondary glaucoma was observed in 28% of the MPS cohort.The anterior segment morphometry in the cloudy cornea due to MPS provides an objective measurement of anterior segment architectural changes, thus diagnosing early-onset secondary glaucoma. These findings highlight that cloudy cornea due to MPS variants merits close monitoring throughout life.

To describe the causes and trends of corneal donor mortality from eye bank data in India during the coronavirus disease 2019 (COVID-19) pandemic.This retrospective eye bank-based study included 13,529 donors who donated their cornea between January 2018 and December 2021. Donors in whom the cause of mortality was documented were included as cases. The data were collected from the eye bank records.Overall, 13,529 corneal donors were included in the study. Most of the donors were males (69.71%). The mean age of the donors was 51.55 ± 20.54 years, whereas the median age was 51 (inter-quartile range: 35-68) years. The mean age of males (49.3 ± 19.47 years) was lesser than the mean age of females (56.72 ± 21.94 years) at the time of donation. The most common age group at the time of donation was during the sixth decade of life with 2,139 (15.81%) donors. The mean age of the donors decreased by a decade from 54.95 ± 20.51 years in 2018 to 44.35 ± 18.88 years in 2021. The most common cause of donor mortality was cardio-respiratory arrest in 5,190 (38.36%) donors and trauma in 3,469 (25.64%) donors, followed by suicide in 2,790 (20.62%) donors. The trend of cardio-respiratory arrest decreased from 53.01% to 9.5% (p =0.00001), whereas the trends of trauma increased from 21.93% to 36% (p =0.00001) and suicide increased from 12.71% to 36.41% (p =0.00001) between 2018 and 2021.Corneal donors are more commonly males in their sixth decade of life. The most common cause of donor mortality was related to cardio-respiratory arrest with a concerning rising trend in suicide cases over the years seen significantly during the pandemic.

To describe the demographics and clinical profile of Fuchs' endothelial corneal dystrophy (FECD) in patients presenting to a multi-tiered ophthalmology hospital network in India.This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of FECD in at least one eye were included as cases. The data were collected using an electronic medical record system.Overall, 2570 (0.08%) patients were diagnosed with FECD. The majority of the patients were female (65.53%) and were predominantly adults (99.92%). The most common age group at presentation was during the seventh decade of life with 867 patients (33.74%). The overall prevalence was higher in patients from a higher socioeconomic status (0.1%) presenting from the urban geography (0.09%) and in retired individuals (0.4%). About half of the 5,140 eyes had mild or no visual impairment (20/70) in 2643 eyes (51.42%) followed by moderate visual impairment (20/70 to 20/200) in 708 eyes (13.77%). The average logMAR was 0.61 ± 0.81 at presentation. The most documented corneal signs were guttae (76.63%), corneal scar (23%) and stromal edema (21.73%). The most associated ocular comorbidity was cataract (47.32%) followed by glaucoma (5.39%). More than a tenth of the affected eyes required a surgical intervention of endothelial keratoplasty (15.58%).FECD more commonly affects females presenting during the seventh decade of life. Majority of the eyes had mild or no visual impairment and endothelial keratoplasty is warranted in a tenth of the affected eyes.

With the growing popularity of lamellar keratoplasty for selective replacement of diseased corneal tissue, it is important to understand the risk of developing an infection after the procedure. Although lesser than that postpenetrating keratoplasty, the reports on post lamellar keratoplasty infectious keratitis are not negligible. Trends of acute infections arising within 2 months of surgery are a subject of interest. Most of these infections are reported post Descemet’s stripping endothelial keratoplasty with a preponderance of Candida species. A donor to host transmission of infection is not uncommon. Among the Candida cases, about 80% seem to occur due to a donor to host transmission. Infections presenting as or progressing to endophthalmitis lead to a poor visual outcome. Strict aseptic measures and protocols during corneal tissue harvesting, tissue processing, tissue storage and surgery are essential to prevent occurrence of these infections. After the infection has occurred, determining the aetiology and drug susceptibility through microbiological testing is vital. This helps to guide treatment protocols and hence determines final outcome of these cases. Most cases require some form of surgical management for resolution of infection, most often a graft removal and therapeutic keratoplasty. Secondary surgical interventions are performed to restore graft clarity and achieve a good final visual outcome.

Purpose The purpose of this study was to report the clinicopathological features of Peters anomaly in a child with nail-patella syndrome. Methods Nail-patella syndrome (NPS) is a rare autosomal dominant connective tissue disorder characterized by several anomalies of the extremities, joints and nails, glomerulopathy, and rarely ocular involvement. NPS is caused by heterozygous loss-of-functional mutations in the LMX1B gene that encodes the LIM homeodomain proteins. Results This case reports a new association of Peters anomaly in a child with NPS that also had classic skeletal/nail anomalies and protein losing nephropathy. Furthermore, DNA sequence analysis identified a novel missense heterozygous mutation in the LMX1B gene (Transcript ID: NM_001174146) resulting in the replacement of tryptophan by serine in codon 266, suggesting that the mutation (p.Trp.266Ser) affects LMX1B function by disturbing its interactions with other proteins. To the best of our knowledge, this association of Peters anomaly is novel and has not been reported earlier in the ophthalmic and systemic literature on NPS. Conclusion The corneal findings in our case with NPS are similar to those seen in congenital corneal opacification because of Peters anomaly. This novel association of Peters anomaly with NPS may be related to the effects of the LMX1B mutation on corneal development.

Purpose To evaluate the outcomes of keratoplasty for xeroderma pigmentosum (XP) performed at a tertiary eye care center. Methods A retrospective review of medical records of those patients who were clinically diagnosed to have XP (54 eyes of 36 patients) and underwent keratoplasty; either deep anterior lamellar keratoplasty (DALK, four eyes), endothelial keratoplasty (EK, eight eyes), or penetrating keratoplasty (PK, 42 eyes) from 1994 to 2018. Results The median age at surgery was 20.6 years (interquartile range [IQR], 14.6-27.6 years) and 20 (55.6%) were males. Graft failure occurred in 15 eyes (35.7%) in the PK group and two eyes (50%) in the DALK group; none failed in the EK group. The probability of graft survival in the PK group was 97.2% ± 2.7% at 1 year, 74.0% ± 8.0% at 2 years, and 54.8% ± 11.7% at 5 years. In the PK group, 13 eyes needed antiglaucoma medications, 11 eyes developed graft infiltrate, and 13 eyes needed secondary interventions (cataract surgery, excision biopsy, and tarsorrhaphy). In the EK group, three eyes needed secondary interventions (excision biopsy). Median postoperative endothelial cell density at the last follow-up in the PK group was 1214 cells/mm2 (IQR, 623-2277 cells/mm2). Conclusion Despite the complexities of the ocular surface and adnexal issues in XP, keratoplasty had reasonably good outcomes. More than half of the PK grafts survived 5 years with no failures in the EK group. Regular follow-up and timely management of suture-related infections raised intraocular pressure, and suspicious ocular surface lesions, in addition to solar protection, are important for the success of keratoplasty in these eyes.

To evaluate the seropositivity of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis from blood samples of cornea donors and assess correlation between seropositivity for HIV and syphilis. Retrospective analysis of blood samples of 31,355 cornea donors for HIV, HBV, HCV, and syphilis was performed. Postmortem blood samples were analyzed by a rapid screening test for anti-HIV envelope antibodies against HIV 1 and 2, HBV surface antigen, antibody to HCV and anti-cardiolipin antibodies for syphilis by rapid plasma reagin test. The overall seropositivity rate was 4.28% (1343/31,355 donors). All positive donors were reactive for a single serological test. The seropositivity rate for HIV was 0.93% (95% CI 0.83–1.04%), for HBsAg was 1.56% (95% CI 1.43–1.7%), for HCV was 1.19% (95% CI 1.08–1.33%) and for syphilis was 0.59% (95% CI 0.52–0.69%). The trends in seropositivity rates showed a decline for three viral markers: HIV (2010, 1.17% to 2018, 0.72%, p = 0.02), HBsAg (2010, 1.98% to 2018, 1.05%, p = 0.0006) and HCV (2010, 1.32% to 2018, 0.43%, p

PURPOSE: To describe the impact of lockdown and unlock phases of the COVID-19 pandemic on keratoplasty trends at a tertiary eye care center in India. METHODS: This cross-sectional hospital-based study included 6,277 patients presenting between March 25, 2017 and March 31, 2021. The data of the patients who underwent keratoplasty during the lockdown and unlock phases were compared with the respective periods in the previous three years before COVID-19. RESULTS: During the year one of pandemic, there was a 29.46% decline in the total number of keratoplasty performed at the institute compared to previous year's annual numbers. The patients undergoing keratoplasty decreased by 90.28% (28/288) of pre-COVID-19 volumes during the lockdown phase. This was mainly because of a 40.6% reduction in the proportion of patients requiring interstate travel. There was complete recovery in the number of patients undergoing keratoplasty to 129.27% (184/142) of pre-COVID-19 volumes by March 2021. This gradual incremental trend was seen across all types of keratoplasty in Descemet stripping endothelial keratoplasty (135.29%), penetrating keratoplasty (117.6%), therapeutic keratoplasty (122.22%), anterior lamellar keratoplasty (150%), and Descemet membrane endothelial keratoplasty (141.18%) by March 2021 with the gradual ease of lockdown regulations. The eye bank affiliated to the institute saw a 55.44% decline in donor cornea collection and an increase in utilization rate from 58.12% in previous years to 83.78% in year one of the pandemic. The overall eye bank donor cornea collection recovered to 86.96% (627/721) and tissue utilization increased by 109.99% (455/414) by March 2021. CONCLUSION: The first year of the COVID-19 pandemic saw an overall reduction of 29.46% of the patients undergoing keratoplasty at the institute. There was a gradual and incremental increase in all types of keratoplasty in the unlock phase, which surpassed the preceding years' monthly numbers in February and March.

Purpose To report the intermediate outcomes of therapeutic penetrating keratoplasty (TPK) performed for severe microbial keratitis using glycerol-preserved corneas during the Corona virus diseases of 2019 (COVID-19). Methods Retrospective non-comparative case series from April to August 2020 in a network of tertiary eye care centers. Glycerol-preserved tissues were used for therapeutic keratoplasty (TPK). We reviewed the demographics, microbiology, surgical outcomes such as wound integrity, recurrence, graft melt, epithelialization, and complications. Results A total of 49 eyes that underwent TPK with glycerol-preserved corneal tissues were analyzed. The primary indication was severe microbial keratitis in 47 eyes. The majority was a fungal infection in 33 eyes (67.3%). The mean age was 53.8 ± 12.2 years, with male predominance (3:1). The corneas were stored for an average of 85.5 ± 53 days prior to transplant. The median donor age was 65 years. The grafts were tectonically stable in 32/36 eyes (88.9%) at 1 month and 20/24 eyes (83.3%) at 3 months. The graft melt was noted in three eyes at 1 and 3 months. The recurrence of the infection was noted in four eyes and all were of fungal etiology. The graft epithelialization was delayed with a mean duration of 48.9 ± 25 days after surgery. Post-TPK, raised intra-ocular pressure (>21 mm Hg) was noted in 51.2% at 1 week, 17.4% at 1 month, and 11.8% at 3 months. Conclusion Glycerol preservation is a reliable alternative with good therapeutic outcomes in the short and interim postoperative period. Delayed epithelialization and secondary glaucoma were the commonest postoperative complications.

Background: Congenital hereditary endothelial dystrophy (CHED) is a rare form of corneal dystrophy and is known to be caused by SLC4A11 gene mutation. The purpose of this study is to find genetic alterations in SLC4A11 using direct sequencing in two Indian familial CHED cases with affected members n=3 and n=2 respectively and five non-familial cases with a single affected member, followed by in silico characterization of identified mutations. Results: All three affected members of the first CHED family were identified with novel hom. c.1514C>G (p.Ser489Trp) mutation while second family showed presence of novel compound heterozygous mutation- het c.529A>C (p.Arg161Arg) + het c.2461insT (p.Val805fs). Among five non-familial cases, two showed novel changes hom. c.1487G>T (p.Ser480Ile) and hom. c.620-2A>G respectively, while the other one had previously reported hom. c.2653C>T (p.Arg869Cys) mutation. The remaining two cases did not reveal the presence of SLC4A11 related pathogenic mutations. Identified mutations were excluded from a large number of controls (n=80) and analyzed in silico using homology-based protein modeling and pathogenicity prediction tools, which predicted these alterations to be pathogenic causing change in protein stability, protein local flexibility and decrease in hydrogen bond interactions. Conclusions: Our study contributed to CHED mutational spectrum adding four novel mutations and confirming a previously reported mutation. Our study demonstrated a spectrum of mutations ranging from coding, non-coding, homozygous, and synonymous compound heterozygous in CHED cases. The identified mutations demonstrated different degrees of pathogenic effects based on in silico analysis. In addition, two non-familial cases could not be identified with pathogenic mutation emphasizing the involvement of other genes or genetic mechanisms for such cases.

The purpose of this study was to compare the corneal endothelial characteristics in Axenfeld anomaly (AXA), Rieger anomaly (RGA), and Axenfeld-Rieger anomaly/syndrome with age-matched healthy controls.This is a retrospective, comparative case-control study of 52 eyes of 30 patients with AXA/RGA and AXA/S and 36 controls.Median age at endothelial imaging was 21.5 years (interquartile range, 13.8-33.3 years). In the study group, the mean endothelial cell density (ECD) was 2112.4 ± 78.5 cells/mm2, the mean cell area (MCA) was 526.9 ± 28.5 μm2, and the coefficient of variation of cell size was 41.2 ± 1.8%. The ECD was significantly (all, P0.0001) lower than controls, while MCA (P0.0001), SD of cell size (P0.0001), and maximum cell area (P = 0.0007) were significantly higher than controls. Four eyes of 3 patients had guttae on slitlamp evaluation and endothelial imaging. There were no differences in the corneal endothelial characteristics among the clinical subtypes.Patients with AXA, RGA, and Axenfeld-Rieger anomaly/syndrome have lower ECD and increased MCA compared with normal eyes. The reduced ECD associated with inherent anterior segment alterations can predispose to the risk of postcataract surgery endothelial decompensation in these eyes. The association of guttae in some eyes needs further investigational studies.

Purpose Xeroderma pigmentosum (XP) is an extreme hypersensitivity to sunlight causing skin freckling and pigmentary changes because of defective DNA repair mechanisms. The purpose of this article is to evaluate the spectrum of ocular and systemic features in XP at a tertiary eye care center in India over 32 years. Methods Data from 418 eyes of 209 patients diagnosed with XP from 1987 to 2018 were reviewed retrospectively for demographics, complaints, ocular features, systemic associations, and their management. Results Median age at diagnosis was 2 years (interquartile range, 0.5-5 years). A total of 124 patients (59.3%) were men. There was parental consanguinity in 74.4% cases. Common ocular complaints were photophobia (47.1%), ocular discomfort (45%), defective vision (36.6%), redness (13.4%), tissue growth (12%), white spot (11.2%), and pain (10.5%). At presentation, 43.5% had corneal scars (45.5% were located inferiorly and 70.9% covered visual axis). Corneal vascularization and limbal stem cell deficiency were noted in 37.4%. A total of 56% of patients had at least 1 tumor, and 6.7% had neurological abnormalities. At least 1 ocular surgery was performed in 37.8% of patients. Ophthalmic surgical interventions included tumor excision (23%), keratoplasty (13.4%), and nontumor ocular surface surgery (3.4%). Conclusions XP is a disorder that has high ocular morbidity in Indian patients. The recognition of common signs and symptoms and relative frequency of various ocular complications with time trends will help in managing and reducing the sequelae of this otherwise untreatable and progressive disease.

Macular Corneal Dystrophy is an autosomal recessive form of corneal dystrophy due to a mutation in CHST6 gene, which results in abnormal proteoglycan synthesis. There is accumulation of abnormal glycosaminoglycans in the corneal stroma and endothelium. The deposition results in progressive loss of corneal transparency and visual acuity. The histopathology shows characteristic alcian blue positive deposits. Management in the cases with visual loss requires keratoplasty either full thickness or lamellar. The decision about the ideal type of keratoplasty depends on age and pre-operative clinical features. Although prognosis after keratoplasty is good, recurrences can occur. Future research should be targeted towards gene therapy in this condition.

Purpose To report the indications, long-term structural and functional outcomes, and prognostic factors for the success of penetrating and lamellar corneal patch grafts. Methods This is a retrospective analysis of 49 patients who underwent the corneal patch graft procedure over 8 years. The baseline, preoperative, and postoperative characteristics along with their outcomes were evaluated. Results Forty-nine eyes (49 patients) with a mean follow-up of 20.3 ± 3.27 months (range 6-48) were included. Thirty-one patients underwent full-thickness grafts for corneal perforation, and 18 underwent lamellar grafts for severe thinning. The most common indication was corneal thinning and/or perforation secondary to microbial keratitis (17 eyes, 34.7%). Anatomic success was achieved in 31 eyes (63.2%), in which no further surgical intervention was required for tectonicity. Functional success was achieved in 22 of 37 eyes (59.5%), where along with anatomic success, significant visual gain was also obtained. Absolute graft failure was noted in 12 eyes (24.5%), which developed recurrence of primary pathology requiring reintervention within the first 6 months. Good prognostic factor for success included sterile corneal perforations. The presence of microbial keratitis was noted to be a guarded prognostic factor for success. Conclusions Corneal patch graft can serve as a good therapeutic modality for corneal ulceration or thinning, not amenable to treatment with tissue adhesive application. Both anatomical success and functional success of 60% was achieved in our series. Those performed for immune-mediated conditions fared the best. Subsequent optical procedures may be performed for further visual rehabilitation at a later stage.

Dear Editor, Recessive cornea plana (OMIM 217300) is a genetic condition with a distinct clinical phenotype characterized by small flat cornea, variable corneal opacity, arcus lipoides, indistinct ...

PURPOSE To describe the clinical profile and demographic distribution of corneal dystrophy in patients presenting to a multitier ophthalmology hospital network in India. METHODS This cross-sectional hospital-based study included 2,151,584 new patients presenting between March 2012 and December 2019 (∼8 year period). Patients with a clinical diagnosis of corneal dystrophy in at least 1 eye were included as cases. The data were collected by using an electronic medical record system. RESULTS Overall, 4198 new patients (0.20%) were diagnosed with corneal dystrophy. The prevalence rates were 0.19% in children (age < 16 years) and 0.20% in adults. Most patients were women (51.86%). The mean age of the patients was 43.61 ± 21.39 years. Most patients (18.79%) were between 61 and 70 years of age. The most common anatomical location of the dystrophy was endothelium (51.71%), followed by stroma (43.55%) and Bowman membrane/epithelium (4.73%). The most common corneal dystrophy was Fuch endothelial corneal dystrophy (41.89%). Most eyes had mild or no visual impairment (43.43%). Of the 8193 eyes, 998 eyes (12.18%) underwent a corneal surgery. Among those who underwent surgical intervention, endothelial keratoplasty was the most commonly performed surgical procedure (52%), followed by penetrating keratoplasty (22%). CONCLUSIONS Corneal dystrophy is a rare disease, affecting patients seeking eye care in India. Endothelial dystrophies were the most common, followed by stromal dystrophies. Among the stromal dystrophies, macular dystrophy was the most common. At initial presentation, visual impairment was mild to moderate in most patients, and surgical intervention was needed in 12.18% of the eyes during the study period.

Aim To evaluate the success of Ahmed glaucoma valve (AGV) implantation in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. Materials and methods This retrospective study included 18 eyes of 18 patients with ICE syndrome and glaucoma who had undergone AGV implantation at our institute between January 2008 and April 2019. The primary outcome was the success of AGV, defined as intraocular pressure (IOP) ≥6 and ≤21 mm Hg with or without topical antiglaucoma medication (AGM). Failure was defined as IOP 21 mm Hg/need for oral AGM/need for additional glaucoma surgery or loss of light perception because of a surgical complication. Corneal clarity and graft survival in these eyes post-AGV were the secondary outcome measure. Results The median (interquartile range) follow-up was at 20.61 (3.9 to 57) months. Of the 18 eyes, 14 (77.8%) had adequate IOP control with or without AGMs. Postoperatively, the mean (±standard deviation) IOP significantly reduced from 29.7(±10) mm Hg to 16(±3.8) mm Hg and the number of AGMs reduced significantly from a mean of 3.6 (±1) to 1.7 (±0.9). The probability of AGV success was 92.3±7.4%, 66.1±11.0%, and 50.5%±17.3% at 1, 3, and 4 years, respectively. All 4 failures were because of uncontrolled IOP and needed either oral AGM or additional surgery for IOP control. At the last follow-up visit, 16 eyes had clear cornea and 2 eyes had pre-existing corneal scar (eccentric) that persisted after AGV implantation. Conclusion AGV implant was reasonably successful for IOP control in glaucoma secondary to ICE syndrome with a few common but manageable corneal complications.

Purpose: To evaluate the clinico-microbiological profile, donor cornea risk factors, and outcomes of postkeratoplasty endophthalmitis at a tertiary care center. Methods: Retrospective analysis of charts of 28 consecutive patients (28 eyes) of acute endophthalmitis following either an endothelial keratoplasty (EK) or an optical penetrating keratoplasty (PK) surgery, performed between 2006 and 2018 (13-year period). Positive microbiology, identification and classification of predisposing factors, surveillance of utilized paired donors, treatment outcomes, and differences in the rate and severity of the event between optical penetrating and endothelial keratoplasty. Results: The estimated incidence of endophthalmitis was 0.23% in the entire cohort; it was 0.34% and 0.15%, after EK and PK, respectively (P = 0.049). The median time of endophthalmitis was 4.5 days postsurgery. Donor-related endophthalmitis was recognized in 7/28 (25%) eyes. Culture positivity was 68% (n = 19 of 28). Bacteria was isolated in 84% (n = 16 of 19) instances; Gram-negative bacilli were more common (87.5%; 14 of 16), and Pseudomonas species (50%; 7 of 14) was the most common Gram-negative bacterium. Majority (>75%) of the Gram-negative bacteria were resistant to all fluoroquinolones, aminoglycosides, 3rd generation cephalosporins, and meropenam; 1/3rd were resistant to imipenem; and 90% were sensitive to colistin. Treatment included intraocular antibiotic injections (96.4%), vitrectomy (42.9%), and therapeutic keratoplasty (50%). In 85.7% (24 of 28), globe was salvaged. The final vision was 20/200 or better in 39.1% (9 of 23) eyes. Conclusion: EK carried a higher risk of endophthalmitis than PK in this cohort. Bacterial infection was more common in this series, with Gram negative bacilli being the commonest organisms. Multidrug resistance was common (~75%) in Gram negative isolates.

To report rapid resolution of corneal clearing with the application of a modified technique of compression sutures in large hydrops.Interventional case series of seven patients.Three patients had acute hydrops secondary to keratoconus, three had pellucid marginal corneal degeneration and another one had ectasia of undetermined etiology. A thorough slit-lamp evaluation and anterior segment optical coherence tomography was performed. The surgical technique involved paracentesis, anterior chamber decompression, compression suture placement within the stroma against the background of partial air fill in the anterior chamber, and bandage contact lens application. All eyes showed a remarkable reduction in corneal edema at 1 h (documented in four eyes) and 1 day (documented on the rest), which continued to improve in further follow up.The modified technique of compression sutures facilitate rapid recovery of corneal edema in acute hydrops seen in keratoconus and pellucid marginal corneal degeneration. The physiologic basis is akin to the external tamponade achieved with buckle in retinal detachment surgeries.

Purpose To describe a previously unreported association of keratoconus in congenital distichiasis. Methods Observational case series of ocular findings in 2 siblings with congenital distichiasis. Results A 17-year-old male presented with tearing and photophobia in both eyes. His parents revealed that he was photophobic since birth. He had a lid surgery previously in both eyes. Clinical examination revealed a central scar with Descemet membrane tear suggestive of healed hydrops in the right eye. The left eye showed topographic features of keratoconus. His younger sibling, a 14-year-old female, also had similar symptoms of photophobia and tearing since birth. She had undergone electrolysis in both eyes. At the present visit, she had an epithelial defect with congestion in the right eye. Electrolysis of the distichiatic eyelashes was performed along with bandage contact lens application, which relieved her symptoms. Her topography revealed subclinical keratoconus in both eyes. The siblings’ father also had complaints of photophobia since birth and had lid surgery and electrolysis in the second decade of his life. Conclusions Patients with congenital distichiasis may have associated keratoconus. Chronic ocular irritation and subsequent eye rubbing in distichiasis could be the risk factor for keratoconus.

A teenage boy who was previously diagnosed to have congenital ichthyosis presented to the eye clinic with complaints of gradually decreasing vision in both eyes since childhood. The best-corrected distance visual acuity was 20/125 in the right eye and 20/40 in the left eye. Clinical examination revealed developmental cataracts in both eyes. He underwent cataract surgery in the right eye and visual acuity improved to 20/25. Hence, we conclude that congenital ichthyosis can be associated with developmental cataracts. Cataract surgery helps in restoring vision in those with visually significant cataracts.

Corneal donor tissue preservation techniques have incrementally improved since the introduction of McCarey-Kaufman storage solution from short-term storage to intermediate duration of storage with the advent of organ culture and Optisol GS storage solutions. Improved understanding of the corneal endothelial cell physiology has helped in designing newer storage solutions, such as the Life 4C and Cornea Cold. The incorporation of antibiotics, ATP precursors, minerals, and vitamins has improved the viability of tissues. In addition, these modifications to the newer storage solutions have increased the endothelial longevity and metabolic activity. Despite these advances, the duration of tissue storage has largely been restricted to 2 weeks in Optisol GS and 4 weeks in organ culture. The role and cost-effectiveness of antifungal supplementation and the need for improved epithelial preservation are additional areas that need to be explored. This review intends to summarize the efficacy and viability of donor corneas in different tissue storage solution and compare clinical outcomes while providing an insight into the challenges in developing newer methods of corneal preservation.

PURPOSE This study was to report the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in managing corneal endothelial disorders in children less than 14 years of age. METHODS Medical records of 180 DSAEK performed, between 2008 and 2020, on 167 eyes of 111 children who had a visually significant endothelial dysfunction were retrospectively reviewed for the primary etiology of corneal decompensation, time of the onset and duration of cloudiness, preoperative visual acuity, the technique of endothelial keratoplasty, surgical modifications, and reintervention. RESULTS Median age at surgical intervention was 7.9 years (interquartile range, 5.2-11.2 years). At a median postinterventional follow-up of 2.5 years (interquartile range, 0.9-3.4 years), 86.2% (144 of 167 eyes, 95% confidence interval 79.9%-90.1%) maintained a clear graft. Median best-corrected visual acuity (logarithm of the minimum angle of resolution) improved from 1.45 ± 0.70 preoperatively to 0.90 ± 0.06 at the last follow-up visit (P < 0.0001). The cumulative overall long-term graft survival was 92.7%, 86.5%, and 77.7% at 1, 3, and 7 years, respectively. Cox proportional hazards regression analysis showed that the indication for DSAEK (P = 0.007; hazards ratio: 2.17 ± 0.62), age at surgery (P = 0.02; hazards ratio: 0.87 ± 0.05), and any subsequent intervention after DSAEK (P = 0.003; hazards ratio: 0.11 ± 0.08) were significant risk factors for DSAEK failure. The endothelial cell loss was 40.1% at 6 months, 45.4% at 1 year, 55.2% at 5 years, and 61.9% at 7 years. CONCLUSIONS DSAEK is a safe and effective surgical strategy in managing endothelial disorders among the pediatric age group.

Purpose To assess the corneal endothelium in patients with Fuchs heterochromic iridocyclitis (FHI) and compare it with the normal fellow eye. Methods Retrospective, observational, cross-sectional study of 31 patients seen between Jan 2016 to Dec 2018, with clinical diagnosis of Fuchs heterochromic iridocyclitis, was performed. Specular microscopic examination was documented in both eyes. The affected eyes formed the study group and the fellow healthy eyes served as controls. Results The mean age of the patients was 29.9 ± 8.2 years. The endothelial cell density (P = 0.0001) was significantly lower, whereas average cell size (P = 0.0001), coefficient of variation (P = 0.004), and maximum cell area (P = 0.01) were significantly higher in the affected eye compared to the control eye. In three patients, the affected eye showed guttae, while the healthy fellow eye revealed a normal specular mosaic. Conclusion Specular microscopic analysis shows endothelial alterations in the affected eyes in FHI.

Human Activity Recognition and assisting user on the basis of his context is attracting researchers since decade Researchers are working in the area to increase the accuracy of detection by various means. The challenging issue is to determine the correct supervised classifier for the detection purpose. This paper intent to examine the methodology used to recognize HAR and the impact of classifiers practiced in training and Testing. We have also tried to identify the suitable supervised machine learning model for HAR. Data of 30 Users with 561 features belonging to accelerometer and gyroscope sensor of smartphone from UCI repository is used for evaluation purpose. Nine different supervised machine learning Models are trained and tested on the dataset. The result concludes that HAR is a process which depends upon the classifiers used. It also conclude that out of 9 different Machine learning models ANN performs well and after that SVM, kNN, Random Forest and Extra Tree are equally good models for the purpose of HAR with Accuracy and execution time as the performance evaluation metric.

The global survey of eye banking and corneal transplantation reveals differences in eye banking trajectories in various countries. There is a need to encourage and lay down foundations of successful eye banking practices in many nations across the world map. The study evaluates demographics, trends in donor cornea retrieval, utilization and eye banking practices in over 30 years at a single eye bank in India. A longitudinal descriptive analysis of eye banking practices from 1989 to 2018 at Ramayamma International Eye Bank, Hyderabad, India, was performed. Data on eye donations, practice patterns and various types of keratoplasty were collected. Data were analysed focusing on practices and historical development of the eye bank. Over the years, the eye bank has made use of several advances in its practice patterns and evolved to a stage of self-sustainability. With the fulfilment of internal demand for corneal transplantation, 50% of retrieved corneas could be distributed for community needs outside the institute. Number of transplants increased from 20 in 1987 to 4738 in 2018. Total number of transplants touched 27,746 in 2018 which might be the highest numbers for a single centre anywhere in the world. The study reveals a dynamic development of the eye bank over the last 30 years and emphasizes the importance of an active quality management in coping with the challenges of modern eye banking. The increasing trend of cornea collection and transplantation is a reflection of the needs and efforts towards treating and eliminating corneal blindness.