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Abstract Objective To analyse the efficacy of the therapeutic use of low-level laser therapy (LLLT) on the tissue repair process of allogeneic scleral grafts in patients with contracted sockets by analysing the speed of graft vascularisation and fornice depth of contraction percentage. Methods A retrospective chart review was performed from April 2015 to April 2021 including 39patients with socket contraction. Allogeneic scleral grafts were used to repair the sockets in all patients. They were randomly enrolled into two groups. The laser group included 18 patients treated with LLLT after the surgery, whereas the control group included 21 patients without LLLT after the surgery who healed naturally. The LLLT equipment used in the research had a wavelength of 650 nm, 10 mW power, and 3.8 J/cm2 dosimetry, and the procedure was performed once daily for 5 min over 7 days, beginning 1 week postoperatively. All patients were followed up over 6 months to examine the changes in the size of the area of the non-vascularised graft and upper and inferior fornice depth. Results The laser group presented a significantly increased speed of conjunctival vascularisation compared with the control group (P = 0.003). The fornice depth of contraction percentage was more apparent in the control group than that in the laser group (P = 0.000). Conclusion LLLT accelerates conjunctival vascularisation, stimulates conjunctival incision healing within a short period, shortens the tissue repair process, reduces the local inflammatory response, and causes no significant shrinkage of the conjunctival sac.

Objective: To analyse the efficacy of the therapeutic use of low-level laser therapy (LLLT) on the tissue repair process of allogeneic scleral grafts in patients with contracted sockets by analysing the speed of graft vascularisation and fornice depth of contraction percentage. Methods: A retrospective chart review was performed from April 2015 to April 2021 including 39patients with socket contraction. Allogeneic scleral grafts were used to repair the sockets in all patients. They were randomly enrolled into two groups. The laser group included 18 patients treated with LLLT after the surgery, whereas the control group included 21 patients without LLLT after the surgery who healed naturally. The LLLT equipment used in the research had a wavelength of 650 nm, 10 mW power, and 3.8 J/cm2 dosimetry, and the procedure was performed once daily for 5 min over 7 days, beginning 1 week postoperatively. All patients were followed up over 6 months to examine the changes in the size of the area of the non-vascularised graft and upper and inferior fornice depth. Results: The laser group presented a significantly increased speed of conjunctival vascularisation compared with the control group (P = 0.003). The fornice depth of contraction percentage was more apparent in the control group than that in the laser group (P = 0.000). Conclusion: LLLT accelerates conjunctival vascularisation, stimulates conjunctival incision healing within a short period, shortens the tissue repair process, reduces the local inflammatory response, and causes no significant shrinkage of the conjunctival sac. [ABSTRACT FROM AUTHOR]

Hala K Mattout, Sameh M Fouda, Haitham Y Al-Nashar&#x200EOphthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptCorrespondence: Hala K MattoutOphthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, EgyptEmail halamattout@gmail.com; HKMtoot@medicine.zu.edu.egPurpose: To report the outcomes of using topical mitomycin-C (MMC) after reconstructive surgery for contracted socket and to compare the results with those of the conventional postoperative treatment.Patients and Methods: The medical records of patients who underwent reconstructive surgery for contracted anophthalmic socket were retrospectively reviewed. Based on the postoperative treatment protocol, two groups of patients were identified; group I (15 patients) who received topical MMC drops (0.02%) 4 times daily for 6 weeks and group II (15 patients) who received the conventional treatment (topical antibiotic-steroid combination). Preoperative data were extracted for age, gender, cause and timing of anophthalmia, history of previous surgeries, preoperative forniceal depth and socket volume (SV). The main postoperative outcome measures were superior fornix depth (SFD), inferior fornix depth (IFD) and SV at the end of 6th postoperative month. Prosthesis fitting and complications were also considered for analysis.Results: The mean preoperative IFD was 1.67± 0.04 mm in group I and 1.58± 0.37 mm in group II, by the end of the 6th postoperative month it increased to 6.1 ± 0.27 mm and 5.12 ± 0.25mm, respectively. The mean preoperative SFD in group I was 8.3± 0.9 mm and 8.9± 1.1 mm in group II, by the end of the 6th postoperative month SFD became 13.4± 1.2 mm and 10.2± 1.4 mm in groups I and II, respectively. The mean SV measured six months postoperatively was 1.9± 0.2 mL and 1.3± 0.09 mL in groups I and II, respectively. These differences in the postoperative SFD, IFD and SV between both groups were statistically significant. More cases reported successful fitting in group I than in group II but this difference was not statistically significant.Conclusion: Postoperative use of topical MMC is associated with higher forniceal depth and greater SV when compared to the conventional treatment in socket reconstructive surgeries with amniotic membrane graft (AMG).Keywords: contracted socket, mitomycin-C, amniotic membrane graft, anophthalmic socket, MMC, AMG

Francesco M Quaranta-Leoni,1,2 Maria Grazia Fiorino,1 Flavia Quaranta-Leoni,3 Matteo Di Marino1 1Orbital and Adnexal Service, Villa Tiberia Hospital – GVM Care & Research, Rome, 00137, Italy; 2Oftalmoplastica Roma, Rome, 00197, Italy; 3Catholic University of the Sacred Heart, Rome, 00168, ItalyCorrespondence: Francesco M Quaranta-Leoni Email fquarantaleoni@gmail.comAbstract: Anophthalmic socket syndrome determines functional deficits and facial deformities, and may lead to poor psychological outcomes. This review aims to comprehensively evaluate the features of the syndrome, based on literature review and authors’ clinical and surgical experience. An electronic database (PubMed,MEDLINE and Google Scholar) search of all articles written in English and non-English language with abstract translated to English on anophthalmic socket syndrome was performed. Data reviewed included demographics, presentations, investigations, management, complications and outcomes. Different types of orbital implants were evaluated; the management of implant exposure was examined; different orbital volume enhancement procedures such as secondary implantation, subperiosteal implants and the use of fillers in anophthalmic patients were described; the problems related to socket contraction were outlined; the treatment options for chronic anophthalmic socket pain and phantom eye syndrome were assessed; the most recent advances in the management of congenital anophthalmia were described. Current clinical evidence does not support a specific orbital implant; late exposure of porous implants may be due to pegging, which currently is seldom used; filler absorption in the orbit appears to be faster than in the dermis, and repeated treatments could be a potential source of inflammation; socket contraction results in significant functional and psychological disability, and management is challenging. Patients affected by anophthalmic socket pain and phantom eye syndrome need specific counseling. It is auspicable to use a standardized protocol to treat children affected by clinical congenital anophthalmia; dermis fat graft is a suitable option in these patients as it helps continued socket expansion. Dermis fat graft can also address the volume deficit in case of explantation of exposed implants and in contracted sockets in both children and adults. Appropriate clinical care is essential, as adequate prosthesis wearing improves the quality of life of anophthalmic patients.Keywords: orbital implants, socket surgery, contracted socket, phantom eye syndrome, congenital anophthalmia

Purpose The aim of this study was to evaluate the effectiveness of a novel preadapted polymethyl methacrylate pressure prosthesis in patients with anophthalmic contracted sockets and its effect on their quality of life. Patients and methods This is a controlled randomized clinical trial that included two groups of patients, with 19 patients in each. Group A received the new preadapted customized prosthesis fixed by periosteal sutures through custom-made holes during the primary reconstruction, whereas group B received the traditional transparent conformer for 6–20 weeks followed by the final cosmetic prosthesis. Prosthesis tolerability, socket inflammation, edema, contraction, and quality of life were assessed by the Medical Outcome Study short form-36 items. Results Most of the patients (89.5%) in group A had a stable and well-centered prosthesis. Only two cases in this group had slightly shifted prosthesis without significant effect on the patient’s appearance. Group A had significantly shorter time (7.5±1.2 days) to return to their usual life activities and to uncover their prosthetic eye than group B (P

AIM: To perform a new method for orbital implant and contracted socket through one time and its results.METHODS: Totally 114 patients 114 eyes, from January 2008 to June 2014, with contracted socket participated in this study. We incised the bulbar conjunctiva horizontally and excised scar tissue, then implanted the hydroxyapatite in the four extraocular muscles and tightly sutured the Tenon' capsule. After that, we put the superior and inferior conjunctival petals backwards and sutured them to the Tenon's capsule. All the patients were divided into four groups according to the vertical diameter length of the conjunctival defect area: Group Ⅰ: ≤5mm; Group Ⅱ: 6-10mm; Group Ⅲ: 11-15mm; and Group Ⅳ: ≥16mm. These patients were followed up for 6mo to 3y to observe the conjunctival sac shaping and growth of conjunctiva.RESULTS: There were 64 cases in Group Ⅰ, 31 cases in Group Ⅱ, 16 cases in Group Ⅲ and 3 cases in Group Ⅳ. All patients' conjunctival defect was covered by new conjunctiva and scar tissue 4 to 6wk after surgeries. Ten cases had contracted socket; 2 cases had orbital implant exposure, requiring reoperation. Of the 114 cases, 8 had contracted socket and could use a smaller conformer, 106 could use a normal size conformer.CONCLUSION: When the conjunctival defect was ≤15mm, this new method can address the orbital implant and contracted socket at the same time. While it was ≥16mm, flap transplantation is necessary.

Background: This study aimed to evaluate the effects of mitomycin C on human tenon fibroblast proliferation in contracted socket tissue. Material and Methods: Human tenon fibroblasts from a patient who underwent socket reconstruction surgery were cultured in vitro. Cell cultures were exposed to 0.2, 0.4, and 1 mg/ml of mitomycin C solution for 5 min, and serum-free culture medium was used as a control. Proliferation was observed with the MTT cell proliferation assay 24 h after treatment. Results: A 5 min exposure to mitomycin C at 0.2, 0.4, and 1 mg/ml caused inhibition of fibroblast proliferation (p < 0.05). The dose of mitomycin C was not significantly related to the rate of fibroblast proliferation inhibition. Mitomycin C 0.4 mg/ml caused the greatest inhibition of fibroblast proliferation compared with doses of 0.2 and 1 mg/ml. Conclusion: Mitomycin C can inhibit tenon fibroblast proliferation of contracted socket tissue. Dose escalation of mitomycin C is not related to the rate of fibroblast proliferation inhibition. [ABSTRACT FROM AUTHOR]

Aim : To evaluate the efficacy of modified temporalis muscle transfer (TMT) by silicone sling for the management of paralytic lagophthalmos. Settings and Design: Prospective interventional study. Materials and Methods : Ten patients of lagophthalmos due to facial palsy underwent modified TMT using silicone sling. The patients were followed-up for a period of 3 months. Palpebral aperture in primary gaze and during eye closure were assessed both pre- and postoperatively along with problems associated with lagophthalmos like exposure keratopathy and lacrimation. Statistical Analysis : Paired t-test was applied to measure the statistical outcome. Results : Eight patients achieved full correction of lagophthalmos with no lid gap on closing the eye. The mean (standard deviation (SD)) lid gap on eye closure was 7.7 (0.86) mm preoperatively, 0.5 (0.47) mm at 1 st postoperative day, and 0.7 (0.75) mm at 3 rd month. There was a reduction in mean lid gap on eye closure of 7 mm at 3 months (P < 0.0001) which is highly significant. The mean (SD) vertical interpalpebral distance during primary gaze was 12.05 (1.12) mm preoperatively, 10 (0.94) mm at 1 st postoperative day, and 10.35 (1.08) mm at 3 rd month. There was a reduction in mean vertical inter palpebral distance of 1.7 mm at 3 months (P = 0.001) which is significant. Exposure keratitis decreased in five out of six patients at 3 months. Conclusion : Modified TMT by silicone sling is a useful procedure with lesser morbidity and good outcomes for the treatment of paralytic lagophthalmos due to long standing facial palsy.

Purpose: To evaluate the role of echography in diagnosis and management of a diverse array of choroidal masses. Materials and Methods: Sixty-two cases of clinically suspected choroidal masses were prospectively analyzed with B-scan (10 Hz), A-scan, and ultrasound biomicroscopy (UBM) (50 Hz) after a meticulous history and ocular examination. Ancillary investigations and systemic evaluation were also done. Results: Based on clinical suspicion, acoustic features, response to treatment, and other ancillary tests combined together, the various masses were differentiated. The cases included in the study were as follows: n = 10 malignant melanomas, n = 16 metastasis and infiltrations, n = 9 hemangioma, n = 7 tuberculoma, n = 8 nonspecific inflammatory masses, n = 2 disciform plaques, n = 4 macular cysts or retinoschisis, n = 2 Coat′s disease, n = 1 melanocytoma, and n = 2 osteomas. Ultrasonography (USG) alone could identify n = 51 lesions, while UBM in combination with USG was needed in remaining 11 masses. Conclusion: Standardized echography is an important adjunct in the diagnosis and management of eyes with intraocular masses. A better understanding of the clinicopathological and echographic picture of the diverse lesions can help in detection, differentiation, diagnosis, proposing a therapeutic approach, and also monitoring response to treatment. Echography is essential to evaluate tumors for extrascleral and anterior segment extension.

Aim: To determine profiles of non-chlamydia conjunctival bacteria and their antimicrobial susceptibility from adults who underwent trachomatous trichiasis surgery in rural areas of Ethiopia. Materials and Methods: A cross-sectional study was conducted in rural districts in West Gojjam administrative zone. Conjunctival swabs were collected during surgery and transported using Stuart transport broth (Oxoid, UK). Antibiotic susceptibility of conjunctival isolates was determined using the Kirby-Bauer disc-diffusion method. Results: Non-chlamydia pathogenic bacteria were recovered from conjunctiva of 438 (31%) participants before treatment. The isolated conjunctival bacteria were Staphylococcus aureus, coagulase-negative Staphylococci, Streptococcus group (A, C, F and G), Enterococci, Streptococcus pneumoniae, Moraxella spp., Escherichia coli, Citrobacter spp., Proteus spp., Klebsiella spp., Pseudomonas spp. and Enterobacter spp. Overall, resistance rates of 57.8% to azithromycin and 68.5% to chloramphenicol were found. However, 86-94.4% sensitivity was demonstrated to ciprofloxacin and norfloxacin. Moderate sensitivity rates (61.8-78.4%) were observed to ceftriaxone, tetracycline and cotrimoxazole. Conclusion: Fluoroquinolones that have activity against the majority of bacterial isolates were potent at in vitro. However, unacceptably high levels of resistance to azithromycin and chloramphenicol in rural community indicated a need for further study and antimicrobial resistance surveillance.

Purpose: The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG). Study Design: Prospective comparative study. Materials and Methods: A total of 24 patients of severe socket contracture (Grade 2-4 Krishna′s classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed-up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured. Results: In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant. Conclusion: Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention.

Purpose: This study was aimed at reporting the outcomes of trabeculectomy in primary juvenile open angle glaucoma (JOAG). Design: This study was a retrospective noncomparative case series. Materials and Methods: We included 60 eyes of 41 JOAG patients who underwent primary trabeculectomy without mitomycin-C (MMC) between 1995 and 2007. The primary outcome was success, defined as complete, if intraocular pressure (IOP) was >5 and ≤21 mmHg without medications or qualified if IOP was >5 and ≤21 mmHg with or without antiglaucoma medications. Secondary outcome measures were mean and percentage IOP reduction, complications, and risk factors for the failure of trabeculectomy. Results: The mean (±standard deviation) age at presentation was 24.1 ± 6.8 years (range, 12-35). Mean follow-up was 67 ± 41 months (range, 12-156). At 1 year, the probability of complete success was 92% (n = 56, 95% CI: 81-96%), at 3 years it was 89% (n = 47, 95% CI: 78-95%), and at the end of 5 years, it was 80% (n = 34, 95% CI: 65-89%). The probability of qualified success was 100% (n = 60) at 1 year, 98% (n = 51, 95% CI: 87-100%) at 3 years, and 96% (n = 36, 95% CI: 84-99%) at the end of 5 years. The mean IOP reduced from 35 ± 10 to 13 ± 2.5 mmHg (P < 0.001) after trabeculectomy. There was no serious postoperative complication. Young age was the only significant risk factor associated with the failure (odds ratio = 0.89, P = 0.03). Conclusion: Primary trabeculectomy without MMC has good success rates in JOAG.

In this retrospective case series, we report the spectrum and outcomes of aggressive posterior retinopathy of prematurity (APROP) in infants ≥1500 g birth weight. Twenty-nine eyes of 15 infants are included. All infants were referred from level I or II nurseries, received supplemental unmonitored oxygen for prolonged duration (>1 week) and had multiple systemic co-morbidities. Of the 29 eyes, 10 (34.5%) had zone 1 and 19 (65.5%) had posterior zone 2 disease. Twenty-five (86.2%) eyes had flat neovascularization and 4 (13.8%) eyes had brush like proliferation. We noticed large vascular loops in 10 (34.5%) eyes. After confluent laser photocoagulation, 22 (75.9%) eyes had a favorable outcome. The study concludes that APROP in heavier (≥1500 g birth weight) premature infants occurs mostly in posterior zone 2 with flat neovascularization and atypical features like large vascular loops. Supplemental unmonitored oxygen for prolonged duration and multiple systemic co-morbidities could be a contributing factor.

Purpose: The purpose of this study is to evaluate the lateral rectus periosteal fixation and partial vertical rectus transpositioning (VRT) as treatment modalities to correct exotropic Duane retraction syndrome (Exo-DRS). Materials and Methods: Prospective interventional case study of cases of Exo-DRS with limitation of adduction. A total of 13 patients were subdivided into two groups. Six patients underwent only lateral rectus periosteal fixation (group A) and seven patients also underwent partial VRT (group B). Assessment involved prism bar cover test, abduction and adduction range, extent of binocular single visual field and exophthalmometry. These tests were repeated at 1 week, 1 month and 3 months post-operatively and data analyzed. Results: The pre-operative mean values and ranges were 26.2 Δ (22-35) exotropia for group A and −21.3 Δ (14-30) exotropia for group B. The post-operative mean and range was +0.6 Δ esotropia (+20 to −8) for group A and 8 Δ (−2 to −20) exotropia for group B. Mean grade of limitation of abduction changed from −3.8 to −3.6 versus −3.6 to −2.8 and mean grade of limitation of adduction changed from −1.9 to −0.7 versus −1.5 to −0.5 in the groups A and B respectively. Mean binocular single visual field changed from 14.7° to 23.3° in group A and 11.8° to 26.4° in the group B respectively. Conclusion: Lateral rectus periosteal fixation is an effective surgery to correct the exodeviation, anomalous head posture and improving adduction in Exo-DRS and partial VRT in addition is effective in improving abduction and binocular single visual fields.

Purpose: To compare the outcome of Collagen cross-linking (CXL) with that following topography-guided customized ablation treatment (T-CAT) with simultaneous CXL in eyes with progressive keratoconus. Materials and Methods: This was a prospective, non-randomized single centre study of 66 eyes with progressive keratoconus. Of these, 40 eyes underwent CXL and 26 eyes underwent T-CAT + CXL. The refractive, topographic, tomographic and aberrometric changes measured at baseline, 1, 3 and 6 months post-operatively were compared between both groups. Results: After a mean follow-up of 7.7 ± 1.3 months, the mean retinoscopic cylinder decreased by 1.02 ± 3.16 D in the CXL group ( P = 0.1) and 2.87 ± 3.22 D in the T-CAT + CXL group ( P = 0.04). The Best corrected visual acuity increased by 2 lines or more in 10% of eyes in the CXL group and in 23.3% of eyes in the T-CAT + CXL group. The mean steepest-K reduced by 0.40 ± 3.71 D ( P = 0.77) in the CXL group and by 2.91 ± 2.01D ( P = 0.03) in the T-CAT + CXL group. The sag factor and surface asymmetry index showed no significant change in the CXL group but reduced by 3.59 ± 5.94 D ( P = 0.01) and 0.72 ± 1.18 ( P = 0.02) respectively in the T-CAT + CXL group. There was a significant increase in the highest posterior corneal elevation in both groups (9.57 ± 14.93 μ in the CXL group and 7.85 ± 9.25 μ in the T-CAT + CXL group, P ≤ 0.001 for both). There was significantly greater reduction of mean coma ( P < 0.001) and mean higher-order aberrations ( P = 0.01) following T-CAT + CXL compared to CXL. Conclusions: CAT + CXL is an effective approach to confer biomechanical stability and to improve the corneal contour in eyes with keratoconus and results in better refractive, topographic and aberrometric outcomes than CXL alone.

We performed endothelial keratoplasty (EK) in three eyes of two siblings (2.5 years, male and 3.5 years, female) with congenital hereditary endothelial dystrophy (CHED) and report the intraoperative and postoperative difficulties. Repeated iris prolapse, apprehension of crystalline lens touch due to positive vitreous pressure, and need for frequent air injections to attach the graft were intraoperative challenges in all three eyes. These were addressed by use of Sheet′s glide instead of Busin′s glide during graft insertion and suturing of main and side ports before air injection. One eye had graft dislocation on second postoperative day due to eye rubbing by the child. Graft was repositioned with air and a venting incision was created. Postoperative examination required repeated general anesthesia. Corneal edema resolved completely in all three eyes. Present case series highlights the possible intraoperative and postoperative challenges and their solutions in pediatric EK for CHED.

Purpose: To analyze the complications and their managements in Descemet′s stripping endothelial keratoplasty (DSEK) in consecutive 430 cases by single surgeon in a tertiary eye hospital. Materials and Methods: 430 eyes of 366 patients with endothelial dysfunctions scheduled for DSEK, were analyzed retrospectively. In all cases donor dissection was performed manually, and ′Taco′ insertion and unfolding technique was used. Intra-operative and postoperative complications with their managements and outcomes were reviewed retrospectively. Periodic endothelial cell density was analyzed for each patient till the last visit. Follow-up period was between 3 to 60 months (mean 18.7 months). Results: 13 (3.0%) eyes had operative complications during donor dissection and 16 (3.7%) had during recipient procedure. In 7 (1.6%) eyes, donor lenticule was replaced with a new one during the surgery. In early postoperative period, 21 (4.9%) eyes had donor dislocation and 12 (2.8%) eyes had air-induced pupillary block; and they were managed immediately. 2 cases had primary graft failure and in 1 case had postoperative bacterial endophthalmitis requiring evisceration. In late postoperative period, 48 (11.3%) eyes had secondary glaucoma and 14 (3.3%) eyes had late secondary graft failure. Endothelial rejection occurred in 5 (1.2%) cases. Mean endothelial cell loss was 19.7% after 3 months and 54.2% after 5 years. Total graft failure in this series was 31 (7.2%) and in 17 cases re-DSEK was performed successfully. Conclusions: Both operative and postoperative complications do occur in DSEK. Most of these complications can be managed by medical or appropriate surgical means. Some of the complications can be avoided and reduced with experience.

Context: The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers. Aims: We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts. Settings and Design: We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group. Materials and Methods: The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item "True/False/I don′t know" quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively. Statistical Analysis Used: Scores on the quiz were compared across groups and time-points using paired t-tests. Results: Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10 -6 ) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10 -16 ). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes. Conclusion: Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.

Background : Konkan coast of India is geographically distinct and its pattern of blindness has never been mapped. Aim : To study the prevalence and causes of blindness and cataract surgical services in Sindhudurg district of West Coast. Subjects : Individual aged > 50 years. Materials and Methods: Rapid assessment of avoidable blindness used to map blindness pattern in the district. Statistical analysis: SPSS version 19. Results: Amongst those examined 1415 (51.7%) had visual acuity (VA) >20/60, 924 (33.8%, confidence interval (C.I) 30.5%-36.8%) had VA 20/200-

Aim : To study long term outcome of bilateral congenital and developmental cataract surgery. Subjects: 258 pediatric cataract operated eyes of 129 children. Materials and Methods: Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF) were noted for before and after surgery. Statistics: Statistical analysis was done with SPSS version 16 including multi-variate analysis. Results: Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years) at the time of surgery. 74/129 (57.4%) were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years). 177 (68.6%) eyes had vision 6/18 and 157 (60.9%) had BCVA >6/60 3-8 years after surgery. 48 (37.2%) had binocular stereoacuity

Aim of Study: The aim of current work was to evaluate in vitro anticataract potential of Moringa oliefera extract. Materials and Methods: Goat eye lenses were divided into 4 groups; Group served as control, Group II as toxic control, Group III and Group IV were incubated in extract (250 μg/ml and 500 μg/ml of extract of M. oliefera) Group II, III and IV were incubated in 55 mM glucose in artificial aqueous humor to induce lens opacification. Estimation of total, water soluble protein, catalase, glutathione and malondialdehyde along with photographic evaluation of lens was done. Results: Group II (toxic control) lenses showed high amount of MDA (Malondialdehyde), soluble, insoluble protein, decreased catalase and glutathione levels, while lenses treated with Moringa oliefera extract (Group III and Group IV) showed significant (FNx01 P < 0.05) reduction in MDA and increased level of catalase, glutathione, total and soluble protein. Conclusion: Results of present findings suggest protective effect of Moringa oliefera in prevention of in vitro glucose induced cataract.

Aim: To report our experience of brachytherapy using ′BARC I-125 Ocu-Prosta seeds′ for the management of intraocular tumors with regard to tumor control, globe preservation visual outcome, and patient survival at Sankara Nethralaya, Chennai, India between September 2003 and May 2011. Materials and Methods: We reviewed records of 35 eyes of 35 patients who underwent ophthalmic brachytherapy between September 2003 and May 2011. Twenty-one cases had choroidal melanoma, nine had childhood retinoblastoma, two had adult-onset retinoblastoma, and there were one case each of vasoproliferative tumor, retinal angioma, and ciliary body melanoma. Brachytherapy was administered using a 15- or 20-mm gold plaque with or without a notch. Brachytherapy was the primary treatment modality in all tumors other than retinoblastoma, wherein brachytherapy was done post chemoreduction for residual tumor. Results: For choroidal melanomas, the mean radiation dose was 68.69 ± 15.07 (range, 47.72-94.2) Gy. The eye salvage rate was 13/20 (65%) and tumor control rate was 16/20 (80%) at an average follow-up of 24.43 ± 24.75 (range, 1.5-87.98) months. For retinoblastoma, the mean dose was 45.85 ± 3.90 (range, 39.51-50.92) Gy. The eye salvage rate and tumor control rate was 5/6 (83.3%) at an average follow-up of 38.36 ± 31.33 (range, 4.14-97.78) months. All eyes with retinoblastoma needed additional focal therapy for tumor control and eye salvage. Conclusion: The results of this retrospective study confirms that the use of ′BARC I-125 Ocu-Prosta seeds′ in episcleral plaques to treat intraocular tumors offers a viable option for the management of intraocular cancers.

Context: Contrast sensitivity (CS) function is one of the most important tests available for evaluating visual impairment. Multiple sclerosis (MS) can produce highly selective losses in visual function and psychophysical studies have demonstrated CS deficits for some spatial frequencies. Aims: This work studies the differences in CS between a group of controls and a group of MS patients, focusing on the location of the maximum sensitivity peak, shape of the curve, and determination of the most affected spatial frequencies. Materials and Methods: Using a sinusoidal stimulus the authors assessed CS function in 28 subjects with definitive relapsing remitting MS, and in 50 controls with acuities of 20/25 or better. The peaks of the CS curves were studied by fitting third degree polynomials to individual sets of data. Results: Compared with the control group, the CS function curve for MS subjects showed more deficits in extreme points (low- and high-spatial frequencies). Our results display significant CS losses, at the high-frequencies band level, in the beginning of the disease. When the disease progresses and the disabilities appear, there are greater losses at the low-frequencies band level. In average, the CS curve peaks for the MS group were shifted in relation to the control group. Conclusions: CS losses in the MS group suggest an association with ageing and disability level in the expanded disability status scale. The position of the CS function peak is influenced by MS, age, and degree of disability.

Purpose: To compare clarity, exposure and quality of anterior chamber angle visualization in congenital glaucoma patients, using RetCam and indirect gonioscopy images. Design: Cross-sectional study Participants. Congenital glaucoma patients over age of 5 years. Materials and Methods: A prospective consecutive pilot study was done in congenital glaucoma patients who were older than 5 years. Methods used are indirect gonioscopy and RetCam imaging. Clarity of the image, extent of angle visible and details of angle structures seen were graded for both methods, on digitally recorded images, in each eye, by two masked observers. Outcome Measures: Image clarity, interobserver agreement. Results: 40 eyes of 25 congenital glaucoma patients were studied. RetCam image had excellent clarity in 77.5% of patients versus 47.5% by gonioscopy. The extent of angle seen was similar by both methods. Agreement between RetCam and gonioscopy images regarding details of angle structures was 72.50% by observer 1 and 65.00% by observer 2. Conclusions: There was good agreement between RetCam and indirect gonioscopy images in detecting angle structures of congenital glaucoma patients. However, RetCam provided greater clarity, with better quality, and higher magnification images. RetCam can be a useful alternative to gonioscopy in infants and small children without the need for general anesthesia.

Purpose: This work was conducted to study the ability of bacterial and fungal isolates from keratitis cases in Upper Egypt to produce enzymes, toxins, and to test the isolated fungal species sensitivity to some therapeutic agents. Materials and Methods: One hundred and fifteen patients clinically diagnosed to have microbial keratitis were investigated. From these cases, 37 bacterial isolates and 25 fungal isolates were screened for their ability to produce extra-cellular enzymes in solid media. In addition, the ability of fungal isolates to produce mycotoxins and their sensitivity to 4 antifungal agents were tested. Results: Protease, lipase, hemolysins, urease, phosphatase, and catalase were detected respectively in 48.65%, 37.84%, 59.46%, 43.24%, 67.57%, and 100% out of 37 bacterial isolates tested. Out of 25 fungal isolates tested during the present study, 80% were positive for protease, 84% for lipase and urease, 28% for blood hemolysis, and 100% for phosphatase and catalase enzymes. Thirteen fungal isolates were able to produce detectable amounts of 7 mycotoxins in culture medium (aflatoxins (B1, B2, G1, and G2), sterigmatocystin, fumagillin, diacetoxyscirpenol, zearalenone, T-2 toxin, and trichodermin). Among the antifungal agents tested in this study, terbinafine showed the highest effect against most isolates in vitro. Conclusion: In conclusion, the ability of bacterial and fungal isolates to produce extracellular enzymes and toxins may be aid in the invasion and destruction of eye tissues, which, in turn, lead to vision loss.

We describe the ocular alterations and the management after stings from Hymenopteran insects. In all the five patients, the insect was identified as bee. The patients presented with significant corneal edema, which resolved dramatically in three of them after removal of stingers. Among the other two one went for permanent corneal decompensation and the other developed Intumuscent cataract with increased intraocular pressure. Although a rare occurrence, ocular trauma caused by Hymenopteran insects has a potential to cause severe ocular damage in humans. A high level of clinical suspicion and immediate removal of the stingers along with administration of high doses of topical and systemic steroids is a must to prevent chances of permanent corneal damage and intraocular complications.

Objective: To investigate the clinicopathological correlation of parapapillary atrophy. Materials and Methods: The study included 16 eyes of rhesus monkeys (Macaca mulatta) - 4 eyes with experimental glaucoma, 11 eyes after experimental temporary occlusion of the central retinal artery, and 1 normal eye. On histological sections, we measured zones with different histological characteristics.On fundus photographs, alpha zone and beta zone of parapapillary atrophy were measured and correlated with the histological data. Results: The size of the clinical alpha zone of parapapillary atrophy was significantly correlated with the size of the histological region with irregularities of the retinal pigment epithelium (P = 0.05; correlation coefficient r = 0.49) and with the size of the histological region with a decreased density of retinal photoreceptors (P = 0.01; r = 0.60). The size of clinical beta zone of parapapillary atrophy significantly correlated with the size of the histological region with complete loss of the retinal pigment epithelium (P

Progressive anterior segment fibrosis syndrome (ASFS), after intraocular surgery in older children (≥9 years) and adults with congenital aniridia, is described in the literature. In this report, we describe an unique case of ASFS in an infant with congenital aniridia following a combined trabeculotomy-ectomy and its recurrence after a descemet stripping endothelial keratoplasty. The ophthalmologists should be well aware of this entity and warn the parents about its possibilities. Use of immunomodulators or prolonged anti-inflammatory therapy may be considered to prevent its occurrence.

Purpose: To evaluate the use of intraoperative topical application of mitomycin C (MMC) for managing cases of recurrent socket contraction.Methods: A prospective comparative randomized study was carried out on 40 patients suffering from contracted sockets. They were randomly enrolled into 2 groups. Group A included 20 patients who had a surgery to treat contracted socket without augmentation with MMC. Group B patients had an MMC-augmented repair for the contracted socket. Patients were followed up over a period of 12 months for changes in inferior fornix (IF) depth and ability to retain the ocular prosthesis.Results: At the end of the follow-up period, postoperative IF depth was significantly deeper in group B (with MMC) than in group A (without MMC). As well, 75% of the patients in group B could maintain the prosthetic eye shell, whereas only 35% of group A could maintain the prosthesis.Conclusion: This study shows that using intraoperative MMC (0.2 mg/mL) in contracted socket reconstruction plays a significant role in maintaining prosthetic eye. To the best of our knowledge, this study is the first to use MMC on a relatively large scale of patients with contracted socket. However, the follow-up period was relatively short and further work is required to verify the effect of MMC on a longer follow-up period. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of our study is to present a surgical technique of primary porous orbital ball implantation with overlying mucus membrane graft (MMG) for reconstruction of severely contracted socket and to evaluate prosthesis retention and motility in comparison to dermis fat graft (DFG). Study Design: Prospective comparative study. Materials and Methods: A total of 24 patients of severe socket contracture (Grade 2-4 Krishna's classification) were subdivided into two groups, 12 patients in each group. In Group I, DFG have been used for reconstruction. In Group II, porous polyethylene implant with MMG has been used as a primary procedure for socket reconstruction. In Group I DFG was carried out in usual procedure. In case of Group II, vascularized scar tissues were separated 360° and were fashioned into four strips. A scleral capped porous polyethylene implant was placed in the intraconal space and four strips of scar tissue were secured to the scleral cap and extended part overlapped the implant to make a twofold barrier between the implant and MMG. Patients were followed-up as per prefixed proforma. Prosthesis motility and retention between the two groups were measured. Results: In Group I, four patients had recurrence of contracture with fall out of prosthesis. In Group II stable reconstruction was achieved in all the patients. In terms of prosthesis motility, maximum in Group I was 39.2% and Group II, was 59.3%. The difference in prosthesis retention (P = 0.001) and motility (P = 0.004) between the two groups was significant. Conclusion: Primary socket reconstruction with porous orbital implant and MMG for severe socket contracture is an effective method in terms of prosthesis motility and prosthesis retention. [ABSTRACT FROM AUTHOR]

Background: To evaluate the effects and side-effects of serial sub-conjunctival injections of 5-fluorouracil (5-FU) in early postoperative period for recurrent anophthalmic contracted socket. Methods: Retrospective comparative case series at tertiary eye care centre including fifteen adult patients with features of postoperative recurrent socket contraction after buccal mucosal graft. Group A comprised eight patients treated with 10 mg weekly sub-conjunctival injection of 5–FU in the fornices. Group B comprised seven patients taken as control. Main outcome measures were: superior fornix depth (SFD), inferior fornix depth (IFD), and socket volume (SV) at 6 months follow up. Patients were re-evaluated clinically for recurrence at last follow-up. Results: The mean ± SD values in group A versus group B were as follows: 10 ± 1.6 mm vs 5.1 ± 0.9 mm ( p < 0.005) for SFD, 6.7 ± 1.5 mm vs 3.5 ± 0.5 mm ( p = 0.02) for IFD; and 2 ± 0.55 ml versus 0.27 ± 0.06 ml ( p = 0.005) for SV at 6 months. There was significant improvement in depth of fornices and volume of socket in seven patients in group A. One patient in group A did not benefit from 5-FU treatment. The beneficial effects of 5-FU were observed when first injection was given within 4 weeks after socket reconstruction. There was no recurrence (in six cases) and no side-effects seen in group A at final follow-up of 18.2 (12–24) months. Conclusions: Weekly injections of 5-FU are effective for stopping the progression of recurrent contracted socket following primary reconstructive surgery. It provides early rehabilitation, and avoids repetitive surgery. [ABSTRACT FROM AUTHOR]

Summary: Objective: To present a surgical technique for socket reconstruction in cases in which forniceal shortening by scar has made it difficult to successfully wear an ocular prosthesis. Methods: A retrospective analysis of 19 contracted eye sockets that underwent forniceal reconstruction with meshed conjunctival incision technique from 2009 to 2012. The technique included three steps: meshed conjunctival incision, lower forniceal reconstruction and upper fornix incision. Results: There were 17 male and two female patients, with an age range between 6 and 67 years. Duration of forniceal shortening varied from 6 months to 8 years. The mean follow-up period was 13.6 months. All patients were able to wear and maintain an acceptable prosthesis following the surgical procedure. Only two patients had mild entropion which occurred at 1 month. No cases of postoperative exposure, infection, extrusion or granuloma formation were encountered. Conclusion: The meshed conjunctival incision technique is a simple, safe and effective method for treating a contracted socket. Most of the patients obtained aesthetically satisfactory results at follow-up from 3 months to 3 years post surgery. [Copyright &y& Elsevier]

Dermis-fat graft (DFG) is often the only promising option in cases of severely contracted sockets. However, there is an increased risk of graft failure in irradiated sockets with decreased vascularity. In such difficult cases, repeat DFG implantation also has higher risks of graft failure. We describe an ingenious method of successful management of an irradiated anophthalmic socket following DFG infection and necrosis, with acceptable cosmetic results. At surgery, an orbital impression was taken with ophthalmic grade alginate. Based on this measurement, a custom-made stem pressure socket-expander made up of high density polymethyl methacrylate (PMMA) was fitted, a week post surgery and kept in situ for six weeks. On review, the fornices had considerably deepened. The expander device was removed and the patient was now fitted with a custom-made thicker prosthesis made up of high-density PMMA. The patient has followed up for a year subsequently and the prosthesis has remained stable.

The authors report the case of a 20-year-old man who underwent enucleation of his right eye with teratoma when he was an infant, without volume replacement by an implant. As a result, an underdeveloped shallow bony orbit finally occurred. Also, a contracted socket was present with shallow lower fornix, making ophthalmic prosthesis fitting almost impossible. The patient underwent surgical reconstruction of the orbit with expansion of the orbit vertically and horizontally. A secondary implant with an adequate volume was inserted to correct the orbital volume deficit. The previous expansion of the orbit allowed the insertion of an 18 mm-diameter hydroxyapatite implant wrapped in fascia lata. The lower fornix was expanded with a mucosal graft in order to overcome the socket contraction and the conjunctival shortage. The authors conclude that the final result of this approach is satisfactory. Almost 20 years after enucleation of an eye with teratoma, an attempt was made to correct most of the difficult problems dealing with a malformed shallow orbit and a contracted socket. The young patient is now able to wear a fine ophthalmic prosthesis and his appearance is greatly improved. [ABSTRACT FROM AUTHOR]