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Purpose: To study vessel density (VD) on Optical Coherence Tomography Angiography (OCTA) at choroid, chorio-capillaries (CC) & various retinal levels in normal population & various stages of dry AMD & how these changes progress with increase in severity of the disease. Methods: Prospective, observational , cross-sectional study done on 252 eyes of 132 patients presenting to tertiary care centre in Central India between February 2021 to January 2022. For study purpose, eyes were divided into 5 groups according to the size and number of the drusen, viz, Group 1: No AMD ( 50 years) , Group 3 : Early AMD and Group 4 : Intermediate AMD & Group 5 : Advanced AMD. In all eyes , VD was measured at choroid , CC, Deep capillary plexus (DCP) of retina & superficial capillary plexus (SCP) of retina. Results: There were total 61 males & 71 females in the study . The mean age in case cohort is 61.90 ± 7.97 years with 52 (51.48%) males and 49 (48.51%) females. At choroidal level, the mean vascular density differed significantly across diagnosis types in all the quadrants (p < 0.05). Similar was the observation at CC & DCP level. At SCP level, except in central quadrant, the differences for remaining quadrants were significant across the groups. At SCP & DCP increase in VD is seen in early AMD cohort compared to No AMD (> 50 years) cohort, which showed continuous reduction later in intermediate & advanced AMD cohort. Conclusion: With increase in the severity of disease, significant reduction in VD is also seen in retinal plexuses, along with the changes in choroid & CC. These VD maps may play a role as non-invasive biomarkers for healthy & diseased aging.

To study the anatomical success rate of light amplification by stimulated emission of radiation (LASERS) as first line of management in stage 4A retinopathy of prematurity (ROP). Observational, prospective case series of 14 eyes of 7 babies (males: 3, females: 4) with stage 4A ROP who underwent LASERS for stage 4A between January 2018 and July 2019. Gestation age (GA), birth weight (BW), and post-menstrual age (PMA) at which laser was done were noted in all cases. A number of clock hours of detachment at the time of presentation were noted in all babies. All babies were followed up up to 6 months after laser for any recurrence. Success was defined as complete regression of disease without the need of any other modality of treatment like anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy. A total of 92.85% (13/14) showed complete regression of disease. One eye progressed to stage 4B ROP warranting lens-sparing vitrectomy (LSV). LASERS is an effective method of management without any need of anti-VEGF or surgical intervention even in babies with stage 4A ROP.

Purpose: The purpose of this study was to determine the effects of dexamethasone implant (0.7 mg) on biomarkers such as hyper-reflective dots, external limiting membrane integrity and disorganization of retinal inner layers in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases with diabetic macular edema and its effects on edema and visual acuity. Methods: This is a prospective study of treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder patients with diabetic macular edema, treated with single dexamethasone implant. Pre- and post-injection-based best-corrected visual acuity, central macular thickness, hyper-reflective dots, external limiting membrane integrity and disorganization of retinal inner layers were assessed. Results: A total of 27 diabetic macular edema eyes, including 9 non-responder eyes, 9 eyes which received less than three anti-vascular endothelial growth factor injections and 9 treatment-naïve eyes, were included in this study. Baseline hyper-reflective dots were 22.22 ± 11.76, 30 ± 7.91 and 19.44 ± 8.82 which reduced to 3.33 ± 1.32, 9 ± 8.35 and 8.78 ± 2.53 four months after implant in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases, respectively. Baseline central macular thickness was 589.44 ± 175.37, 537 ± 181.81 and 673.11 ± 138.24 and the central macular thickness after dexamethasone implant was 272.11 ± 39.00, 336.44 ± 132.88 and 524.00 ± 200.39 in treatment-naïve patients, patients who received less than three anti-vascular endothelial growth factor injections and non-responder cases, respectively. External limiting membrane integrity was restored in two patients in each group, whereas two patients with disorganization of retinal inner layers in treatment-naïve group showed reorganization of retinal structures after treatment with dexamethasone implant. Conclusion: Better response to dexamethasone implant in cases with more hyper-reflective dots shows that these hyper-reflective dots can be used as a predictive biomarker. Dexamethasone implant might help in restoring external limiting membrane integrity and resolution of disorganization of retinal inner layers.

Purpose: The purpose of this study is to study the anatomic and functional success of pars plana vitrectomy (PPV) in rhegmatogenous retinal detachments (RRD) with choroidal detachment (CD) after the complete settlement of CD following oral steroids. Materials and Methods: A prospective, observational, case series was conducted on 30 eyes of 30 patients with RRD with CD during January 2014–October 2017. Oral steroids (tablet omnacortil in dose of 1 mg/kg) were started before surgery, and the patient underwent PPV after choroidals was settled (approximately 5–7 days after starting oral steroids). Primary and final anatomical success rates and functional success rates were obtained. The exclusion criteria included previous retinal detachments surgery, combined RRD, and traumatic RRD. Results: Primary success was 53.3% (16/30) Final success was observed in 80% cases. Sixty percent of patients achieved best-corrected visual acuity of >20/200. Conclusion: The perioperative use of oral steroids help in increasing the success rate by reducing hypotony and reducing inflammatory component.

Aim: A case which highlights the challenges faced in treating a case of type 1 early treatment of retinopathy of prematurity (ETROP) with persistent corneal defect. Case Report: We report a case of a preterm boy born at 28 weeks with birth weight of 700 g who presented with persistent corneal defect along with type 1 ETROP disease. Because of the inability to complete LASER, intravitreal ranibizumab was given as a rescue therapy to buy some time. But unfortunately, baby succumbed to disease because of associated systemic problems. Conclusion: ROP can present with persistent corneal defect which can challenge the treatment of underlying pathology.

Purpose: The aim of this study was to evaluate the application and safety of three-dimensional (3D) visualization system in varied anterior segment procedures and Scleral Buckle. Methods: This was a prospective observational study of 313 eyes. Patients undergoing phacoemulsification (PE) with intraocular lens (IOL), trabeculectomies, glaucoma triple procedure (GTP), scleral fixated (SF) IOL, and scleral buckle (SB) were included in the study. Cases were randomly distributed in 3D visualization system (learning and post-learning phase) and conventional microscope group. Parameters studied were complications (intraoperative and early postoperative), surgical outcomes, and surgeon's perspective on various parameters (through a validated questionnaire) like surgical time, time lag, learning curve, ease of doing various steps and its value as an educational tool, for both groups [Questionnaires 1 and 2]. Results: Complications rates were not different in two groups. Surgical outcomes (anatomical and physiological) were similar in both the groups. Mean duration of surgery in PE+IOL, Trabeculectomy, GTP in learning stage by 3D was significantly higher than Microscope, which became insignificant in postlearning stage. For, SB and SFIOL, duration between two groups were insignificantly different. There was significant learning struggle in PE+IOL, SB, and Trabeculectomy. Image resolution, depth perception, illumination and postural comfort was graded higher for 3D surgery across the stages. Time lag, poor color contrast, and field of view were appreciated during the learning stage. Educational relevance of 3D was higher, as appreciated by resident and nurses. Conclusion: 3D surgery is as safe, faster, and predictable after initial learning struggle. Even in anterior segment procedure, no apparent lag was appreciated after learning curve.

This is a case report which highlights the challenges faced in treating Type 1 early treatment of retinopathy of prematurity (ETROP) with corneal haze. We report a case of a preterm boy born at 28 weeks with birth weight of 1000 g who presented with corneal haze along with Type 1 ETROP. Because of inability to complete LASER and increase in posterior plus disease , intravitreal ranibizumab was given as a rescue therapy to buy time. Finally, we could succeed in treating the disease with complete regression and clear cornea on the last follow-up.

Purpose: A case of disc drag as a cicatricial sequelae of spontaneously regressed threshold ROP. Case report: 8 months old male baby was brought for examination for Right eye strabismus noted since 1 month. Examination revealed disc drag with falciform fold from disc to ora with peripheral fibrous proliferation. Past history revealed preterm birth of baby at 28 weeks of gestation age with birth weight of 1170 grams. Old reports suggested Both Eyes Zone 2 Stage 3 threshold ROP with haemorrhage in right eye, at post menstrual age (PMA) of 31 weeks for which baby was advised laser. No treatment was taken for the same. Conclusion: Timely screening, diagnosis & management of type 1 ETROP may help in preventing such cicatricial sequelae.

Purpose: To compare the anatomic success of pars plana vitrectomy (PPV) after internal limiting membrane (ILM) peeling at macular area and macular plus peripapillary area versus no peeling in rhegmatogenous retinal detachments (RRD). Methods: A prospective observational study between July 2014 and March 2017 conducted on 289 eyes of 287 patients with RRD were randomly assigned to three treatment procedures, viz., PPV with no ILM peeling, PPV with macular peeling, and PPV with macular plus peripapillary peeling. Recurrent RD (ReRD) was treated as an event and accordingly the overall primary (PS) and final success (FS) rates were obtained. The risk of ReRD associated with peeling procedures after adjusting for risk factors were obtained using Cox-proportional hazard analysis. Results: The PS percentage for no peel, macular, and macular plus peripapillary procedures were 77.78% (70/90), 82.18% (83/101), and 94.89% (93/98; maximum), respectively, which was statistically significant with a P value of 0.003. The FS percentage for no peel, macular, and macular plus peripapillary were 93.33%, 95.04%, and 100%, respectively, which was significantly different with a P value of 0.048. With reference to no peeling, the adjusted hazard ratio for macular peeling was 0.841 [95% CI: 0.44–1.60] while 0.235 [95% CI: 0.088–0.626] for macular plus peripapillary peeling. Conclusion: The anatomic success rate of PPV with macular plus peripapillary ILM peeling was significantly higher as compared to no peel category. The hazard of ReRD in patients undergoing macular plus peripapillary peel was significantly reduced as compared to no peel procedure.