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Purpose: The primary objective was to evaluate the clinical response of refractory cases of fungal keratitis to topical 1% posaconazole therapy. Methods: Prospective longitudinal non-randomized open label dual-cohort study of 70 eyes of refractory fungal keratitis, 35 were recruited as posaconazole treatment (PCZ) group for topical 1% posaconazole therapy and compared to 35 eyes on conventional antifungal therapy. Study parameters included demographic and treatment details, visual acuity, comprehensive slit-lamp biomicroscopy, clinical photography, ASOCT at recruitment and weekly (week 1, 2, 3 and 4 after treatment initiation). Clinical assessment included keratitis severity grade, time of healing, and healing response. Anti-fungal susceptibility testing was performed. Results: The mean age of 35 patients recruited in the PCZ treatment group was 45 ± 17.32 years and that for the conventional treatment group was 43.22 ± 15.04 years. Culture isolation was possible in 25 eyes (71.4%) in the PCZ treatment group, with Fusarium and Aspergillus spp. being the most common cornea pathogenic mycotic organisms. The mean healing time in the PCZ group was 27.13 ± 5.8 days and in the conventional treatment group was 26.41 ± 4.81 days. Healing response in the PCZ treatment showed that 27 eyes (77.14%) had healed, 3 (8.5%) had delayed healing, and 5 (14.28%) required therapeutic keratoplasty, whereas in the conventional treatment group, 26 (74.28%) healed, 2 (5.7%) had delayed healing, and 7 (20%) needed keratoplasty (P = 0.65, 0.72, 0.54, respectively). Topical 1% PCZ therapy of chronic mycotic keratitis was helpful in resolution in 85.7% of cases (30 eyes) with five eyes needing surgical intervention, which was comparable to that of conventional antimycotic therapy cohorts. Fusarium isolates showed greater susceptibility to natamycin in our study per MIC[sub.50] values, with susceptibility to the common antimycotic agents varying between the Aspergillus spp. in both PCZ treatment and conventional treatment groups. All isolates showed minimal values of MIC-[sub.50] with PCZ. Antifungal susceptibility testing in our study recruits showed that about 90% of the Fusarium spp. isolates to be best responsive to natamycin and PCZ, whereas Aspergillus niger isolates were sensitive to voriconazole, itraconazole, amphotericin B, and PCZ, Aspergillus flavus to voriconazole and PCZ, Aspergillus fumigatus to both polyenes and triazoles. Cladosporium spp. were best sensitive to natamycin and PCZ, Penicillium spp. to natamycin and azoles. Alternaria keratitis isolates were sensitive to voriconazole and PCZ, whereas Rhizopus isolate was best sensitive to PCZ. Conclusion: Topical 1% PCZ therapy in refractory fungal keratitis was comparable to that of conventional antimycotic agents, with lower MIC-[sub.50] against the common pathogenic fungi as compared to natamycin, amphotericin B, and voriconazole. Keywords: Anti-fungal susceptibility testing, azalea, fungal keratitis, mycotic keratitis, posaconazole, Author(s): Murugesan Vanathi (corresponding author) [1]; Devendra K Yadav [1]; Thirumurthy Velpandian [2]; Nishat Hussain Ahmed [3]; Manu Muraleekrishna [1]; Abhijeet Beniwal [1]; Neiwete Lomi [1]; Noopur Gupta [1]; Radhika [...]

Corneal perforations are potentially sight-threatening conditions if not promptly treated. Management depends on the size, location, cause, and severity of the perforation. Various methods, including tissue adhesives, amniotic membrane grafting (AMG), and keratoplasty, are available. However, the limited availability of donor tissue in emergencies poses a significant challenge. Recently, Tenon's patch grafting (TPG) has emerged as a promising treatment option due to its autologous nature, availability, and lack of immunogenicity. This review provides a comprehensive overview of various aspects of TPG, along with relevant images. A literature search using keywords such as 'Tenon's patch graft,' 'Tenon's capsule,' 'corneal patch graft,' 'amniotic membrane,' and 'corneal perforations' yielded 37 articles, included in this review. TPG is suitable for cases involving corneal tissue degradation leading to perforation, impending perforation, or descemetocele, with lesion sizes ranging from 2 to 6 mm. For larger perforations, the procedure may be modified by combining it with AMG or tissue adhesives. Postoperatively, the graft undergoes characteristic changes, including epithelialization and collagen deposition, resulting in the formation of a thick scar. Complications such as delayed epithelialization, wound leaks, and graft dehiscence can occur. High success rates have been reported, ranging from 74% to 87%. However, TPG may result in suboptimal visual outcomes, particularly when the graft is centrally located, necessitating future keratoplasty for visual rehabilitation. Overall, TPG is a safe and cost-effective technique for restoring structural integrity in corneal thinning disorders and perforations, especially in emergency settings when donor tissue is unavailable. Keywords: Corneal perforation, cyanoacrylate glue, descemetocele, fibrin glue, Tenon's capsule, Tenon's patch graft, Author(s): Rakhi Kusumesh [1]; Alisha Kishore [2]; Anitha Venugopal [3]; Sushmita G Shah (corresponding author) [4]; Murugesan Vanathi [5] Various modalities exist for the management of corneal perforation. These include [...]

The Descemet membrane (DM) is the basement membrane of corneal endothelial cells, which are responsible for maintaining corneal transparency. DM detachment (DMD) can occur due to various reasons, with the most common etiology being post-surgical. Older age, blunt instruments, and faulty surgical technique predispose to the intraoperative or postoperative occurrence of DMD, and one should have a high index of suspicion for DMD in cases with unexplained or an atypical pattern of corneal edema after surgery. Prompt intervention for DMD management is imperative to effect early visual rehabilitation, decrease corneal morbidity, and avoid permanent damage leading to scarring of the cornea. Various classifications of DMD and management protocols have been described. Anterior-segment optical coherence tomography (AS-OCT) imaging is the most effective imaging to detect DMD and quantify its extent. Desmetopexy with air/gas is the initial treatment of choice and could be aided by suture fixation. Non-responsive cases might need endothelial keratoplasty. Keywords: AS-OCT, Descemet membrane detachment, Descemetopexy, Author(s): Abhijeet Beniwal [1]; Murugesan Vanathi (corresponding author) [1]; Anitha Venugopal [2]; Sunita Chaurasia [3]; Radhika Tandon [1] Descemet membrane (DM) detachment (DMD) is a potentially serious and sight-threatening complication [...]

This study aimed to comprehensively explore the intricacies of corneal neurotization (CN) and the nuanced factors that set it apart from routine clinical practice, exerting a substantial influence on its success. A symbiotic relationship is evident between corneal innervation and ocular surface health. The loss of corneal innervation results in a potentially challenging corneal condition known as neurotrophic keratopathy (NK). The majority of treatments are primarily focused on preventing epithelial breakdown rather than addressing the underlying pathogenesis. Consequently, to address the impaired corneal sensation (underlying etiology), a novel surgical approach has emerged, namely CN, which involves transferring healthy sensory nerve axons to the affected cornea. This review offers valuable insights into the existing body of supporting evidence for CN, meticulously examining clinical studies, case reports, and experimental findings. The aim is to enhance our understanding of the effectiveness and potential outcomes associated with this innovative surgical technique. The exploration of innovative therapeutic avenues holds promise for revolutionizing the management of NK, offering a potentially permanent solution to a condition once deemed incurable and severely debilitating. Keywords: Corneal neurotization, donor nerve, insensate cornea, interpositional nerve graft, neurotrophic keratopathy, reinnervation, Author(s): Manu Saini [1]; Arun Jain [1]; Murugesan Vanathi (corresponding author) [2]; Aman Kalia [1]; Kulbhushan Saini [3]; Parul Gupta [1]; Nripen Gaur [4] Neurotrophic keratopathy (NK) represents a rare [...]

Author(s): Murugesan Vanathi (corresponding author) [1] 'This is the day upon which we are reminded of what we are on the other three hundred and sixty-four.' - Mark Twain As [...]

Author(s): Murugesan Vanathi (corresponding author) [1] An enhanced understanding of corneal physiology and the fibrotic molecular pathways influencing corneal clarity has facilitated innovative research aimed at countering corneal scarring. Recent [...]

Author(s): Murugesan Vanathi (corresponding author) [1] Trachoma, caused by the bacterium Chlamydia trachomatis , is a significant infectious eye disease responsible for preventable blindness. Recurrent childhood infections with Chlamydia trachomatis [...]

Author(s): Murugesan Vanathi (corresponding author) [1] Pediatric vision impairment and blindness need to be explored with a wider perspective, given the diverse profiles of clinical conditions that affect children in [...]

Byline: Rebika. Dhiman, Divya. Singh, Murugesan. Vanathi, Radhika. Tandon, Karthikeyan. Mahalingam Purpose: To study the correlation of corneal topography, corneal biomechanical properties, and ocular aberrations with the magnitude of refractive [...]

Byline: Rahul. Bafna, Nidhi. Kalra, Mohamed. Asif, Abhijeet. Beniwal, Suman. Lata, Sumant. Sharma, Rinky. Agarwal, Murugesan. Vanathi, Prafulla. Maharana, Jeewan. Titiyal, Namrata. Sharma Acute corneal hydrops (ACH) is a rare [...]

Byline: Vinita. Gupta, Himani. Pal, Saurabh. Sawhney, Aashima. Aggarwal, Murugesan. Vanathi, Gaurav. Luthra High-precision biometry and accurate intraocular lens (IOL) power calculation have become essential components of cataract surgery. In [...]

Byline: Sridevi. Nair, Murugesan. Vanathi Dear Editor, We read with interest the review article 'A brief account on ocular graft versus host disease' by Chatterjee,[1] which comprehensively covered most aspects [...]

Byline: Navneet. Sidhu, Murugesan. Vanathi, Noopur. Gupta, Radhika. Tandon Systemic coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has had several ocular consequences. Many vaccines have [...]

Byline: Murugesan. Vanathi Trauma to the globe and ocular adnexa remains the most common emergency room consult in all parts of the world. Studies from across the globe have prognosticated [...]

Byline: Murugesan. Vanathi World Sight Day features as an annual day of awareness of vision wellness, which is coordinated by the International Agency for Prevention of Blindness (IAPB) on the [...]

Byline: Josephine. Christy, Anand. Bhadari, Priya. Mathews, Muthiah. Srinivasan, Murugesan. Vanathi Corneal blindness ranks third among the causes of blindness worldwide, after cataract and glaucoma. Corneal transplantation offers us a [...]

Byline: Ritika. Mukhija, Murugesan. Vanathi, Meena. Verma, Nimmy. Raj, Noopur. Gupta, Radhika. Tandon Purpose: Barrett toric calculator (BTC) is known for its accuracy in toric IOL (tIOL) calculation over standard [...]

Byline: Vishal. Kumar, Pooja. Kumari, Neiwete. Lomi, Murugesan. Vanathi, Noopur. Gupta, Radhika. Tandon, T. Velpandian, Nishat. Ahmed, Gita. Satpathy Purpose: To evaluate the efficacy of liposomal amphotericin B (L-AMB) for [...]

Byline: Sandhya. Gaur, Pooja. Kumari, Neiwete. Lomi, Ranjan. Gupta, Murugesan. Vanathi, Radhika. Tandon A 13-year-old girl presenting with mucopurulent conjunctivitis (left > right) was diagnosed with Behçet's disease. Intraoperatively, the [...]

Byline: Murugesan. Vanathi, Ravinder. Naik, Navneet. Sidhu, Nishat. Ahmed, Noopur. Gupta, Radhika. Tandon Purpose: To study the antifungal susceptibility of common corneal pathogenic fungi to antifungal agents in the North [...]

Byline: Nishat. Ahmed, Deepanshi. Mishra, Prachala. Rathod, Gita. Satpathy, Jeewan. Titiyal, Radhika. Tandon, Sushma. Nandyala, Tushar. Agarwal, Murugesan. Vanathi, Rajesh. Sinha, Noopur. Gupta, Prafulla. Maharana, Manpreet. Kaur, Namrata. Sharma Purpose: [...]

Byline: Neelam. Runda, Souvik. Manna, Murugesan. Vanathi, Radhika. Tandon, Noopur. Gupta Purpose: To compare the efficacy of physiological, non-detergent eyelid wipes with conventional lid hygiene in patients with meibomian gland [...]

Byline: Saumya. Yadav, Noopur. Gupta, Tarjani. Makwana, Murugesan. Vanathi, Radhika. Tandon Purpose: To assess the role of noninvasive ocular surface analyzer (OSA) in workup of meibomian gland dysfunction (MGD) and [...]

Byline: Shweta. Agarwal, Tanveer. Khan, Murugesan. Vanathi, Bhaskar. Srinivasan, Geetha. Iyer, Radhika. Tandon Infectious keratitis is a medical emergency resulting in significant visual morbidity. Indiscriminate use of antimicrobials leading to [...]

Byline: Bharat. Gurnani, Kirandeep. Kaur, Anitha. Venugopal, Bhaskar. Srinivasan, Bhupesh. Bagga, Geetha. Iyer, Josephine. Christy, Lalitha. Prajna, Murugesan. Vanathi, Prashant. Garg, Shivanand. Narayana, Shweta. Agarwal, Srikant. Sahu Pythium insidiosum is [...]

Byline: Murugesan. Vanathi, Alisha. Kishore, Yogita. Gupta, Prithvi. Setty, Seema. Sen, Tapas. Nag, Ranjan. Gupta, Arundati. Sharma, Radhika. Tandon We report a case series highlighting clinical correlation of recurrence of [...]