Indian Journal of Ophthalmology
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Item Safety and effectiveness of brolucizumab in patients with neovascular age-related macular degeneration: A phase IV study from India(Wolters Kluwer – Medknow, 2025-06) Ghosh, Asim K; Chakraborty, Debdulal; Sudhalkar, Aditya; Chawla, Rohan; Singh, Simar R; Sahu, Atul K; Venkatesh, Ramesh; Raval, Vishal; Shah, Sonali; Preetha, Padma; Bhavsar, Maulik; Patil, Sandip; Khadke, Isha; Thorat, AnupPurpose: The purpose of this study is to evaluate the safety and effectiveness of brolucizumab intravitreal injections (IVI) in Indian patients with neovascular age?related macular degeneration (nAMD). Methods: This prospective, interventional, single?arm, open?label phase IV study included 105 treatment?naïve nAMD patients prescribed brolucizumab as per the local prescribing information, across ten centers. The treatment period consisted of 56 weeks, including loading doses at Weeks 0, 4, and 8, followed by disease activity assessment at Week 16, evaluating patients for 12?weekly (q12w) or 8?weekly (q8w) dosing. The primary endpoint was the incidence and characteristics of treatment?emergent adverse events (TEAEs) during 56 weeks. Secondary endpoints included changes in effectiveness variables – visual acuity, intraretinal fluid (IRF), subretinal fluid (SRF), and central subfield thickness (CST), at 16 and 56 weeks. Results: Post?Week 16, 74 (70.5%) patients received q12w, and 27 (25.7%) patients received q8w dosing. Four TEAEs were reported in three (2.9%) patients, all ocular: vitritis in two patients who were discontinued and retinal vasculitis and uveitis in one patient who completed the study. No TEAEs were severe, and there were no serious adverse events. Best corrected visual acuity (BCVA) improved significantly by seven letters (95% CI: 5.0, 10.0) at Week 16 and by 15 letters (95% CI: 10.0, 18.0) at Week 56 (P < 0.0001 for both). All anatomical parameters also showed significant reductions over the study period. Conclusions: Brolucizumab 6 mg IVI, given as per the prescribing information, demonstrated a positive benefit/risk profile in Indian patients with nAMD, with no new safety signals.Item Long-term outcomes of drusenoid retinal pigment epithelium detachment in eyes with age-related macular degeneration(Wolters Kluwer – Medknow, 2025-06) Karabulut, Sinem; Kaderli, Sema Tamer; Karalezli, AylinPurpose: We aim to evaluate the changes in the size of drusens and drusenoid pigment epithelial detachments (PED) in patients with age?related macular degeneration. Design: This study was designed as an observational retrospective cohort study. Methods: We evaluated eyes with drusenoid PED tracked using spectral?domain and enhanced depth imaging optical coherence tomography. The cases were classified according to the follow?up visits and divided into two groups as eyes with collapsed PED and persisting PED. The best?corrected visual acuity (BCVA), size of drusens and PED, central macular thickness (CMT), and subfoveal choroidal thickness (SCT) were recorded. Results: We included 11 patients’ 22 eyes with drusenoid PED. In the final comparison, the mean CMT, SCT, and BCVA were significantly lower in Group 1 compared to Group 2 (P = 0.05; P = 0.05; P = 0.002, respectively). The mean CMT, SCT, and BCVA were significantly decreased from baseline to the last visit in Group 1 (P = 0.013; P < 0.001; P = 0.001, respectively). No significant changes were observed regarding the mean CMT, SCT, and BCVA in Group 2 during the follow?up visits. (P = 0.317, P = 0.682, P = 0.056). Conclusion: Spontaneous collapse of drusenoid PED is associated with poor visual outcome.Item Exploring the use of millipore filters to prevent post-injection endophthalmitis: A proof-of-concept in-vitro study(Wolters Kluwer – Medknow, 2025-06) Kumawat, Devesh; Ahmed, Nishat H; Venkatesh, PradeepPurpose: Millipore filters are routinely used in vitreous surgeries for loading intraocular gas. This study purports to establish feasibility of in?line Millipore filter as a filtration barrier and rationalize their use during intravitreal antivascular endothelial growth factor (antiVEGF) injection to reduce the risk of endophthalmitis. Design: Proof?of?concept in?vitro study. Methods: At the Ocular Microbiology section of a tertiary care eye center in North India, bacterial broths of various microorganisms (Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli, Corynebacterium species, Streptococcus species, and a mixture of Staphylococcus aureus and Pseudomonas aeruginosa) of different concentrations (McFarland 0.5 and McFarland 1) were inoculated onto blood, chocolate, and/or MacConkey agar with (Group 1) or without (Group 2) in?line sterile Millipore filter of 0.22?micron pore size (Set GS Mini filter, ARCEOLE, France). The filter was attached to a one?ml syringe with bacterial broth solution at one end and a 30?gauge needle at the other. Culture plates were incubated and observed daily for colony formation with photographic documentation for up to 5days. Results: Bacterial broths could be injected across the filter with little resistance. None of the culture media showed growth when filters were used, compared with growth in all culture plates when inoculation of broth was done without the filter. The fluid loss in the filter (dead space volume) ranged from 0.12 to 0.17ml. Conclusions: Millipore filter act as an effective filtration barrier and could enhance the safety of intravitreal antiVEGF injection by reducing the risk of endophthalmitis. Further microbiological and toxicology studies are essential before their integration into clinical practice.Item Failure of primary immunosuppressive agents in uveitis(Wolters Kluwer – Medknow, 2025-06) Kawali, Ankush; Rizvi, Sara; Mishra, Sai Bhakti; Mahendradas, Padmamalini; Shetty, RohitPurpose: This retrospective study aimed to evaluate the effectiveness of various immunomodulatory therapy (IMT) regimens in managing non?infectious uveitis (NIU) and to identify optimal treatment strategies for refractory cases. The study focused on patients who failed primary IMT and required revisions due to uncontrolled inflammation or frequent relapses. Methods: The study was conducted over 1 year (December 2023 to November 2024) and included patients diagnosed with NIU, scleritis, or episcleritis who failed primary IMT. The primary IMT and subsequent revisions were analyzed to identify patterns in the use of different IMT regimens and their effectiveness. Results: The study cohort consisted of 54 patients. Panuveitis was found to be the most common anatomical diagnosis (44.4%). The primary IMT used was predominantly methotrexate (MTx) (83.3%). The first revision of IMT often involved combination therapy, with MTx + mycophenolate mofetil (MMF) being the most common combination (24.1%). Subsequent revisions also favored combination therapy, with increasing use of biologics like Adalimumab (ADA) and tofacitinib (Tofa). Subgroup analysis revealed Vogt?Koyanagi?Harada (VKH), being the most common etiologically diagnosed uveitic entity with primary IMT failure and increased use of Tofa in subsequent revisions of IMT. Conclusions: The study highlights the challenges in managing refractory uveitis. Combination therapy, particularly with MMF and MTx, is commonly advocated. The use of biologics like Tofa, especially in VKH, can be a valuable treatment option. Future prospective studies with larger cohorts are needed to validate these findings and explore the disease?specific effectiveness of IMT regimens.Item Evaluation of anterior scleral thickness in eyes with central serous chorioretinopathy(Wolters Kluwer – Medknow, 2025-06) Prabhakaran, Parvathy; Pradeep, BC; Pandit, Akanksha D; Sagar, Pradeep; Varsha, A; Sweta, Shubhra; Biswal, Suchitra; Ravishankar, HNPurpose: To compare the anterior scleral thickness in eyes with central serous chorioretinopathy (CSC) and healthy eyes. Design: Cross?sectional observational study. Methods: The study included patients with CSC and age and gender?matched healthy individuals. The subfoveal choroidal thickness (SFCT) and scleral thickness at 3 mm, 4 mm, and 8 mm posterior to the scleral spur were measured using swept source optical coherence tomography (Topcon DRI?OCT Triton plus). Results: The study included 35 eyes with CSC and 35 control eyes. In CSC group, 82.86% were simple and 17.14% were complex. There was no statistically significant difference in the scleral thickness in CSC and control groups. Though the sclera was thicker in the complex CSC group compared to simple CSC at 3 mm (nasal: 724.33 ± 180.53 vs 658.48 ± 57.63, temporal: 696.17 ± 212.91 vs 628.83 ± 107.7) and 4 mm (nasal: 656.67 ± 109.34 vs 621.62 ± 79.31, temporal: 640.17 ± 191.31 vs 616.48 ± 86.30), the difference was not statistically significant. A moderate negative correlation was noted between SFCT and scleral thickness at 8 mm (r ?0.349) and 3 mm on the nasal side (r ?0.388) in the control group. A moderate negative correlation was noted between SFCT and scleral thickness at 4 mm (r ?0.377) and 3 mm (r ?0.403) on the temporal side in CSC group. Conclusion: The anterior scleral thickness was similar in CSC and healthy eyes. As the study sample predominantly included simple CSC, the findings indicate that the anterior scleral thickness may not be involved in the pathogenesis of simple CSC.Item Four-flanged, intrascleral fixation of foldable intraocular lens using straight-needled 7-0 polypropylene suture – A surgical technique(Wolters Kluwer – Medknow, 2025-07) Vivekanandan, Vellam R; Nachiappan, Sivagami; Odayappan, Annamalai; Gangapatnam, Naveen N; Benzy, Merlin; Venkatesh, RengarajThe occurrence of intraocular lens (IOL) implantation failure in phacoemulsification is relatively uncommon. However, because cataract surgery is the most prevalent surgical procedure worldwide, the aggregate instances of post?surgical aphakic status are significant. Though several alternatives, including anterior chamber IOL, iris?fixated IOL, and scleral?fixated IOL (SFIOL), exist for secondary IOL implantation, recent trends favor SFIOL implantation. In the realm of SFIOLs, all sutureless variants necessitate the exteriorization of the haptic through the sclera, implying a larger sclerotomy. Sutured SFIOL requires special lenses and typically involve rigid ones, which necessitate a larger incision. We describe a technique that involves utilizing a straight?needled 7?0 polypropylene suture for the 4?flanged intrascleral fixation of any foldable IOL that can be manually loaded onto a cartridge. This method combines the advantages of a reduced incision size and a smaller sclerotomy, addressing concerns associated with both sutureless and rigid SFIOL implantation.Item Capsule-augmented scleral fixation of intraocular lenses(Wolters Kluwer – Medknow, 2025-07) Tebhla, Soema; Jayadev, Chaitra; Nayak, Rohita; Raj, Pragati; Gambhir, Vedant; Krishnappa, Nagesha CIn?the?bag placement of intraocular lenses (IOLs) generally yields optimal results in terms of alignment and minimizes decentration or tilt. However, this approach can be counterproductive if the capsular bag is compromised, potentially leading to IOL malposition or inability to secure the lens. Repurposing the compromised capsular bag to its maximum potential can help place the initially intended IOL. This surgical series showcases techniques and options for scleral fixation of the same or a newer IOL, using the compromised bag as augmented support. The capsular bag provides alignment guidance, while scleral fixation stabilizes the IOL, thereby demonstrating a hybrid technique called capsule?augmented scleral fixation (CASF). This article provides a detailed description of CASF and explores its expanding applications in accommodating diverse IOL designs. This technique provides surgeons with an alternative when unexpected intraoperative challenges are encountered.Item OCT angiography findings in type 2 macular telangiectasia: A meta-analysis(Wolters Kluwer – Medknow, 2025-06) Zare Hosseinabadi, Vahid; Abdi, Fatemeh; Parvin, Sadaf; Hemmati, Sara; Chaibakhsh, SamiraThis meta?analysis evaluates optical coherence tomography angiography (OCTA) results in macular telangiectasia (MacTel) type 2, a rare retinal condition marked by vascular abnormalities. We analyzed 26 studies for OCTA findings in MacTel type 2. We examined parameters like best corrected visual acuity (BCVA), foveal avascular zone (FAZ), and superficial and deep capillary plexus densities. The pooled mean BCVA was 0.37 log of minimum angle of resolution (20/50). FAZ enlargement was observed, with a pooled mean FAZ size of 0.39 mm2. Foveal deep vascular density (FDVD) and parafoveal superficial vascular density (PSVD) were significantly reduced (P = 0.021 and P < 0.001, respectively). Parafoveal deep vascular density (PDVD) and foveal superficial vascular density (FSVD) did not decrease significantly (P = 0.067 and 0.114, respectively). MacTel type 2 has unique OCTA characteristics, including reduced FDVD, PSVD, and enlarged FAZ. However, FSVD and PDVD did not statistically decrease in patients. Future studies using more parameters are required to expand our understanding.Item Comparison of utilization rate and graft outcomes of corneas from cadaveric donors (CDs) versus multiorgan donors (MDs)(Wolters Kluwer – Medknow, 2025-07) Rathod, Aishwarya; Tandon, Radhika; Vanathi, Murugesan; Gupta, Noopur; Lomi, Neiwete; Ahmed, Nishat Hussain; Beniwal, Abhijeet; Gupta, DeepakPurpose: The purpose is to compare the utilization rate and corneal graft outcomes from multiorgan donors (MDs) versus those from cadaveric donors (CDs). Methods: In this ambispective and observational study, 36 corneas obtained from MDs and 72 corneas from their age?matched and sex?matched voluntary donors under the Hospital Cornea Retrieval Program (HCRP) from an eye bank were assessed clinically using slit lamp and under a specular microscope for their suitability for utilization. The percent utilization for keratoplasties was noted and compared between the two donor sources as the primary outcome. The transplanted corneas were followed up for 18 months for the assessment of graft survival and other outcome parameters. Results: The utilization rate of corneas obtained from MDs (80.6%) was significantly higher than that of corneas obtained from CDs (68.1%). The mean endothelial cell density (ECD) was significantly higher in corneas from MD as compared to those from CD (P = 0.037) at 18 months. The Kaplan?Meier survival analysis revealed a cumulative graft failure rate over 1.5 years as 10.3% for corneas obtained from MD and 16.3% for corneas obtained from CD. The microbiological analysis of the corneoscleral rim sent intraoperatively revealed three culture?positive specimens, two from CD, and one from MD. Conclusion: The donor source was a significant factor in determining the suitability of corneas for keratoplasty. Death preservation interval, cause of death, ECD, and processing had a modest influence on tissue suitability or quality. This data may help eye banks formulate policies that can maximize the procurement of corneas from MDs under HCRP.Item Herpes simplex keratitis in central India: Clinical types, treatment patterns, and outcome measures(Wolters Kluwer – Medknow, 2025-07) Chatterjee, Samrat; Agrawal, Deepshikha; Malik, MehvishPurpose: Report clinical subtypes, treatment details, outcome, and recurrences in herpes simplex keratitis (HSK). Design: Retrospective, observational study. Methods: The medical records of all patients diagnosed with HSK between July 2019 and December 2023 at a single center were reviewed. The primary outcome measure was the clinical type of HSK, while secondary outcomes were treatment, and its outcome, and recurrences. Results: In total, 223 patients (225 eyes) were diagnosed with HSK. The most common type was herpes simplex virus (HSV) stromal keratitis without ulceration (102 eyes, 45.3%), followed by epithelial keratitis (57 eyes, 25.3%), endothelial keratitis (41 eyes, 18.2%), and stromal keratitis with ulceration (25 eyes, 11.1%). More males presented with epithelial and endothelial keratitis, while more females presented with stromal keratitis with ulceration (P = 0.02). Following treatment, 95 (42.2%) eyes were lost to review, 126 (56.0%) were resolved, and four (1.8%) developed microbial keratitis. Posttreatment visual acuity was highest in stromal keratitis without ulceration and lowest in stromal keratitis with ulceration (P = 0.001). Twenty?seven (12.1%) patients experienced 35 episodes of HSK recurrence. HSV stromal keratitis without ulceration (20 patients, 57.1%) was the most common form of recurrence, followed by epithelial keratitis (seven patients, 20%), endothelial keratitis (five patients, 14.3%), and stromal keratitis with ulceration (three patients, 8.6%). Conclusion: HSV stromal keratitis without ulceration was the most common presentation. Posttreatment improvement in visual acuity was best in this particular type of HSK and worst in stromal keratitis with ulceration. Recurrent disease was present in a significant proportion of patients.Item Comparative efficacy of intrastromal amphotericin B versus voriconazole in treating deep-stromal refractory fungal keratitis(Wolters Kluwer – Medknow, 2025-07) Singh, Charul; Mohanty, Amrita; Rajagopal, Raksheeth N; Ali, Md Hasnat; Joseph, Joveeta; Bagga, BhupeshPurpose: To compare the outcome of adjuvant intrastromal Amphotericin B (ISAMPB) and Voriconazole (ISVCZ) in managing refractory deep stromal fungal keratitis. Methods: We reviewed the records of patients treated between January 2020 and December 2022 for microbiologically confirmed refractory fungal keratitis that had worsened despite treatment with topical Natamycin, with or without oral Ketoconazole. These patients received adjuvant therapy with either intrastromal Amphotericin B (ISAMPB, 5–10 ?g/0.1 ml) or intrastromal Voriconazole (ISVCZ, 50 ?g/0.1 ml). The demographics, clinical profiles, and outcomes of the ISAMPB and ISVCZ groups were compared, with key outcomes being the proportion of patients achieving clinical resolution and the number of therapeutic keratoplasty procedures performed. A logistic regression model was constructed for multivariate analysis to adjust for potential confounders. Results: Medical records of 49 patients with refractory fungal keratitis were analyzed: 34 (69.3%) received ISAMPB, and 15 (30.6%) received ISVCZ. The overall mean LogMAR visual acuity was 1.90 ± 0.6, and the infiltrate size averaged 4.28 ± 1.30 mm vertically and 4.3 ± 1.4 mm horizontally. Aspergillus and Fusarium each accounted for 32.3% of ISAMPB patients, and 40% and 20% of ISVCZ patients, respectively. The median time to intrastromal injection was 12 days for ISAMPB and 11 days for ISVCZ. ISAMPB achieved resolution in 53% of cases, while 41.1% required TPK; ISVCZ resolved in 10%, with 86% requiring TPK (P < 0.01). The adjusted odds ratio for ISAMPB response was 21.98 (P = 0.013). Conclusion: Intrastromal Amphotericin B has been shown to provide better outcomes than Voriconazole in the treatment of deep stromal refractory fungal keratitis.Item A novel ultrasonic intraocular lens (IOL) cutting tip and IOL holding forcep(Wolters Kluwer – Medknow, 2025-07) Dholakia, Neha; Pirdankar, Onkar H; Shah, SmiteshTo address the challenges related to IOL explantation and associated complications, we have developed an innovative tip that utilizes the ultrasonic power of phaco machine for efficient IOL cutting. The tip can be easily screws into phaco machine, while the other end is forked with sharp inner margins. This cutter is complemented by the ergonomically designed microforceps which are inserted through a side port to grasp the lens securely during cutting.Item Peripheral capsulorhexis – A novel technique to prevent Argentinian flag sign in intumescent white cataracts(Wolters Kluwer – Medknow, 2025-07) Bhalla, Jatinder; Khatoon, Sadiqua; Patidar, Tarun; Majumdar, Ashis; Sakhuja, Ridhima; Dhepe, KarunaThe most challenging step in handling an intumescent cataract is the creation of a well?sized, round, centered, continuous, and curvilinear capsulorhexis. Due to high intralenticular pressure, the capsulorhexis tear has high tendency to extend equatorially leading to development of Argentinian flag sign. To overcome this, we describe a novel technique of capsulorhexis for intumescent white cataracts that does not need special instrumentation. Antero?posterior diameter of lens is more in the center due to its biconvex configuration. This leads to more intralenticular fluid accumulation and thus comparatively higher intralenticular pressure in the center. Thus, it was decided not to touch central, tense, bulging capsule, and initiate capsulorhexis in the periphery. Two perimetric flaps were created, sheared circumferentially, and joined midway resulting in a complete circular capsulorhexis. This minimized the tendency of capsulorhexis runway to the periphery and allowed one?stage creation of a well?sized capsular opening for phacoemulsification.Item Clinical outcomes of DSAEK with pre-cut grafts of thickness more than 150 microns(Wolters Kluwer – Medknow, 2025-07) Roy, Aravind; Mudgil, Tanvi; Das, Nikita; Peddi, Megana; Chaurasia, SunitaPurpose: To study the clinical outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) with pre?cut lenticules of thickness above 150 microns. Methods: During the study period Jan 2019 to Sept 2020, 1865 pre?cut DSAEK lenticules were prepared at the institute?affiliated eye bank by two trained technicians. Of these, 28 (1.5%) grafts had a thickness >150 microns and were utilized at the institute. Retrospective review of medical records was performed for these patients. Results: Median donor age was 39 (range, 20–62) years, death to preservation time was 6 (range, 0.28–8.4) hours, endothelial cell density (ECD) was 2738 (range, 2203–3788) cells/mm2, graft thickness was 186 (range, 170–250) microns. The mean recipient age was 58 (range, 36–76) years, and 17 were males. The most common indication for surgery was pseudophakic corneal edema (n = 14, 50%). The mean log MAR visual acuity at 1?month, 3?month, and 6?month post?operative visits improved to 0.8, 0.7, and 0.5, respectively. The mean lenticule thickness at 3? and 6?month post?operative period reduced to 161 and 151 microns, respectively. Graft detachment needing rebubbling in 5/28 (17.8%) eyes. Primary graft failure was noted in six (21.4%) eyes, which included one eye that underwent rebubbling. Secondary graft failure was noted in four eyes (14.2%). Eighteen (81.8%. 18/22) eyes were maintained graft clarity till the end of the study period, mean follow?up of 10.5 (range, 3–18) months. Conclusions: With the currently practiced nomograms in automated methods of DSAEK graft preparation, graft thickness over 150 microns can occur infrequently (<1.5%); however, DSAEK lenticules above150 microns can have a favorable outcome in large majority (81.8%). The study noted rebubbling and primary graft failure rate in a fifth of all eyes with lenticule thickness > 150 microns.Item Management and outcome of microsporidia-induced stromal inflammatory keratitis – A long-term follow-up study(Wolters Kluwer – Medknow, 2025-07) Mohanty, Amrita; Behera, Himansu Sekhar; Das, Sujata; Fernandes, Merle; Parida, Priyadarshini; Sahu, Srikant KumarPurpose: To describe the course of disease, management, and outcome of immune stromal keratitis (ISK)/ interstitial keratitis (IK) associated with microsporidial epithelial keratitis with a long?term follow?up. Methods: We reviewed the medical records of 20 patients with microsporidia?associated IK between October 2020–2022. Microsporidia involvement was confirmed microbiologically (smear/molecular diagnosis) using corneal epithelium scrapings and clinically characterized by the presence of disciform keratitis, immune ring, and sub?epithelial infiltrates. Patients with over three months of follow?up were included. The course of the disease and management was analyzed. Results: We found 11 out of 20 (55%) microsporidia?associated IK during the study period followed beyond three months. The mean duration of follow?up was 342.1 ± 178.3 days (100 days–23 months). Topical steroids and topical tacrolimus ointment 0.03% were discontinued in nine out of 11 patients after the resolution of initial episode. Among the five out of nine (45%) had six episodes of recurrences 4 ± 3.9 months after discontinuing medications. Re?scraping was performed in four episodes, and microsporidia spores were detected again on two occasions. Among five patients with recurrence, topical steroids were used in the initial treatment for 6 ± 2.1 weeks, and topical tacrolimus was prescribed to only one patient for eight weeks. For the recurrent attacks, topical tacrolimus was added for over 10 weeks, with topical steroids. The patients were followed up for at least six months, with no new episodes of recurrence. Conclusion: Microsporidia?associated ISK/IK is a novel condition having a chronic course with recurrences. It requires close follow?up for recurrences at least six months after discontinuing medications, and topical 0.03% tacrolimus ointment is an effective corticosteroid?sparing agent.Item Phacoemulsification with combined capsular tension ring, supracapsular glued IOL, and optic capture in progressive subluxations for expanding and immobilizing the capsular bag(Wolters Kluwer – Medknow, 2025-07) Jacob, Soosan; Narasimhan, Smita; Agarwal, Amar; Tsatsos, Michael; Sivagnanam, Soundari; Abraham, Riya; Kumar, ArunTo report and assess a new technique of phacoemulsification with capsular tension ring (CTR), supracapsular intra?scleral haptic fixation (ISHF), and optic capture in eyes with progressive subluxations and to assess stability of capsular bag?CTR?IOL optic complex. Cases with progressive subluxation first underwent phacoemulsification with CTR implantation. Supracapsular ISHF in the form of glued IOL was then performed by externalizing the haptics through a plane below the iris and above the anterior capsule via sub?flap sclerotomies created 180 degrees apart as for glued IOL. Intra?scleral haptic tuck together with optic capture of the supracapsular glued IOL was then performed. Patients were followed up for safety and stability. Five patients underwent surgery successfully. All had more than one quadrant subluxation. All eyes had well?centered IOL with adequate haptic tuck and no significant tilt. Optic capture was successful in all. Uncorrected distance visual acuity (DVA) improved from 0.18 ± 0.18 to 0.65 ± 0.36, and spectacle?corrected DVA improved from 0.59 ± 0.33 to 0.83 ± 0.24. Post?operative intraocular pressure was 17 ± 3.08, and there was no evidence of any uveitis at the 1?month visit. The anterior capsule opacified around the captured optic; however, the bag continued to remain expanded with stable IOL centration at 1?year follow?up. Phacoemulsification with CTR followed by supracapsular ISHF with optic capture is a viable technique for progressive subluxations. This technique spares the vitreous cavity thus decreasing the risk of posterior segment complications. It expands and immobilizes the capsular bag?CTR?IOL optic complex and has shown good results at 1?year follow?up.Item Ten years of Descemet membrane endothelial keratoplasty: Identifying risk factors and early failure signs(Wolters Kluwer – Medknow, 2025-07) Mechleb, Nicole; Rizk, Maria; Debellemanière, Guillaume; Gatinel, Damien; Saad, AlainPurpose: To evaluate the effect of surgical indications and complexity on long?term clinical outcomes in Descemet membrane endothelial keratoplasty (DMEK) and identify early signs of graft failure. Design: Retrospective case series of 105 patients who underwent DMEK from March 2012 to December 2014. Methods: Surgical results were analyzed at 1 year, 3 years, 5 years, and 10 years based on surgical indication: fuchs endothelial dystrophy (FECD) (n = 47) and bullous keratopathy (BK) (n = 58), and on the presence of anterior segment comorbidities: simple (n = 63) versus complex (n = 42) DMEK. Results: Fifty?two patients (54 eyes) were followed up for 3 years, 35 patients (42 eyes) reached the 5?year follow?up, and 20 patients (26 eyes) achieved the 10?year follow?up. Simple DMEK procedures and FECD demonstrated significantly better best corrected visual acuity (BCVA) compared to complex DMEK and BK at 1 year, 3 years, 5 years, and 10 years, respectively (P < 0.01). No statistically significant difference in endothelial cell density (ECD) decline was noted between simple and complex DMEK procedures, nor between FECD and BK (P > 0.05). Central and peripheral pachymetry were significantly higher in BK and complex surgeries at 10 years. Conclusion: While DMEK represents a promising therapeutic avenue for corneal decompensation alongside anterior segment comorbidities, extended follow?up indicates a rise in central and peripheral pachymetry in comparison with simple DMEK. This increase could serve as an early indicators of corneal decompensation, potentially leading to reduced survival rates.Item Microkeratome-assisted vs femtosecond laser-assisted superficial anterior lamellar keratoplasty: A randomized controlled trial(Wolters Kluwer – Medknow, 2025-07) Mishra, Sanjay Kumar; Singh, Mrinalini; Joshi, Amrita; Shukla, Sarvadarshi; Sati, Alok; Pannu, Anju; Kumar, Sonali V; Kaushik, JayaPurpose: The purpose is to compare the outcomes between microkeratome?assisted superficial anterior lamellar keratoplasty (MK?SALK) and femtosecond laser?assisted superficial anterior lamellar keratoplasty (FL?SALK) for superficial corneal opacities. Methods: Seventy?five eyes with superficial corneal opacities were prospectively randomized into the MK?SALK control arm and an FL?SALK study arm. Follow?up examinations were set at day 1, day 7, day 30, and at the third and sixth month after the surgery. The primary outcome measure was best?corrected visual acuity (BCVA), whereas secondary outcome measures were contrast sensitivity, corneal aberrations, K?readings, corneal thickness, and complications after the surgery. Results: Seventy?two eyes completed the six?month follow?up interval. An insignificant difference in BCVA was observed at day 30 [control arm (n = 36); 0.80 ± 0.27 logarithm of the minimum angle of resolution (log MAR), study arm (n = 36); 0.78 ± 0.12 log MAR, P = 0.63], at third month [control arm; 0.65 ± 0.28 log MAR, study arm; 0.66 ± 0.10 log MAR, P = 0.93], and sixth month [control arm; 0.61 ± 0.28 log MAR, study arm; 0.62 ± 0.10 log MAR, P = 0.84] following surgery. In addition, an insignificant difference was observed between the two groups in terms of contrast sensitivity, corneal aberration, mean keratometric value, mean central corneal thickness, and complications following surgery. Conclusions: MK?SALK is non?inferior to FL?SALK for the treatment of superficial corneal opacities. By demonstrating comparable outcomes, our study alleviates apprehension and doubts about choosing between the techniques and allows the surgeon to make a choice based on his expertise and resources.Item JAK-STAT inhibitors in noninfectious uveitis – A review(Wolters Kluwer – Medknow, 2025-06) Pyare, Richa; Shaikh, Nawazish; Sen, Ahana; Kene, Rakshita; Bagri, Narendra; Janarthanan, Mahesh; Chawla, Rohan; Ramanan, Athimalaipet V; Dutta Majumder, ParthopratimThe management of noninfectious uveitis (NIU) has involved the use of corticosteroids and immunomodulators (IMT). However, a certain subset of NIU patients does not respond to conventional IMT therapy, such as methotrexate and azathioprine. In these patients, biological IMT with specific targets is employed. One such example is the use of TNF?? inhibitors, such as adalimumab and infliximab. These biologics target specific inflammatory cytokines, unlike the Janus kinase (JAK)?signal transducer and activator of transcription (STAT) signaling pathway. JAK?STAT inhibitors (JAKinibs) are classified as targeted synthetic disease?modifying antirheumatic drugs (tsDMARDs), which are small?molecule drugs that are chemically synthesized rather than biologically derived. In contrast to biologic DMARDs or bDMARDs, tsDMARDs are smaller molecules that are orally available, nonimmunogenic, and capable of crossing the cell membrane. JAKinibs can simultaneously block multiple cytokine?signalling pathways, such as those driven by IL?6, IL?12, IL?23 and IL?17, as they dampen Th1? and Th17?driven inflammation. This ability to target a broad range of inflammatory cytokines and immune pathways theoretically enables JAKinibs to be viable alternatives for the treatment of NIU resistant to conventional IMT and biologicals. JAK?STAT inhibitors, such as tofacitinib, baricitinib, upadacitinib, peficitinib, delgocitinib, and filgotinib have been FDA?approved for use in autoimmune diseases such as rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, and inflammatory bowel disease. The available literature suggests the potential efficacy of these drugs in controlling uveitic inflammation; however, their use in NIU is still under investigation, with no randomized controlled trials providing Level I evidence.Item Indications for exchange of posterior chamber phakic intraocular lens in high myopia(Wolters Kluwer – Medknow, 2025-07) Sudanaboina, Priyanka; Murthy, Somasheila IPurpose: To enumerate and analyze the indications for the exchange of phakic intraocular lens (pIOL) in patients with high myopia. Design: Retrospective observational case series. Methods: We retrospectively analyzed the medical reports of patients who underwent an exchange of posterior chamber pIOL at our institution between 2015 and 2022. Preoperative refractive and biometric measurements, pIOL parameters, cause for exchange, and outcomes were assessed. Results: During the study period, 1715 posterior chamber pIOL implantations were performed. Spherical pIOLs were implanted in 328 (19.1%), and toric pIOLs were implanted in 1387 (80.8%) eyes during primary surgery. Nineteen eyes from 18 patients (1.107%) required exchange. Indications for pIOL exchange included high vault in nine eyes, low vault in two, and rotation of the pIOL in five. The mean follow?up period after the pIOL exchange was 3.3 months (range: 1–6.04 months). Repeat surgery was not required for any case. None of the patients had any residual refractive error, and their best?corrected visual acuity was preserved. Conclusion: Overall, the rate of pIOL exchange in our study was low, and it is associated with good outcomes. The most common cause for exchange was high vault, followed by toric pIOL misalignment.