Indian Journal of Ophthalmology
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Item Idebenone vs. rAAV2-ND4 gene therapy in the treatment of Leber’s hereditary optic neuropathy: An indirect comparison meta-analysis(Wolters Kluwer – Medknow, 2025-05) Hassan, Amr K; Abu, Serhan HashemHassan, Amr K; Abu Serhan, Hashem To compare the outcomes between idebenone oral therapy and rAAV2?ND4 intravitreal injection in the treatment of Leber’s hereditary optic neuropathy. A systematic literature review was performed of publications from 1990 to 2023 in PubMed, Ovid MEDLINE, Cochrane CENTRAL, Google Scholar, Embase, CrossRef, OpenAlex, and Web of Science for studies evaluating the outcomes of idebenone or rAAV2?ND4 therapy in Leber’s hereditary optic neuropathy. The primary outcome measure was improvement in visual acuity. Secondary outcome measures were improvement of retinal nerve fiber layer thickness, ganglion cell layer volume, and visual field mean deviation. There are no studies directly comparing the two interventions. Our analysis included 645 patients from 17 studies; 338 patients from nine studies received idebenone, and 307 patients from eight studies received rAAV2?ND4. When compared to each other, rAAV2?ND4 provided better visual improvement at 6 months with a mean difference of 0.07 (P = 0.8289), but idebenone provided better visual improvement at 1 year with a mean difference of 0.35 (P < 0.0001). At 2 years, the rAAV2?ND4 group’s visual acuity improved from baseline by 0.18 (P = 0.08). There was no data for improvement at 2 years for idebenone, only for rAAV2?ND4. rAAV2?ND4 provides better visual acuity results at 6 months, and idebenone provides better visual acuity results at 1 year. Further studies are recommended to formulate a complete idea about the long?term results (>2 years).Item The effects of hemodialysis on the eye(Wolters Kluwer – Medknow, 2025-05) Protsyk, Olena; Lacorzana, JavierThe purpose of this study was to examine the effects of hemodialysis on the eye and its long?term consequences. Hemodialysis is a process that purifies the blood and maintains the balance of water, solutes, acid?base, and electrolytes. The eye, being primarily composed of fluid, has been speculated to be affected by this technique. To analyze these effects, a literature review was conducted, focusing on the anatomical structures, functions, and changes in the eye following hemodialysis. The search for relevant articles was carried out on PubMed, including studies published in English between 2000 and 2023. The results of the review showed that certain observations such as visual acuity, refraction, intraocular pressure, biometric parameters, and retinal nerve fiber layer did not show significant timing?related impacts, or there were conflicting findings. However, a connection was established between hemodialysis sessions and visual fields, parameters of visual?evoked potential, intraocular pressure in glaucoma, tear break?up time, Schirmer’s test values, choroidal thickness, flow velocities of vessels, and ocular perfusion pressure values. In conclusion, it was determined that hemodialysis sessions can cause fluctuations that may complicate the assessment of eye health. To obtain a more accurate baseline evaluation, it is recommended to schedule ophthalmological examinations, a few hours after the hemodialysis session. Additionally, it is important to provide appropriate management for dry eyes and ocular hypertension, particularly during hemodialysis sessions. Coordination of these examinations with the timing of renal replacement therapy is advised to ensure optimal patient care.Item The pattern of visual impairment in the spectrum of hypoxic ischemic encephalopathy(Wolters Kluwer – Medknow, 2025-05) Phuljhele, Swati; Balasubramaniam, Niranjana; Saluja, Gunjan; Saxena, Rohit; Sharma, Pradeep; Kumar, Pavan; Kusiyait, Sanjay; Gulati, SheffaliPurpose: This study aimed to evaluate the relationship between visual impairment, social maturity, and clinical severity of hypoxic?ischemic encephalopathy (HIE) in the Indian population. Methods: An observational study was conducted in children with HIE sequelae aged between 6 months and 5 years. Sixty diagnosed cases of perinatal HIE were recruited, with twenty children in each of clinical grades 1, 2, and 3 according to the Sarnat clinical staging. All children underwent cycloplegic refraction using atropine 1% eye ointment, visual Acuity (VA) testing by teller acuity cards (TAC), anterior and posterior segment examination, FLASH visual evoked response (VER), strabismus workup, and social maturity assessment using the vineland social maturity scale (VSMS). Results: Sixty children, including 14 preterm and 46 term infants, with a mean age of 26.11 ± 16.06 months were studied. Normal birth weight was observed in 54% of the cases, whereas 42% had low birth weight and 4% had very low birth weight. There was no statistically significant difference between birth weight and the clinical severity of HIE (P = 0.970). A significant relationship between VA and clinical severity (TAC? p < 0.0001) and between VA and social maturity was observed. Optic disc pallor was present in 85% of grade 3 HIE cases. Among the 37 children with strabismus, the convergent type was predominant (86.4%). Refractive error was comparable across all grades of HIE. Conclusion: Visual impairment was significantly related to the clinical severity of HIE and had a negative impact on the social maturity of these children.Item Pediatric endogenous endophthalmitis: Clinical features and treatment outcomes(Wolters Kluwer – Medknow, 2025-05) Nanda, Ridham; Das, Taraprasad; Padhi, Tapas Ranjan; Panda, Krushna Gopal; Ger, Marina; Padhy, Srikanta KumarContext: Forty?eight pediatric patients treated for endogenous endophthalmitis were analyzed. Redness and vitritis were the common symptom and sign, respectively; infection with Gram?negative bacilli was frequent. Children under 5 and with systemic illness had poorer visual prognosis. Purpose: To Analyze the demographics, clinical?microbiological profiles, and treatment outcomes of pediatric patients with endogenous endophthalmitis. Methods: We conducted a retrospective analysis of electronic medical records covering 8 years from 2016 to 2023 at a tertiary eye care center in India, focusing on patients of age <18 years diagnosed with endogenous endophthalmitis. Data extraction included demographic variables, clinical presentations, microbiological analyses, therapeutic interventions, and visual outcomes. Results: The analysis included 48 patients with an average age of 5.4 ± 4.98 years and an equal gender ratio. During the study period, 48 children with endogenous endophthalmitis were treated; it was 5% (48 of 961) of all endophthalmitis patients and 20.8% (48 of 231) of pediatric endophthalmitis patients. Common symptoms included redness (62.5%), reduced vision (20.8%), leucocoria (27.08%), pain (22.91%), and watering/discharge (29.16%). Clinical signs included vitritis (89.58%) and anterior chamber exudates/ hypopyon (47.91%). Vitreous culture positivity was 54.05%; common isolates were Gram?negative bacilli (35%), Gram?positive cocci (25%), and Gram?positive bacilli and fungi (20% each). Systemic infection was present in 72.9% (35 of 48) of patients, with respiratory tract infection being the most common (39.5%). All eyes received intravitreal antibiotic injections, and 28 (75.7%) received vitrectomy. Children under 5 with systemic illness had a worse visual prognosis. Unfavorable outcomes were associated with Gram?positive bacilli and fungal infection. Approximately 45% of eyes worsened to phthisis. Conclusions: Any redness in a child with systemic infection warrants prompt ophthalmic evaluation. Children under 5 with systemic illness are associated with a worse visual prognosis. Unfavorable outcomes are linked to Gram?positive bacilli and fungal infection.Item Coats disease in infants, toddlers, and preschoolers: Clinical presentation and treatment outcomes(Wolters Kluwer – Medknow, 2025-05) Hansraj, Saarang; Jalali, Subhadra; Raval, VishalPurpose: To study the stage of presentation, clinical features, and treatment outcomes of patients diagnosed with Coats disease in infants, toddlers, and preschoolers (aged ?5 years). Methods: A retrospective hospital?based study of 98 patients with Coats disease was conducted. Results: The mean age at presentation was 30 months (range, 4–60 months). Majority were males (n = 72, 73%) with unilateral presentation (n = 98, 100%). The most common stages at presentation were total retinal detachment (stage 3B; 36%), advanced end?stage disease (stage 5; 22%), and total retinal detachment with secondary glaucoma (stage 4; 16%). The most common cause of referral to our institution was Coats disease (n = 23, 49%), followed by retinoblastoma (n = 17, 36%). The most common presenting symptom was a white reflex (n = 49, 50%) or strabismus observed by the parents (n = 34, 35%). Treatment modalities included observation (n = 30 eyes, 31%), surgical intervention (n = 22, 22%), and laser photocoagulation ± cryotherapy ± intravitreal injection (n = 22, 22%). At a mean follow?up of 29 months (range, 1–100 months), the anatomical status of the disease remained unchanged in 35 eyes (36%), worsened in 18 eyes (18%), and resolved in 15 eyes (15%). Ten eyes (10%) underwent enucleation. At the last follow?up, two?thirds of eyes (n = 76) had visual acuity ?20/400 and were categorized as blind. Conclusion: Coats disease in patients ?5 years presents at an advanced stage (3B or more). At the last follow?up, the disease had stabilized in half of the eyes, whereas two?thirds of the eyes were blind, necessitating early diagnosis and treatment.Item Vernal keratoconjunctivitis in human immunodeficiency positives: A case series(Wolters Kluwer – Medknow, 2025-04) Agarwal, Shweta; Srinivasan, Bhaskar; Iyer, Geetha; Patel, Nilay; Rajagopal, Rama; Gurumurthy, Srividya; Sudharshan, SridharanPurpose: To analyze the clinical profile of vernal keratoconjunctivitis (VKC) and its response to treatment in human immunodeficiency virus (HIV) patients and its relation with CD4 counts. Methods: This study is a retrospective observational case series of patients with HIV and VKC. Results: Thirteen patients presented with HIV and VKC, with 69.2% having a severe?grade VKC. Median age of onset of VKC was 5 years in children and 31.5 years in adults. Seventy percent had a drop in CD4 counts at the onset of VKC. The duration between diagnosis of HIV and onset of VKC was statistically less in adults than in children. Eleven were on highly active antiretroviral therapy at presentation, and three patients were changed to second line of therapy, two of whom showed worsening of VKC just before shifting. Conclusion: The study thus highlights the correlation between worsening of VKC and decrease in CD4 counts, and thus there is a need for aggressive management of HIV to prevent VKC?related complications.Item Evaluation of topical 1% posaconazole therapy in refractory fungal keratitis(Wolters Kluwer – Medknow, 2025-01) Vanathi, Murugesan; Yadav, Devendra K; Velpandian, Thirumurthy; Ahmed, Nishat Hussain; Muraleekrishna, Manu; Beniwal, Abhijeet; Lomi, Neiwete; Gupta, Noopur; Tandon, Radhika; Khan, Maroof APurpose: 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 MIC50 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?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?50 against the common pathogenic fungi as compared to natamycin, amphotericin B, and voriconazole.Item Adjunct Topical Human Immunoglobulin IgG Therapy in Dry Eye Disease(Wolters Kluwer – Medknow, 2025-04) Vanathi, Murugesan; Khan, Livia; Velpandian, Thirumurthy; Dubey, Ashish; Gupta, Noopur; Seth, Tulika; Mahapatra, Manoranjan; Khan, Maroof Ahmed; Jain, Sandeep; Tandon, RadhikaPurpose: The aim of this study was to evaluate the role of topical human IgG eye drops (4 mg/mL) as adjunct therapy in eyes with moderate to severe refractory dry eye disease (DED). Methodology: A prospective, longitudinal, open label, dual cohort study of patients with chronic DED of moderate to severe grade comprise of OSIG therapy group cohort on topical immunoglobulin IgG 0.4% four times daily, as adjunctive therapy for one year, to study the role of OSIG therapy in comparison with conventional treatment. Patients above 18 years of age with chronic moderate to severe grade DED with tear break?up time (TBUT) ?7 seconds, Schirmer test ?9 mm/5 minutes, ocular surface disease index (OSDI) score ?13, National Eye Institute (NEI) corneal staining score >3, and conjunctival staining score >3 were recruited into the study. Study participants in the conventional treatment cohort group were on topical lubricants four hourly (carboxymethyl cellulose 0.5% and lubricant ointment at bedtime), topical steroids (prednisolone 1%/fluorometholone 0.1%/loteprednol 0.5%) therapy as per the severity of the DED requirement and topical immunomodulators (cyclosporine A 0.1% eye drops or tacrolimus 0.1% eye ointment) twice daily. Study participants in the OSIG treatment cohort group were started on topical human immunoglobulin IgG 0.4% four times daily as adjunct therapy in addition to the all the above?mentioned medications for a period of 12 months. Study parameters included DED severity level assessment, NIH score, ocular surface evaluation tests, Schirmer’s I test, TBUT, corneal and conjunctival staining score, OSDI score, and conjunctival hyperemia score. Ocular surface imaging using LipiView and ocular surface analyzer imaging for non?invasive TBUT (NITBUT), meibomian gland, and tear imaging was performed for the OSIG treatment cohort. Study characteristics were evaluated at time of recruitment into the study (baseline visit) and at serial follow?up of months 3, 6, and 12 in OSIG treatment group and follow?up at month 6 in conventional treatment group. Treatment grading score was devised in accordance to the frequency of application of lubricants and steroids and potency of steroids. Results: Our study of 71 eyes of 36 patients [mean age 39 ± 11.80 years] in OSIG treatment cohort group and 64 eyes of 32 patients [mean age 40 ± 11.53 years] in conventional treatment cohort group observed a significant reduction in the objective ocular surface symptom assessment parameters of OSDI scores, and dry eye severity level with improvement in clinical assessment parameters of TBUT, ocular surface staining scores, and conjunctival hyperemia grades in eyes on adjunct OSIG treatment cohort as compared to the conventional therapy cohort. The frequency of topical lubricants and steroids along with the potency of steroids used showed a decreasing trend with 45.28% noted to have become free of steroid dependence at the end of 12 months of OSIG therapy. Adjunct topical IgG therapy also enabled the shifting of 37.14% of eyes from higher to lower potency steroids by the end of 12 months of treatment with OSIG therapy. The frequency of administration of lubricants decreased in 83.33% of eyes 12 months follow?up. The success rate determined based on improvement in ocular surface evaluation was 75.76%, treatment scores improved in 74.98%, and symptoms evaluation (OSDI) was 75.76% in the OSIG therapy cohort. Conclusion: Topical immunoglobulin IgG 0.4% as adjunct therapy seems to have a definitive role in reducing topical steroid and lubricant dependency in moderate to severe chronic DED compared to conventional therapy.Item Rare pediatric retinal diseases: A review(Wolters Kluwer – Medknow, 2025-05) Vinekar, Anand; Wu, Wei-Chi; Lorenz, Birgit; Bavaskar, Snehal; Berrocal, Audina; Lopez-Cañizares, Ashley; Fung, Nicholas; Lam, Wai Ching; M.llop, Stephanie; Mangalesh, Shwetha; Ozdek, Sengul; Toth, CynthiaRare pediatric retinal disorders present significant challenges in diagnosis and management due to their limited prevalence and diverse clinical manifestations. This paper provides a comprehensive review of select rare retinal disorders affecting the pediatric population, focussing a brief on their epidemiology, clinical characteristics, diagnostic modalities, and therapeutic interventions. Through a systematic examination of current literature and clinical case studies, this review aims to elucidate the distinct features and challenges associated with each disorder. Despite the rarity of these conditions, their impact on visual function and quality of life necessitates heightened awareness among clinicians and researchers to facilitate timely diagnosis, appropriate management, and improved outcomes for affected children as their visual systems are still developing. Furthermore, advancements in diagnostic modalities such as fundus fluorescein angiography, optical coherence tomography, electroretinography, and genetic testing are examined for their role in enhancing our understanding of rare pediatric retinal disorders and facilitating early intervention strategies. The literature selection for this article was conducted through PubMed, Google Scholar, and the Cochrane Library databases. A thorough systematic search was carried out for the concerned diseases. Relevant review articles, original research studies, case series, and reports were examined. Additionally, references from these sources were reviewed and included if they provided pertinent information on the topic. The search was not restricted by publication date.Item Advances in origin, evolution, and pathogenesis of optic disc drusen: A narrative review(Wolters Kluwer – Medknow, 2025-05) Liu, Xiyuan; Yan, YanOptic disc drusen (ODD) is acellular calcified deposits found mainly in front of the lamina cribrosa within the optic nerve. It can cause chronic or acute vision loss. There has been progress in clinical diagnosis using ophthalmic multimodal imaging in recent years. We conducted a database search on PubMed and Google Scholar (April 2023) with no restrictions on publication year or language. We used the terms: (“optic disc drusen”) OR (“optic nerve head drusen”) OR (“drusen of optic nerve head”). Other terms included gene, mutation, scleral canal, axonal transport, calcinosis, mitochondria, blood vessel, vasculature, visual field, vision, and optical coherence tomography to identify publications. Etiologically, ODD may stem from congenital genetic defects, aberrant axoplasmic transport, anatomical abnormalities, and mechanical factors during ocular duction. Clinically, ODD is linked to progressive visual field defects and vascular complications. Detection of deeply buried ODD can be challenging, but advances in optical coherence tomography make early identification possible. Structural changes, including retinal nerve fiber layer thinning, can be monitored. Increasing reports indicate vascular complications, including anterior ischemic optic neuropathy, in ODD patients. Currently, ODD?related visual field defects are not effectively treated, and observation remains the primary management approach. Future pathological discoveries or the establishment of animal models may provide new evidence for revealing the pathogenesis of ODD.Item Could ocular demodicosis be a risk factor for punctal stenosis, dry eye, and blepharitis?(Wolters Kluwer – Medknow, 2025-04) Basol, Ibrahim; Yazisiz, Hatice; Ilhan, Hatice Deniz; Ozyurt, Ozlem Koyuncu; Ozhak, BetilPurpose: Demodex, an ectoparasite, can threaten eye health by settling into different eyelash bases. It is particularly suggested to cause dysfunction in the Meibomian glands. This cross?sectional study aimed to investigate the relationships between ocular demodicosis, punctal stenosis, dry eye, and blepharitis. Methods: A total of 144 patients who presented to the Ophthalmology Clinic and volunteered to participate in the study were included. The demographic characteristics of the patients, presence of blepharitis, tear breakup time, eye?watering according to Munk’s epiphora scoring, and punctal structures according to Kashkouli classification were recorded. Eyelash epilation was performed while preserving the root structure, and the eyelashes were examined under a light microscope. The relationship between Demodex presence and severity with punctal structure, dry eye status, and blepharitis was evaluated. Results: No significant relationship was found between punctal stenosis and Demodex spp. infestation in both eyes (P > 0.05). Overall, there was a statistical relationship between the presence of Demodex spp. settled in the eyelashes (right lower and upper, left upper eyelid lashes) and dry eye (P < 0.05), but there was no relationship with Demodex density (>3/ eyelid). In eyes with blepharitis, especially in patients with anterior blepharitis, the presence and density of Demodex spp. were higher than in patients without blepharitis (P < 0.001 for the right upper, left lower, and upper eyelids, P = 0.001 for the right lower eyelid). Conclusion: Demodex infestations may be associated with blepharitis and dryness of eyes, but there is no association with punctal stenosis.Item Unpacking VKC: How gender and age shape the clinical picture(Wolters Kluwer – Medknow, 2025-04) Chauhan, Gaurav; Mathimaaran, Suhita; Chandrasekar, Ambika; Chavda, Varsha B; Mugundhan, R; Srinivasan, Bhaskar; Iyer, Geetha; Rajagopalan, Murlidhar; Agarwal, ShwetaPurpose: To investigate gender differences in childhood? and adult?onset vernal keratoconjunctivitis (VKC), as well as the variations between these onset groups. Methods: This was a retrospective, observational study (Jan 2015–Dec 2020). Electronic medical records of VKC patients managed by cornea specialists were analyzed based on their age of onset (<16 years for childhood [C?VKC], >16 years for adult [A?VKC]) and gender. Results: Out of 1018 VKC patients, 931 had childhood onset and 87 had adult onset. Both groups showed a male predominance; however, it was slightly less in A?VKC, with a mean follow?up of 28.6 ± 36.2 and 25.03 ± 40.3 months in C?VKC and A?VKC, respectively. A family history of allergies was observed only in C?VKC, with no gender differences. Asthma was more common in C?VKC, while skin allergies were more prevalent in A?VKC. Mixed VKC with Grade 4 severity was the most common in both age groups, with no gender differences in C?VKC; however, the limbal variant was more common in females with A?VKC. The proportion of A?VKC and C?VKC patients who developed complications was similar (P value 0.85). However, the C?VKC group had a significantly higher number of patients with multiple complications (P value 0.0076) as well as those requiring surgical intervention (P value 0.02). Keratoconus was the most common complication in both groups, but limbal stem cell deficiency was significantly higher in A?VKC across genders. Conclusion: Adult?onset VKC is a distinct condition with minor differences and a milder course compared to childhood?onset VKC. Notably, there are no significantItem Comparative evaluation of aqueous solution and oil emulsion formulations of 0.05% cyclosporine eye drops in dry eye disease – A randomized clinical trial(Wolters Kluwer – Medknow, 2025-04) Salam, Ayesha A; Sen, Seema; Lomi, Neiwete; Gupta, Noopur; Vanathi, Murugesan; Tandon, RadhikaPurpose: To compare the clinical response of patients with moderate?to?severe dry eye disease to treatment with 0.05% cyclosporine eye drops as an aqueous solution or oil emulsion. Study Design: Prospective randomized clinical trial. Methods: An institutional study where 88 patients with moderate?to?severe dry eye was enrolled after written informed consent and randomized to receive either aqueous solution (Group 1) or oil emulsion (Group 2) 0.05% cyclosporine eye drops in twice daily dosing in addition to lubricant eyedrop 0.5% carboxymethylcellulose six times/day in both eyes. Comprehensive eye examination and baseline parameters were recorded, and clinical assessment was repeated at 4, 8, and 12 weeks. Parameters evaluated included ocular surface disease index score (OSDI), Schirmer test, tear break?up time (TBUT), corneal fluorescein staining – National Eye Institute (NEI) scoring, lipid layer thickness (LLT), tear meniscus height (TMH), non?invasive tear break?up time (NIBUT), percentage loss of meibomian glands, and impression cytology (number of goblet cells/hpf). Results: The mean age was 39 ± 15.6 years and 42 ± 17.7 years, and the M:F ratio was 26:19 and 20:24 in Groups 1 and 2, respectively. Both the groups showed comparable values at baseline. After treatment, there was statistically significant improvement over baseline values in both groups at 4, 8, and 12 weeks. At 12 weeks for the following parameters, there was no significant difference between the groups, though there was an improvement over baseline in Groups 1 and 2, respectively, as follows: OSDI score – 30.89, 33.28 (P < 0.001), Schirmer test – 5 mm, 4 mm (P < 0.001), TBUT – 2.65 sec, 3.07 sec (P < 0.001), NEI score – 2, 2 (P < 0.001) and the number of goblet cells/hpf – 1.5,9 (P = 0016, P = 0.001). A higher number of patients, by a value of 9, in Group 2 showed an increase in the number of goblet cells/hpf. The NIBUT value showed statistically significant improvement in Group 2 compared to Group 1 (P = 0.011). Group 2 also showed statistically significant improvement in TMH by the 8th week (P = 0.015) and in LLT by the 12th week (P < 0.001). Group 1 comparatively showed earlier improvement in LLT by the 4th week (P = 0.027). Conclusion: Both aqueous solution and oil emulsion 0.05% cyclosporine formulations appear to be equally effective in the management of dry eye disease with a comparatively better response with oil emulsion formulations.Item Amniotic membrane grafting for acute ocular involvement in Stevens-Johnson syndrome: Review of perioperative considerations, surgical techniques, and outcomes(Wolters Kluwer – Medknow, 2025-04) Singh, Prabhakar; Palit, Aparna; Gupta, Abhishek; Niyogi, Subhrashis G; Loganathan, Sekar; Chattopadhyay, Mahuya; Meshram, Sheel; Verma, Abhishek; Tripathy, Peeyush KTo review the perioperative considerations, surgical techniques, and outcomes of amniotic membrane grafting for acute ocular manifestations in Stevens?Johnson syndrome (SJS) and discuss a novel amniotic membrane grafting method. An online literature search of published articles on amniotic membrane grafting in acute SJS was performed using appropriate keywords on March 1, 2024. The relevant articles were included and analyzed. The review summarizes the relevance of amniotic membrane grafting in the current scenario. It also compares different techniques of amniotic membrane grafting and the ocular surface coverage each procedure provides. A novel technique of amniotic membrane grafting has been discussed with a schematic explanation. It also summarizes the complications of amniotic membrane grafting and their management, and the long?term outcomes of amniotic membrane grafting in preventing chronic sequelae. One should have a lower threshold for doing amniotic membrane grafting in cases with ocular involvement. This prevents the development of long?term sequelae and subsequent corneal blindness.Item Corneal breakdown in thyroid eye disease: Presentation and outcomes over a decade(Wolters Kluwer – Medknow, 2025-04) Narnoli, Prasansha; Rath, Suryasnata; Tripathy, Devjyoti; Mohapatra, Samir; Priyadarshini, Smruti R; Das, Sujata; Ali, Md HasnatPurpose: Corneal breakdown in thyroid eye disease (TED) is an ocular emergency. This study aimed to assess the outcome of multimodal management for corneal breakdown in TED. Methods: This retrospective audit included all consecutive corneal breakdowns in TED patients between November 2011 and May 2023. The primary outcome measure was the best corrected visual acuity (BCVA), and secondary outcome measures included proptosis, clinical activity score (CAS), and proportion of globe salvage. Results: In all, 35 TED patients (50 eyes; 15 bilateral) were included in this study. The mean age was 50.6 + 16 years (range 17–83), and 23 were male. Median TED duration was 5 months (range 1–108). Seven patients (nine eyes) developed corneal breakdown ?2 years after disease onset. Corneal breakdown was graded as superficial punctate keratopathy in 18, microbial keratitis in 14, and microbial keratitis with thinning and/or perforation in 18 eyes. At median follow?up of 17 months (range 2–72), in the orbital decompression group, overall mean BCVA before and after orbital decompression showed improvement from 1.2 to 0.7, mean proptosis from 25.4 ± 3.5 to 20.7 ± 2.1 mm, and median CAS from 4.2 ± 1.3 to 0.3 ± 0.6. In the medical management group, the mean BCVA changed from 1.7 to 1.5, mean proptosis from 22.5 ± 2.5 to 22.3 ± 2.4 mm, and CAS from 3.0 ± 1.4 to 1.1 ± 1.4 before and after treatment, respectively. At the final follow?up, 44 eyes (88%) achieved globe salvage, while six eyes were eviscerated. Conclusion: Corneal breakdown necessitates expeditious and intensive multimodal management – topical medications, systemic medications, eyelid surgery, and orbital decompression surgery. In severe corneal breakdown with microbial keratitis with thinning and perforation, multimodal management helps achieve a high percentage of vision and globe salvage.Item OSSN in South India: Clinical presentation, treatment outcomes, and histopathologic correlations(Wolters Kluwer – Medknow, 2025-04) Prasad, P V Tejaswi; Krishnan, Shanti Radha; Radhakrishnan, Naveen; Bhaskaran, Sahithya; Prajna, N VenkateshPurpose: This study aimed to analyze the clinical presentation, treatment outcomes, and histopathology features of ocular surface squamous neoplasia (OSSN) in a South Indian population and correlate the area of lesions to the histopathological grade/severity of carcinoma in situ (CIN) and squamous cell carcinoma (SqCC) invasive and noninvasive tumors. Methods: The study was a retrospective cross?sectional study. The study reviewed electronic medical records (EMRs) of 99 eyes of 99 South Indian patients who underwent en bloc excision and biopsy for tumors in the corneal and conjunctival epithelium with suspicion of OSSN over 1 year from January 2019 to December 2019. Postoperatively, patients were treated with three cycles of topical 0.04% mitomycin C eye drops. Sixty?three had requisite EMR data with a follow?up period of 1 year. Results: Patients had equal gender distribution with an age range of 28–83 years. The most common clinical variant was leukoplakic lesion, and the area of the lesion was the only predicting factor for SqCC and CIN. Conclusion: Bigger (T2) lesions should be strongly suspected for OSSN and promptly excised. Histopathologic analysis should be performed, and post?op topical mitomycin C or interferon alpha 2b is administered to avoid recurrence. In this study, by correlating the area of the lesion, we introduce a new variable that may aid in clinical prognostication alongside the AJCC classification.Item Autologous Tenon’s patch graft: Techniques, clinical outcome, and complications in cases of immune corneal melt(Wolters Kluwer – Medknow, 2025-04) Rani, Nisha; Sahu, Srikant K; Sahoo, SonaliPurpose: To study the techniques, clinical outcomes, and complications of autologous Tenon’s patch grafting in patients with non?infectious corneal melt. Methods: This retrospective analysis included 15 eyes from 15 patients with non?infective corneal melt who underwent autologous Tenon’s patch grafting between January 2021 and December 2023 at our tertiary care institute. The age of the patients ranged from 16 to 79 years (mean: 46.64 ± 17.20 years), and there were eight males and seven females. Tenon’s tissue was harvested from the same eye in all patients, placed on the perforation site, and tucked in and secured with 10?0 nylon sutures in 14 eyes and with additional cyanoacrylate glue in one eye. The follow?ups ranged from 1 month to 2 years (mean: 9.17 ± 6.83 months). Results: The graft healed with scarring and vascularization in 10 eyes (66.67%), and loss of Tenon’s patch graft was seen in two eyes (13%). Three (20%) patients were lost to follow?up, and five (33%) achieved a vision of >20/200. Conclusion: In active immune corneal melt, Tenon’s patch graft restores cornea and globe integrity, delaying the need for keratoplasty in an inflammatory condition.Item Outcome of tenonplasty in scleral ischemia secondary to acute ocular surface burn(Wolters Kluwer – Medknow, 2025-04) Gupta, Nidhi; Singh, Shweta; Sangwan, Virender; Mathur, UmangPurpose: To study the outcome of tenonplasty in eyes with perilimbal ischemia in acute ocular surface burns. Methods: This was a single?center retrospective study that included all patients presenting between May 2012 and December 2022 with acute ocular surface burn (within 6 weeks from injury) with perilimbal scleral ischemia, without perforation or previous surgical intervention for the same. All these patients underwent single?stage tenonplasty with amniotic membrane transplantation and medical management. Successful outcome was defined as globe preservation at 6 months. Results: Twenty?three eyes of 20 patients were included in our study. Out of these, alkali was the most common offending agent (10 eyes of 8 patients). The extent of scleral ischemia was <90° in seven eyes, 90°–180° in six eyes, and >180° in 10 eyes. The mean interval between the injury and tenonplasty was 16.5 days. Globe integrity in 20 of the 23 eyes was maintained 6 months post injury. Three eyes that developed hypotony at the end of 6 months had more than 180° of perilimbal scleral ischemia at presentation. The extent of scleral ischemia correlated with the development of phthisis bulbi, but the values were not statistically significant (P = 0.081). Conclusion: Tenonplasty in the acute stage acts as a globe?salvaging procedure in acute chemical burns with perilimbal scleral ischemia. Extensive scleral ischemia in an acute chemical burn remains a poor prognostic factor for globe integrity in the long term.Item Quantitative and qualitative assessment of evaporative dry eye post intense pulsed light therapy, a prospective study(Wolters Kluwer – Medknow, 2025-04) Patwardhan, Sourabh D; Sangle, Ankita; Patwardhan, Nidhi S; Mane, SeemaPurpose: This study aimed to determine the effect of intense pulsed light(IPL) treatment on meibomian gland disease. Settings and Design: This is a prospective interventional study. Methods: Seventy eyes of patients with dry eye disease undergoing three sessions of IPL therapy, 15 days apart, were included. Each patient completed the dry eye questionnaire (SPEED) for symptomatic assessment. Dry eye evaluation tests were performed, including Schirmer’s 1 test, meiboscopy, noninvasive tear break?up time (NIBUT) and interferometry. These tests were repeated before each IPL session. Statistical Analysis Used: Data analysis was performed using IBM SPSS Statistics software (Version 20, Inc., Chicago, Illinois, USA). To Kolmogorov–Smirnov test was used to assess the normality of the variables. The Chi?square test was applied for statistical analysis. Level of significance was set at p ? 0.05. Results: The mean symptom score from the dry eye questionnaire(SPEED) showed a significant reduction of 24.5% (p < 0.001) in symptoms. Schirmer’s 1 test showed an improvement of 16.43% on day 15 and 40.13% on day 45. Meiboscopy grade improved by 13.54% on day 45. NIBUT improved from 53.29% on day 15 to 135.53% on day 45. Interferometry showed an improvement of 58.91% on day 45.Conclusions: The various investigative tests demonstrated both qualitative and quantitative improvements in dry eye disease, and patients reported symptomatic relief. The effects of IPL therapy, in terms of symptomatic relief, continued to improve with each session. The quality of the tear film also improved progressively. IPL therapy is a potential therapeutic option for MGD.Item Immunotherapy: Current indications and recommendations in the management of ocular allergy(Wolters Kluwer – Medknow, 2025-04) Mahesh, Padukudru Anand; Samajdar, Shambo Samrat; Nagarajan, Sowmya Arudi; Murthy, Greeshma Mandya Venkatesh; Moitra, SaibalAllergic diseases, including allergic conjunctivitis (AC), pose a significant health burden, affecting both developed and developing nations. Despite its importance, AC is often underreported, leading to underestimated incidence and prevalence. The coexistence of AC with allergic rhinitis and its comorbidity with asthma underscore its clinical relevance. The prevalence of nasal symptoms with eye symptoms related to eye allergy varies among different age groups and regions worldwide. Climatic factors, aeroallergens, and environmental exposure play significant roles in the prevalence of ocular allergies. Allergen immunotherapy (AIT) represents the only disease?modifying treatment for IgE?mediated allergic diseases. This review provides a comprehensive overview of the history, mechanisms, and evidence of AIT for ocular allergies, with a focus on AC. The primary routes of AIT, subcutaneous immunotherapy (SCIT), and sublingual immunotherapy (SLIT) are discussed in detail. The evidence for AIT in treating AC is extensive and demonstrates its effectiveness in alleviating ocular symptoms, reducing medication usage, and improving the quality of life in patients. Both SCIT and SLIT have shown positive results, with SLIT having a more favorable safety profile. Considerations for initiating and maintaining AIT, including adherence, financial burden, and treatment duration, are highlighted. In summary, AIT is a valuable treatment option for AC, offering long?term symptom relief and potential cost?effectiveness. By understanding the history, mechanisms, and evidence of AIT, healthcare providers can better manage ocular allergies and improve patient outcomes.