Indian Journal of Ophthalmology
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Item Outcomes of intravitreal anti-VEGF injections and panretinal photocoagulation in preretinal hemorrhage secondary to proliferative diabetic retinopathy involving the fovea(Wolters Kluwer – Medknow, 2024-05) Brar, Manpreet; Sharma, Mansi; Grewal, Satinder Pal Singh; Dogra, MangatPurpose: To evaluate the outcome of intravitreal anti?vascular endothelial growth factor (VEGF) injections and panretinal photocoagulation (PRP) in fovea involving preretinal hemorrhage (PRH) secondary to proliferative diabetic retinopathy (PDR). Methods: Retrospective non?comparative cross?sectional series of patients diagnosed with fovea involving PRH secondary to PDR at our institute from March 2019 to October 2021 who were treated with combination treatments of intravitreal anti?VEGF and PRP and have completed a minimum 6?month follow?up. The primary outcome measure was serial changes in the visual acuity (VA) and PRH regression from the fovea. Secondary outcome measures were the quantitative assessment of the size of PRH, its association with VA improvement and time to regression, and the proportion of patients who underwent surgery for poor response. Results: In total, 22 eyes of 21 patients showed regression of PRH from the foveal center at 33.6 days, and complete regression was seen at 140.7 days. The average number of anti?VEGF injections required for clearance of PRH from the fovea was 1.6. Mean LogMAR visual acuity improved from 0.54 at baseline to 0.32 at 4 weeks and 0.18 at 6 months (P < 0.01). Three eyes (13.6%) required vitrectomy surgery during follow?up. The mean area of PRH as measured by Image J analysis was 14.78 mm2 at baseline, 8.97 mm2 at 4 weeks, and 1.25 mm2 at 3 months (P < 0.01). No statistically significant difference was seen between the size of PRH and PRH clearance time and VA improvement. No systemic side effects were observed following the intravitreal injections during follow?up. Conclusion: Intravitreal anti?VEGF injections and PRP were found to be effective and safe treatment methods for fovea involving PRH secondary to PDR. Long?term studies are warranted to assess the long?term efficacy.Item Multiple sclerosis-associated uveitis – A series from South India(Wolters Kluwer – Medknow, 2024-05) Babu, Kalpana; Janardhana, Geethanjali C; Murthy, Krishna RPurpose: To report clinical profiles of multiple sclerosis (MS)?associated uveitis in seven cases from a single tertiary eye care center in South India. Methods: Retrospective case series 2013–2023. Results: Seven cases of MS?associated uveitis were retrieved from our databases. There were five females and two males. The diagnosis of MS was made by the neurologist in all cases. Bilaterality was seen in all cases. Intermediate uveitis was the most common presentation (five cases). It was associated with peripheral retinal vasculitis (two cases) and disc pallor (two cases). Fuchs heterochromic iridocyclitis (one case) and incomplete Vogt–Koyanagi–Harada (VKH)?like presentation with a peripapillary choroidal neovascular membrane (one case) were the other presentations. In the case with incomplete VKH?like presentation, whole genome sequencing revealed a heterozygous non?synonymous variation (c.1228C>T) in exon 10 of TNFRSF1A, suggestive of susceptibility to multiple sclerosis 5 due to mutation in the TNFRS1A gene on chromosome 12p13.31. All cases received systemic steroids. Azathioprine (three cases) and rituximab (three cases) were the commonly used immunomodulatory drugs. The visual outcome was good in all cases at the last follow?up. Conclusion: MS?associated uveitis is underreported in India. This series highlights the clinical profile of MS?associated uveitis in India.Item Systemic lupus erythematosus (SLE) associated uveitis in India – A case series(Wolters Kluwer – Medknow, 2024-05) Magesan, Kowsigan; Nangia, Purna; Manoharan, Anitha; Sitaula, Ranju K; Srikantiah, Chandrashekara; Biswas, JyotirmayPurpose: To report the uveitic manifestations of patients with systemic lupus erythematosus (SLE). Methods: This was a retrospective analysis of all SLE cases with ocular manifestations seen by a single ophthalmologist between 2015 and December 2021. Results: In total, seven patients with a median age of 40 (range 18–50) years were included in the study. Female (85.7%) predominance was noted. Ocular findings were bilateral in 71% (five patients) of cases. Majority (10 eyes, 83%) of the patients had retinal vasculitis as the common finding. Antinuclear antibodies were positive in all the patients. The vision improved in two (16.6%) eyes, was stable in eight (66%) eyes, and worsened in one (8%) eye. All the patients were treated with oral steroids along with immunosuppressive agents. Conclusion: Though SLE is rare cause of uveitis, it can be associated with significant ocular morbidity. Hence, early diagnosis and treatment can salvage vision in many cases.Item Dyschromatopsia and contrast sensitivity changes in COVID-19 patients(Wolters Kluwer – Medknow, 2024-05) Sharma, Aditi; Singh, Aditya; Bansal, Yashik; Mohan, Aditi; Gnanaraj, Ramya; Khulbe, Pranita; Pangtey, Kavita; Tripathi, Kaushiki; Khan, Mohammad Ali; Sharma, Akshita; Jain, ManishPurpose: To evaluate the alterations in the psycho?physical tests, contrast sensitivity (CS) and hue discrimination (total estimation score, TES) in COVID?19 patients. Methods: A prospective case?control study was undertaken in 2021?22 to look at CS and TES among COVID?19 patients and RT?PCR negative normal subjects by a mobile app “smart optometry” and X?Rite’s free online version of Farnsworth?Munsell 100 hue test. Strict visual acuity (minimum of 6/9 equivalent on Snellen) and other clinical parameters were used as exclusion criteria to filter potentially confounding pre?receptoral co?morbid conditions. The effect of mismatch in recruiting age and sex matched controls during the pandemic were analyzed by multivariate linear regression. Result: One?way ANOVA ruled out any influence of gender on CS and TES; however, there was significant difference in the TES on Mann Whitney U test (TES? 2.95 +/? 3.8 for cases; 0.30 +/? 1.1 for controls; p <0.001) and it persisted after accounting for age. Six controls with breakthrough infections had a significant deterioration in TES (Mean scores ?3.0; 95% CI = ?5.89 to ?0.11; p = 0.04) on paired t test. Qualitative analysis showed that S?cone mediated deficiencies outnumber those affecting M?L cone mediated deficiencies. Among 53 subjects exhibiting three sensory features, anosmia, loss of taste and dyschromatopsia, nine (16.98%) had all features concurrently. Conclusion: The study demonstrates that COVID?19 infection leads to altered TES representing dyschromatopsia ?an ocular counterpart of anosmia, with little difference on CS.Item Posterior segment manifestations of Takayasu arteritis: A narrative review(Wolters Kluwer – Medknow, 2024-05) Sharma, Unnati; Rishi, Ekta; Rishi, Pukhraj; Gupta, Vishali; Raman, RajivOcular symptoms can be the presenting manifestation of Takayasu arteritis (TA) or could be indicative of disease reactivation. A review of published literature related to posterior segment manifestations of TA by using the keywords “Takayasu arteritis,” “ophthalmic manifestations,” “retina,” “retinopathy,” “ocular,” “optic nerve,” and “optic neuropathy” was performed. In total, 62 case reports and 12 case series were included. The majority of the articles were from Asia (n = 47, 64%). Females outnumbered males in the ratio of 7:1. The mean age of patients was 33 years (range: 8–78 years, SD: 13.5 years). In 58% (n = 41 out of 71) cases, ocular symptoms were the presenting manifestation of the underlying disease. Hypotensive retinopathy was found in 70% of eyes, and hypertensive retinopathy was found in 27%. The mean presenting visual acuity (VA) was +1.03 logMAR (range: ?0.12 to 3, SD: 1.07), and at the final follow?up was +1.02 logMAR (range: ?0.12 to 3, SD 1.17). VA improved in 34% (n = 29/86), remained stable in 45% (39/86), and worsened in 21% (18/86). The mean follow?up was 9 months (range: 0.5–204, SD: 16 months).Item Optical coherence tomography in papilledema: A probe into the intracranial pressure correlation(Wolters Kluwer – Medknow, 2024-05) Bassi, Shikha Talwar; Pamu, Ramesh; Ambika, Selvakumar; Praveen, Smita; Priyadarshini, Durga; Dharini, Vidhya; Padmalakshmi, KPurpose: To study the optic nerve head characteristics on optical coherence tomography (OCT) in patients with papilledema and correlate them with intracranial pressure (ICP). Methods: A retrospective hospital?based study of 46 eyes of 23 patients with bilateral optic disc edema secondary to increased ICP. The clinical profile and the OCT features in terms of retinal nerve fiber layer thickness (RNFL), ganglion cell inner plexiform layer (GCIPL) thickness, and enhanced depth imaging (EDI) B scan images of the optic nerve head were studied and correlated with the ICP. Results: Papilledema was secondary to idiopathic intracranial hypertension (IIH) (n = 20), obstructive hydrocephalus (n = 2), and communicating hydrocephalus (n = 1). The mean ICP in 20 IIH patients was 347 mmH2O. The ICP and RNFL thickness in all four quadrants were found to be weakly positively correlated: superior RNFL r (38) = 0.17, P = 0.30, and nasal RNFL r (38) = 0.30, P = 0.05, inferior RNFL r (38) = 0.29, P = 0.07, and temporal RNFL, r (38) = ?0.001, P = 0.99. The GCIPL layer thickness and the ICP were weakly negatively correlated in all sectors: superior (38) = ?0.23, P = 0.16, superonasal, r (38) = ?0.07, P = 0.67, inferonasal r (38) = ?0.08, P = 0.64, inferior r (38) = ?0.21, P = 0.19, inferotemporal r (38) = ?0.23, P = 0.17, superotemporal, r (38) ?0.21, P = 0.20. Descriptive features on the B scan, such as peripapillary hyperreflective ovoid mass?like structures and microcystic spaces, were observed most commonly with an ICP of 251–350 mmH2O, and the hyperreflective dots in the RNFL layer and Bruch’s membrane inward denting were observed more commonly with an ICP of 351–450 mmH2O. Conclusion: The RNFL thickness in all four quadrants had a weak positive correlation, and the GCIPL layer had a weak negative correlation with the ICP. The EDI descriptive features on OCT may vary with ICP.Item Subretinal hyporeflective globule: A novel OCT finding in central serous chorioretinopathy(Wolters Kluwer – Medknow, 2024-05) Goel, Sugandha; Mishra, Samarth; Bhattacharya, Sampurna; Majumdar, Bristi; Sen, Ahana; Mukherjee, Riya; Ramandhane, Raghul Nandan; Goel, Nikita; Saurabh, Kumar; Roy, RupakPurpose: To describe the subretinal hyporeflective globule in cases of central serous chorioretinopathy (CSC). Methods: A retrospective analysis of consecutive cases of CSC presenting to a tertiary eye care center in eastern India was conducted. Subretinal hyporeflective globules were identified as small globular lesions below the external limiting membrane/ellipsoid zone, but above the RPE layer. They had a hyperreflective border with a hyporeflective core and a clear posterior tail of hyper?transmission. Results: The present study analyzed 137 eyes of 137 patients. Eighty (58.4%) eyes had acute disease at presentation, 48 (35%) eyes had chronic disease, and eight (5.8%) eyes had resolved CSC. Subretinal hyporeflective globules were seen in 27 (21.8%) eyes, of which choroidal caverns were seen in seven (5.1%) eyes. Twenty?five eyes with chronic CSC and only two eyes with acute CSC had subretinal hyporeflective globules. Three eyes with resolved CSC had subretinal hyporeflective globules. Conclusion: We describe subretinal hyporeflective globule as a novel optical coherence tomography (OCT) finding in cases of CSC and describe its clinical correlates.Item Ophthalmic manifestations in hematological malignancies: An observational study from a tertiary care health center in Eastern India(Wolters Kluwer – Medknow, 2024-05) Thareja, Japesh; Minj, Anita; Samal, Priyanka; Panigrahi, Pradeep KumarPurpose: This study aimed to document the spectrum of ocular manifestations of hematological malignancies presenting to a tertiary health center in Eastern India and their association with blood parameters. Methods: This hospital?based cross?sectional study was conducted from August 2021 to July 2022. Patients diagnosed with leukemia, lymphoma, and multiple myeloma were enrolled in the study. A comprehensive ophthalmic evaluation was done in each case. Results: A total of 97 patients with a confirmed diagnosis of hematological malignancies and meeting the inclusion and exclusion criteria were included in the study. Ocular manifestations were noted in 48 (49.48%) patients. Acute lymphocytic leukemia accounted for 35.4% of cases, followed by acute myeloid leukemia (31.25%), lymphoma (4.2%), and minimum manifestation in multiple myeloma (2.1%) patients. Among 48 patients with ocular manifestations, anterior segment involvement was found in 6.2% of cases, with subconjunctival hemorrhage being the most common, and the posterior segment was involved in 100% of patients, with intraretinal hemorrhages being the most common manifestation. A statistically significant association was noted between hemoglobin, total red blood cell count, and total platelet count with posterior segment manifestations (p < 0.001). On multivariable logistic regression, only total leucocyte count and total platelet count were significant predictors for ocular manifestation. Conclusion: Indirect involvement of the retina is the most common ocular pathology in hematological malignancies, with intraretinal hemorrhages being the most common finding. Ophthalmic examination is highly recommended as a part of the routine evaluation at the time of diagnosis of hematological malignancies and periodically thereafter to diagnose any ocular involvement.Item Clinicodemographic profile, management, and treatment outcomes in advanced retinoblastoma at a tertiary care center in North India(Wolters Kluwer – Medknow, 2024-05) Kumar, Sonali Vinay; Kumar, Vinay; Sati, Alok; Mishra, Sanjay Kumar; Khera, Sanjeev; Mishra, Atul; Mathur, Ankit; Gopinath, Manoj; Mohimen, Aneesh; Malik, Virender; Kumar, Natasha VPurpose: The study was undertaken to look into the clinicodemographic profile, management, and clinical outcomes of advanced retinoblastoma at a tertiary care center. Methods: A prospective cohort study was conducted from Jan 2019 to Dec 2022. Forty?two patients of intraocular advanced retinoblastoma were assessed. The treatment protocol was formulated based on size, extension of tumor, and laterality. Primary outcome measure was response to the treatment in terms of regression of tumor and seeds and no evidence of recurrence after 12 month in enucleated eyes. Secondary outcome measures were complications like implant exposure, metastasis, and death associated with each treatment modality. Results: The mean age of the study group was 13 months. The most common presentation was leukocoria with diminished vision. Most of the patients had group E retinoblastoma (n = 40, 95%) as per the International Classification of Retinoblastoma. In 12 patients with group E retinoblastoma, primary enucleation was performed and in six patients, secondary enucleation was done, in which initially, globe salvage treatment was tried. In 30 patients, globe salvage treatment was attempted and we could manage to save 23 eyes. The most common treatment modality was intra?arterial chemotherapy using a triple?drug regimen. One patient developed intracranial spread and died due to systemic metastasis during the follow?up period. Conclusion: The current study showed that globe salvage is possible in advanced retinoblastoma if appropriate therapy is instituted depending upon the extent of the tumor and availability of latest treatment modalities. Intra?arterial chemotherapy using triple drugs can be offered as a first?line therapy in advanced unilateral retinoblastoma as it has been found to be very effective in the present study.Item Flow capsulorhexis: A novel technique in white and hypermature cataracts(Wolters Kluwer – Medknow, 2024-01) Thulasidas, Mithun; Geetha, GWe described a novel “flow capsulorhexis” technique in white and hypermature cataracts and compared it with the standard “needle decompression capsulorhexis” technique. Six hundred and eight eyes of 420 patients with intumescent or non?intumescent mature white cataracts who had undergone phacoemulsification or manual small incision cataract surgery with “flow capsulorhexis” (Group 1) or “needle decompression capsulorhexis” (Group 2) were assessed. The mean continuous curvilinear capsulorhexis (CCC) completion time was 6.6 ± 3.4 seconds in Group 1 and 10.4 ± 4.2 seconds in Group 2 (P < 0.001). The mean number of times for an ophthalmic viscosurgical device (OVD) supplement was 0.4 ± 0.2 and 1.8 ± 0.8 in Group 1 and Group 2, respectively (P < 0.001). CCC success rate was 95.8% in Group 1 and 87.2% in Group 2 (P = 0.001). The new technique was observed to have better outcomes in terms of surgical time, OVD supplement times, and success rate than the standard needle decompression technique.Item Predictive accuracy of Barrett TK toric calculator compared to measured posterior corneal astigmatism using Pentacam in toric IOL power calculation(Wolters Kluwer – Medknow, 2024-04) Tamilarasi, S; Joseph, Ashalyne James; Dandapani, RamamurthyPurpose: To compare the predictive accuracy of Barrett total keratometry (Barrett TK) toric calculator with the measured posterior corneal astigmatism (PCA) by using Pentacam in toric intraocular lens (IOL) power calculation. Methods: A prospective analysis was done on 118 eyes requiring toric IOL power implantation. The absolute prediction error of the Barrett TK toric calculator and the measured PCA in the online toric calculator were assessed and compared to the standard Alcon toric calculator (with Barrett toric calculator incorporated). Results: The mean absolute prediction error of the online toric calculator (0.32 D) (with Barrett toric calculator incorporated), Barrett TK Toric (0.34 D), and measured PCA of Pentacam in Barrett toric calculator (0.33 D) were found to be similar with no statistically significant difference. Subanalysis in eyes with with?the?rule astigmatism, against?the?rule astigmatism, and oblique astigmatism showed similar results. Alpins analysis showed that all three methods overcorrected corneal astigmatism. Conclusion: The Barrett TK toric calculator and the measured PCA of Pentacam in the Barrett toric calculator have similar predictive accuracy to the online toric calculator (with Barrett toric calculator incorporated).Item Comparative histomorphologic study of basement membrane side staining and additional epithelial side staining of the anterior lens capsule with Trypan Blue(Wolters Kluwer – Medknow, 2024-04) Srinija, Kommana; Bhat, Subrahmanya K; Prasad, Kishan H LPurpose: To compare the histomorphologic changes on the anterior lens capsule by both epithelial and basement membrane side staining to those of only basement membrane side staining of the anterior lens capsule with Trypan Blue (TB). Methods: A cross?sectional study was done on 72 samples from patients who underwent cataract surgery between April 2021 and September 2022. After capsulorhexis of the TB?stained capsule, it was made into two halves externally and one half labeled as controls (sample A). The other half was immediately stained further with TB on the epithelial side and was taken as cases (sample B). Samples were analyzed for lens epithelial cells and basement membrane changes. Results: The loss of intactness of lens epithelial cells, partial or complete detachment of lens epithelial cells, degeneration of lens epithelial cells, and basement edema were significantly higher in cases compared to controls, whereas intactness of the basement membrane did not show any statistical significance between the two groups. There was a statistically significant decrease in cell density in cases compared to controls. Conclusion: Staining the epithelial side of the capsular bag with TB is more detrimental to lens epithelial cells and paves the way for a further study of staining the capsular bag before intra?ocular lens implantation to reduce the incidence of posterior capsule opacification.Item Corset suture: A novel technique of overlay appositional continuous sutures with air tamponade for management of large acute corneal hydrops(Wolters Kluwer – Medknow, 2024-04) Parmar, Gautam Singh; Agrawal, Ashish; Meena, Ashok; Mutha, Priyanka; Gurnani, BharatManagement of large acute corneal hydrops (ACH) has always been a challenge. Various medical and surgical management options have been used, such as topical steroids, cycloplegics, antiglaucoma medications, antibiotics, Descemet’s membrane reposition, and pre?Descematic sutures, for the management of acute hydrops, but have shown limited benefit. We hereby describe a novel technique of appositional continuous overlay sutures along with air tamponade for surgical management of corneal edema following large ACH. In this technique, the epithelium is scraped to visualize the stromal cleft, and then corneal marking is done to locate the suture placement site. Next, a continuous overlay, 10?0 nylon suture is passed in a crisscross fashion, just like the laces of a corset. A small paracentesis is made to lower the intraocular pressure. Stromal fluid is milked out using two iris spatulas, simultaneous suture tension adjustment is done, and the knot is secured. Appropriate anterior chamber tamponade is achieved using air, paracentesis is hydrated, and a bandage contact lens is applied. We noted complete resolution of corneal edema within 2 weeks of the procedure, with significant improvement in visual acuity.Item Femtosecond laser-assisted cataract surgery for complex cataracts – A review(Wolters Kluwer – Medknow, 2024-05) Chen, David Z; Chee, Soon-PhaikSince its inception in 2009, femtosecond laser?assisted cataract surgery (FLACS) has become an alternative to conventional phacoemulsification cataract surgery (CPCS). Clinical studies were unable to demonstrate superior visual outcomes, but revealed reduced endothelial cell loss. More recently, the cost?effectiveness of FLACS over CPCS in routine cataract surgeries has been challenged. However, the unique abilities of FLACS to customize anterior capsulotomies precisely, soften and fragment the nucleus without capsular bag stress, and create corneal incisions may have special utility in complex cataract and less?common scenarios. In this article, we review the unique role of FLACS in complex cataract surgeries and how it could play a role to improve the safety and predictability of nonroutine cataract surgery.Item Sideways sculpting - A novel technique in eyes with posterior polar cataracts(Wolters Kluwer – Medknow, 2024-04) Patwardhan, Sourabh D; Patwardhan, Nidhi S; Sangle, AnkitaPosterior polar cataracts (PPCs) have long been a concern for cataract surgeons due to their natural proclivity for posterior capsule rupture. Although problems can be avoided, there is no surgical procedure that can completely eliminate the possibility of posterior capsular rupture. Research reports a higher percentage of capsule rupture and related complications post surgical intervention. The sideways sculpting technique is a novel method to alleviate unnecessary tension on the posterior capsule. To disseminate this novel technique to practicing ophthalmologists to reduce the risk of complications related to polar cataracts. This video presents the creation of sculpting or trench at the center of the nucleus, sideways movement of the phacotip trench, rotation of the nucleus, and phacoemulsification steps while operating a dense PPC. Step?by?step demonstration of sideways sculpting and an overview of its significance. Video Link: https://drive.google.com/file/d/17ukCjdr9DlEgguCgfh0DPAPYxCCEzirq/view?usp=sharing.Item Clinical profile and management of ocular superglue injuries: Case series and review of literature(Wolters Kluwer – Medknow, 2024-04) Malepati, Nikhila; Sharma, Supriya; Kate, Anahita; Basu, Sayan; Shanbhag, Swapna SPurpose: To describe the clinical profile and management of patients with ocular superglue injury (OSI). Methods: This retrospective study included all patients with OSI who presented at a tertiary eye care institute between 2016 and 2020. Data regarding demographics, clinical profile, and management were collected. Results: A total of 66 eyes of 58 patients (24 children, 34 adults) with a median age of 22.5 years [interquartile range (IQR): 11.3–31] were included. All cases sustained accidental injuries, with domestic injury at home being the most common location of injury among children (79%) and adults (53%) (P = 0.39). The median visual acuity at presentation was worse in children [0.3 logMAR (IQR: 0.2–0.4)] as compared to adults [0.1 logMAR (IQR: 0.1–0.3)] (P = 0.03)]. The most common clinical sign at presentation was conjunctival congestion in 77% of eyes (51/66) followed by polymerized glue stuck to the eyelashes and eyelids in 52% of eyes (34/66). The median duration from the time of injury to presentation was 2 hours in both groups. All eyes resolved with medical management. Examination under anesthesia was required in three children (13%) to evaluate the extent of OSI. None of the patients had long?term ocular complications. Conclusion: Improper and careless handling of superglue in the domestic setting may cause accidental ocular injuries that require immediate medical attention. OSI represents less severe ocular injuries that respond to medical therapy alone and is not associated with long?term visual morbidity. Modifications in the packaging of superglue containers and awareness about their deleterious effects could prevent these injuries.Item The role of corneal biopsy in the management of microbial keratitis(Wolters Kluwer – Medknow, 2024-04) Dutta, Anirban; Sahu, Srikant K; Das, Sujata; Mohanty, Amrita1; Priyadarshini, Smruti RPurpose: Corneal biopsy helps in diagnosing deep?seated or recalcitrant lesions of microbial keratitis (MK). We aim to analyze its role in managing these challenging cases. Methods: This is a retrospective review of 22 cases of corneal biopsy at our institute from January 2010 to December 2021. Data were retrospectively collected using the electronic medical record (EMR) system. Those cases of indolent, progressive MK or deep?seated lesions where cornea scraping was not possible were considered for corneal biopsy to establish the microbiological diagnosis. The primary aims of our study were to analyze the indications, success rates, and outcomes for biopsy patients in our series. Additional outcomes that were analyzed included the average time from presentation to biopsy, the type of causative organism isolated from the biopsy by either histopathological or microbiological method, and the frequency and outcome of surgical interventions performed. Descriptive statistics using mean (±standard deviation) and median (±range) were used to interpret the demographic data. Results: Overall, 15 of 22 patients (68%) had a positive corneal biopsy after microbiological or histopathological examinations. The most identified organism was microsporidia (n = 4,30.7%), followed by mycobacteria (n = 2,15.4%), gram?negative bacilli (n = 2,15.4%), acid?fast bacilli (n = 1,7.6%), fungus (n = 2,15.4%), gram?positive cocci (n = 1,7.6%), and mixed bacterial infection (n = 1,7.6%). Conclusion: Corneal biopsy should be considered a diagnostic modality for patients with deep?seated or unresponsive MK. It can improve the treatment for MK, ensuring targeted therapy.Item Comparison of cosmesis, mydriasis, fundus visibility, and anterior chamber depth following single-pass four-throw pupilloplasty in congenital and traumatic iris defects(Wolters Kluwer – Medknow, 2024-04) Singh, S P; Gupta, Shweta; Chaudhary, Aparajita; Dwivedi, Kshama; Singh, Vinod K; Singh, ShivangiPurpose: To compare postoperative cosmesis, mydriasis, fundus visibility, and anterior chamber depth (ACD) in congenital and traumatic iris defects after single?pass four?throw pupilloplasty (SFTP). Settings and Design: Hospital?based non?randomized interventional study. Methods: SFTP was done along with phacoemulsification in six patients each with congenital and traumatic iris defects, and the patients were followed for a minimum period of 3 months. The postoperative pupil shape, size, mydriasis, and ACD were compared between the two groups. Results: Tissue approximation was successful in 11 out of 12 patients (91.7%), whereas it failed to do so in one patient with traumatic iris tear (8.3%). A central round pupil was attained in all six patients with congenital defects (group 1), whereas in the traumatic group (group 2), a central round pupil was attained in four cases. Group 1 did not show a significant reduction in horizontal pupil diameter, but group 2 had a significant reduction in pupil diameter postoperatively. Mydriasis and fundus visibility were satisfactory in all cases. There was a significant deepening of ACD in both groups. Conclusion: Traumatic mydriasis usually requires SFTP at two opposite poles to achieve a central pupil with a significant reduction in pupil size, whereas congenital coloboma requires SFTP to be done at the site of coloboma with occasional enlargement at the opposite pole if the pupil is eccentric.Item Effect of decentration on the quality of vision in two aspheric posterior chamber intraocular lenses: A contralateral eye study(Wolters Kluwer – Medknow, 2024-04) Thakur, Anchal; Adiga, Sushant; Malhotra, Chintan; Sachdeva, Kulbhushan; Singh, Shubhi; Jain, Arun KumarPurpose: To perform an intraindividual comparison of the quality of vision and the effect of decentration between two aspheric intraocular lenses: aspheric balanced curve (ABC) design Vivinex iSert XY1 (Hoya Surgical Optics, Singapore) and anterior aspheric design Tecnis ZCB00 (Abbott Medical Optics, CA). Setting: Tertiary Eye Care Centre. Design: Prospective, randomized comparative study using a random number table. Methods: Thirty patients were randomized to the implantation of Vivinex iSert XY1 in one eye and Tecnis ZCB00 in the contralateral eye. Then, 12 weeks postoperatively, a laser ray?tracing aberrometer was used to evaluate the visual Strehl ratio, higher?order aberrations (HOA), decentration of IOL from the visual axis and geometric axis, angle alpha, and angle kappa. Contrast sensitivity was measured using the functional visual analyzer. Results: The visual internal Strehl ratio was higher (P < 0.05) at all pupil sizes and the spherical aberrations values were lower (P < 0.05) at larger pupil sizes (5 mm and 6 mm) in the Vivinex group. The mean decentration from the visual axis in the Vivinex group was significantly more than that in the Tecnis group (P < 0.01). With an increase in angle alpha, there was a greater decline in the visual Strehl ratio for Tecnis; however, there was a statistically significant decline at 3 mm pupil size for Tecnis ZCB00 (P = 0.028). The contrast sensitivity was similar for both IOLs. Conclusion: In comparison to an anterior aspheric design IOL, the ABC design IOL yielded better quality of vision, neutralized spherical aberrations to a larger extent, and provided a relatively superior quality of vision with decentration.Item Visual performance and patient satisfaction with AcrySof® IQ Vivity® IOL: Experience from a tertiary care center in central India(Wolters Kluwer – Medknow, 2024-04) Bhasin, Purendra; Sarkar, Deepayan; Bhasin, Priyamvada; Dhanapal, Praveen P; Ubhal, Gopal N; Bhargava, MeenuPurpose: To study the visual outcomes and patient satisfaction profile among patients post phacoemulsification with the Vivity intraocular lens (IOL) implantation. Method: This was a hospital?based, prospective, observational study cons isting of 64 study subjects who were followed up for 1 month to look for the objective and subjective aspects of visual outcomes of Vivity IOLs. Objective parameters included distance vision, intermediate vision, near vision, and contrast?sensitivity, whereas subjective parameters were assessed using the modified Catquest 9SF Questionnaire. Results: Among the total study population, 82.5% were males and 17.5% were females, the most common age group was 41–50 years. In addition, 93.6% had a distance visual acuity of 6/9 or better, 93.7% had an intermediate vision of N18 or better, whereas 50.8% had a near vision of N18 or better. Good contrast sensitivity was reported among 79.4% of subjects, and 95.2% of study subjects were comfortable with distance vision, whereas 74.6% and 22.2% were comfortable with intermediate and near vision, respectively. Only two patients complained of glare, whereas none complained of halos and starbursts. A total of 88.8% of study subjects were satisfied with their postoperative visual outcomes, whereas 87.3% were willing to Vivity IOL in the other eye or were willing to refer this IOL to others. Conclusion: The study demonstrated a good distance and intermediate visual acuity post?Vivity IOL implantation, whereas near activities mostly required the use of near?addition glasses, though requiring lesser near?addition power.