Aims: The aim of this study is to analyze the outcomes of air descemetopexy with/without suture augmentation (AD) for Descemet's membrane detachment (DMD) post-cataract surgery. Materials and Methods: This prospective study included 51 eyes that underwent AD at a tertiary hospital. The outcome measures were successful Descemet's membrane (DM) reattachment and improvement in visual acuity by at least two Snellen lines. Statistical Analysis: Mean, standard deviation, and percentage were used to summarize the data. Wilcoxon signed-rank test, Chi-square test, and Fischer's exact test were used to calculate statistical significance. P < 0.05 was considered statistically significant. Results: Out of 52,396 cataract surgeries, 51 patients required surgical intervention for DMD, postoperatively. The mean age of the participants was 66.67 ± 9.8 years with a male: female ratio of 6:11. A nonplanar DMD was found in 56.87% (n = 29). The most common surgery preceding DMD was small incision cataract surgery (68.6%; n = 35). The mean interval between cataract surgery and descemetopexy was 9.3 ± 7.9 days. The mean pre- and post-descemetopexy visual acuities were 1.01 ± 0.6 and 0.44 ± 0.49, respectively (P < 0.00001). After an air tamponade, an additional suture (s) had to be placed in 62.8% (n = 32) cases, out of which 23 required a single suture, seven needed two sutures, and two needed three sutures. A successful DM reattachment was seen in 92.2% (n = 47) with the first attempt. There was a statistically significant improvement in visual acuity post-descemetopexy irrespective of the timing of surgery (P < 0.001 for all surgeries performed within 2 weeks and P = 0.03 for surgeries performed later). Conclusion: AD is a safe and effective procedure for the treatment of post-cataract surgery DMD.

Context: This study was done to evaluate the effectiveness and safety of biosimilar Razumab for the treatment of diabetic macular edema (DME), neovascular age related macular degeneration (ARMD), and cystoid macular edema (CME) due to retinal vein occlusions (RVOs) and to assess the central foveal thickness (CFT) and LogMAR best corrected visual acuity(BCVA) post Intravitreal Anti- VEGF Razumab at the end of 1 month from the baseline values. Aims: The purpose of this study was to evaluate the safety and efficacy of intravitreal biosimilar Razumab© in the treatment of wet ARMD, DME, and RVOs. Settings and Design: This was a retrospective, observational study which was conducted in a tertiary eye care institute in Tamil Nadu. Subjects and Methods: Three hundred and nine patients having active or previously treated retinal vascular conditions including neovascular ARMD, DME, and CME due to RVO were subjected to best-corrected visual acuity (BCVA) using LogMAR charts, Goldmann applanation tonometry to measure intraocular pressures, slit-lamp biomicroscopy, indirect ophthalmoscopy, color fundus photography, and spectral-domain optical coherence tomography at baseline and 1 month postintravitreal injection Razumab©, respectively. Statistical Analysis Used: Microsoft Excel was used to enter the data of the findings, and the analysis was done using SPSS 22 version software (IBM, SPSS Inc.,Chicago,IL). Frequencies and proportions were used to enter the categorical data. Chi-square was used as a test of significance. Continuous data were represented as mean and standard deviation. BCVA and CFT data were analyzed using two-tailed paired t-test. Paired t-test is the test of significance for paired data such as before and after injection. P < 0.05 was considered statistically significant. Results: There was a significant improvement in visual acuity and a marked reduction in CFT at the end of 1 month from the baseline values collectively and in each disease pathology. Conclusions: Our study revealed the short-term result of the efficacy of Razumab©, the biosimilar of ranibizumab, as an effective treatment alternative in the management of wet ARMD, DME, and RVO by reducing CFT and improving visual acuity. However, long-term follow-up and repeat injections are required to determine its long-term safety and efficacy.

Purpose: To study the safety and effectiveness of SubCyclo (subliminal transscleral cyclophotocoagulation [TSCPC] – Vitra 810, Quantel Medical) laser procedure for patients with various subtypes of glaucoma. Methodology: This pilot study was conducted in a tertiary eye care hospital in South India from October 2019 to December 2019. The study included ten eyes of nine patients who were diagnosed with different types of glaucoma and received subliminal TSCPC under local anesthesia. The laser settings were customized based on the patients' intraocular pressure (IOP). The patients were followed up after 1 week, 1 month, and 2 months after the laser procedure. Results: Ten eyes of nine patients were treated with subliminal TSCPC and were followed up 2 months of the procedure. The mean age of the patients was 63.33 years. The mean preoperative IOP was 31 mm Hg, which reduced to 20.7 mmHg 1 week after the procedure. At 1 month, the average IOP was 19.3 and 17.3 mmHg at 2 months. The mean number of antiglaucoma medications used was 3 before the laser intervention, which reduced to 2.8 following the treatment. In our pilot study using SubCyclo laser, we observed a 33.22% drop in the IOP from the baseline after 1 week and 44.19% reduction in IOP at the 2^nd month follow-up with a single laser session. Conclusions: This study concludes that a satisfactory decrease in IOP could be achieved by SubCyclo laser procedure in the early postoperative visits with a low-risk profile.

Background and Objective: It has long been recognized clinically that several forms of glaucoma may occur in association with the formation of cataracts, which are an important cause of secondary glaucoma in the developing world.^- These lens-induced glaucomas are a common occurrence in India, hardly surprising in a situation where the incident of cataract cases far exceeds the total number of surgeries performed currently. In the developing world, like India, financial, cultural, and psychosocial barriers to accessing excellent surgical services still exist. There is an ever-increasing backlog of cataract due to the population explosion, increased life expectancy, and low productivity in terms of utilization of the available surgical services. The uptake of eye care services by the rural community has also been sub-optimal in countries like India, where lens-induced glaucomas (LIGs) are a common cause of ocular morbidity. The present study has endeavored to determine the characteristics, risk factors, and their consequences on postoperative visual outcome, intraocular pressure (IOP), including optic disc changes in LIGs. Materials and Methods: This study included 50 cases of different types of LIG, admitted in the wards of the Community Health Center, Bandikui, Dausa, Rajasthan, during the period January–September 2019. All consecutive patients diagnosed as LIG on the basis of clinical symptoms and signs were included. Clinical features included pain, loss of vision, redness of the eye, presence of an intumescent, mature, or hypermature cataract associated with raised IOP of >21 mm Hg. Results: In this study series, it is observed that the most frequent type of LIG was phacomorphic glaucoma (PMG) (64%) followed by PhacoLyticc Glaucoma (PLG) (28.00%). In this study, good visual acuity achieved by cases with phacolytic glaucoma (57.00%) was more than PMG (50.00%) optic disc, at last, follow-up in the affected eyes was normal in the majority (36.00%). There were six cases of cystoid macular edema, and the media was hazy in two cases. Glaucomatous disc damage was found in 52% of cases. Although clinically significant disc damage was found more in PMG (57.7%) than PLG (33.33%). Conclusion: Results have shown that the LIGs were more common in the age group of 60–69 years and in females, good visual acuity can be achieved in lens-induced glaucoma presenting within 2 weeks, with intraocular pressure of <35 mm Hg and with meticulous control of intraocular pressure and inflammation with medications preoperatively. Planned small incision cataract surgery with intraocular lens implantation, minimal tissue handling, a good follow-up with efficient management of attendant complications and inflammation, are the key factors in the management.

Purpose: To create awareness about glaucoma through a novel exhibition and also to assess the impact of the same among the participants. Materials and Methods: An innovative three-dimensional click art exhibition was designed to create awareness about glaucoma among general public at Puducherry beach, during the World Glaucoma Week, 2019. The exhibition was also used to screen visitors for glaucoma, and a questionnaire-based survey was conducted to assess the impact of exhibition in creating glaucoma awareness. Results: Twenty thousand people visited the exhibition. A total of 2198 people were screened for glaucoma, of which 106 (4.8%) were found to be glaucoma suspects and were referred to the base hospital. Twenty-two out of 106 (20.75%) glaucoma suspects presented to the hospital during March 2019, of which 12 (54.5%) were confirmed to have glaucoma. A total of 531 people took up the 10-point questionnaire out of which 273 (50.1%) people answered eight or more questions correctly. Conclusion: Innovative approaches to create awareness about glaucoma can significantly aid in increasing the awareness and knowledge about glaucoma in general population.

Medical myths develop when existing beliefs are not challenged. They remind us that we can be mistaken and need to question ourselves. Oculoplasty, a vital branch of ophthalmology, has been of interest to surgeons since olden days. This field has seen transformative changes in the last few years in light of new understanding and sophisticated techniques. In this write-up, we wish to address a dozen of these “unchallenged” myths which may not be wrong concepts but conventional approaches that need renewed thinking.

Primary open-angle glaucoma is a condition with multiple risk factors. Although intraocular pressure is the most established among them, vascular factors and ocular blood flow (OBF) also play a significant role, especially in patients of normal tension glaucoma. This review article discusses the various vascular factors and the various methods of measurement of OBF with their clinical importance.

A 58-year-old immunocompetent male developed acute endophthalmitis after intravitreal ranibizumab injection for choroidal neovascular membrane. The preinjection vision in the left eye (LE) was 6/24. One-day postinjection, he presented with pain, redness, and defective vision. The vision in the LE was hand movements at presentation. On examination, the presence of circumcorneal congestion, hypopyon (2 mm), and anterior-chamber reaction was noted. Core vitrectomy was done along with intravitreal injections of vancomycin and ceftazidime. Vitreous biopsy grew Enterococcus faecalis. The isolate was sensitive to vancomycin and moxifloxacin. There was an improvement in vision (6/36) at the final follow-up. We present the case of acute endophthalmitis caused by E. faecalis after intravitreal ranibizumab injection with better visual outcome.

Osteomas are fibro-osseous lesions of the nose and paranasal sinuses. We report a case of a 14-year-old girl who presented with complaints of left-sided epiphora along with intermittent mucoid discharge for 6 months. Based on the clinical diagnosis of left nasolacrimal duct obstruction, radiological investigations were done which reported as an osteoma of the left maxillary sinus, compressing the nasolacrimal duct. The patient underwent conventional dacryocystorhinostomy and the tumor was removed. To the best of our knowledge, acquired nasolacrimal duct obstruction due to an osteoma of maxillary sinus is a rare presentation and has been reported only in few literatures.

We report a rare case of the left-sided anterior chiasmal lesion causing junctional scotoma. A 50-year-old female presented with sudden, painless complete loss of vision in the left eye with no perception of light and Grade IV relative afferent pupillary defect. The rest of the anterior segment and fundus of both eyes were normal. Visual fields of the right eye showed temporal hemianopia. Computed tomography of the brain plain and contrast showed a space-occupying lesion in the suprasellar region extending into the left optic canal compressing the left anterior chiasma. A junctional scotoma due to compression of the left anterior chiasma was diagnosed which is usually caused by lesions such as pituitary adenoma, meningiomas, cerebral aneurysms, and ischemic anterior chiasmal lesions. This usually resolves after intracranial decompression surgeries but the ischemic etiology carries a poor prognosis.

A 53-year-old woman presented with plaque-like lesions on the upper and lower lids of both eyes including the tear trough. To confirm the diagnosis, incisional biopsy of one of the lesions was done. Histopathology confirmed the diagnosis to be sarcoidosis, with typical noncaseating granulomatous changes. Systemic evaluation revealed hilar lymphadenopathy. She was treated with oral steroids, and the lesion had completely resolved by 3 months. Sarcoidosis of the eyelids is a rare condition and may present as the first manifestation. An early biopsy can help confirm diagnosis and avoid systemic morbidity.

Chronic endophthalmitis can occur following uncomplicated cataract surgery with intraocular lens (IOL) implantation secondary to slow-growing organisms such as Propionibacterium acnes. A 68-year-old male presented with pain and diminution of vision 4 months after uneventful phacoemulsification with IOL implantation. Slit-lamp examination showed trace hypopyon, conjunctival congestion with anterior chamber cells and flare, vitreous haze, and posterior capsular plaque-like deposits suggestive of probable P. acnes endophthalmitis. Intravitreal antibiotics did not provide any relief. The diagnosis was confirmed using PCR on the aqueous aspirate. Intracameral and in-the-bag injection of antibiotic caused the resolution of infection and improvement in visual acuity. This report thus highlights that in-the-bag antibiotics can help conservatively manage this condition without the need for an invasive procedure like vitrectomy and IOL explantation.

A 35 year old female presented to us with sudden painless diminution of vision in the right eye (RE) since 10 days. There was no history of trauma. She gave systemic history of hearing loss since 4 years of age and also complained of joint pains on and off for which she was taking medical treatment. Best corrected visual acuity in the RE was Hand movements (HM+) and in the left eye (LE) was 20/20 with -5D spherical correction. Anterior segment examination in the RE revealed horizontal jerky nystagmus, typical complete inferonasal iris coloboma with aphakia in primary gaze(Figure 1). On examining the eye in downgaze on slit lamp, heterogenous lenticular opacity could be seen in the anterior vitreous phase suggestive of spontaneously dislocated crystalline lens in the vitreous cavity(Figure 2). LE anterior segments was within normal limits. Fundoscopy of the RE revealed Type 4 Retinochoroidal(RC) coloboma (Ida Mann's classification) with posterior vitreous detachment (PVD) and LE fundus was normal. Ultrasound B scan of the RE revealed dislocated crystalline lens in the vitreous cavity with PVD and RC coloboma thus confirming the findings(Figure 3,4,5). The patient was planned for pars plana vitrectomy with lensectomy in the RE.

Senior Loken syndrome is a rare autosomal recessive genetic disorder. This syndrome mainly targets kidney and eye. Nephronophthisis, a chronic kidney disorder, is the common renal manifestation of this syndrome. End-stage renal disease eventually occurs during adulthood if not intervened. Thus, Senior Loken syndrome is a rare combination of chronic kidney disease, anemia, bronchiectasis, and retinitis pigmentosa. Retinitis pigmentosa that starts in early childhood is the typical ocular manifestation of this syndrome although Leber congenital amaurosis occurs in severe cases. Retinitis pigmentosa is a type of retinal dystrophy affecting mainly rods and cones in a later stage. Although X-linked inheritance causes severe form of retinitis pigmentosa, autosomal recessive is the most common mode of inheritance where retinitis pigmentosa forms part of many systemic syndromes. Night blindness is the presenting symptom which progresses to tubular vision in later stages, with the characteristic fundus features of bony spicule, arteriolar attenuation, and waxy pallor of the disc. Counseling of patient and caretakers about the course of disease and the need for low-vision aids in later stages is vital in retinitis pigmentosa patients. Patients should also be educated about the need for regular nephrology and ophthalmology follow-up to prevent further morbidity.

Central retinal artery occlusion (CRAO) is an ophthalmologic emergency. Carotid artery atherosclerosis, cardiogenic emboli, hypertension, smoking, diabetes, and giant cell arteritis (GCA) are the contributing risk factors for CRAO. It is imperative to rule out GCA in patients aged above 50 years as it can cause severe visual loss involving both eyes, if not treated promptly, making diagnosis critical. Elevated C-reactive protein and erythrocyte sedimentation rate with a raised platelet count favor GCA as a probable diagnosis. Typical granulomatous inflammation on temporal artery biopsy confirms the diagnosis. The vision loss is permanent, but early steroid therapy is effective in preventing further visual loss.

Roth spots are white-centered hemorrhages which can be the first clinical presentation of an underlying systemic disorder such as subacute bacterial endocarditis, leukemia, and anemia. We present a case of Roth spots in a patient with acute myeloid leukemia.