Umbilical amnion and amniotic membrane transplantation for infectious scleritis and scleral melt: A case series.

Purpose: To report the outcomes of two cases of infectious scleritis with severe scleral thinning managed using combined mechanical debridement, cryopreserved umbilical amnion (UA) and amniotic membrane (AM) grafts, and antimicrobial therapy. Observations: Two patients presented with severe infectious scleritis with progressive scleral melts secondary to Pseudomonas aeruginosa subsequent to pterygium surgery and intravitreal injection, respectively. Surgical debridement was followed by UA grafting, AM transplantation, and antimicrobial therapy. Epithelialization and vascularization were seen within 1–4 weeks post-operatively. At last follow up of 5–6 months, the structural integrity of the sclera remained preserved with no infection recurrence, graft necrosis, or wound dehiscence. Conclusions and importance: This case series highlights the utilization of UA grafting along with AM trans-plantation and topical and systemic antibiotics to preserve the globe in cases of severe infectious scleritis

A Factorial Study of Consumer Buying Behaviour towards Durable Goods With Reference To Urban Working Women

"Many things that were considered as luxuries till about ten years ago have become necessities for more peo ple today" .And in case of durable goods consumption it has happened also as which were luxury at once becomes necessity now. Consumer centric marketing style is predominant in durables which in turn revolves round the consumer purchase attitude. Today wom ens are chief purchase officer controlling 85% of all purchase decision .In India women hold more than 25% of the white collar jobs in sector like IT, ITES, Pharmaceutical, Biotechnology , market research, financial services ,advertising, marketing and med ia. The new Indian women is a hard working professional women. The research paper deals with the study of urban working women purchase attitude with special reference to consumer durables. This has been evaluated on the basis of a comparative study of facets with special reference to consumer durable with sample frame of middle class working women families of Lucknow

Bilateral Interstitial Keratitis Following COVID-19: A Case Report

BACKGROUND: Although the primary target of severe acute respiratory syndrome coronavirus 2 is the respiratory tract, the expression of the angiotensin-converting enzyme 2 receptor in other tissues facilitates viral entry in others parts of the body, including ocular structures. Ocular manifestations may occur before, during, or after systemic infection. CASE PRESENTATION: We report the case of a 60-year-old male who presented with bilateral interstitial keratitis after the onset of COVID-19, with ocular symptoms starting within 7 days after systemic symptoms. Laboratory investigation did not identify any alternative etiology for his disease, although the possibility of Epstein-Barr virus or herpes simpex virus could not be definitively ruled out. The patient had already developed significant corneal scarring and visual debilitation by the time topical steroids were initiated, and his final corrected visual acuity with rigid gas permeable contact lenses was 20/50 and 20/80 in the right and left eye, respectively. CONCLUSIONS: The involvement of ocular tissue by the virus can lead to permanent sequelae such as severe visual loss, and clinicians should be aware of and recognize ophthalmic manifestations of this disease to prompt early intervention

Association of Angiotensin-Converting Enzyme and Glutathione S-Transferase Gene Polymorphisms with Body Mass Index among Hypertensive North Indians

Objectives: This study aimed to examine the association of angiotensin-converting enzyme (ACE) and glutathione S-transferase (GST) gene polymorphisms with body mass index (BMI) in hypertensive North Indians. Methods: This case-control study was carried out between May 2013 and November 2014 at the Era’s Lucknow Medical College & Hospital, Lucknow, India, and included 378 subjects divided into three groups. One group constituted 253 hypertensive individuals (sustained diastolic blood pressure of >90 mmHg and systolic blood pressure of >140 mmHg) who were subcategorised according to normal (<25 kg/m2) or high (≥25 kg/m2) BMI. The third group consisted of 125 age-, gender- and ethnically-matched normotensive controls with a normal BMI. Gene polymorphisms were evaluated by polymerase chain reaction. The genotypic and allelic frequency distribution among both groups were analysed. Results: A significant difference was found between GST theta 1-null and GST mu 1-positive genotype frequencies among the hypertensive overweight/obese individuals and controls (P = 0.014 and 0.033, respectively). However, no difference was observed in the frequency of ACE polymorphisms. ACE insertion/insertion genotype (P = 0.006), insertion and deletion alleles (P = 0.007 each) and GST theta 1-null and GST theta 1-positive genotypes (P = 0.006 each) were found to differ significantly between hypertensive cases and controls, regardless of BMI. Conclusion: ACE and GST gene polymorphisms were not associated with BMI but were significantly associated with hypertension among the studied group of North Indians

ABCD progression post crosslinking for Keratoconus

Introduction: Keratoconus is a corneal disease that leads to various ocular illnesses such as scarring and thinning and the most common treatment for this disease at this time is Cross Linking. Previously, post-surgical outcomes of cross linking were analyzed using the AK (Amsler- Krumeich) system which didn’t account for posterior corneal surface and corneal thickness. In order to overcome these shortcomings, a new ABCD classification was developed which accounts for anterior (A) and posterior (B) radius of curvature, thinnest corneal pachymetry (C) and distance for best corrected vision (D). Methods: A retrospective study was done using 104 patients who underwent CXL treatment for keratoconus at Wills Eye between 1/2016 and 6/2019. The ABCD values of these patients were analyzed at 1, 3, and 6 months post-op visits Patients who had undergone a previous Lasix surgery were excluded from this study as their cornea might show different post-surgical changes. Results: Paired T-test analysis showed the A value progressed initially (from 3.6 to 3.88) but improved compared to baseline by 6 months. This A value roughly correlates to Kmax value and this improvement from baseline matched up with what was seen in previous studies. The B (posterior measurements) and C (thickness) values also increased significantly at 3 months and showed regression by 6 months, but was still progressed when compared to baseline. Discussion: A, B and C all initially progressed post-operatively and then regressed. However, at 6 months post operatively, the A values improved compared to baseline measurements while the B and C values did not. Thus it seems as if CXL surgery is able to improve keratoconus in the anterior cornea but is not as effective in the posterior cornea. Having this data is helpful in evaluating post-operative patients. Seeing an initial regression in the B and C value should not be a concern as it seems that they stabilize later than the A value; it does not mean that the CXL surgery was unsuccessful

Effect of Recipient Diabetes Status on Immune Rejection after Descemet Stripping Endothelial Keratoplasty

This study seeks to determine whether recipient diabetes status relates to incidence of immune rejection following Descemet Stripping Endothelial Keratoplasty (DSEK). We hypothesized that patients with diabetes would have a greater risk of graft immune rejection. This is a retrospective cohort study to compare recipient diabetes status in 794 DSEK surgeries at Wills Eye Hospital between January 2008 and July 2019. Kaplan-Meier functions of survival time until first immune rejection was compared between groups. Pearson’s chi square test and Wilcoxon test were used to test the null hypothesis. During the study period, 146 of 794 DSEK recipients had diabetes. At 1 year, diabetics had a significantly higher risk of immune graft rejection compared to non-diabetics (OR 2.28, p=0.047). Likewise, there was a reduced rejection free mean survival time in diabetics (6.9 vs 8.9 years) as well as a significant difference in hazard functions (p=0.044). Recipient diabetes confers a greater risk of immune rejection following DSEK. This may have implications for counseling, monitoring, and managing post-operative steroid regimens in this at risk population

Effects of Corneal Transplant on Rates of Retinal Detachment

Introduction: Corneal transplant remains the gold standard treatment for irreversible corneal damage. The purpose of this study is to evaluate retinal detachment rates and clinical outcomes after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). We hypothesized that corneal transplants would increase the rate of RD. Methods: This retrospective cohort study utilized corneal transplant data from all surgical visits from PK or EK between April 1, 2012 and August 31, 2018. Individual charts were reviewed from patients who had a subsequent retinal detachment. Incidence of retinal detachment following PK or EK was the main outcome measured. Results: A total of 1,676 PKs and 2,292 EKs were performed for 3,069 patients during the study period. Fifty-four cases of retinal detachment occurred during the study period; forty-two cases occurred after PK and twelve cases occurred after EK. The rate of retinal detachment after EK (11 of 2,292; 0.5%) was significantly lower than that after PK (43 of 1,676; 2.6%) (p = 0.01). Additionally, the odds of developing retinal detachment after PK or EK performed in conjunction with anterior or pars plana vitrectomy were significantly higher than after either PK or EK alone (OR: 8.66; 95% CI: 2.98-25.18; p \u3c 0.001). Discussion: Overall rates of retinal detachment for individuals receiving either PK or EK were low. Rates of retinal detachment were significantly lower for EK compared to PK. These results support our hypothesis and can help patients make informed decisions on their surgical options and associated risks

Applications of Mitomycin C in Cornea and External Disease

Isolated from Streptomyces caespitosus, mitomycin C (MMC) has various applications in the management of corneal and external disease due to its ability to modulate cellular proliferation. It has been employed in pterygium surgery, ocular surface neoplasia, and refractive surgery. Currently, there is no definite consensus on the treatment protocols for each of the aforementioned applications. Although its benefits in the management of corneal and external diseases are promising, MMC use has potential complications including endothelial cell loss, corneal perforation, scleral melt, secondary glaucoma, iritis, and endophthalmitis. This article will review the literature regarding the use of MMC in the field of cornea and external disease and describe protocols employed with corresponding outcomes

Microbial Keratitis After Penetrating and Endothelial Keratoplasty

Introduction: The purpose of this study is to review the incidence, risk factors, and outcomes of bacterial and fungal keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). Methods: The medical records at Wills Eye Hospital were reviewed for all cases of confirmed microbial keratitis following PK or EK performed between May 1, 2007 and September 1, 2018. Charts were examined to obtain demographic information, past ocular history, details of the microbial keratitis, and graft outcomes. Results:A total of 2100 transplants (1269 PK and 831 EK) were performed in 1864 eyes of 1601 patients. The incidence of microbial keratitis after PK (7.5%) was significantly higher than after EK (1.3%) (p Discussion: : Microbial keratitis is a relatively common occurrence in patients with prior keratoplasty, and particularly in eyes with prior PK or multiple prior transplants. Infection is an important cause of graft failure and further surgical intervention. To the best of our knowledge, this is the largest review of microbial keratitis in cases of prior PK, and the only review in eyes with prior EK

Corneal Wound Healing in the Presence of Antifibrotic Antibody Targeting Collagen Fibrillogenesis: A Pilot Study

Highly organized collagen fibrils interlacing with proteoglycans form the crucial architecture of the cornea and facilitate its transparency. Corneal scarring from accidental injury, surgery, or infection alters this highly organized tissue, causing severe consequences, including blindness. There are no pharmacological or surgical methods to effectively and safely treat excessive corneal scarring. Thus, we tested the anticorneal scarring utility of a rationally designed anticollagen antibody (ACA) whose antifibrotic effects have already been demonstrated in nonocular models. Utilizing a rabbit model with an incisional corneal wound, we analyzed ACA’s effects on forming collagen and proteoglycan-rich extracellular matrices in scar neotissue. We used microscopic and spectroscopic techniques to quantify these components and measure crucial parameters characterizing the structure and organization of collagen fibrils. Moreover, we analyzed the spatial distribution of collagen and proteoglycans in normal and healing corneas. Our study demonstrated significant changes in the quality and quantity of the analyzed molecules synthesized in scar neotissue. It showed that these changes extend beyond incision margins. It also showed ACA’s positive impact on some crucial parameters defining proper cornea structure. This pilot study provides a stepping stone for future tests of therapeutic approaches that target corneal extracellular scar matrix assembly