Anterior Segment Trauma: The Fundamentals of Management

Anterior segment trauma is the one of most common ocular condition seen in accident and emergency The ocular trauma may vary from minor injury such as a corneal abrasion to a grievous sight threatening injury such as a corneo-scleral tear or a chemical injury. The most crucial element in the management of ocular injuries is a thorough examination to identify all possible injuries to the eye and institute the appropriate treatment. The initial management plays a very important role in determining the prognosis of the vision, the need for further surgeries and also provide us with a realistic goals of visual rehabilitaion. In this chapter we aim to enumerate the common modes of ocular injury, manifestations of ocular trauma, the diagnostic features and provide the reader with a comprehensive overview of the treatment instituted. We will also include the accepted international trauma scoring systems and their utility in prognosticating the visual rehabilitation

Lacrimal Gland Involvement in Lymphomatoid Granulomatosis and Review of the Literature

Objective. To describe the clinicoradiological and histopathological findings in a case of lacrimal gland enlargement secondary to lymphomatoid granulomatosis (LG) and to review the literature. Design. Case report and systematic literature review. Methods. A 75-year-old woman presented with right ptosis. Computerised tomography showed lacrimal gland enlargement, and biopsy done was inconclusive. She subsequently developed pulmonary symptoms and underwent transbronchial biopsy that was diagnosed as LG. Pub Med and OVID databases were searched using the term “orbit/eye involvement in lymphomatoid granulomatosis”. Articles that predated the databases were gathered from current references. Results. The patient underwent lacrimal gland biopsy which revealed necrotic and inflamed tissue with no further categorisation but transbronchial biopsy helped in establishing the diagnosis of LG. On initiation of prednisolone and cyclophosphamide, her orbital lesion resolved but the patient died following massive pulmonary hemorrhage within a month of diagnosis. Conclusion. Ophthalmic involvement in LG is very rare. Varied presentations are due to central nervous system involvement, vasculitis, or infiltration of ocular or orbital structures. LG is an angiocentric and angiodestructive granulomatous disorder and can involve any tissue, thus accounting for the variable presentations reported in literature

An unusual case of hemorrhage along the capsulotomy margin following Nd YAG capsulotomy

Posterior capsular opacification is the most common cause of reduced vision postcataract surgery. It is treated with neodymium: yttrium–aluminum–garnet capsulotomy, and patients usually have good vision following the procedure. Complications after laser capsulotomy are usually limited to iritis and raised intraocular opacification. We report a rare case of bleeding around the capsulotomy margin following capsulotomy. This was probably due to the placement of intraocular lens in the sulcus and adherence between the anterior and posterior capsule with adhesion to the iris. We present this case to highlight this unusual complication postlaser capsulotomy

Ocular manifestations in acute stage Stevens-Johnson syndrome/toxic epidermal necrolysis - A retrospective study in a tertiary hospital in south India

PURPOSE: To describe the ocular manifestations in the acute stage of Stevens-Johnson syndrome/ toxic epidermal necrolysis. MATERIALS AND METHODS: We reviewed all the medical records of patients diagnosed with Stevens-Johnson syndrome/ toxic epidermal necrolysis and erythema multiforme between 2012 and 2019. Demographics, ophthalmic manifestations, and the treatment given systemically and locally were reviewed and analyzed. RESULTS: We had forty-five patients admitted to our hospital between Jan 2012 to Dec 2019 with SJS/TEN as a diagnosis.Twenty-six (57.5%) of them were females, and 19(42.2%) were males. The mean age was 27.5 years.Forty (88.9%) of our cases were diagnosed as Stevens-Johnson syndrome, and five (11.9%) as toxic epidermal necrolysis.We found antiepileptics as a triggering agent in thirteen cases (28.8%).Fever (84.4%) and mucosal lesions (86.7%) were the most common presenting symptom.We found ocular symptoms in only 22 (48.9%) patients.The treating physicians referred only thirty-one cases to the ophthalmologist, out of which 22 cases were referred within three days of admission.The most common ocular involvement was conjunctival congestion (69%).Ocular grading showed that mild grade included 42.9%, moderate grade 28.6%, and severe grade 28.6% of the cases.The ocular treatment involved medical management with lubricating drops (100%), topical steroids (58.6%), and topical antibiotics (68.9%). Five individuals with a severe grade of ocular involvement underwent amniotic membrane transplantation. CONCLUSION: Ocular examination and grading are essential in the acute stage of SJS/TEN. It helps the ophthalmologist recognize the sentinel findings and institute appropriate treatment in the acute stage as early as possible

Effect of wet-laboratory training on resident performed manual small-incision cataract surgery

Purpose: The aim of this study was to study the effect of wet-laboratory training on the surgical outcome of resident performed manual small-incision cataract surgery (MSICS). Methods: We conducted a retrospective, comparative observational study on resident performed MSICS in our institute. We collected data of 464 patients of which Group A had 232 cases performed by residents without prior wet-laboratory training and Group B had 232 resident performed cases after adequate skill training in the wet laboratory. The demographics, type of cataract, intraoperative, postoperative complications, and immediate visual outcome were compared between the two groups. Results: The age, sex, and type of cataract were similar in both groups of residents. The frequency of intraoperative complications was higher in Group A (23.7%) than in Group B (15.08%) (P = 0.019). The occurrence of posterior capsule (PC) rupture and vitreous loss showed a statistically significant difference, with Group A showing a high rate of 14.3% PC rent and vitreous loss while only 6.9% (P = 0.01) had this complication in Group B. The postoperative visual outcome also was better in Group B than in Group A, with 62.06% of patients in Group B, having a postoperative day 1 vision of better than 6/18 as compared to only 38.36% in Group A. Conclusion: The wet-laboratory training is an effective method of improving the skills of the ophthalmology residents in MSICS. The reduction of complications will improve the quality of surgery and improve the postoperative visual outcome

The Basics of Scientific Writing

Writing a scientific article remains a challenge to many medical professionals. The importance of scientific writing is understood by many, but the process seems daunting. In this article, we attempt to embark upon the reader on the importance of publishing and the reasons to publish. We discuss the main elements that are essential to be included in a basic article. We enumerate how to organise thoughts and ideas and discuss the nuances that one needs to be aware of while writing a scientific article. It is a comprehensive article that helps the reader to understand the principles of scientific writing