Ultrawide field fluorescein angiogram in a family with gyrate atrophy and foveoschisis

Gyrate atrophy of choroid and retina is an autosomal recessive condition characterized by peripheral multiple sharp areas of chorioretinal atrophy which become confluent with age. Macula and central vision is typically involved late in the disease. Macular involvements such as cystoid macular edema, epimacular membrane, and choroidal neovascularization have been reported in gyrate atrophy. In this report, we present a family with diminished central vision presenting within 8 years of age. All of three siblings had typical peripheral chorioretinal atrophic lesions of gyrate atrophy and hyperornithinemia. On spectral domain optical coherence tomography, two of elder siblings showed macular edema. Hyporeflective spaces appeared to extend from outer nuclear layer to the inner nuclear layer level separated by multiple linear bridging elements in both eyes. Ultrawide field fluorescein angiogram (UWFI) even in late phase did not show any leak at macula suggesting foveoschisis. Foveoschisis in gyrate atrophy has not been reported before

Changing pattern of utilization of human donor cornea in India

Purpose: To review the changing pattern of donor, corneal utilization in an eye bank at a Tertiary Care Center in Northern India by analyzing the trend in the years 2003, 2008, and 2011. Methods: A retrospective review of eye bank records for 3 years (2003, 2008, and 2011) was performed at the National Eye Bank. Details including a clinical grade of donor cornea, indication of corneal transplantation (therapeutic or optical), type of procedure (penetrating or lamellar keratoplasty [LK]), and clinical diagnosis of the graft recipients were recorded. Primary outcome measure was to observe any preference toward LK, judicious usage of donor corneal tissue, and impact of lamellar corneal transplant in the usage of donor corneas. Secondary outcomes included overall utilization rate and change in trend of indication for keratoplasty. Results: A total of 673, 745, and 864 corneas were retrieved in the years 2003, 2008, and 2011, respectively. The percentage of donor corneal utilization increased significantly over time with the rate being 65.08%, 70.06%, and 68.29%, respectively, in the years 2003, 2008, and 2011 (P = 0.014); however, this change was reflected only in the usage of nonoptical grade corneas and not for the optical grade corneas. There was an overall increase in lamellar corneal procedures for any clinical grade of cornea (P = 0.0019); number of Descemet's stripping automated endothelial keratoplasty (DSAEK) procedures increased significantly (P < 0.001), particularly for pseudophakic corneal edema (PCE) (P = 0.0085) and failed graft (P = 0.002). Significant increase in the utilization of nonoptical grade corneas was observed over the years (P = 0.005), though the utilization did not increase significantly for optical purposes viz., LK (P = 0.08). Conclusions: Utilization rate of donor corneas increased over the years, primarily due to increase in usage of nonoptical grade corneas for therapeutic purposes. There was a procedural shift toward DSAEK for PCE and failed graft. However, an increase in usage of nonoptical grade corneas for LK, a single donor corneal tissue for two recipients, and retrieval or utilization of optical grade cornea was not observed

Changes in stereoacuity following implantable Collamer lens implantation in patients with myopia

The study evaluated the impact of implantable Collamer lens (ICL) implantation on stereoacuity in myopes in a retrospective case series. Ninety-five eyes of 48 patients were recruited. Distance and near stereoacuity were measured using distance Randot stereotest and TNO test, respectively, before surgery and at 4 weeks postoperatively. Mean age of the patients was 23.67 ± 3.7 years. Mean uncorrected distance visual acuity (UDVA) was 1.28 ± 0.37 logarithm of the minimum angle of resolution (logMAR) (median: 1.3; range: 0.3-1.8), and median best-corrected distance visual acuity (BDVA) was 0.18 logMAR (range: 0-0.6). There was a significant improvement in both UDVA and BDVA postsurgery (P < 0.001; Wilcoxon signed rank test). The overall improvement in stereopsis was observed in 15/48 (31.25%) and 13/48 (27.10%) subjects for near and distance, respectively, with no significant difference between the two (P = 0.82; Fisher′s exact test). Among stereoblind individuals, the odd′s ratio for near stereoacuity to improve in comparison to distance stereoacuity was 8.85 (95% confidence interval: 1.68-46.70; P = 0.01). ICL implantation for refractive correction aided stereoacuity improvement in myopes more so for near

Endoilluminator-assisted scleral buckling: Our results

Aims: The aim was to evaluate the long-term surgical outcomes of endoillumination assisted scleral buckling (EASB) in primary rhegmatogenous retinal detachment (RRD). Methods: Twenty-five eyes of 25 patients with primary RRD and proliferative vitreoretinopathy ≤C2 where any preoperative break could not be localised, were included. All patients underwent 25 gauge endoilluminator assisted rhegma localisation. Successful break determination was followed by cryopexy and standard scleral buckling under surgical microscope. Anatomical and functional outcomes were evaluated at the end of 2 years. Results: At least one intraoperative break could be localized in 23 of 25 (92%) eyes. Median age of these patients was 46 years (range: 17-72). Thirteen eyes (56.52%) were phakic, 8 (34.78%) were pseudophakic and 2 (8.6%) were aphakic. Anatomical success (attachment of retina) was achieved in 22 (95.63%) of 23 eyes with EASB. All eyes remained attached at the end of 2 years. Significant improvement in mean visual acuity (VA) was achieved at the end of follow-up (1.09 ± 0.46 log of the minimum angle of resolution [logMAR]) compared with preoperative VA (1.77 ± 0.28 logMAR) (P < 0.001). Conclusion: EASB can be considered an effective alternative to vitreoretinal surgery in simple retinal detachment cases with the added advantage of enhanced microscopic magnification and wide field illumination

Evaluation of predictors for anatomical success in macular hole surgery in Indian population

Purpose: The aim was to evaluate outcomes and predictors for anatomical success in macular hole (MH) surgery. Materials and Methods: This was a prospective cohort study of patients operated for idiopathic MH with stages II, III or IV. Patients underwent pars plana vitrectomy with internal limiting membrane (ILM) peeling, internal gas tamponade, and postoperative face down positioning. The primary outcome measure was anatomical closure of MH, while secondary outcome measure was postoperative external limiting membrane (ELM) continuity. Effect of MH size, duration of MH, size of ILM peel, type of gas tamponade (SF6 vs. C3F8) and macular hole index (MHI) on anatomical MH closure was also evaluated. Results: Of the 62 eyes operated, anatomical closure of MH was achieved in 55 eyes (88.7%). The median duration of follow-up was 8 months (range: 6-15 months). Mean BVCA improved from 0.94 ± 0.26 at baseline to 0.40 ± 0.23 logMAR at last follow-up (P = 0.01). There was a statistically significant association between size of ILM peel and anatomical closure of MH (P = 0.04). Duration of symptoms, size of MH, type of gas tamponade, MHI had no effect on anatomical closure (P = 0.22, 0.28, 0.40 respectively, Chi-square test). Postoperative continuity of the ELM was significantly associated with a shorter symptom duration (<6 months) before surgery. Conclusion: Acceptable anatomical closure could be attained with the defined technique. Size of ILM peel is a new predictor of anatomical success while symptom duration affects postoperative ELM continuity

Prevailing clinical practices regarding screening for retinopathy of prematurity among pediatricians in India: A pilot survey

Aims: To evaluate the prevailing practices for proper screening and referral scheme among Indian pediatricians for retinopathy of prematurity (ROP). Materials and Methods: Pediatricians registered with Indian Academy of Pediatrics from six states of India were selected randomly and were telephonically interviewed in accordance with a preformed questionnaire which comprised of questions regarding demographic factors, number of premature children seen per month, awareness and referral scheme to ophthalmologist; responses thus obtained were analyzed. Results: Hundred percent knowledge about ROP and need for screening in premature babies was observed among the respondents. However, only 135 (58%) pediatricians always referred for ROP screening, 19 (8%) referred only sometimes and 80 (34%) did not refer at all. Consistent referral protocols taking into account all plausible risk factors for ROP were followed by only 25% of those who always referred. Major deterrent in ROP screening was perceived as non-availability of trained ophthalmologists. Conclusions: Only 14.5% of total pediatricians contacted were following international recommendations for ROP referral. Screening for ROP remains dismal as observed in this pilot survey as a consequence of non-availability of trained ophthalmologists as well as inconsistent screening guidelines

Trans-epithelial versus conventional corneal collagen crosslinking: A randomized trial in keratoconus

Purpose: The purpose was to compare transepithelial versus epithelium off technique of corneal collagen crosslinking (CXL) in patients of keratoconus. Materials and Method: Totally, 40 eyes (40 patients) with progressive keratoconus were subjected to transepithelial CXL (20 eyes; Group I), and conventional CXL (20 eyes; Group II). Patients were evaluated for uncorrected distance visual acuity, best corrected visual acuity (BCVA), slit lamp-biomicroscopy, keratometry, 9-point pachymentry, orbscan II, and endothelial cell count at baseline and post CXL at 1, 3, and 6 months. Results: The two groups were similar with respect to the evaluated parameters both at baseline and at the end of 6 months. There was an improvement in mean BCVA from Log Mar 0.327 ± 0.1 (Group 1), 0.36 ± 0.08 (Group 2) to 0.23 ± 0.08 (Group 1; P < 0.001), 0.22 ± 0.06 (Group 2; P < 0.001), respectively, at 6 months. Mean Sim K astigmatism decreased from 6.6 ± 1.93 D (Group 1), 6.64 ± 1.93 D (Group 2) to 5.14 ± 1.86 D (Group 1; P = 0.001), and 4.77 ± 0.06 (Group 2; P = 0.001), respectively, at 6 months. The mean pachymetry increased from 432.05 ± 19.36 μm (Group 1), 429.91 ± 16.66 μm (Group 2) to 447.8 ± 16.09 μm (Group 1; P < 0.001), 440.25 ± 11.18 um (Group 2; P = 0.002), respectively, at 6 months. All cases showed stabilization of keratoconus two eyes in epithelium off group developed persistent stromal haze. Most of the patients in Group II experienced pain and photophobia during first 2 days, but not of Group I. Conclusion: Trans-epithelial technique offers visual and topographic outcomes similar to the conventional method with superior patient comfort postintervention