Central serous chorioretinopathy (CSC), the fourth most common nonsurgical retinopathy, is characterized by serous retinal detachment most commonly involving the macular region. Although natural history of CSC shows a self-limiting course, patients are known to present with persistent, recurrent, or even bilateral CSC with distressing visual loss. Multimodal imaging techniques for CSC include optical coherence tomography (OCT) with enhanced depth imaging, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and OCT angiography. Evolution of new imaging techniques in addition to conventional imaging modalities has revolutionized the understanding about the pathophysiology of CSC and hence the diagnosis and management. This review article elaborates on current understanding about pathophysiology and risk factors, as well as multimodal imaging-based features of CSC.

BACKGROUND: Cataract surgery is associated with a variety of complications, one of which is vitreous loss. Doctors and policymakers should be aware about the precipitating factors, associations, and expected outcomes of vitreous loss. This study was, therefore, undertaken to set guidelines to improve the visual outcomes of patients. MATERIALS AND METHODS: A retrospective 8-year analysis was conducted from 2007 to 2014 using the national eye database. Demographic features, ocular comorbidities, grade of surgeon, type of surgery, and the associations with the occurrence of vitreous loss, and the final visual outcomes of these patients were studied. RESULTS: Out of 12,992 eyes, only 3.2% had vitreous loss, mostly aged <40 years. Pseudoexfoliation was the only ocular comorbidity causing vitreous loss. Medical Officers and Gazetting Specialists got more vitreous loss compared to specialists. Intracapsular cataract extraction, phaco convert to extracapsular cataract extraction (ECCE), ECCE, and phaco all had a significant vitreous loss. Vitreous loss was the most significant intraoperative complication causing poor vision and resulted in impaired or poor visual outcome. CONCLUSION: Vitreous loss occurred in almost all types of cataract surgeries, especially by junior surgeons, among those aged <40 years and significantly caused poor visual outcome compared to other complications. Pseudoexfoliation had higher occurrence of vitreous loss. Vitreous loss patients had impaired/poor visual outcome due to preexisting comorbidity and astigmatism. Patients at risk and junior surgeons should be closely monitored to improve outcomes. Further studies need to be done to see why and when the vitreous loss occurred.

CONTEXT: Topical anesthesia has been used for pars plana vitrectomy (PPV) with limited patient comfort. Thus, augmenting topical anesthesia with intracameral anesthesia (Trojan horse anesthesia) will provide pain-free experience during PPV. AIMS: This study was undertaken to evaluate the patient comfort and surgical safety using 2% lignocaine jelly augmented with intracameral 1.0% lignocaine solution for anesthetizing the eyes undergoing PPV. SETTINGS AND DESIGN: This was a prospective interventional case series at tertiary care hospital. SUBJECTS AND METHODS: Patients planned for PPV for indications other than retinal detachment were included in the study. The pain perception of the participants undergoing PPV under Trojan horse anesthesia was evaluated using visual analog scale (VAS). STATISTICAL ANALYSIS USED: Data analysis was done using descriptive statistics and nonparametric analysis with level of significance at P < 0.05. RESULTS: There were 114 eyes of 114 patients in the study out of which 68.4% (n = 78) were males. The mean age was 42.31 years (range 14–80 years, standard deviation [SD] 18.7). The mean surgical time was 34.0 min (range 13–80 min, SD 14.2). The pain perception on VAS scale averaged 3.0 (range 0–8, SD 1.59, median 3.0). Pain scores were not affected by the age (Pearson correlation = 0.098, P = 0.3), gender (P = 0.44), or the educational status of the participant (P = 0.28). The pain scores were not affected by the indications of surgery (P = 0.58) or the use of silicone oil (P = 0.07). CONCLUSIONS: Trojan horse anesthesia provides adequate analgesia for comfortable and safe 23-gauge PPV with high patient acceptability.

BACKGROUND: Use of conjunctival autograft following excision has reduced the recurrence rate of primary pterygium. This study compares the use of fibrin glue, autologous blood, and sutures in placing the conjunctival autograft in reference to surgical time taken, postoperative discomfort, and recurrence during follow-up. MATERIALS AND METHODS: Sixty patients with primary pterygium were included in the study and divided into three groups. In Group I, autograft was attached in place with help of 10-0 polyamide monofilament suture; in Group II, with autologous blood; and in Group III, with fibrin glue. All three groups were compared in terms of surgical time, postoperative discomfort, and recurrence. RESULTS: The average surgical time taken was least with fibrin glue group (Group III), i.e., 36.2 min, followed by 44.8 min with autologous blood group (Group II) and maximum of 53.3 min with suture group (Group I). Postoperative discomfort was seen maximum in th suture group (Group I) and was minimal in the fibrin glue group (Group III). At the end of final follow-up at 6 months, one case of recurrence was seen in both Group I and Group II. No recurrence was seen in Group III. CONCLUSION: The study concluded that fibrin glue remains the most effective method for attaching conjunctival autograft in pterygium surgery with least surgical time and postoperative discomfort. Autologous blood is an effective alternative which is easily available, economical, vis a vis fibrin glue with less surgical time and postoperative discomfort. Use of sutures is an older technique with maximum surgical time and postoperative discomfort. Recurrence is least with fibrin glue.

BACKGROUND: Few studies have examined the prevalence of convergence insufficiency (CI) in a school-based population in Sudan. This study sought to determine the prevalence of CI and its related clinical characteristics among Sudanese secondary school students. MATERIALS AND METHODS: A descriptive cross-sectional survey was conducted in Central Khartoum North, Sudan, in the academic year 2013/2014. A total of 4211 secondary school students, with a mean age of 15.5 ± 2.5 years, underwent complete eye examination, and were screened for symptoms associated with near work. Near and distance heterophoria was measured with the alternate cover test using a prism bar; near point of convergence (NPC) and positive fusional vergence (PFV) at near were determined. RESULTS: Of the 4211 students screened, 329 (7.8%) were diagnosed with CI. Of these, 173 (52.6%) students were male and 156 (47.4%) were female; there was no significant relationship between sex and CI (P > 0.05). Standard schools had a higher prevalence of CI (43%) than geographic schools (36%) and there was a significant association between CI and the type of school (P < 0.05). In most of the students (78.42%), CI was due to both remote NPC and decreased PFV; in 20.36% of the students, CI was due to remote NPC only, and in very few students (1.22%), it was due to decreased PFV only. CONCLUSIONS: These findings suggest that CI is prevalent in the secondary school population in Central Khartoum North, Sudan.

BACKGROUND: Langerhans cell histiocytosis (LCH) of the orbit is a rare clinical entity with a diagnostic and therapeutic dilemma. MATERIALS AND METHODS: This was a retrospective study of eight patients with orbital LCH. RESULTS: All eight patients in our series were male, and the mean age at presentation was 8 years (median 6 years; range, 7 months–23 years). All of them had unilateral disease, and the most common presenting complaint was upper eyelid swelling (n = 6). The mean duration of symptoms was 6 weeks (median, 3 weeks; range, 2–20 weeks). Visual acuity was unaffected in seven cases. Clinical diagnosis included rhabdomyosarcoma (n = 4), malignant lacrimal gland tumor (n = 2), orbital cysticercosis (n = 1), and orbital tuberculosis (n = 1). The diagnosis of orbital LCH was confirmed by incisional biopsy (n = 7) or fine-needle aspiration cytology (n = 1). Four cases underwent careful limited curettage and received intralesional steroid, and four cases were treated with intralesional steroid alone after incisional biopsy. Complete tumor resolution was achieved in seven cases after receiving a mean of one intralesional steroid injection (median, 1; range, 1–2), while one patient was advised systemic chemotherapy for residual tumor. No tumor recurrence was noted in any case at a mean follow-up duration of 30 months (median, 23 months; range, 7–96 months). None of the cases developed diabetes insipidus or multisystem disease during the follow-up period. CONCLUSION: Minimal local intervention with intralesional steroids with/without careful curettage achieves complete tumor resolution in unifocal orbital LCH.

BACKGROUND: To compare the intraocular pressure (IOP)-lowering efficacy and safety of brimonidine (0.2%), brimonidine purite (0.15%), and brimonidine purite (0.1%) in patients of primary open-angle glaucoma (POAG). MATERIALS AND METHODS: Sixty patients of POAG with IOP >21 mmHg were enrolled into this study for 6-week duration. The patients were randomly divided into three groups with 20 patients in each group. Group A instilled brimonidine 0.2%, Group B instilled brimonidine purite 0.15%, and Group C instilled brimonidine purite 0.1% twice daily. IOP was recorded by applanation tonometry at baseline and subsequently at 2, 4, and 6 weeks at 9:00–10:00 am during each visit around 30 min after instillation of eye drops. RESULTS: Mean IOP reduction in Group A was from 25.55 ± 2.01 to 19.85 ± 2.05 mmHg at the end of study, thus resulting in fall of 5.70 mmHg (22.30%), in Group B, it decreased from 25.65 ± 2.41 to 19.55 ± 2.43 mmHg, thus resulting in fall of 6.10 mmHg (23.78%), and in Group C, it decreased from 25.80 ± 2.26 mmHg to 19.85 ± 2.16 mmHg, thus resulting in fall of 6.35 mmHg (24.61%). There was no statistically significant difference in IOP-lowering efficacy of study drugs. Conjunctival hyperemia, foreign body sensation, dry eye, and papillary reaction were the important side effects seen with study drugs. Brimonidine 0.2% caused more side effects than brimonidine purite 0.15% and brimonidine purite 0.1%. CONCLUSION: All the three formulations of brimonidine produced statistically equal lowering of IOP in patients of POAG with reduced systemic and ocular adverse reactions with brimonidine purite 0.15% and 0.1%.

> CONTEXT: Intraocular lenses with variable total diameter are supposed to fit better in the capsular bag and lead to fewer complications. AIMS: This study aims to investigate the efficacy and the safety of an intraocular lens model with variable total diameter. SETTINGS AND DESIGN: Prospective randomized intraindividual study. SUBJECTS AND METHODS: Thirty-two eyes of sixteen patients with bilateral age-related cataract received standard cataract surgery with implantation of an intraocular lens with a standard diameter in one eye (Quatrix®, Group A) and with a variable total diameter in the fellow eye (Quatrix Evolutive®, Group B). Primary study endpoints included evaluation of refraction stability and posterior capsule opacification (PCO) over a follow-up period of 6 months. STATISTICAL ANALYSIS USED: SPSS (Version 19.0) was used for statistical analysis. RESULTS: Uncorrected and corrected distant visual acuity after 6 months were 0.24 and 0.1 LogMAR in Group A and 0.23 and 0.09 LogMAR in Group B, respectively. The objective and manifest spherical equivalent (OSE, MSE) 6 months postoperatively were + 0.65 D and + 0.62 D in Group A compared to + 0.33 D and + 0.33 D in Group B respectively (P = 0.665 for OSE, P = 0.208 for MSE). PCO-index increased statistically significant in both groups (P = 0.004 in Group A, P = 0.046 in Group B), but the difference of PCO-index between both groups was not statistically significant (P = 0.569). CONCLUSIONS: An intraocular lens with a variable total diameter shows good visual outcomes and safety performance as well as same outcomes concerning postoperative refractive stability and development of PCO compared to an intraocular lens with standard total diameter.

BACKGROUND:Stargardt disease, a juvenile retinal dystrophy, may show secondary changes in the choroid which may have importance while considering future treatments such as stem cell transplant. OBJECTIVE: To evaluate the choroidal and retinal morphology in patients with Stargardt disease and compare with age-matched normals. SETTING AND DESIGN: This was a case–control study at a tertiary level eye care institute. METHODS:Twenty-six patients (52 eyes) clinically diagnosed with Stargardt disease underwent detailed evaluation with swept-source optical coherence tomography. Retinal and choroidal layers were analyzed and compared with 52 eyes of controls. RESULTS: The median age of patients with Stargardt disease was 23 years. The mean best-corrected visual acuity was 0.82 logMAR (20/125 Snellen). Mean diameter of the lesion was 2810.92 ± 1311.15 μ. The lesion size increased with increasing extent of flecks and was significantly correlated with visual acuity (r = 0.622, P < 0.001). The retinal and choroidal thicknesses (CTs) were significantly reduced in Stargardt group. The mean subfoveal CT was 290.59 ± 60.43 μ(range: 184–395) in Stargardt and 331.31 ± 68.90 μ (range: 199–464) in normal group, P = 0.043. CT in Early Treatment Diabetic Retinopathy Study grid pattern showed significant thinning in Stargardt group. The small choroidal vessel (SCV) layer was more affected than the large choroidal vessel (LCV) layer. There was thinning of SCV and thickening of LCV inside the macular lesion. The CT was not correlated to lesion size, extent of flecks, or visual acuity. CONCLUSIONS: Stargardt disease shows generalized thinning of the choroid affecting mainly the SCVs. In the macular lesion, there is atrophy of SCV with compensatory dilation of LCV. The visual acuity did not correlate with CT but showed worsening with increasing lesion size and wider extent of flecks.

Waardenburg Syndrome is a rare disorder of neural crest cell development. It is genetically inherited. Varying in prevalence from 1:42000 to 1:50,000, it compromises approximately 2-5% of congenital deaf children. The syndrome is not expressed in its complete form, in about 20% cases, which adds for its heterogenisity . Even among people affected in the same family,the features do vary. Unilateral heterochromia that manifests as lighter pigmentation of one iris is associated with Waardenburg syndrome and Parry-Romberg syndrome and less commonly with Hirschsprung disease. A case of ten yrs. old boy with a typical facial profile and hearing loss is reported.

A 49-year old male with corrected visual acuity of 20/25 OD and 20/20 OS was found to have an asymptomatic dark iris mass OD with suspicion for ciliary body melanoma. Predilation slit-lamp biomicroscopy revealed a well-circumscribed brown round mass arising posterior to the iris, presumably from the ciliary body; however, postdilation demonstrated an extended fusiform mass of the iris pigment epithelium (IPE). By anterior segment imaging, the well-circumscribed IPE mass was cystic and measured 1440 microns in thickness peripherally predilation and 300 microns in thickness postdilation. There was no solid IPE or ciliary body component. A diagnosis of midzonal IPE cyst was rendered and observation advised. Clinical features and anterior segment imaging can assist in differentiation of midzonal IPE cyst from adenoma and ciliary body melanoma. The diagnostic methodology described in this paper can be used by ophthalmologists to promptly rule out underlying melanoma.

We report a 78 year old male with acute RPE tear with sudden vision loss, who underwent intravitreal C3F8 injection for reattaching the RPE. The impact of gas on detached RPE was studied by serial OCTs and Fundus pictures.

Von Hipple-Lindua (VHL) syndrome is an autosomal dominant neoplastic disorder in which multiple benign or malignant tumours and cysts develop in central nervous system and visceral organs. Retinal capillary hemangioma is the most frequent and often the earliest manifestation of VHL syndrome. We report a case with multisystemic involvement diagnosed as a case of multiple endocrine neoplasia (MEN) syndrome but the presence of multiple, unilateral peripheral and juxtapapillary retinal capillary hemangioma was able to clinche the definative diagnosis of VHL and thus helped in appropriate management of the patient.

Ocular Trauma by the peck of a hen can cause grievious eye injuries.We report a rare case of uniocular blindness in a 5 year old girl ,following a hen peck which caused a penetrating eye injury along with a total retinal detachment.

Glaucoma drainage devices are mostly used for refractory glaucoma. Early postoperative complications include flat anterior chamber, choroidal effusion, and suprachoroidal hemorrhage. An 8-year-old male patient with a prior history of vitreous surgery for traumatic vitreous hemorrhage, presented to us with angle recession glaucoma in his right eye. His intraocular pressure (IOP) was 44 mmHg despite maximum antiglaucoma medication. Ahmed glaucoma valve (AGV) surgery was performed to control his IOP. In the early postoperative period, the patient developed premacular subinternal limiting membrane (ILM) hemorrhage, which did not resolve even after 4 weeks. Vitreoretinal intervention involving removal of the thickened ILM and sub-ILM bleed had to be performed. To the best of our knowledge, no case has been reported with sub-ILM bleed post aqueous humor shunts. Here, we report a case of premacular sub-ILM bleed following AGV in vitrectomized eye.

Pseudomelanoma is a condition that mimics a uveal melanoma. Various methods are used to differentiate between uveal melanoma and mimicking conditions, but none is definitive. We report a case of localized hemorrhagic choroidal detachment in monocular middle-aged Asian lady of Indian origin with opaque media secondary to failed corneal graft. An ultrasound scan revealed a mass lesion suspected to be choroidal melanoma. After 10 weeks of observation and follow-up, lesion showed complete regression as seen with serial ultrasound scans. This case is being presented for its rarity and unique presentation in a bilaterally blind patient with spontaneous resolution of pseudomelanoma documented with serial imaging.

Malignant glaucoma (MG), also known as aqueous misdirection and cilio-vitreo-lenticular block, is an infrequent cause of secondary angle closure glaucoma. Despite conventional treatment, it often has a poor visual outcome. It is recognized clinically by raised intraocular pressure associated with shallowing of the peripheral and central anterior chamber in the presence of a patent peripheral iridotomy/iridectomy. Despite being known to occur after a variety of surgical procedures, it most commonly presents following filtration surgery in hypermetropic eyes with angle closure glaucoma. It can present within a range of postsurgical latencies, ranging from 1 day to many months. We describe a case of pseudophakic MG that was unusual in that it presented spontaneously many years following cataract surgery. We postulate the etiology of our spontaneous onset pseudophakic MG was the anterior subluxation of the large diameter intraocular lens secondary to zonular weakness.

Surgical management of advanced coats' disease has always been a challenge to a surgeon. Various different techniques have been tried. With the advancement in surgical instruments and machines, surgeons are now modifying older surgical techniques. We have tried a novel minimally invasive surgical technique for the management of advanced coats' disease patient having high bullous exudative retinal detachment. Intravitreal injection of Bevacizumab at the end of the surgery has a role in such cases.

We report two cases of anterior megalophthalmos with cataract. Both cases have megalocornea, cavernous anterior chamber, enlarged iris–lens diaphragm, and normal axial length. The vision was less due to cataract. To restore vision, phacoemulsification was performed in each eye in both cases. Intraoperatively, to overcome anatomical challenges, we made scleral tunnel incision, stained anterior capsule, and fixated intraocular lens (IOL) by different techniques. In the first case, IOL was fixated through the sclera, whereas in the second case, IOL stabilization was achieved by capturing the optic in anterior capsulorhexis margin and placing the haptics in sulcus. Successful vision was restored in both cases without pseudophacodonesis.