The surgical reconstruction of eyes with iris defects is almost invariably complex and challenging. A number of prosthetic iris devices are available including large-incision, rigid diaphragm, aniridic intraocular lens style devices, small-incision devices incorporating a capsular ring, and flexible, customized, small-incision iris prostheses. The surgical techniques for rehabilitation are dictated by the configuration of the iris defect, the presence of concurrent ocular pathology, and the functional complaint of the patient. Successful rehabilitation requires careful surgical planning and appropriate patient selection. Nonetheless, endowed with the modern surgical armamentarium, the reconstructive surgeon may achieve significant functional and cosmetic improvement.

Pediatric optic neuritis (PON) is one of the commonest causes of acute vision loss in children. Although it might often be postinfectious or postvaccination, recent understanding and available evidence suggest that it can be the first manifestation of a neuro-inflammatory syndrome such as multiple sclerosis, neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis or myelin oligodendrocyte glycoprotein associated optic neuritis. Therefore, neuroimaging, serological testing, cerebrospinal fluid analysis, testing for various systemic autoimmune conditions become a part of the workup. However, this can be exhaustive and expensive, especially in countries with limited access to health insurance. Many recent studies suggest that neuroimaging and few clinical features can provide clues to the underlying etiology. However, serological tests can provide a confirmatory evidence. Therefore, in this mini-review, we propose a balanced approach to the evaluation of PON, based on the available literature emanating in the last decade.

OBJECTIVE: The objective of the study was to assess the perceived utility and the impact of web-based teaching programs being conducted following the COVID-19 pandemic. METHODS: An online survey was sent to trainee ophthalmologists across India through various social media platforms. The responses were tabulated and analyzed. RESULTS: A total of 768 valid responses were recorded. Majority of respondents (52.2%) felt that the ideal duration for webinars was 1 hour or less. Factors that helped trainees in choosing a webinar were the topic (95.1%), the timing (53.6%), and the speaker list (42.4%). Residents indicated a preference for webinars to attend aimed at postgraduate residency training, more specifically clinical problem-solving. Further questions were answered using a 1-10 Likert scale (1: least useful and 10: extremely useful). The median score when asked for overall usefulness of the webinars in general was 8 (interquartile range/IQR: 2). The median response when asked about utility of webinars in enhancing theoretical knowledge was 8 (IQR: 2) and the median for utility of webinar-based teaching programs in enhancing practical knowledge/surgical learning was also 8 (IQR: 2). The median score when asked about the utility of the webinar programs in acquiring skills for writing research papers/thesis was 7 (IQR: 3). Connectivity issues, audio/voice issues, and the long duration of webinars were some of the problems faced while attending webinars. CONCLUSIONS: Ophthalmology trainees in India found online teaching programs and webinars to be useful in enhancing their theoretical knowledge and practical skills/surgical learning. Administrators and educational institutes should tailor online teaching programs as per the needs and preferences of the residents.

CONTEXT: Emergence of coagulase-negative staphylococci as pathogens in ophthalmia neonatorum. AIMS: To analyze the bacteriological spectrum of ophthalmia neonatorum and its associated risk factors. SETTINGS AND DESIGN: Retrospective analysis in a tertiary care hospital in India. SUBJECTS AND METHODS: A retrospective review was performed in a tertiary care center in India on 139 neonates presenting with conjunctivitis over a period of 3 years. All the neonates presenting to the out-patient department, those admitted in the Neonatal Intensive care Unit and in-patient wards were included in our study. The neonates were clinically examined and followed-up by a single experienced ophthalmologist. Details including demographic data, age of the infant, type of delivery, investigations, and treatment outcomes were analyzed. STATISTICAL ANALYSIS USED: Frequency calculation using Microsoft Excel for windows 10. RESULTS: In the 92 samples with growth (66.2%), the most common organisms isolated were coagulase-negative Staphylococci (35.9%), Klebsiella pneumoniae (16.3%), and Acinetobacter species (16.3%). Others were Staphylococcus aureus (14.1%), Pseudomonas aeruginosa (8.7%), and Escherichia coli (8.7%). Ophthalmia neonatorum was significantly higher in preterm infants born out of lower-segment cesarean section and those requiring ventilatory support. CONCLUSIONS: Unlike gonococcus, which is implicated in ophthalmia neonatorum, our study shows varied microbiological spectrum and sensitivity patterns with coagulase-negative staphylococci as the key pathogen. The role of coagulase-negative staphylococci as a disease-causing pathogen becomes increasingly important with an imperative need for prudent use of common antibiotics in treating these pathogenic bacteria.

OBJECTIVES: The objective of this study was to estimate the prevalence and risk factors of methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) carriers among staff of a tertiary eye hospital in Saudi Arabia. METHODS: This retrospective study was conducted in 2019. Nasal and axillary swabs of health-care staff were used to determine carriers of MRSA. Bacteria were identified by culture and sensitivity tests. These isolates were grouped as antibiotic resistant, sensitive, and others not in the S. aureus group. Demographics and other determinants were associated with carrier status. RESULTS: We evaluated the carrier status of 430 staff. There were 110 (24.9%; 95% confidence interval [CI]: 21.5, 29.7) S. aureus-positive staff, 21 (11.7%; 95% CI: 11.7, 26.4) of who carried the MRSA strain. Carrier status was significantly higher among physicians (31%) compared to nurses (22.5%) and other staff (5.7%) (P < 0.001). MRSA carrier status was significantly associated with >5 years of employment at the eye hospital (P = 0.02). MRSA was significantly associated with staff who were of Indian nationality (75%) compared to other nationalities (P = 0.04) and those who were at the hospital for <5-year stay compared more than 5 years at the hospital (P = 0.001). All carriers responded to decolonization treatment. CONCLUSIONS: The high prevalence of MRSA and relatively easy treat MRSA carriers points at the need for universal screening for MRSA carriers among eye health staff.

BACKGROUND: To evaluate the predictability of the Kane formula in estimating postoperative refractive outcome with various corneal curvatures and axial lengths (ALs) besides comparing with existing intraocular lens (IOL) formulae. MATERIALS AND METHODS: A prospective cross-sectional study was carried out among patients having uneventful cataract surgery at an eye hospital. A total of 50 eyes were considered for the study. The corresponding A-constant for the model of IOL implanted into the patient's eye was taken along with the actual power of IOL implanted and corresponding predicted power for the IOL power inserted were taken for all the chosen formulae and was termed as "Adjusted Predicted Refractive Power." This was compared with the actual refractive outcome and the absolute error (AE) was measured. The eyes were separated into groups in terms of corneal curvature as flat (<42D), medium (42D–46D), and steep (>46D) corneas. In terms of AL, it was grouped as short (≤22 mm), medium (>22.0–<24.0 mm), and long (>24.0 mm) eyes. RESULTS: The study included 50 eyes and the mean AE for all the selected formulae were calculated for each group. Over the entire corneal curvature range, none of the formulae showed any significance when compared with the Kane formula (P > 0.05). In short AL, SRK-T formula had a statistical significance over the Kane formula (P = 0.043), whereas no other group had any significance over the Kane formula in AL groups. CONCLUSION: The study shows, all formulae (SRK-T, Holladay1, Hoffer Q, Hill RBF, Barrett Universal II, Kane) are interchangeable to predict the IOL power for any of the corneal curvature and ALs.

AIMS: Hyperlacrimation due to ocular surface or lid abnormality was ruled out and apposition of lower punctum to globe was checked. SUBJECTS AND METHODS: This was a pilot study at a tertiary eye care center where 40 patients of proximal canalicular block <8 mm on probing were divided into two equal groups. The external CDCR group underwent routine dacryocystorhinostomy with partial carunculectomy. A tract was created from canthus to nasal cavity with von Graefe knife. In the laser CDCR group, the osteotomy was created using 980 mm diode laser with a power of 8 W. Glass tubes of appropriate length were placed and fixed using 5-0 polypropylene with our "mirror tuck technique." Results were analyzed using the Chi-square test for parametric and ANOVA test for nonparametric variables using SPSS software. RESULTS: Success defined as patency on syringing was achieved in 18 patients in the laser group and 16 in the external CDCR group which was comparable (P > 0.05). Complications include tube extrusion, dislocation, conjunctival overgrowth, and sump syndrome. CONCLUSION: Laser and external CDCRs are both effective and safe procedures for the treatment of proximal canalicular blocks with comparable success rates and complications.

A 71-year-old woman presented with progressive, bilateral, blurred vision and nyctalopia for the last 6 months. Her past medical history included total hysterectomy and chemotherapy for ovarian cancer 4 years ago, without metastases. Optical coherence tomography revealed outer retinal layers' thinning bilaterally, while diffuse retinal pigment epithelium abnormalities were found in fundus autofluorescence. Full-field electroretinogram showed abnormalities in both a- and b-waves with significant reduction of retinal sensitivity, affecting however more the rod system. The patient was positive for alpha-enolase and was diagnosed with cancer-associated retinopathy (CAR), which developed 4-year primary cancer. Computerized tomography scan revealed an enlarged para-aortic lymph node at the left kidney, and the patient was started on chemotherapy, combined with immunosuppressive treatment. In conclusion, CAR should be suspected in patients experiencing unexplained visual disturbances, especially in the context of previous cancer.

We report the case of a 54-year-old male who presented with complaints of decreased vision in the left eye (LE). He gave a history of multiple bee stings following which he had an episode of allergic anaphylaxis to the face and neck region for which he was admitted and treated with steroids. On examination, he was found to have LE central retinal artery occlusion (CRAO) which was the cause of his reduced vision. This is the first report of a bee sting venom as a cause for CRAO.

Aplastic anemia is a rare, usually autoimmune disorder of bone marrow stem cells leading to pancytopenia and hypoplastic marrow that presents with anemia, infection or bleeding which can be potentially sight and life-threatening. Patients with aplastic anemia may present with various ocular manifestations; lid and orbital hematoma, sub-conjunctival hemorrhage, sudden visual loss due to vitreous hemorrhage or retinopathy and optic disc edema. A young male patient had symptomatic sever bilateral hemorrhagic retinopathy secondary to aplastic anemia; succeeding systemic allogenic hematopoietic stem-cell transplantation showed almost complete spontaneous resolution of the retinopathy and significant improvement in vision over a period of 16 weeks.

Spontaneous lens absorption and dislocation of empty capsular bag in anterior chamber is an extremely rare phenomenon. The common predisposing factors can be weak zonular structure as in pseudoexfoliative syndrome, historical trauma or spontaneous absorption of hypermature morgagnian cataract. Here we describe a unique and rare presentation of a 53 years old gentleman who presented with defective vision in right eye (RE) for past 7 months.Visual acuity in RE was finger counting close to face and 6/60 in the left eye (LE). Anterior segment examination revealed a translucent membrane with rolled up margins in the right anterior chamber, anterior lens capsule calcification and posterior capsular breach, iridodonesis, pseudoexfoliation, sluggish pupil, and aphakia along with few vitreous strands. B scan revealed cortical matter in the anterior vitreous face in RE. The patient was planned for membrane removal, pars plana vitrectomy along with scleral fixation of intraocular lens. This case highlights the extremely rare presentation of capsular bag in anterior chamber in a spontaneously absorbed cataractous eye.

Primary epithelial iris cysts are benign innocuous lesions, which are mostly bilateral and asymptomatic in nature. They can lead to creeping angle closure, when the angle progressively narrows due to age-associated changes. This photoessay, herewith, signifies the dual importance of identifying minute bumpy elevations in the iris by a thorough slit lamp examination as well as the use of ultrasound biomicroscopy in patients presenting with creeping angle closure, frequently misdiagnosed in the primary angle closure disease spectrum.