1 Oily Multifocal IOL , Amber Amar Bhayana1*, Priyanka Prasad1
A 58 year old male operated for cataract surgery implanted with a multifocal Intraocular Lens (IOL), later underwent vitreoretinal surgery for retinal detachment with silicone oil injection. Even after removal of silicone oil, the patient had oil deposits in the groves between the multifocal IOL as shown in the Fig. 1. Multifocal IOLs are indeed a bad choice for patients who require treatment for retinal disorders because not only fundus visualization is difficult in these patients due to multifocal refractive/diffractive phenomenon but also the groves might become a niche for oil deposition.
2 Corona Days: Quite Challenging in Many Ways , David Berkow1*
The World Health Organization (WHO) has declared that Coronavirus (COVID-19) is a pandemic that requires a combined effort worldwide, at least until a vaccine is found [1]. In December 2019, an unknown virus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) or (2019-nCoV) spread in the Hubei province of China. The symptoms of the infection are like those of seasonal flu: fever, headache, shortness of breath, cough, muscle pain, tiredness and a sudden loss of taste or smell. These symptoms may appear 12-14 days after exposure to the virus [2]. It has been shown that the SARS-CoV-2 virus is found in tears and conjunctival secretions [3]. Therefore, as eye care professionals, we must be extremely careful. According to the WHO, as of the 9th of October 2020, there were 36,361,054 confirmed cases of COVID-19 including 1,056,186 deaths. I do not think that, early in 2020, when the outbreak of the virus was confirmed, that people would have imagined the current situation and would have believed that some countries would be in their second lockdown or quickly heading there.
3 Khokhar’s Dot , Sudarshan Kumar Khokhar1, Amber Amar Bhayana1*, Priyanka Prasad1
Persistent fetal vasculature can have a wide spectrum of presentations varying from Bergmeister’s papillae to persistent pupillary membrane (from posterior to anterior) [1]. Just like Mittendorf’s dot which is seen as an opacity on the posterior capsule and represents attachment of hyaloid artery to the lens, we would like to describe another form of persistent fetal vasculature which we would like to call Khokhar’s dot after the author which represents crumpled mass of opacity seen trapped in the network of persistent pupillary membrane anterior to the crystalline lens (Fig. 1) [1].
4 The Nasal Coastline of Traquair’s Island: The Influence of Gaze Direction on the Recorded Nasal Visual Field , Hans Callø Fledelius1*
Objective: In a pilot study to evaluate the importance of the nose for the definitive size and shape of the nasal visual field. Methods: Six eye-healthy individuals aged 12-59 years volunteered for regular bilateral assessment by kinetic Goldmann perimetry, which was compared with recordings performed after changing access from visual space by monocular horizontal shifts of fixation. Results: Despite increased visual access at lateral fixation the nasal visual span uniformly maintained its size. Conclusion: Establishing the definitive visual field seems to be part of a toddler’s development of full visual function, as apparently based on an interplay between visual input and functional maturation. A scant literature supports it as being close to adult norm already from the age of 6-12 months, and not restricted on its way to full field by periocular facial contours, as often forwarded in literature of the past.
5 A Study on Ocular Manifestations Seen in Patients with Cerebral Palsy , Reshma Shaikh1*
Background: Cerebral palsy is a multitude of neurological disorders due to abnormal development of brain or permanent insult to the brain tissue affecting the muscle tone, movement of limbs thus leading to motor abnormalities. It hinders the body’s ability to move in a coordinated and purposeful way. Aim: To evaluate and assess the manifestations in the eyes of patients with cerebral palsy including visual acuity, refractive error, ocular alignment and movement, anterior and posterior segment of the eye. Methodology: This study included 100 eyes of 50 patients who were diagnosed with cerebral palsy by paediatrician between January-June 2020. Results: In this study we found that spastic type of cerebral palsy was the most common. 84% of children were found to have refractive error. Hypermetropia (36%) followed by hypermetropic astigmatism (30%) was most commonly seen refractive error among these children. Alternating convergent squint (20%) was the most common form of strabismus. Ptosis (2%), nystagmus (8%) and optic nerve head hypoplasia (6%) were also found. Cortical visual impairment was found in 12% of children with cerebral palsy. Healthcare professionals need to be aware of these manifestations and the parents/guardians need to be counselled regarding the upbringing of such children so as to influence overall development of children with cerebral palsy. Conclusion: Most of the children with cerebral palsy are found to have some ocular abnormalities. Hence a regular ophthalmic examination has to be conducted at regular intervals of time to prevent complications in these children. This will help to cater to the needs of these children ensuring their overall development.
6 Refractive Red Reflex Test in Zonular Cataract , Sudarshan Kumar Khokhar1, Amber Amar Bhayana1*, Priyanka Prasad1
Here hypermetropia in a 4 year old with zonular cataract (Fig. 1) is demonstrated with red reflex with indirect ophthalmoscopy as a bright area is seen in inferior part of the eye (Fig. 2) [1-3]. It is hard to pick up the same sign using red reflex with direct ophthalmoscope (Fig. 3) due to lesser distance between illumination and visualization axes in direct ophthalmoscope (as compared to indirect) allowing formation of better crescent that too just only through a peripheral rim of clear media in case of indirect ophthalmoscopy (Fig. 2,3) [2,3]. Axial length of the same eye as depicted was 19.68 mm on ultrasound A-scan and keratometry using autorefractor-keratometer was 46.5/47.5D@120o/30o. Cycloplegic refraction revealed a spherical equivalent of +6.5D. We would thus like to propose that red reflex test with indirect ophthalmoscope can be done to elicit refractive errors even in cases of media opacity provided some area even so in periphery as in our case permits reflex formation.
7 Pentacam Anterior Float Anomaly Due to Band Shaped Keratopathy , Sudarshan Kumar Khokhar1, Amber Amar Bhayana1*, Priyanka Prasad1
A 27 year old female with best corrected visual acuity 20/60 and 20/30 in the right (OD) and left (OS) eyes respectively presented to us for refractive surgery. Refractive errors were -9.25 D and -7 D spherical equivalent OD and OS respectively. She had undergone scleral buckling for OD rhegmatogenous retinal detachment 4 years back. On examination OS was normal. OD had band shaped keratopathy in the cornea near inferotemporal and inferonasal limbus (Fig. 1). Posterior segment OD showed attached retina with buckle indent and cryopexy scarring (Fig. 1). Pentacam OD showed red area in the front float elevation difference on Belin Ambrosio enhanced ectasia display map (Fig 1). The patient was started on lubricants for corneal surface treatment before planning for refractive surgery.
8 Retinitis Pigmentosa, Staphyloma and Myopia Syndrome-A Rare Entity , Shorya Vardhan Azad1, Amber Amar Bhayana1*, Akshaya Balaji1
Retinitis Pigmentosa (RP) is a common retinal dystrophy which causes progressive vision loss. Waxy disc pallor, arteriolar attenuation with mid-peripheral bony spicules form characteristic triad of the disease. Beginning as nyctalopia, the disease progresses to cause significant vision loss and visual field defect. Pathological myopia, staphyloma and cataract may be associated with the disorder as spectrum of MRCS syndrome which has a varied phenotypic presentation. We would like to report one such case.
9 Temporal Artery Biopsy Roulette: Playing to Win , Kyle Swerhun1, Thomas Cousineau2, Sanjoy K Gupta3*
Giant Cell Arteritis (GCA) is an auto inflammatory response often found in the superficial temporal artery. Patients may present with a localized headache overlying the temporal artery, as well as other symptoms such as weight loss, jaw claudication, shoulder stiffness and vision loss. Visual impairment from giant cell arteritis, associated with ischemic damage to the optic nerve or central retinal artery, may be irreversible.  The diagnosis of giant cell arteritis may be confirmed by the presence of multinucleated giant cells in a temporal artery biopsy. We present two case reports of patients with suspected GCA where diagnosis and management were complicated by delayed/negative temporal biopsies. We suggest a practical algorithm for the management of patients with suspected GCA.
10 Ocular Causes of Headache in Patients Presenting To a Sub-Urban Eye Hospital , Sanket Parajuli1*, Ruchi Shrestha1, Senny Chapagain1, Ramesh Shrestha1, Prerana Singh1, Sarmila Acharya1
Background: Headache is one of the most frequent complaints for which the patients visit the medical practitioners. The current study was planned to determine the aetiology of headache in patients seen for an ocular examination in ophthalmology outpatient clinics in a Sub-Urban Eye Hospital. Methods: This is a cross-sectional study conducted in Reiyukai Eiko Masunaga Eye Hospital, Banepa, Nepal over a period of 3 months from 1st March 2020 to 1st June 2020. 200 patients with headache with or without ocular pain were enrolled in the study. The patients were assessed for any ocular cause of headache. Results: Of the 200 patients, 115(57.5%) were female and 85(42.5%) were male. The overall mean age was 37.19 years (range: 11-65 years). 69 of 200 patients had refractive error (34.5%).Most common error was astigmatism (69.5%) followed by myopia (17.3%) and hyperopia (13.05%). 58(29%) patients were above the age of 40 years and hence were presbyopic 14% had convergence insufficiency, 4.2% had accommodation insufficiency and 3.5% had fusional insufficiency various ocular morbidities that were noted were corneal ulcer, disciform keratitis, epithelial defect, primary angle closure glaucoma, phacomorphic glaucoma, primary angle closure suspect, chronic angle closure, ocular hypertension, anterior uveitis ,  posterior scleritis, optic neuritis, intracranial space occupying lesion indicated by papilledema, acute dacryocystitis, herpes zoster ophthalmicus , preseptal cellulitis and painful internal hordeolum. Conclusion: A detailed evaluation of patient with headache is necessary to properly identify and treat the cause of headache. The role of ophthalmologist in assessing the patients with headache has been emphasized by this study.
11 Magnitude, Pattern and Factors Associated with Ocular Manifestations in Pre-eclampsia/Eclampsia at Mulago National Referral Hospital, Uganda , Beatrice M Bako1*, Anne Ampaire1, Annette Nakimuli2, Charity Zalwango1, Joanita Nalunjonji4, Moses Kasadhakawo3
Background: Preeclampsia is a condition where expectant mothers experience a sudden spike in blood pressures and in its severe form of eclampsia they tend to experience seizures. Over 25% of patients with severe pre-eclampsia and 50% of patients with eclampsia have visual symptoms of clinical significance, with 1-3% remaining with irreversible blindness due to involvement of the visual cortex. The ocular changes in preeclampsia usually occur from 20+ weeks of gestation and progress gradually. Hence, early screening of pre-eclampsia mothers can help in timely diagnosis and intervention. With limited data on the ocular conditions of mothers with preeclampsia, this study sought to determine the magnitude, pattern and factors associated with ocular manifestations of preeclampsia/eclampsia mothers at Mulago National Referral Hospital. Methods: This was a descriptive cross-sectional study with 450 consenting pre-eclampsia mothers at Mulago National Referral Hospital from September to December. Ethical Approval was obtained, and pre-tested questionnaires were used to record relevant history and ocular examination findings. Data was cleaned and entered into a computer in EPI-DATA (epidemiology data) and analyzed with STATA 14.0. Results: The prevalence of ocular manifestations was 16.5 % CI (13.3-20.2%). The commonest patterns of ocular manifestations were optic disc edema 19 (26.7%), retinal hemorrhages 17(22.9%) and cotton wool spots 16(21.6%).The factors associated with ocular manifestation of preeclampsia/eclampsia were education (p-value=0.042), sub-urban residence (p-value=0.045), severe preeclampsia and eclampsia (p-values=0.008 and 0.00), abnormal liver function test (p-value=0.002) and abnormal visual acuity (p-value=0.000). Conclusion: The prevalence of ocular manifestations of pre-eclampsia and eclampsia among women in Mulago National Referral hospital is high and warrants active screening programmes.
12 Spontaneous Closure of Macular Hole Following the Separation of Vitreomacular Traction , Ayse Gul Kocak Altintas1*
A 65-year-old man had continuously increased VMT that progress to symptomatic IMH during the treatment of fellow eye for AMD was presented. Spontaneous closure of IMH following detachment of VMT and completely resolved macular edema associated with recovery of the foveal structure observed by OCT, after four years follow up period.
13 The Effects of Primary Pterygium on Corneal Endothelial Cells Density in Iraqi Eyes , Alyaa Abood Kereem1, Imad Salih Mehdy2*, Hayder Sabah AL-Rubaye3
Pterygium considered as a common inflammatory and proliferative growth that extends across the limbus and can invade the cornea. It had been found that a long standing Pterygium can be associated with the changes in corneal endothelial layer. Subjects and method: In our study an eighty-one patients (162 eyes) with unilateral pterygium were randomly taken and consecutively enrolled at the out- patient clinic in Ibn Al-Hiatham Eye Teaching Hospital, using specular microscope, the endothelial density, hexagonality and coefficient of variation in cell area were measured for both eyes, using the results of normal eyes for comparison. Results: This study showed a significant decrease in means of endothelial cell density and % of hexagonal cells in affected eyes versus healthy eyes (P0.05), mean of endothelial cell density 2385.8 ± 220.74 versus 2487.9 ± 208.2 ( P-value= 0.003 ) , mean of % of hexagonality 46.92 ± 9.16 versus 53.30 ± 8.64 ( P < 0.001). The study showed no significant difference in coefficient of variation of affected eyes versus healthy eyes, 34.86 ± 5.06 versus 35.15 ± 5.50 (P =0.174).There were significant differences between means of coefficient of variation by size of pterygium. Type I 32.34 ± 3.32, Type II 34.09 ± 4.58, type III 38.47 ± 5.65 (P0.002). There was significant negative linear correlation between endothelial cell density and duration of pterygium among affected eyes. Conclusion: The long standing pterygia can be associated with reduction in endothelial cell density. This reduction is markedly apparent with the increase in size and duration of pterygium.
14 Visual and Refractive Outcomes after Cataract Surgery with a Monofocal Intraocular Lens Using Two Optical Biometers: IOL Master and Aladdin with EyeCeeOne Preloaded IOL , Alberto Parafita-Fernandez1,2*, Maria N Moraña1,2, Jorge García-Borregón1, Martin Jabif1, Joao C Soares da Costa1, Alba Feal1, Eloy Viso1
Purpose: To report visual and refractive outcomes obtained with a preloaded, hydrophobic, monofocal, intraocular lens in two series of patients with two different optic biometers for power calculation. Methods: Two comparable series of 38 eyes that underwent cataract surgery, followed by EyeCeeOne Preloaded IOL implantation, in two different centers from march 2018 to march 2019 are retrospectively studied. Two different optic biometers (IOLMaster and Aladdin), one in each center, were used to measure the eyes of the patients and calculate pseudophakic IOL power with SRK/T formula. Exclusion criteria included: corneal astigmatism larger than 1.5D, intraoperative complications (i.e. posterior capsular tear, vitreous loss) cases in which capsular tension ring was implanted, cases with postoperative complications unrelated to IOL placement (i.e. macular edema, endothelial failure). Statistical comparisons were made using the unpaired Student t- Test assuming heteroscedasticity. Results: Uncorrected distance visual acuity in decimal notation was 0.87±0.13 in Aladdin group and 0.84±0.19 in IOLMaster group (p=0.409), mean spherical equivalent (SE) obtained was -0.21±0.34 and -0.13±0.43 (p=0.359) and the mean difference among predicted and obtained SE was -0.02±0.34 and 0.10±0.39 (p=0.179) respectively. 84.2% and 81.5% of patients were among ±0.5D of SE respectively. Conclusion: In this study the EyeCeeOne Preloaded IOL proved to be a safe and effective IOL for pseudophakia. Predictable and satisfactory refractive outcomes can be achieved using two different biometers. Further studies with extreme axial lengths are needed to evaluate IOL performance in those situations.
15 Cataract Surgery with Systemic Diseases: Is Perioperative Management Necessary? , Devika S Joshi1*, Shrikant D Joshi MS2
Background: Cataract Surgery is commonly done surgery in the geriatric age group. These patients may have several systemic diseases to which adequate attention must be paid during surgical planning, local anesthesia administration and in the postoperative period. This study aimed to find the actual need for any anesthetic intervention during surgery, pertaining to the patient’s systemic condition. Objectives: To assess perioperative management required for patients who have undergone cataract surgeries with respect to (w.r.t.) specific systemic comorbidities. Methods: Hospital records of 2022 patients who had undergone cataract surgery over two years were analyzed retrospectively. 519 patients were found to have one or more systemic comorbidities and were included in this study. Data were analyzed to determine perioperative management (monitoring and interventions) required for these patients w.r.t. their systemic comorbidities. Results: 320 patients (61.7%) were males and 199 (38.3%) were females. Various systemic diseases were observed: cardiovascular 166 (28.6%) (most common), hypertension 143 (24.7%), neurological 56 (9.1%), malignancies 39 (6.7%), renal 24 (4.1%), and respiratory 37 (6.4%). 511 (98.5%) patients did not require any preoperative interventions. 30 patients (5.8%) required intraoperative interventions like some intravenous drug injections. 2 patients (0.2%) required the postoperative intervention of Tablet Sorbitrate for chest pain and physician’s consultation. 17 (3.3%) required sedation during surgery. None required overnight hospitalization. Conclusion: Most patients with systemic comorbidities who undergo cataract surgery under local anesthesia do not require perioperative management, with an anesthesiologist standby. Such surgeries may be safely carried out at standalone centers in a resource-limited setup with an anesthesiologist standby.
16 The Influence of Angles Kappa and Alpha and Pupil Size on Vision after Implantation of Soleko Evolve and Lucidis Lenses with a “Pure” EDOF Structure , Adam Cywinski1*
Background: Two models of artificial intraocular lenses with a “pure” EDOF structure, i.e. Soleco Evolve and Lucidis, were used in 36 patients in 43 eyes. Results of postoperative visual function were analysed, like also a correlation between preoperatively measured parameters of pupil size, kappa and alpha angles. Methods and Findings:  Cataract and an unacceptable refractive error mainly hyperopia, were the reasons for the removal of the lens from the eye. High values of angles kappa and alpha or a large pupil were not a disqualifying factor for implantation of these lens models. The beneficial effect of improving vision too far and near distances was achieved in most eyes. The dependence on light intensity and pupil size are the main factors affecting visual acuity too far and near distances. High values of angles alpha and kappa had only a slight, negative effect on the postoperative visual acuity values. Conclusion:  A sufficiently large pupil size determined preoperatively allows for satisfactory visual acuity too far and near distances to be obtained. In hyperopic eyes after refractive lens exchange, the values of visual acuity to far distances were slightly lower than before surgery. This information determines the indication for the use of “pure” EDOF lenses in non-dominant eyes and in patients with a large pupil. In cases of a very large pupil diagnosed preoperatively, vision to near distances without the need for additional correction, obtained in good lighting conditions, is an added value, which seems to be a sufficient advantage over the benefits of monofocal lens implantation.
17 Spontaneous Giant Retinal Pigment Epithelium Rip with Exudative Retinal Detachment-An Unusual Presentation , Vinit J Shah1*, Syed Mohideen Abdul Khadar1, Syed Saifuddin Adeel1, Shobita Nair1
Retinal Pigment Epithelial (RPE) rip or tears are known to occur as a natural result in the course of a retinal Pigment Epithelial Detachment (PED) in patients with neovascular Age-Related Macular Degeneration (AMD) or response to intravitreal anti-VEGF or laser for Wet AMD. After endophthalmitis, the most dreaded complications post Anti-VEGF injection is RPE tears leading to detrimental visual loss. Here, we report a case of a 57-year-old diabetic male patient who developed exudative retinal detachment in the left eye who underwent inguinal hernia surgery 20 days back. Uveitic workup done for exudative detachment was normal. FFA showed transmitted choroidal hyper fluorescence in the early phase suggestive of RPE rip and in late phase dye pooling in bullous detachment. The patient underwent Retinal detachment surgery with unexpected post-operative re-detachment noted at 1 week.  This report highlights giant RPE rip as an uncommon cause for extensive exudative detachment, its evaluation, and difficult surgical management.
18 The Ophthalmology Development of Hyperbaric Medicine for Treating Central Retinal Artery Occlusion in Hong Kong , Sunny Chi Lik Au1*, Callie Ka Li Ko1
Hong Kong first established the Hyperbaric Oxygen Therapy (HBOT) for treatment of Central Retinal Artery Occlusion (CRAO) since November 2018 [1]. Before the era of hospital-based HBOT in 2018, similar service was provided by the Fire Services Department of the government on a remote island situated Recompression Treatment Center, which was designed to train and treat divers [2]. CRAO was not on the treatment indication list during that divers-oriented era. From September 2018 onwards, HBOT public hospital service was provided under the Accident and Emergency department in Pamela Youde Nethersole Eastern Hospital, the only territory public hospital with HBOT chambers currently [3]. CRAO was then included as one of the treatment indications supported by the Undersea and Hyperbaric Medical Society (UHMS) and United States Food and Drug Administration approval [4].
19 COVID-19 Publication and the Future of Research , Seraph Shi Kei Wu1, Sunny Chi Lik Au2*
It has been more than 1 year since the COVID-19 pandemic despite the advance in medicine and healthcare, human appears small in front of the frequent emerging infectious diseases in recent decades [1]. These are partly caused by the raise in microbial adaptation, human activity, and substantial international movement. A global pandemic with multi places lockdown affected our way of living and inevitably the way of conducting academic studies and researches. It has significantly delayed recruitment in clinical research trials, and potentially gapping the development of science. Translational research took up the leading role in converting the scientific findings into practical health care provision [2]. Practitioners played the intimate role in collaborating across research centers and hospitals where COVID-19 patients were hospitalized. During the COVID-19 pandemic, many innovative advances emerged such as telemedicine, teleconsultation, virtual webinar or even conferences were blooming in the healthcare sector [3,4]. We should all grasp this golden opportunities to cooperate at the national and international level, which the evolvement of the Journal of Ophthalmology and Advance Research is one of the many examples among all. Few fundamental obstacles in research still got to be sort out, including efficacy of recruitment, reaching out to potential participants, validating the results, and dissemination of scientifically true findings. By the time of pandemic, numerous reports have been published online or were submitted to preprint servers [5]. New pre-print platforms were even opened particularly to cater COVID-19 materials. Worldwide researchers invested their time, and spent their efforts on their respective fields to carry out their scientific work across different disciplines like ocular biochemistry, virology, immunology, and pathology. Ophthalmologists were also working hard on ocular disease transmission, infection control practices, experimental treatment, and even in post-vaccine era [6]. An exponential increase in scientific manuscripts has been collected in several databases about COVID-19. Scientists, researchers and publishers collaborated to mobilize sharing of resources and build the evidence-based practices addressing the COVID-19 pandemic under the difficult times. Developing ophthalmology research is important with the focus to enhance healthcare.
20 Outcome of Immediate Management in Chemical Ocular Burns , Shreya Thatte1*, Garima Tiwari2
Purpose: To evaluate the outcome of immediate management in acute ocular chemical burns. Methods: 29 eyes of 19 patients with acute chemical burns were studied. All patients received immediate first aid. Limbal and conjunctival involvement were graded as per Dua’s classification. 86.8% patients with grade 1, 2 and 3 were managed conservatively while amniotic membrane transplantation was performed in 13.7% of patients who had grade 4 or grade 5 involvement. All patients were followed up for a period of 6 months. Results: 73.6% patients presented with alkali burns while 26.3% patients presented with acid burns. 3.4% eyes had grade I involvement, 55.1% eyes had grade II, 27.5% eyes had grade III, 3.4% eyes had grade IV and 3.4% had grade V involvement. Of 29 eyes, 86% showed epithelialization by 8 weeks, and rest 13.7% showed complete epithelialization by 4 months. On long term follow-up, complications were seen in 13.6% eyes. Symblepharon occurred in 6.8% eyes and rest 6.8% eyes developed corneal vascularization due to secondary limbal stem cell deficiency. None of the eyes showed worsening signs of corneal thinning and perforation. Conclusions: Immediate intervention in acute ocular burns, in the form of medical or surgical, prevents further ocular surface damage, promotes wound healing, and hinders visually debilitating cicatricial sequelae. In our experience, surgical intervention in patients with Grade 4 involvement and above leads to early rehabilitation and gain of visual function.
21 Paralytic Strabismus: A Review of 13 Years at a Tertiary Care Center in Western-Central India , Shreya Shah1, Mehul Shah1, Pradeep Chandane1, Sakshi Makhloga1, Meera Sanghani1, Deeksha Thorat1, Drashti Netralaya1*
Purpose: To describe the incidence, aetiologies and follow-up of patients with paralytic strabismus. Methods: This retrospective study included 193 strabismic patients with isolated III, IV or VI cranial nerve palsy, cases of the strabismus from the Department of Ophthalmology of the tertiary care center in western-central India between January 2007 and December 2020. The present study analyzed the injured cranial nerve, the affected eye, sex distribution, etiology and follow-up. Results: About 5.7% of the cases were congenital and 16.1% were of pediatric age. The Trochlear nerve was the most frequently affected (56.5%) in these cases. Incidence was higher in males (58.1%) than females. Trauma was the common cause of III (7.1%), IV (8.3%) and VI (50%) nerve palsy. The disease management modalities included surgical, medical and spontaneous resolution. Conclusions: The sixth cranial nerve was affected most frequently. However, the most common underlying cause was yet undetermined.
22 Cosmetic Laser Related Retinal Injuries , Leon Chun On Lee1, Sunny Chi Lik Au2*
Cosmetic industries are booming in many Asian cities where the uptake of laser treatment is becoming more frequent. The close proximity of the cosmetic laser handheld probe to the ocular adnexa is at risk of jeopardizing the retina. Cosmetic laser related eye injury was rare, and as an occupational hazard to the laser operating personnel was even rarer. Here, we present our opinion on reviewing reported cases in English literature. We aim to raise the awareness of cosmetic laser procedures’ devastating effect to the eye and subsequent ophthalmic management issues.
23 Masquerade Syndrome: Diagnostic Challenges in a Case of Primary Central Nervous System Lymphoma , Michael Liam O’Sullivan1, Anastasios Catanzaro2, Kyle Swerhun2, Sanjoy K Gupta3*
The objective of this investigation was to present a case of masquerade syndrome secondary to primary CNS lymphoma in a Northern Ontario community. Masquerade syndrome of primary CNS lymphoma in the eye can often be misinterpreted as an immune-mediated process, owing to its tendency to first present with only vitreous cell, or chronic uveitis. Correct diagnosis of intraocular primary CNS lymphoma requires clinical suspicion and ophthalmologists should have a low threshold for triggering a diagnostic work-up of older and immunocompromised patients with a characteristic presentation.
24 Mercureid Gives New Opportunities for Treatment and Prevention of Complications Caused by COVID-19 in Patients with Ophthalmic Pathologies , Sergey N Gusev1*, Velichko LN2, Bogdanova AV2, Khramenko NI2, Konovalova NV2, Kovtun AV3
The coming era of COVID-19 introduces critical challenges for researchers.  Accordingly, new questions connected with the current state of people’s health arise, namely, what consequences will be for the patients who have suffered from long COVID-19; what diseases are supposed to threaten the patients in the future; what immunity responses will be after the influence of antigen SARS-CoV-2; to what extent the organism changes caused by SARS-CoV-2 contribute to or prevent from the development of long-term protective immunity; how effective COVID-19 vaccine will be for these patients. In this connection, some of the above-mentioned items have been highlighted in this research work. The study was conducted in 49 patients with ophthalmic pathologies who had previously undergone COVID-19. It should be stressed that examination of eye disorders is very essential because they allow in a non-traumatic way to obtain lifetime visualization of the state of blood vessels and capillaries, as well as to assess the effect of the virus on the central nervous system. Moreover, immunological studies made it possible to draw a conclusion about the state of antiviral immunity, immune status and its correlation with the severity of inflammatory processes in the eye structure, the central nervous system including the vascular endothelium. The novelty of the study is in establishing a causal relationship between SARS-CoV-2 infecting and formed dysfunction of immune parameters that caused the manifestation of chronic inflammatory diseases. As a result, light adaptation was impaired by 2.3 times, due to the damage to blood circulation owing to the neurotoxic effect of SARS-CoV-2 and hypoxemia. The corrective effect of drug Mercureid was registered in 73.4% of patients. It should be indicated that the most serious cases were observed in the group of patients with the damage to the retinal vascular system: the phenomenon of re-thrombosis of both the central retinal vein and its branches, as well as circulatory disorders in the optic nerve trunk – ischemic optic neuropathy with a sharp deterioration in vision. In these patients, the combination of vascular drugs and drug Mercureid allowed stabilizing the patients’ state, achieving remission and in 50.0% of cases having higher visual functions. Firstly, Mercureid made venotonic and angioprotective effect. It reduced vein elasticity and capillary permeability. Moreover, it improved venous outflow and microcirculation that allowed in some cases to restore lymphatic drainage. According to the results of the immune study, the targeted effect of the new drug Mercureid, aimed at modulating the activity of several critical target proteins, such as CD3, CD4, CD8, CD25, CD38, CD54, CD95 was revealed. The therapeutic efficacy of Mercureid was 75.1%. The second research finding is that in patients with manifestation of chronic inflammatory diseases who have previously been infected with SARS-CoV-2, the production of specific protective antibodies is supposed to be impaired (as these patients often have pathologically low levels of CD4, CD8, CD25 and overexpression of CD38, ICAM-1, CD95 that, consequently, causes apoptosis of immune cells, lymphopenia and also forms the phenotype of exhausted T-cells with activation of the expression of inhibitory receptors). Thus, we consider vaccination to be ineffective for them, due to the presence of a compromised immune system. Accordingly, the provision of corrective multitarget immunotherapy aimed at several target proteins, which are critical for the formation of long-term effective post-viral immunity to SARS-CoV-2, is certainly an important therapeutic need. This immunotherapy can be carried out both before and after vaccination in order to achieve the maximum protective effect from the vaccine. However, the definite answer to this research question requires another type of study design, which is under our further consideration.
25 Following Editor’s Steps in Ophthalmology and Advance Research before the End of 2021 , Sunny Chi Lik Au1*
2021 has already been coming to the end when I am writing this in the 4th quarter, and Christmas is on the way. With the COVID-19 pandemic continuously hoisted throughout 2021, most of the academic conferences were turned into virtual, or if possible, hybrid form to cater only for local delegates [1,2]. Air travel and border crossing are still not common despite the gradually increasing rate of vaccination worldwide. Here, to celebrate the success of our journal’s second volume to expand up to her third issue, I am going to introduce a few virtual conferences in ophthalmology and advance researches before 2021 ends. Famous international ophthalmology conferences like American Academy of Ophthalmology (AAO), World Ophthalmology Congress (WOC), Asia-Pacific Academy of Ophthalmology (APAO) congress are all well known to the readers [3-5]. Concerning our locality in the Asia pacific region, we could go through the official website of APAO’s meeting calendar page. I would like to highlight two coming virtual conferences, the 14th Asia-Pacific Vitreo-retina Society (APVRS) Congress on December 11th-12th and 33rd Annual Scientific Meeting Hong Kong Ophthalmological Symposium 2021 from 4th to 5th December 2021.
26 Complications of Delayed Tube Removal after Dacryocystorhinostomy Surgery in the COVID Era , Sthapit PR1*, Manandhar A1, Paudel M1, Amatya M1, Saiju R1
Purpose: A silicon stent intubation, done after Dacryocystorhinostomy (DCR) surgery, is generally removed after 6 weeks. However COVID-19 related lockdown as well as recommendation to hold the lacrimal procedures for safety related purpose had led to delay in silicon tube removal for many months. Side effects of even short term silicon stenting are well known. The purpose of this study was to assess the complications of delayed stent removal after DCR surgery, due to COVID restrictions. Materials and Methods: A cross sectional study that included 35 post DCR patients whose silicon tube removal was delayed due to COVID restrictions, was done. Detail history and clinical examination to note the DCR surgery and tube related complications were noted. Silicon tube was removed and syringing done where possible. Result: Mean age was 41 years (SD 14.3; range 7-68 years). Among them, 29(83%) were females. The most common presenting symptom was persistent watering in 19 patients (54.2%); however syringing was found to be patent in 30 patients (85.7%). Out of 35 eyes, 26 (74.3%) had the silicon tube in situ in normal position without puncta or canaliculus complications. The mean (SD) time of delay in tube removal after DCR surgery was 9.5 (2.9) months. The average (SD) delay time in months of study participants who had complications and without complications were 8.3 (2.7) and 10 (2.8) respectively, which was not statistically significant. Conclusion: Delay in silicon tube removal is a safe practice in COVID era.
27 Peripheral Ulcerative Keratitis: Another Ocular Manifestation of Behçet's Disease , Moctar Issiaka1*, Soukaina Bahti1, Adil Mchachi1, Leila Benhmidoune1, Rayad Rachid1, Mohamed El Belhadji1
Ocular involvement in Behcet’s Disease (BD) is typically characterized by uveitis, which is present in over 50% of cases. However, more and more cases of corneal involvement are reported. We report a rare case of Peripheral Ulcerative Keratitis (PUK) associated with Behçet’s disease. This is a 38-year-old man who has been followed for Behçet’s disease for 5 years, in remission and without treatment for one year and without overt anterior ocular involvement, who presented a deep ulcerative lesion with a peri-lesional disorder in the nasal peripheral cornea of the left eye on a background of moderate dry eye. Initial visual acuity was 13/20 without correction and there was no anterior chamber reaction or posterior segment involvement. Because of the worsening of the ulcer despite 3 days of treatment with antibiotics and antivirals, the diagnosis was reconsidered given the patient’s history of BD and a course of topical and oral corticosteroids and wetting agents were instituted. The evolution was spectacular, after 5 days of treatment, with visual acuity back to 20/20 and almost complete healing, thus confirming the etiology of this keratitis. Any marginal ulcer, especially one that is refractory to antibiotics and antivirals, should be investigated for Behçet’s disease.
28 Optical Coherence Tomography Angiography for Macular Telangiectasia Type 2 , Sunny Chi Lik Au1*, Clarice Kai-ying Su2
Optical Coherence Tomography Angiography (OCT-A) is an evolving retinal imaging modality for vascular diseases. By avoiding the intravenous fluorescein dye and its associated complications, OCT-A better identifies abnormal vasculature in the retinal and choroidal layers without any interference from fluorescein leakage. This is particularly useful for visualization of pathology in macular telangiectasia. Classified as non-proliferative and proliferative, macular telangiectasia can eventually progress to subretinal neovascularization. In this article, we review its pathology at different stages and corresponding OCT-A findings in different retinal layers: from the superficial and deep retinal capillary plexus, through the retinal pigment epithelium, and down to the choriocapillaris layers.
29 Eyes Over Exposed: Ocular Health of Students in Higher Education , Dhabaria Vidur J1*, Naik Vidya V2, Galliara Meena A3, Dudani Ajay4, Dudani Krish A5
Purpose: The study aimed to explore the virtual academic routine of students pursuing higher education, map their screen time, and ascertain their visual hygiene challenges. Methods: The online survey comprised of 600 students (389 undergraduates and 211 postgraduates). Chi-square test of Independence was applied to study the association between level of education and screen time; use of spectacles and consumption of eye medicines; and the increase in eye power. A value of P ≤ 0.05 was considered significant. A three-point rating scale was developed to capture information on categorical variables. Results: While 1 out of 7 undergraduate students had a screen time of at least 8 hours/day, 1 out of 6 postgraduate students had a screen time of at least 9 hours/day. More than 90% of students reported facing at least one symptom of digital eye strain. Despite having eye-related problems, 78% of respondents did not consult an ophthalmologist. Due to the eye strain, 1/4th of the respondents self-medicated themselves. Close to 14% of respondents reported an increase in their eye power. Conclusion: The study confirms that overuse of digital technology has unintended consequences on students’ ocular health. Gadgets and Apps provide students with the necessary convenience, but learning to use them responsibly is crucial. Going ahead, the digitized world calls for in-depth studies and significant empirical research to mitigate the impending challenges of ocular health and the physical and mental health of students.
30 A Case Report of Intraocular Radiotherapy with Strontium-90 for Juxtapapillary Retinal Capillary Haemangioma , Navaratnam J1*, Eide N1, Bærland TP1, Rekstad B2, Nilsen T2
Juxtapapillary retinal capillary haemangiomas are rare benign vascular tumors located adjacent to the optic disc. They may occur sporadically or in association with von Hippel-Lindau disease. Treatment modalities for juxtapapillary retinal capillary haemangiomas vary from observation to aggressive vitreoretinal surgery.  A combination of different treatment modalities is often tried with modest success. We report a patient diagnosed with right-sided juxtapapillary retinal capillary haemangioma at the age of 36 in an amblyopic eye previously treated with patching and surgery. In 2013, at the age of 45 he presented with increasing shadow in his right visual field. The ophthalmological examination revealed a right-sided subtotal serous retinal detachment with 6.2×5.6×3.5 mm juxtapapilllary retinal capillary haemangioma and visual acuity of hand movements. He underwent vitreoretinal surgery, radiation of juxtapapillary retinal capillary haemangioma with intraocular strontium applicator and insertion of silicone oil, all in one session. We describe a novel treatment, the intraocular radiation with strontium. This can be applied in complicated cases where vitrectomy is necessary.
31 A Case Report of Phialemonium Curvatum Endophthalmitis , Navaratnam J1*, Bærland TP1, Solberg EL2, Hermansen NO3, Andersen CT4, Eide N1
Endophthalmitis caused by Phialemonium species are rare. We report a 68-year-old female with unilateral Phialemonium curvatum endophthalmitis. She presented with a two day history of right-sided floaters and reduced vision to finger counting, initially treated as iridocyclitis with topical and systemic steroids. Due to worsening, a diagnostic vitrectomy was performed. The culture from the vitreous cavity yielded Phialemonium curvatum growth. She was treated with amphotericin B intravitreally once and voriconazole tablets for three months with gain of Best Corrected Visual Acuity (BCVA) to 0.3. Six weeks following discontinuation of voriconazole, the patient developed right-sided eye pain and deterioration of the visual acuity. A second diagnostic vitrectomy was performed and once again the culture demonstrated growth of Phialemonium curvatum. She was treated with voriconazole for six months. Further, she developed eye pain and reduced vision in her right eye about 2 years following the second diagnostic vitrectomy. A third diagnostic vitrectomy was performed which was negative.  Two weeks following the third diagnostic vitrectomy, the patient presented with retinal detachment and macular hole in the same eye. Retinal detachment persisted even following surgical repair with silicone insertion. The patient declined further surgeries. About ten years following initial presentation she developed intolerable right-sided eye pain and phthisis. The eye was eviscerated.
32 Editor Advice on Writing a Good Manuscript , Sunny Chi Lik Au1*
With the advancing technology and expanding ophthalmology researches, more and more manuscripts were received by our journal concerning different aspects of ophthalmology, such as optical coherence tomography angiography, extended depth of focus intraocular lens, periocular cosmetic laser and COVID-19 related researches, etc [1-4]. Despite an increasing submission rate, not many manuscripts were successful to proceed towards publication. By reviewing our previous submission received, hereby we summarize some advices on improving an ophthalmology manuscript writing. Although following these advices does not guarantee acceptance of manuscript, it would definitely pass you further on the reviewing process, and approaching successful publication. Firstly, provide a background that contain the scientific rationale for the study. Introduction should end with a statement of the aims of the study. Each statement of fact should be supported by references. Secondly, clearly describe the selection of observational or experimental subjects, inclusion and exclusion criteria, randomization, and the use of controls. Include details of the power analysis used to determine the study size. The data acquisition protocol, procedures, investigated parameters, methods of measurements, and apparatus should be described in sufficient detail to allow other scientists to reproduce the results. A must-read are the guidelines released by the Committee on Publication Ethics (COPE). Clearly mentioning the concerned institution ethics committee approval number of the presented study is the responsibility of the authors. Sources for all reagents and equipment should be given in the format of (Company, City, Country). The statistical methods should be described in detail to enable verification of the reported results.
33 Objective Spherical Refractive Error Estimation Using Ocular Biometrics , Kwok Hei MOK1*
Objective: To investigate the potential of clinical application spherical refractive error (SpRx) estimation using Ocular Biometrics (OB). Methods: 28 children aged from 6 to 14 years old with inter-ocular SpRx difference between 1 to 2 Dioptres (D) were recruited. Both eyes were measured with non-cycloplegia subjective refraction. OB was performed by the IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). For OB SpRx estimation, right eye Intraocular Lens Power (IOL), (A constant 118) was taken with right eye SpRx, the flattest central corneal curvature (FK) and Axial Length (AL) using SRK/T formula. Left eye OB SpRx was taken using identical calculation with right eye IOL, left eye FK and AL respectively. Results: No statistically inter-ocular differences were observed of the average FK (p=0.84) and average lens thickness (p=0.88), but not average AL (p<0.01). Average left eye SpRx by OB estimation and subjective refraction were determined as -2.86±1.02D and -2.82 ±1.16D (mean±SD) respectively. No significantly difference (p=0.84) and highly correlation (r=0.94. p<0.01) were found. Conclusion:  Objective SpRx appears to be reliably estimated using OB. It likely provides a crucial SpRx reference for comparison with subjective refraction. OB SpRx may also play a vital role for monitoring the children myopic progression.
34 Isolated Foveal Hypoplasia Assessed by Multi-Focal Electroretinogram: A Clinical Presentation , Konstantinos AA Douglas1, Marios D Tibilis1, Georgios S Dimtsas1, Vivian Paraskevi Douglas2, Konstantinos Nanopoulos1, Marilita M Moschos1*
Foveal hypoplasia is a term commonly used to describe the lack of development or underdevelopment of the foveal pit which anatomically and functionally correlates with a region of high visual acuity. Despite the fact that, fovea facilitates more precise and greater visual processing, the absence of foveal pit does not mean, a priori, poor visual acuity. While foveal hypoplasia has been usually associated with variable ocular abnormalities, isolated foveal hypoplasia though rare, has been also described. We present a case of a 31 year-old Caucasian male with an isolated foveal hypoplasia and the clinical evaluation in combination with the imaging findings, documented by multifocal ERG for the first time in literature.
35 Results of Minimally Invasive Device TrabEx+ in Patients with Primary Open Angled Glaucoma , Ioanna Gourgouli1, Sofia Spai1, Konstantinos AA Douglas2, Vivian Paraskevi Douglas2, Anastasia Kourtesa2, Marilita M Moschos2*
Purpose: The aim of our prospective study is to present the results of trabecular meshwork excision with the minimally invasive device TrabEx+ in patients with Primary Open-Angle Glaucoma (POAG). Methods: Patients diagnosed with POAG resistant to pharmacological treatment were included. All patients underwent as first non-medical treatment a trabecular meshwork excision with the use of TrabEx+. Results: 50 eyes of 50 patients with POAG (75.38±8.45 years, 21 males) were evaluated. The use of TrabEx+ resulted in a decrease of IOP the first postoperative day (by 11.2 mmHg) and remained decreased after one month (by 7.3 mmHg), three months (by 7.3 mmHg), six months (by 7.7 mmHg), one year (by 7.3 mmHg) and two years (by 6.7mmHg). Conclusion: The use of TrabEx+ is associated with a significant reduction in IOP pressure and medication and provides immediate and long-term effective results. TrabEx+ minimally invasive surgery is a safe and reliable alternative that could be added in the armamentarium of glaucoma management.
36 Odontogenic Optic Neuropathy, Clinic, Treatment Dynamics: A Case Report , Moyseyenko NM1*
Optic nerve neuropathy due to dental lesions is rare but causes complex persistent functional disorders that are difficult to diagnose. The aim of this case report is to show odontogenic optic neuropathy through treatment tactics and observation of structural dynamics and functional changes of the optic nerve with the help of a clinical case. The consultation of the patient was done as per the Department of Ophthalmology, Ivano-Frankivsk National University, Ukraine. Tests such as computed perimetry, Optically Coherent Tomography (OCT) of the optic nerve, Magnetic Resonance Imaging (MRI) of the brain, Computed Tomography (CT) of the paranasal sinuses and immunological blood tests were performed. The patient gave informed consent to access personal data and use it for scientific purposes. In the case of patient S., the combination of neuritis with lesions of the anterior part of the vascular tract is attributed to the background of multiple caries and prolapse of the teeth of the upper jaw in the sinus. Treatment includes a regimen by a dentist for caries and pulse therapy with corticosteroids. From the result, it was possible to reduce the swelling in the nerve fibers of the right eye by 35% and the left eye by 19%. The average sensitivity threshold in the right eye increased by 79% and in the left eye by 90%. In conclusion, we confirm that odontogenic optic neuropathy is a rare form of optic nerve damage. Two-stage treatment (dental and corticosteroids) reduces the nerve fibers swelling and increases retinal ganglion cells sensitivity.
37 Conjunctival Folliculosis Presenting as Hemolacria, Manu Saini1*, Arun K Jain1, Shubham Manchanda1, Kulbhushan Saini2, Pankaj Gupta1
A 13-year-old female reported a one-year history of hemolacria in her left eye following an episode of a migraine attack and anger outburst. Ophthalmic examination revealed inferior fornix follicles with petechia and absent inflammatory reaction. The patient was treated with topical antibiotics, steroids followed by topical 1% cyclosporine and vitamin C. Bloody tear symptoms resolved and no bloody tear was observed for the three months insinuating that conjunctival folliculosis should be considered in the differential diagnosis of hemolacria and entity needs to be differentiated from follicular conjunctivitis. Through this case report we would like to emphasize the importance of the conjunctival folliculosis identification and possibility of shedding a bloody tear in presence of vascular dysfunction. Therefore, necessitate treatment of the benign entity similar to reactive lymphoid hyperplasia.
38 Role of Ultrasound Biomicroscopy in Predicting Intraoperative Surgical Strategies in Penetrating Keratoplasty with Cataract Extraction and IOL Implantation, Shreya Thatte1*, Komal Jaiswal2
Background: Penetrating Keratoplasty with cataract extraction and Intraocular Lens (IOL) implantation (Triple procedure) is very challenging procedure because in cases of Opaque cornea, status of anterior segment is difficult to predict that can lead to intraoperative surprises. If not managed properly, these can severely affect visual outcome. To avoid this, we performed Ultrasound Biomicroscopy (UBM) preoperatively for detailed analysis of anterior segment structures and associated pathologies and later compared it with intraoperative findings to judge predictive accuracy of UBM in guiding surgical strategies, decision making and modifications intraoperatively. Methods and findings: 20 eyes of 20 patients with different grades of corneal opacities like simple corneal opacities (6 eyes) or adherent leucoma (7 eyes) or anterior staphyloma (7 eyes) that underwent Triple procedure (Penetrating Keratoplasty+ cataract extraction+ IOL implantation) were evaluated preoperatively by UBM and the findings were compared intraoperatively to find predictive accuracy of UBM. Extent and depth of corneal lesions, corneal thickness, anterior chamber depth, type, position and extent of synechiae, pupillary membrane and status of lens and capsule were assessed. Scan was performed to visualize any posterior segment pathology and to find Axial Length (AL). Keratometry readings of other eye were taken to calculate IOL power for implantation. Preoperative UBM findings when co-related intraoperatively was found to be accurate in 71.42%- 100% parameters and accordingly these cases underwent penetrating Keratoplasty with other modifications like Iridectomy, Membranectomy, Synechiolysis, iris reconstruction, Trabeculectomy, cataract extraction and IOL implantation. Conclusion: In cataract coexisting with corneal pathologies, UBM is Best and reliable guide in predicting and preplanning of surgical strategies f
39 Peculiarities of Ocular and Systemic Pathology in the Elderly, Dumitrache Marieta1, Lascu Rodica2*
The pathology of the elderly is the direct result of the aging process, aggravated by the physical and mental involution that occurs with advancing age. Age-related eye changes are present, such as: presbyopia, decreased tears, peripheral visual field reduction, vitreous liquefaction (with posterior vitreous detachment and retinal detachment), decreased vision due to cataracts, glaucoma, diabetic retinopathy, macular lesions, Age-Related Macular Degeneration (AMD), optic atrophy. At the same time, there are multiple systemic diseases in the elderly, at the cardiovascular, respiratory, locomotor, neurological, auditory level. The diseases of the elderly can be multiple, with a long, chronic evolution, with periods of exacerbation, frequent complications, prolonged convalescence. Aging is a continuous, dynamic process that must be followed because in its evolution new connections and balances are created that must be identified and treated properly, old age being a distinct stage of ontogenesis that should not be seen as a state of disease. In an elderly patient, the normal aging should be differentiated from pathology.
40 Review on Cancer and the Immune System, Akbar Nikkhah1*, Masoud Alimirzaei2
Supplemental Microbials (SM) could offer commercial young dairy calves with healthy subjects to enhance gut microbial diversity and host health if calves are managed properly and optimally. The possible helpfulness of SM, however, must not be overstated and overemphasized. The major aim of this editorial was to address whether SM is practically workable in preventing digestive disorders namely diarrhoea. Another aim was to underline the possible efficacy of such products in enhancing calf health and immunity. Protecting newborn calves against infectious diseases and concurrently, improving their health and growth in early life is strictly related to herd economics and production sustainability. Diarrhoea is the most prevalent infectious disease, causing calf morbidity and mortality worldwide. Supplementing dairy calf diets (i.e., milk or starter) with potentially beneficial microorganisms such as bacteria and yeast has been attempted to improve the gut microbial ecosystem and optimize nutrient assimilation and immunity. However, infectious diarrhoea still remains a major problem in many dairy and beef farms around the globe. Since diarrhoea has a multi-factorial nature, it seems that the possible efficacy of SM depends on the environmental and management conditions in which the calves are raised. The rearing system (e.g., individual vs. group housing), diet, environmental microbial load and other management factors are involved in the incidence of diarrhoea. Therefore, using probiotic products may interact with such factors, thus influencing their effectiveness and likely causing inconsistencies concerning probiotics’ usefulness in commercial dairy farms.
41 Isolated Foveal Hypoplasia Assessed by Multi-Focal Electroretinogram: A Clinical Presentation, Kwok Hei MOK
Spherical Refractive error (Rx) has been reported to be reliably estimated with Ocular Biometrics (OB) using intra-ocular lens calculation method such as SRK/T formula [1]. Further supplementary data was presented regarding the evaluation of the extent of Rx alterations with Axial Length (AL) elongation using this calculation method. Rx were calculated using intraocular lens power (IOL) (22.5D A-Constant 118) and various AL (23.0 to 26.0 mm) and corneal curvature (K) readings (41.00 to 44.00 D) using SRK/T formula. IOL was estimated with Rx (Plano), AL (23.2 mm) and K reading (42.00 D).
42 Visual Outcomes of Secondary Lens Implants in Children with Different Etiologies , Shreya Shah1, Mehul Shah1, Apeksha Kataria1, Ashvini Korane1, Drashti Netralaya1*
Aim: This study investigated visual outcomes and factors that impact vision in children receiving secondary Intraocular Lens (IOL) implants. Methods: Children who had traumatic or congenital cataracts and underwent secondary lens implantation for aphakia at Drashti Netralaya between 2000 and 2019 were retrospectively examined. We included all the eyes with secondary implants for aphakia correction with placement either in the bag or sulcus or through scleral fixation. We obtained data from electronic medical records and analyzed using SPSS 22 through descriptive analysis, cross tabulation and t test. We evaluated visual outcomes among different patients. Results: Our cohort consisted of 84 eyes (mean age: 7.88 ± 6.07 years). Of the 84 eyes, 24 (28.6%) and 60 (71.4%) were female and male patients, respectively and 32 (38.1%) had traumatic cataract. We observed significant improvements in vision following lens implantation (p=0.000). Those with nontraumatic cataracts exhibited better outcomes that did the traumatic cataract group (p=0.004). Corneal opacity caused comorbidities in the traumatic group (14/52, 14.29%). Visual outcomes significantly improved in young patients and were not affected by other variables. Conclusion: Secondary lens implantation significantly improved vision in aphakic children. Young patients and those with nontraumatic cataracts demonstrated more favorable visual outcomes.
43 Communication between the Eye Care Practitioner and Parents of the Myopic Child, David Berkow1*
This article is based on a poster presented at the International Myopia Conference which took place in Rotterdam, Holland in August 2022. The poster and the article were both self-funded. Due to lack of space on the poster not all possibilities were noted therefore only some were chosen. In a follow-up article I will investigate other options available on the market. I have no financial interest in any of the products mentioned in this article. My main objective is to give the eye care practitioner a set of tools to help him illustrate to the parents the reason why their child’s myopia should be treated, and not only corrected, and the importance of trying to slow its progression.
44 Hybrid Ophthalmology Conferences: Paradigm Shift in 2022, Sunny Chi Lik Au1*
Introduction: It has been almost a year since our journal talked about ophthalmology conferences under the COVID-19 era [1]. With the COVID-19 pandemic continuing throughout 2022, scholars and academics are finding their ways out for scientific exchange of knowledge and research advances [2]. Virtual conferences were mostly turning into hybrid form to cater for delegates from around the world both physically and electronically [3]. Going through the Asia-Pacific Academy of Ophthalmology (APAO) official website’s meeting calendar page, recent international conferences are 40th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS) held on 16-20 September 2022; American Academy of Ophthalmology (AAO) 2022 held on 30 September to 3 October 2022, and 15th Asia-Pacific Vitreo-Retina Society (APVRS) Congress held on 18-20 November 2022. These are all conducted in hybrid formats. There are few similarities, but also differences, across these hybrid conferences.
45 Computer Vision Syndrome in Medical Students: Awareness, Prevalence and Risk Factors, Masoud Mohammed Alqahtani1*, Abubakar Mohammed Jibo2, Elhadi Miskeen3,4, Adel Mohamed Aboregela5,6
Background: Computer Vision Syndrome (CVS) is a common problem among students, with very little conducted research about it on Saudi users. The aim of this study was to determine the awareness, prevalence and risk factors of CVS among medical students at the University of Bisha, Saudi Arabia. Methods: A cross-sectional study was conducted on the students registered in the faculty of medicine at the University of Bisha, Saudi Arabia. Two hundred thirty-four students were asked to fill out a predesigned online questionnaire covering sociodemographic characters, frequency of using computers, the associated symptoms and the relieving strategies. Results: The participation rate was 87.5% (n=196), of which males formed 78.1% (n=153) and females 21.9% (n=43). The age ranged from 18 to 27 years, with a mean ± SD of 21.3 ± 2.1. Participants spent variable hours using their computers with a mean ± SD of 5.1 ± 1.37. Most respondents experienced diverse symptoms (92.1%), including neck pain, headache, eye strain, redness of the eyes, dry eyes, backache and shoulder pain. Significant relationships were confirmed between the average time spent on computers daily, the onset of symptoms, the awareness of bad effects and the different symptoms encountered. Conclusion: Symptoms of computer vision syndrome are widely distributed among medical students at the University of Bisha, especially headaches which might be misinterpreted. Students’ awareness is acceptable but needs more persuasion to relieve eye stress by taking short, frequent breaks.
46 Patients’ Awareness and Knowledge of Their Ophthalmic Condition at Lagos University Teaching Hospital (LUTH), Olubanke Theodora Ilo1*, Olufemi Emmanuel Babalola2, Adetunji Olusesan Adenekan1, Olufemi Oduneye1, Folashade Akinsola1
Purpose: To assess patient’s awareness of their ophthalmic conditions following their clinic visits with the aim of improving communication between patients and health practitioners and enhancing care. Methods: A hospital-based cross-sectional quantitative survey carried out in subjects over 18 years of age, attending the Guinness Eye Centre Clinic (Lagos University Teaching Hospital) over a four week period in 2019. Results: A total of 250 subjects were surveyed. Male:Female 1:1.7 Age range 41-80 years. 42.4% had at least tertiary education. Although the majority of subjects (>70%) had enough time to ask questions from their doctors/nurses, 76.8% did not know the diagnosis of their ophthalmic conditions, 43.8% didn’t know their treatment options, and 62% did not know the names of their eye drops. 95.2% of subjects, however agreed that a simple information leaflet explaining their ophthalmic condition and treatment will increase their understanding. Patients with tertiary education or higher are three times more likely to have knowledge of the condition and treatment compared with patients with lesser education. Odds ratio 3.07 CI:1.82 to 5.19 P < 0.0001. Conclusion: Clinics should have counsellors who can spend more time to discuss with patients about their ophthalmic conditions. Information leaflets (in different languages) on different common medical conditions which include; Cataract, Glaucoma, Pterygium, should be printed in the simplest of language for patients to not only hear but also read to assimilate and enhance awareness in patients.
47 Ocular Damage in Craniofacial-Orbital Trauma: About 170 Cases , A Abounaceur1*, J Aitelhaj1 S Laababsi1, A Mchachi1, L Benhmidoune1, R Rachid1, M EL Belhadji1
Background: Ocular trauma represents an important part of the pathology observed in ophthalmologic emergencies, since it represents about 20% of the reasons for consultation. Ocular damage in cranio-orbital trauma is frequent and constitutes a major but avoidable cause of acquired monocular blindness and poor vision in adults.Thus, the aim of this work is to study the epidemiologic, clinical, therapeutic and evolutionary aspects of this clinical entity. Patients and Methods: This is a cross-sectional study with descriptive and analytical aims; retrospective over 3 years (January 1, 2019 to June 1, 2022) on 170 files of patients admitted to the ophthalmological emergency department, hospital 20 August 1953 of Casablanca, Morocco, for craniofacial trauma with orbito-ocular damage. Results: The frequency of ocular involvement was 38.6%. The average age was 27.95 years, with a male predominance (72.3%). Lesions of the anterior segment were more frequent than those of the posterior segment (16.5% versus 4.8%). The prognosis was much better in patients with closed globe trauma (96% without sequelae). Despite this, patients may still have anatomical and functional sequelae. Conclusion: Cranio-facial-orbital trauma is a public health problem in our context and affects mainly young people. It is urgent to strengthen prevention actions at various levels.
48 Correlation Between Contrast Variability and Refractive Error, Shreya Thatte1*, Haritima Sharma2, Shruti Patidar3
Background: Contrast sensitivity, is defined as the ability to detect the lowest lumination difference between an object and the background. It is one of the main requisites for good quality vision as the eye works by perceiving an object by comparing the difference between the target and the background contrast difference. Aims and Objectives: To assess patterns of contrast sensitivity functions in patients in different types of refractive errors using Pelli Robson chart and also to measure the severity of refractive error within each group and compared the contrast sensitivity function with severity in different types of refractive errors. Material and Method: This cross-sectional study was conducted on 500 patients (Age range from 10 to 80 years) who presented with chief complaint of refractive errors mainly myopia and hypermetropia. Patients who had previous history of ocular surgery and other ocular co- morbidity were excluded from study. Selected patients were enrolled for the study after taking a written informed consent. The patterns of contrast sensitivity function in different types of refractive errors were recorded on a prescribed proforma with respect to: Visual acuity, type of refractive error, severity of refractive error, duration of refractive error, age of the patient, fundus examination and Contrast sensitivity. Statistical analysis was undertaken with P