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Journal of Ophthalmology and Advance Research

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Journal Papers (27) Details
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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.