In view of the increasing use of visual evoked potentials (VEP) technique in neuro-ophthalmological diagnosis, it was thought pertinent to appraise the changes brought about in VEPs in the presence of refractive error (RE) as studied by the vision researchers and neurophysiologists. The purpose of this review was to provide a comprehensive quintessence of the work carried out in this fi eld with an attempt to summarize the previous concepts, recent perspective and current notion about the value of RE in electrophysiologic testing particularly the VEP technique.

Aim: Pseudoexfoliation (PXE) is a common and clinically important systemic condition that affects elderly people, who are also likely to undergo cataract surgery. It can cause serious complications during cataract surgery due to the pupillary rigidity and zonular weakness and instability. The purpose of this study was to study the frequency and types of complications of small incision cataract surgery (SICS) and phacoemulsification surgery in patients with cataract and PXE. Materials and Methods: This cross-sectional descriptive study was carried out on 52 eyes of 52 patients with cataract and PXE who underwent SICS or phacoemulsification surgery in a tertiary care hospital. Their perioperative and post-operative complications were documented and analyzed through statistical package for social sciences version 15.0 (IBM). Results: Poor pupillary dilatation in spite of use of standard mydriatic drops and non-steroidal anti-inflammatory drugs was the most common finding. This single factor made subsequent steps of surgery very difficult due to poor peripheral visualization. Pupillotomy was done in 25% cases. Other problems encountered were accidental iridodialysis, posterior capsule rupture, vitreous loss, retained cortical matter, decentered intraocular lens and zonular dialysis. Conclusion: Presence of associated PXE in cataract patients significantly increases the risk of vision threatening complications. Use of flexible iris hooks for small pupils and for capsular stability, capsular tension rings and high viscosity viscoelastics are useful modifications of surgical technique for good visual outcome.

Background: Cataract is the principal cause of curable blindness in India. The most recent estimates from World Health Organization reveal that 47.8% of global blindness is due to cataract and in South Asia region, which includes India, 51% of blindness is due to cataract. Aims: Our study was to assess the post-operative visual outcome after small incision cataract surgery (SICS) in camp patients during the study period from October 2011 to June 2012. Materials and Methods: Cataract surgeries were carried out in patients (with no known systemic illnesses), after screening at community based screening camps. All senile cataracts were included and complicated cataracts were excluded from the study. Patients underwent manual SICS with posterior chamber intraocular lens implantation. Post-operatively patients received oral antibiotic for 5 days and antibiotic-steroid eye drops for 6 weeks. Patients were followed-up at regular intervals. Spectacle correction was given at the end of 6 weeks. Results: A total of 164 patients were included in this study. At the end of 6 ^th week, best corrected visual acuity (BCVA) was 6/12 on Snellen's chart and even better (6/9-6/6) in 86.1% cases with post-astigmatism of 2.5 diopter (D) + 1 D. Results showed good vision after SICS at low cost in camp patients. Conclusion: Our study assessed the efficacy of hospital base camps in terms of visual. Our study results in terms of visual recovery showed 86.1% of patients had BCVA more than 6/12 on Snellen's chart. Average astigmatism was 2.5 D with no intraoperative complications justifying efficacy of hospital base cataract camp surgeries.

Aim: The aim of this study is to compare the mean macular thickness between normal and amblyopic eyes in unilateral strabismic and anisometropic amblyopia. Materials and Methods: A spectral domain-optical coherence tomography (Carl Zeiss Meditech, Inc.) was used to evaluate 51 patients (mean age 11.63 ± 2.84 years) with unilateral strabismic (n = 29) and anisometropic (n = 22) amblyopia. Data between the two eyes were compared using a paired t-test and a P value <0.05 was considered as significant. Results: Mean best-corrected visual acuity was +0.53 LogMAR (range 0.2-1.0) in the amblyopic eye. Mean macular thickness in the amblyopic eyes was 277.5 μ ± 15.3 and in the fellow normal eyes was 272.4 μ ± 13.1 (P < 0.05). On subgroup analysis, the difference was statistically significant in strabismic (P = 0.01) and not significant in anisometropic amblyopia (P = 0.08). Conclusion: The mean macular thickness was greater in amblyopic eyes as compared to the normal fellow eyes, and this difference was significant in strabismic amblyopia, but not significant in anisometric amblyopia.

Aim: To report the parental feedback on the 'squint surgery fees' of their ward in an urban private practice. Design: Prospective cohort study. Subjects and Methods: Three months after the surgery, a 10 item questionnaire was administered on the parents of the children who underwent a squint surgery. Multivariate analysis was performed. Results: The parents of 46 children were included. Thirty-three respondents were fathers. The educational status ranged from 6 ^th grade to postgraduates including doctors. Four respondents refused to disclose the income. The mean total and per capita monthly income of the families were 59,590/- INR (Indian Rupees) and 14,670/- INR, respectively. Thirteen parents found the surgical charges inappropriate. Concession was demanded when the total cost of surgery (28,417/- INR) exceeded the per capita income of the family (10,149/- INR) by three times. The most appropriate cost of the surgery adjudged by the parents was two times the per capita income. The "appropriateness of the fees" had no correlation with the outcome (P = 0.4). All the parents recommended heavy concession in the fees for the reoperations. The quality of the medical expertise was considered the most important determinant of the surgical fees. Of 18 children with mediclaim, 12 had rejection due to 'congenital' nature of the disease. Two were considered "cosmetic". Conclusions: In a private practice, the parental feedback on fees is desirable to make surgical services demand sensitive. Clinician should avoid the term "congenital" in the medical records and loudly express, "restoration of binocular vision" as the indication of squint surgery in children.

We report a case series of four eyes of four patients where resistant strains of Pseudomonas aeruginosa in nosocomial ocular infections were treated with topical meropenem with a successful outcome. Pseudomonas infections are known to be very fulminant. We observed strains of P. aeruginosa in four eyes resistant to all routine drugs such as fluoroquinolones, aminoglycosides and cephalosporins. Three eyes presented with infective corneal ulcers and one eye had endophthalmitis. Culture sensitivity of corneal scrape and aqueous tap respectively of each patient showed P. aeruginosa (Gram-negative bacilli) sensitive to carbapenem (meropenem and imipenem) group of drugs. These patients were treated with a topical meropenem 50 mg/ml once in an hour and responded dramaticaly and we could salvage all eyes. Topical meropenem 50 mg/ml, which is not routinely used in ocular infections is thus an effective drug for management of hospital acquired resistant Pseudomonas ocular infections.

Predisposing causes of preseptal cellulitis includes sinusitis, impetigo, trauma, chronic dacrocystitis, and external hordeolum. Intramuscular abscess in temporalis muscle as a cause of preseptal cellulitis has never been reported in ophthalmic literature. We here report a case of preseptal cellulitis following temporoparietal cellulitis as a result of intramuscular (temporalis) abscess. Surgical removal of the abscess along with parenteral antibiotic therapy was the mainstay of the treatment in such a case.

Tumors of the lacrimal sac are rarely encountered in clinical practice. The importance of recognizing this entity lies in the fact that the majority of the lacrimal sac tumors turn out to be malignant and thereby potentially life-threatening. Hence appropriate management of the lacrimal sac tumors is of utmost importance. We report a case of transitional cell carcinoma of the lacrimal sac, its presentation and management along with the review of the published literature.

Autoperimetry is an essential investigation for glaucoma management, which helps in the initial diagnosis as well as the follow up of glaucoma patients. The interpretation of autoperimetry is tricky and crucial. This article deals with the basics of autoperimtery explaining the various terminologies which are frequently used. This is followed by guidelines and algorithms for interpreting single field analysis. It also deals with the follow up strategies used in autoperimetry with emphasis on understanding the interpretation of "glaucoma progression analysis" (GPA) on Humphrey. This article will be of great help to comprehensive ophthalmologists as well as the post graduate student of ophthalmology, in understanding the intricacies of autoperimetry analysis which will be of great help in the management of glaucoma.

Computers and mobile computing devices are being used by increasingly larger number of people today. This has led to an increase in the number of patients complaining about ocular and nonocular symptoms related to computer use. Eye-strain, tired eyes, irritation, burning sensations, redness of eyes, dry eyes, blurred, and double vision reported by the visual display unit users was termed "Computer Vision Syndrome" (CVS). It is a repetitive strain disorder characterized by one or more of the following symptoms - eyestrain, eye fatigue, burning sensations, irritation, redness, blurred vision, and dry eyes when associated with operating a computer and looking at a computer monitor in a temporal association. CVS has a multifactorial causation. Several factors have been linked to symptoms. Many treatment modalities have been described. Treatment needs to be tailored to the individual patient. However, a large body of work is still required to uncover gaps in our understanding of the problem. A specially designed ocular examination for computer users and associated counseling about the current good practices in computer use would go a long way in preventing loss of productivity and morbidity from the condition.