Purpose: To study the barriers for cataract surgery among walk-in bilateral cataract blind in a paying outpatient department (OPD) at a tertiary eye care center in urban India. Materials and Methods: One hundred consecutive walk-in patients attending the paying OPD at a tertiary eye hospital in a tier two city of India and diagnosed to be bilateral cataract blind (better eye vision 10/200 or less) were recruited for the study. The duration of the study was 6 months. A structured interview was administered by a consultant ophthalmologist in the patient's language, and response was recorded in the pro forma. Patient was allowed to go through the system like any other regular OPD patient being advised surgery. Results: The dataset showed 67 (67%) females, 47 (47%) urban, 8 (8%) literate, 47 (47%) living within a distance of 25 km from hospital, and the average age of the patient was 67.18 years (95% confidence interval - 65.27–69.09). The top three reasons that patients cited which caused the delay was cost of the cataract surgery (27 patients), followed by residence location (staying in a rural area 22 patients) and the delay caused in getting fit for surgery due to systemic illness (17 patients). A sizable number of patients also complained late about their diminishing vision (16 out of 100) causing the delay in their reporting to the hospital. Although cost was the top reason cited for the delay in the surgery, none of the patients approached for 100% charity. Conclusion: While cost remains an important barrier to cataract surgery, factors such as coexisting system illness, staying in rural areas and no one to accompany, and fear of surgery are other important factors that we observed through the study. Opting for surgery with the basic package or not approaching for charity reinforces role of factors other than financial.

Background: The spectrum of uveitis cases is largely influenced by genetic, geographic, and environmental factors. The causes and types of posterior uveitis cases in patients attending a Tertiary Care Eye Hospital, attached to Government Medical College, in a major South Indian city catering to two important states were studied. Aim: To analyze the pattern of posterior uveitis in a tertiary care government eye hospital. Design: Retrospective noncomparative case series. Materials and Methods: A retrospective analysis of 101 posterior uveitis cases attending the retina/uvea outpatient department of a major government eye hospital, seen between January 2014 and June 2015, was done to know the clinical pattern of the posterior uveitis entities. A comprehensive eye examination with a tailored laboratory investigations approach was used to arrive at a diagnosis. Results: Of the 101 patients, there were 56 (55.5%) males and 45 (44.5%) females, in the age group of 15–65 years. A specific diagnosis could be established in 75% of the patients, including infections in 19 cases (18%), specific ocular disease in 45 cases (44.5%). Idiopathic group comprised 25 cases (24.75%). In the infective group, tuberculosis was more than toxoplasmosis. Vogt-Koyanagi-Harada (VKH) cases, presenting as posterior uveitis, comprised 19 cases (18.8%). Conclusion: Tuberculosis and toxoplasmosis were the common infective causes, and VKH, multifocal choroiditis, and serpiginous choroidopathy were the common noninfective entities.

Background: The ocular manifestations of dengue and chikungunya have been reported in different parts of the world, but they differ in different areas and epidemics. As these major mosquito-borne viral febrile illnesses are considered to be an important public health concern, ocular manifestations if any, may give a clue to the disease severity, significant cases can be referred early to the tertiary center. Aim: To study the pattern of ocular manifestations in mosquito-borne viral fever cases admitted in a tertiary care hospital. Study Design: Descriptive observational case series study. Materials and Methods: Forty-two patients admitted in the medical wards having clinical features of chikungunya and dengue with serological confirmation during the epidemic between April and October 2010 were included in this study. They were subjected to ophthalmological evaluation with necessary investigations. Statistical analysis was done by software SPSS-16. Results: The ocular manifestations associated with the epidemic of mosquito-borne viral fever were periorbital ecchymosis, conjunctivitis, subconjunctival hemorrhage, episcleritis, scleritis, nongranulomatous anterior uveitis, trabeculitis, posterior uveitis, retinal vasculitis, and macular edema. These patients were having significant thrombocytopenia and leukopenia. The visual prognosis was generally good with treatment. Conclusion: Considerable number of patients had various ocular manifestations in patients with dengue and chikungunya.

Purpose: To evaluate the reasons for poor visual outcome and the socioeconomic impact of the consequent blindness in patients with simultaneous bilateral rhegmatogenous retinal detachment (SRD). Materials and Methods: A retrospective cohort study was done at a tertiary eye center including patients seen between 2012 and 2014 where 46 eyes in 23 patients with SRD were studied. The postoperative visual outcome and its socioeconomic impact including mean change in annual income, change in occupation before and after blindness, direct costs incurred, and mean years of productivity loss were analyzed. Results: Among the total 190 operated cases of retinal detachment during the study period, 23 (12%) patients had SRD at presentation. Their mean age was 31.9 years, and 57% were males among them. Delayed presentation (average 26 months) and complex detachments (39% Grade C proliferative vitreo-retinopathy) were the prominent features. Thirty-eight of 46 (82%) eyes were operated. Best-corrected acuity of 20/200 was achieved in 62% of eyes. Change of occupation in 78% (18) and >70% decrement in income was noted in 74% (17) of patients. Mean years of productivity loss was 27.6 years. Conclusion: Delayed presentation and complex detachments at diagnosis correlate to poor visual outcomes and social blindness in SRD. This is likely to impart a negative effect on their family and social life, occupation, and income.

Background: In India, most tissues are received from voluntary donors. There is a huge potential of harvesting surgically competent tissues by the Hospital Cornea Retrieval Program which involves counselors trained in grief counseling and tissue retrieval, posted at hospitals. They approach families of all the deceased in the hospital motivate them to pledge the eyes of the deceased: Advantage being that no potential donor is missed, easy availability of medical history, and reduced time interval between death and corneal excision. Aims: The aim of this study is to examine the utilization of corneas procured and determine how maximum tissue procurement and utilization can be ensured. Setting and Design: Tissue utilization analyzed at a tertiary care eye bank (EB) postapplication of revised guidelines of standards of eye banking of India, 2009. Materials and Methods: Data between January 2010 and December 2012 were reviewed. Reasons for rejection of corneas for transplantation were noted. Statistical Analysis: Retrospective analysis. Results: Of 1908 corneas accepted at our EBs in that duration, 1239 (65%) were received from voluntary donors at their residence and from other associated EBs; 599 corneas (31%) from hospitals and 70 (4%) came from mortuary. Six hundred and twenty-three corneas (33%) were transplanted, 1007 (53%) were directed toward research or training and 91 (5%) tissues had to be incinerated. Seven hundred and thirty-four (38%) were excluded from transplantation due to a contraindication in the donor's medical history. Conclusion: Majority tissues are received from voluntary eye donation with most tissues excluded due to contraindication in donor's medical history. Ensuring thoroughly trained, well-equipped enucleation teams reaching out to all suitable donors from hospitals and voluntary donors can hugely increase the numbers of surgically competent tissues.

The Sturge-Weber syndrome consists of unilateral port wine hemangioma of skin along the trigeminal distribution associated with an ipsilateral leptomeningeal angioma. Nevus of Ota (oculodermal melanosis) is a hamartoma of dermal melanocytes which presents as a blue or gray patch on the face and conjunctiva, which is congenital or acquired and is within the distribution of the branches of the trigeminal nerve. The coexistence of cutaneous hemangioma and pigmentary naevi is known as phakomatosis pigmentovascularis. We report the first case of phakomatosis pigmentovascularis in the Indian literature.

There are many different causes for corneal clouding/opacification which include both local ophthalmic causes as well as systemic causes. Mucopolysaccharidosis is a rare cause. Hence, we present a case of mucopolysaccharidosis type IV, who presented with bilateral corneal clouding and other systemic features of this storage disorder.

A 13-year-old female presented with gradually increasing painless swelling of the left lower eyelid for 2 years with no history of watering, ocular trauma, or sinus infection. The swelling (10 mm × 5 mm) was soft, nontender, and free from the skin. The left nasolacrimal duct was patent on syringing. There was regurgitation of serosanguinous fluid from lower puncta on firm pressure over the swelling. Computed tomography scan showed a soft tissue-enhancing mass near the left medial canthus. Dacryocystography revealed diverticulum of the left lacrimal sac. The diverticulum was excised leaving the sac behind. Histopathological examination of the excised mass was found to be infected with rhinosporidiosis. A fistula developed postoperatively discharging spores. Dacryocystectomy with fistulectomy and electrocauterization of the area was done. No recurrence was seen till 12 months follow-up. After PubMed search, we have found only one such case report. We would like to discuss the clinical presentation and management of this rare case.

Optic neuritis (ON) is the demyelinating inflammation of the optic nerve head usually associated with multiple sclerosis. It is usually associated with sudden onset loss of vision with dyschromatopsia and retro-orbital pain. Atypical features for a demyelinating ON include the absence of pain, severe visual loss, progression of visual loss, pain for more than 2 weeks, and lack of recovery after 3 weeks. Atypical features in fundus examination include marked swelling of the nerve with retinal exudates, peripapillary hemorrhages and bilateral presentation, which may occur either simultaneously or sequentially. Atypical ON requires careful consideration and differentiation from demyelinating ON and ischemic optic neuropathy since the treatment is different. We describe a patient who presented with recurrent, sequential episode of visual loss over 2 years, without evidence of any additional neurological deficits, sarcoidosis, or systemic autoimmune disease. A diagnosis of chronic relapsing inflammatory optic neuropathy was made, and she was given intravenous steroids for 3 days, which improved the vision from hand movement close to face to 5/60 in the right eye. She was given immunosuppressants for 3 months, and oral steroids were gradually tapered. Her present vision is the right eye is 6/6 with normal intraocular pressure and color vision.

Nocardiosis is an opportunistic infection reported among immunocompromised subjects. Endophthalmitis secondary to hematogenous spread is a well-known sequel in such cases. In healthy individuals, ocular manifestations are limited to surface infections like keratitis. We report a case of endogenous endophthalmitis due to dissemination from cutaneous nocardiosis in a healthy adult who also had evidence of the right atrial nocardial mass.