Aim: The aim of this study is to comparatively evaluate “internal limiting membrane (ILM) blue (0.025% brilliant blue G (BBG) +4% polyethylene glycol” and “Brilliant Peel (0.025% BBG + heavy water)” in idiopathic full-thickness macular hole (FTMH) surgery with respect to anatomical and functional outcome and surgical ease of ILM peeling. Materials and Methods: It was a prospective comparative study. Thirty patients with idiopathic FTMH selected for pars-plana vitrectomy with ILM peeling were included in the study. Cataract extraction was combined with vitrectomy if cataract was significant. Fifteen eyes underwent ILM peeling with ILM blue – Group 1 and fifteen eyes with Brilliant Peel – Group 2. The adequacy of ILM staining was noted intraoperatively. All patients followed up next day, at 1 week, 6 weeks, and 3 months. Macular hole closure rate and gain in visual acuity (VA) and contrast sensitivity (CS) were noted. Statistical Analysis: Student's t-test was used to assess the baseline numeric differences among groups. Repeated measures ANOVA was used to assess VA improvement over time in each group. Chi-square test was used to compare two groups in terms of stage of macular hole. Means test was used to check the effect of lens status in visual recovery. Results: Both groups were well matched in demographic data, baseline VA, stage of macular hole, and percentage of eyes undergoing simultaneous cataract extraction. Macular hole closed in 100% of eyes. Mean pre- and postoperative logMAR best-corrected VA was 0.80 and 0.40 in ILM blue group and 0.993 and 0.527 in the Brilliant Peel group. VA improvement was clinically and statistically significant in both ILM blue (P = 0.004) and Brilliant Peel (P = 0.003) groups. The groups did not differ from each other at 3 months in terms of gain in VA (P = 0.291) and CS. Intraoperatively, both the dyes stained the ILM well. Conclusion: ILM peeling with ILM blue and Brilliant Peel dyes showed comparable intraoperative staining and good postoperative anatomic and functional outcome.

Introduction: Ocular involvement in children with HIV AIDS most commonly include allergic conjunctivitis, herpes zoster ophthalmicus,molluscum contagiosum, retinal vasculitis, CMV retinitis and isolated cotton wool spots. Materials and Methods: Non comparative prospective study was conducted at a tertiary care hospital from January 2015 to December 2015. A total of 506 patients of upto 12 years of age, affected with HIV AIDS, attending ART centre of the institute, were thoroughly examined for ocular involvement. Preliminary history which includes blurring of vision , deviation of eyes, night blindness or any other ocular complaints was documented. Detailed ocular examination was done thoroughly. Patient's ART case sheet was also referenced to know about any systemic conditions like tuberculosis, pneumocystis pneumonia, kaposi's sarcoma etc. Patients' most recent CD4 count was also documented. Results: Out of 506 children examined, 140 were found to have ocular involvement (27.6%). Anterior segment findings were found in 14.8% whereas retinal and optic nerve findings were found in 12.45% of patients. Ocular manifestations were also co-related with the CD4 count of the patients which showed that lower CD4 counts is significantly associated with increased ocular involvement. Conclusion: Our study concludes that the most common ocular manifestations in paediatric HIV patients include retinal perivasculitis, allergic conjunctivitis, herpes zoster ophthalmicus and dry eye and also demonstrates that ocular involvement is significantly associated with lower CD4 counts.

Purpose: The purpose of this study is to evaluate the etiology, prognosis, and associated neurological and ophthalmologic findings of pediatric cortical visual impairment (CVI) at a tertiary care center in South India. Methods: Records of 120 patients visiting either directly or referred by pediatrician and pediatric neurologist during 2006–2012 at a tertiary eye care hospital were retrospectively reviewed. Ninety children were diagnosed with CVI. The diagnosis of CVI was based on an ocular examination that revealed poor visual function bilaterally that could not be accounted by age, ocular examination findings, optic atrophy, or high refractive error and neuroimaging results were correlated. The modification of the six-level scale was used (graded on a scale of I to VI) for visual acuity. Results: The mean age at presentation was 19 ± 17.21 months (range 2–96 months). The mean age at follow-up was 29.05 ± 25.61 months (range 8–108 months). In this study, 79% of the patients at initial presentation had Level I or level II vision acuity. The most common etiology was perinatal hypoxia (29%), followed by prematurity (26%), and structural abnormalities (22%). Forty-one children (46%) had some neurological manifestation, and 34% had ocular deficits. The most common findings were ischemic encephalopathy (31%), periventricular leukomalacia (28%), cortical and subcortical atrophy and structural malformations (22%). Conclusion: The major risk factors for pediatric CVI are perinatal hypoxia, premature birth, and structural abnormalities. Most patients have associated neurological and ophthalmologic abnormalities. The majority of children with CVI showed some recovery, but visual function tended to be poor in most children.

Introduction: Exfoliation syndrome (ES) is associated with a variety of findings in the angle of the anterior chamber of the eyes. We undertook the present study to record such findings with the help of gonioscopy. Materials and Methods: Complete ocular examination including visual acuity, slit-lamp examination, applanation tonometry, dilated fundus examination, gonioscopy, and perimetry was done, and the findings recorded in all the patients of ES detected from among 2000 consecutive patients above the age of 40 from the outpatient department of a rural hospital in the western Indian state of Maharashtra. Results: A total of 2000 patients were examined of which 62 (3.1%) were detected as having ES. On gonioscopy, angle was found to be open in 56 (90%) and occludable in 6 (10%) patients. Deep pigmentation of trabecular meshwork (TM) was seen in 54 (87%) patients. Sampaolesi line was seen in all the 56 (90%) patients with angles open and was not seen in the 6 patients who had occludable angles. Exfoliative material was seen in 2 (3%) patients. Laxity of the zonules was detected in 8 (13%) patients, but their angle was open. The average intraocular pressure (IOP) of the study group was 19.4 mmHg with 18 (29%) patients having IOP >21 mmHg. Fundus examination was normal in all the patients. The visual field examination showed glaucomatous field defects in one patient. Conclusions: Open angles showing dense pigmentation of the TM and the presence of Sampaolesi line were the most common findings on gonioscopy in a large majority of patients with ES. Sampaolesi line was not seen in patients having occludable angles.

Introduction: Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly characterized by partial or complete adhesion of upper and lower eyelids, usually seen as an isolated finding but often associated with other anomalies or as a part of well-defined syndrome. Materials and Methods: Newborn male was referred to eye hospital for ophthalmic examination. It revealed four fine extensible bands of skin in right eye and two bands in left eye. Apart from this, he was perfectly healthy. It was managed by dividing the adhesions by Vanas scissors. Results and Conclusion: It is a rare but potentially amblyogenic congenital abnormality of the eyelids. Treatment should be performed to minimize the risk of amblyopia.

Aim: We aimed to detect a possible biomarker, in tear samples, for POAG. Method: It was a case–controlled prospective study conducted over a period of 2 years. Tear samples were collected from 30 glaucoma eyes to 30 control eyes tears were collected using a sterile capillary tube and then stored in the laboratory refrigerator at 0°C for measuring the Total antioxidant activity using modified nitroblue tetrazolium method. Protein estimation by modified Lowry's method for protein quantification (1951). Sodium dodecyl sulfate-polyacrylamide gel electrophoresis for protein profiling for various determination of molecular weight. Lipase estimation by Modified Winkler and Stuckmann method, 1979.Carbonic anhydrase-like enzyme activity using synthetic substrate. For Statistical analysis The data were entered in Microsoft Excel and analyzed using Stata Version 24. Results: The mean protein level in glaucoma patients in our study was 8.68 mg/ml, whereas the mean protein level in the control group was 8.34 mg/ml. There was no statistical difference in the mean protein level was between glaucoma and normal patients. Our study shows that the antioxidant activity was significantly lower in glaucoma patients, as compared to controls. The mean level of carbonic anhydrase-like enzymes in glaucoma patients' eyes was 12.90 IU/ml while the mean level for control eyes was 10.03 IU/ml. This is statistically significant. Glaucoma samples showed a mean lipase level of 0.05 IU/ml while controls showed a much higher value of 0.25 IU/ml. After matching the mean levels for age and sex, they were statistically significant. Conclusion: In our study, we found the levels of carbonic anhydrase, lipase, and antioxidants to be significantly different in glaucoma eyes. Each of these hold a promise of being useful as a predictive biomarker for POAG. Further studies need to be carried out to confirm all of the above findings and to thus find a sensitive and specific biomarker for glaucoma, which can be used as a screening tool in the near future.

The aim of this study is to see the effect of transportation on corneoscleral buttons and to correlate them with the weight of ice used during transportation. This is a prospective cross-sectional study. A total of 119 corneas were graded using slit-lamp examination and specular microscopy before and after transportation. Groups were made based on the weight of ice used during transportation and the number of hours of storage in McCarey-Kaufman (MK) media. The overall median percentage of endothelial cell loss (ECL) was 11.33%. The median percentage of ECL was significantly more with <500 g of ice as compared to ≥500 g (13.6% vs. 7.56%) with P = 0.006. There was no significant difference in percentage of ECL on storage in MK media for ≤48 h, ≤72 h, and ≤96 h. Corneal buttons have ECL on storage and transportation which can be minimized using the appropriate weight of ice during transportation.

Juvenile xanthogranuloma (JXG) is the most frequent form of non-Langerhans histiocytosis, a rare benign inflammatory skin disorder. Eye involvement is the most frequent extracutaneous manifestation of the disease. Limbal JXG is an uncommon ocular presentation. We present a 7-year-old White female child who developed a limbal nodule suspicious of JXG with no cutaneous manifestations. Due to rapid progression and no response to topical steroids, the lesion was surgically excised. Histopathological analysis revealed large numbers of foamy histiocytes, Touton multinucleated giant cells, and lymphocytic infiltration. Immunohistochemical staining showed cellular expression of the histiocytic marker: CD68, and absent expression of Langerhans cell marker: CD1a. A definitive diagnosis must be made in such cases to rule out other limbal lesions presenting during childhood such as dermoid, dermatofibroma, neurofibroma, and eosinophilic granuloma. In addition, because spontaneous regression of the lesion is improbable, surgical excision is recommended to avoid its recurrence and ocular complications.

Orbital injuries occur in a variety of settings, road traffic accidents (RTA) being the commonest. Injuries vary in severity and have potential for visual impairment and disfigurement. Diligent history-taking and careful examination is desirable in all cases. Circumstances of injury and subtle external wounds indicate orbital foreign body. CT scan of the orbits axial and coronal views and thin cuts around the apex of the orbit reveal the nature of injury and help plan management. Traumatic optic neuropathy (TON) and injury to the globe threaten vision. Management of traumatic optic neuropathy is controversial. Systemic steroid is considered harmful. Decompression of the optic nerve offers no benefit. Blow-out fracture of the orbit associated with diplopia and soft tissue entrapment may require surgery and interdisciplinary approach. Orbital compartment syndrome needs immediate reduction of orbital pressure. Type of the intraorbital foreign body, its mechanical effect, and presence of infection guide their management. This article presents an overview of evaluation and management of orbital injuries from the point of view of comprehensive ophthalmologists.