Limbal stem cells (SCs) represent a key component of the corneal-conjunctival barrier and play a vital role in the regeneration and replacement of the corneal epithelium. These SCs are located in the basal region of the limbus, in the palisades of Vogt.Limbal SCs may be lost in a wide variety of conditions, the most common being chemical injury, thermal burns, Stevens-Johnson syndrome (SJS), and vernal keratoconjunctivitis. Limbal SC deficiency (LSCD) may result in a painful and blinding ocular surface disorder leading to epithelial defects and conjunctivilization of the cornea. The management of LSCD depends primarily on the laterality, extent of involvement of the eye, and the condition of the other eye. Amniotic membrane transplantation is an established technique used in acute stage to minimize the primary insult and prevent the development of LSCD. In cases of established LSCD, transplanted tissue may be derived from autologous or allogenic sources. Long-term results of cultured limbal epithelial stem cell transplant have demonstrated greater therapeutic success when compared to previous forms of treatment. Moreover, with the help of advances in microsurgical techniques and immunosuppressant drugs, clinical assessment of the outcome of ocular surface rehabilitative procedures grows increasingly optimistic. This article describes the role of SCs in corneal epithelial regeneration, as well as the etiology and clinical features of LSCD.

Background: A review of pediatric cataract cases operated between January 2007 and May 2008 in a Tertiary Eye Care Hospital in Western Maharashtra was done. Aim: To evaluate postoperative visual status for distance and near after pediatric cataract surgery. Settings and Design: Retrospective and prospective medical record retrieval type of cohort study. Materials and Methods: The demographic data, preoperative, intraoperative, and postoperative details were noted. The surgical procedure included cataract extraction with intraocular lens implantation with primary posterior capsulorrhexis and anterior vitrectomy in most of the cases. The visual status of eyes was evaluated before and 6 weeks after surgery. Statistical Analysis: Univariate and multivariate type of statistical analysis using SPSS software. Results: Three hundred and sixteen eyes of 250 children were included in the study. Sixty-six children had bilateral, and 184 children had unilateral cataract. Most common were congenital cataracts seen in 124 eyes (39.2%). Distant vision following surgery was more than 6/60 in 86 eyes (49.1%). Aided near vision of N12 and above was seen in 75 eyes (68%). The common causes for noncompliance with spectacles were heavyweight, repeated breakage, and peer pressure. Conclusion: Early detection and management of cataract in children is the key to good visual outcomes. Postoperative care should include a special emphasis on near vision. Improved coordination is needed between parents, school teachers, and the pediatric eye care center to improve the compliance with spectacles.

Background: Trauma to the eye and ensuing visual disability is an important cause of preventable mono-ocular blindness in the pediatric age group in India. Policy decisions are helpful in preventing this kind of trauma and improving the required trauma management services warrant an accurate estimate of various aspects of ocular trauma and its outcome in Indian population. Aims: To understand the patterns of ocular trauma in Indian pediatric population and its short-term visual outcome. Settings and Design: A tertiary center based, retrospective, observational study. Materials and Methods: Data collection from January 2010 to June 2013 including demographic profile, place of injury, distance from tertiary center, type of health care facility first sought, time delay in first treatment, medico-legal status, pattern of ocular injury on Birmingham Eye Trauma Terminology System (classification), trauma elsewhere in the body, treatment given by us, and best corrected visual acuity (BCVA) at the time of presentation and 3 months. Statistical Analysis: Multinomial logistic regression analysis to identify factors independently affecting BCVA posttreatment which included age, time of the first contact, and time delay in treatment, pretreatment BCVA. Results and Conclusions: Mean age of injury was 7.6 ± 3.3 years with 151 (79.1%) males and 40 (20.9%) females. Seventy-eight percent of patients were from rural areas and 43% first sought treatment at some other government health facility. Majority of children 83/191 (43.5%) sustained injuries at agricultural fields. Best visual acuity was observed in cases of closed globe injuries which was better than 6/18 in 81.8% (18/22) cases.

Background: It has been a long standing challenge to clinicians and investigators to explain the pathophysiology of Idiopathic Intracranial Hypertension (IIH).Therefore, the goal of this study is to delineate the clinical course of this disorder. Aim: To delineate the clinical course of Idiopathic Intracranial Hypertension with an emphasis on visual prognosis. Settings and Design: Prospective, observational study of 18 patients. Materials and Methods: Patients with unilateral or bilateral disc oedema; CSF pressure >25 cm H ₂ O non- focal neurological examination, and normal CT/MRI/MRV scans were included in the study, while those with concurrent ocular disease were excluded .Ocular examination, visual acuity, fundus photography and visual fields evaluation was done at presentation and during follow up visits for a period of two years. Statistical analysis: Descriptive study. Results: Of the 18 patients, 16 were females. The average age of onset was 31.5 years. Hypertension was the most common systemic comorbidity, seen in 5 patients. Headache was the most common presenting symptom, seen in all 18 patients .Diminution of vision was seen in 16 eyes, out of which 14 improved while 2 showed progressive impairment of vision. Abnormal visual field tests included an enlarged blind spot in 11 out of 36 eyes and peripheral constriction in 14 out of 36 eyes .17 patients had a bilateral and symmetric disc swelling. A CSF opening pressure of more than 40 cm of H ₂ O was noted in 6 patients. All the patients were managed medically with diuretics therapy (acetazolamide) and weight reduction. Conclusion: A strong suspicion of Idiopathic Intracranial Hypertension in chronic severe headaches and immediate investigations followed by proper treatment can salvage vision of patients even in cases with established papilledema.

Context: Low vision is an important aspect of glaucoma care which required custom based prescription of low vision devices (LVDs) to suit the needs of the patient. Purpose: To evaluate preference pattern of LVDs in glaucoma patients. Setting and Design: Retrospective hospital-based review in a low vision service of a tertiary eye care center. Materials and Methods: Criteria for low vision was defined as best corrected distance visual acuity < 20/80 in the better eye with logarithm of the minimum angle of resolution chart and/or near visual acuity < N10 binocularly with Bailey-Lovie word reading chart and/or visual field 20° or < 20° from the point of fixation. The data collected included age, gender, diagnosis, extent of visual field loss (mean deviation and central residual field of vision), type of visual disability, and the type of low vision aid preferred by the patients for daily routine use. Statistics: Multivariate logistic regression was used to assess the association between different variables influencing preference of particular LVD. Results: The mean age of patients (n = 67) was 50 ± 22.7 (9-83 years) which included 21 developmental (31%), 11 primary angle closure glaucoma (16%) and 35 primary open angle glaucoma (52%) with 61% older than 50 years. On multivariate regression, age < 30 years (β = −0.04, P = 0.005), color matching disability (β = 3.08, P = 0.002), glare (β = 2.04, P < 0.001) were significant influences for preference for electronic LVD. Conclusions: Younger patients < 30 years with glare and color contrast impairment may be prescribed electronic LVDs for optimal visual function.

Autoimmune polyendocrine syndrome type 1 (APS 1) is a rare autosomal recessive disorder that is characterized by autoimmunity against endocrine and ectodermal tissues. Clinical manifestations usually appear in childhood and consist of hypoparathyroidism, oral candidiasis, and adrenocortical insufficiency. Ocular complications include keratoconjunctivitis, dry eye, iridocyclitis, cataract, retinitis pigmentosa, and optic atrophy. We report a 9-year-old girl with APS 1 who had polar cataract in her left eye (LE), retinal changes with retinal pigment atrophy, and a new autoimmune regulator (AIRE) gene defect on chromosome 21. When a pediatric patient presents with decreased visual acuity with a history of chronic mucocutaneous candidiasis, ectodermal dysplasias, or hypoparathyroidism, we should consider the diagnosis of APS type 1 and arrange a pediatric endocrinological evaluation. The gene studied in this case may contribute to the characterization of the molecular pathology of the AIRE gene and may allow preclinical diagnosis in families at risk.

There is abundance of physiological and pathological evidence of individual variations in response to soft contact lens wear. Purpose of the study was to observe and to measure changes in corneal curvature, corneal endothelium, corneal thickness and tear-film status that might occur following soft contact lens wear over a period of 1 year. A prospective study was conducted from November 2009 to October 2011. Thirty subjects, 20 females and 10 males, in the age group of 15-30 years who were fitted with Bausch & Lomb soft contact lenses for the first time, on a 10-12 hours daily wear basis, were evaluated for changes in corneal curvature, corneal endothelium, corneal thickness and tear-film status that might occur following soft contact lens wear over 1 year. We concluded that soft contact lens used on a daily wear basis induces changes in corneal curvature, endothelium, thickness and tear-film status.

Stevens-Johnson syndrome (SJS) or erythema multiforme (EM) major is a complex immunological syndrome characterized by acute blistering, affecting skin and at least two mucous membranes. Toxic epidermal necrolysis (TEN) is the most severe form of EM involving skin, which sloughs in sheets. Corneal damage is the most severe long-term complication for survivors of SJS and TEN. Conjunctival inflammation is commonly encountered in Ophthalmic practice. In children, allergy and infections form the most common etiology of conjunctivitis and antibiotics are often prescribed for all conjunctival inflammations presenting with red eye. The purpose of this report is to report the rare case of SJS with topical use of fluroquinolone.

We intend to report an interesting case of topiramate-induced bilateral uveitis (TIU) and angle closure glaucoma that gradually developed signs of Fuchs' uveitis (FU) in right eye after resolution of the attack. A 41-year-old female was started on oral topiramate for migraine following which she developed bilateral acute angle closure glaucoma and uveitis. She improved with topical and systemic steroids. As the attack resolved, her right eye started developing classical features of FU which were initially confused with viral uveitis. Patient was followed-up without steroids for 2 years. She remained asymptomatic in right eye and healthy systemically proving diagnosis of FU. We recommend high index of suspicion for FU in an asymptomatic low-grade uveitis even though typical features of FU are absent initially. Few weeks of observation may allow FU to manifest on its own, which will prevent unnecessary investigations and treatment.

Over the past three decades, intravitreal delivery of pharmacotherapeutic agents has advanced tremendously with many drugs being developed solely for intravitreal use. Intravitreal injections have now become routine in the management of various ocular conditions, most commonly diabetic macular edema and age-related macular degeneration, with the benefits of targeted therapy far outweighing the risks of the procedure. Herein we review the variety of agents available and currently being used for intravitreal therapy of various retinal and intraocular conditions, their indications as well as the optimal technique that should be employed in their administration.