037137   SHAH A, RAO V G, VERMA A, BISWAS J (Uvea Dep, Sankara Nethralaya, Chennai? 600 006, Tamil Nadu, Email: drjb@snmail.org) : Evaluation of change in the vascular density of choriocapillaris on optical coherence tomography angiography in eyes with serpiginous choroiditis. Indian J Ophthalmol 2018, 68(9), 1901-4.

Serpiginous choroiditis (SC) is primarily an inflammation of choriocapillaris leading to nonperfusion. A quantitative assessment of choriocapillaris perfusion can be done by measuring the flow‑density by OCT‑Angiography (OCTA). This study measures a change in the flow‑density of choriocapillaris with the resolution of inflammation. The OCTA images of a choriocapillaris slab of 30 eyes with active SC were subjected to binarization and vessel density was measured at baseline and final visits and compared. Upon comparing the vessel density of the affected areas by OCTA of choriocapillaris‑slab at baseline and final visits, there was statistically significant (P < 0.0001) improvement after the resolution of inflammation. The vessel density of a demarcated normal area was significantly higher when compared to that of lesions at baseline (P < 0.0001) and final visit (P < 0.0001). OCTA is a useful tool to assess reduction in the inflammatory activity on treatment in SC. This study shows that with treatment the perfusion of choriocapillaris improves; however, it remains lower than normal.

4 illus, 12 ref

037135   SUDHARSHAN S, MENIA N K, SELVAMUTHU P, TYAGI M, KUMARASAMY N, BISWAS J (Sankara Nethralaya, Chennai- 600 006, Tamil Nadu, Email: drdharshan@gmail.com) : Ocular syphilis in patients with human immunodeficiency virus/acquired immunodeficiency syndrome in the era of highly active antiretroviral therapy. Indian J Opthalmol 2020, 68(9), 1887-93.

Re‑emergent ocular syphilis in patients with Human immunodeficiency virus (HIV) co-infection has both diagnostic and management difficulties because of the overlapping risk factors. The clinical manifestations described in non‑HIV may not be the same in patients with HIV coinfection. Immune recovery uveitis (IRU) may also alter the course of the disease causing recurrences. We studied the clinical features in correlation with CD4 counts, systemic immune status, sexual preferences and management outcomes in HIV/AIDS patients with ocular syphilis in the highly active antiretroviral treatment (HAART) era from ahigh endemic HIV population like India. Retrospective analysis of all patients with ocular syphilis and HIV/AIDS seen between 2016 and 2019 was done.  A total of 33 patients (56 eyes) with a CD4 count range of 42–612 cells/cu.mm were included. Ocular syphilis was found to be higher in individuals with high risk behavior such as men who have sex with men (MSMs) (45%). Panuveitis was the commonest manifestation (53.57%) and was even the presenting feature of HIV and syphilis in many patients. Significant vitritis, usually uncommon in HIV/AIDS immuno compromised patients was noted even with low CD4 counts in patients with ocular syphilis. Significant correlation was noted between ocular presentation andCD4 counts (P < 0.05). Ocular syphilis presents differently in patients with HIV/AIDS. Diffuse retinitis is seen commonly in low counts (<100 cells/cu.mm). Classical placoid chorioretinitis lesions usually described in non‑HIV individuals is uncommon in HIV patients and is seen in higher CD4 counts ( >400 cells/cu.mm). Ocular manifestations can be an indicator of the immune status of the patient. Not all patients with ocular manifestations have associated features of systemic syphilis. Ocular manifestations can be the first presentation of HIV/AIDS. Although, there is good response to systemic penicillin and HAART, recurrences and immune recovery uveitis (IRU) can also occur.

4 illus, 1 table, 23 ref

037134   TYAGI M, KAZA H, PATHENGAY A, AGRAWAL H, BEHERA S, LODHA D, PAPPURU R R, BASU S, MURTHY S (L V Prasad Eye Institute, Visakhapatnam- 530 040, Andhra Pradesh, Email: hrishikesh.kaza@gmail.com) : Clinical manifestations and outcomes of ocular syphilis in Asian Indian population: Analysis of cases presenting to a tertiary referral center. Indian J Opthalmol 2020, 68(9), 1881-6.

To describe disease manifestations and outcomes of ocular syphilis in Asian Indian population. Retrospective analysis of patients diagnosed with ocular syphilis at a tertiary referral center in India. Demographics, history, extraocular and ocular manifestations, ocular and systemic investigations,treatment and visual acuity outcomes were noted. All patients were diagnosed after necessary laboratory investigations including HIV ELISA (Human immunodeficiency virus, enzyme‑linked immunosorbentassay), VDRL (venereal disease research laboratory), and TPHA (treponema pallidum hemagglutination). Totally, 20 patients with mean age at presentation 38.25 ± 9.76 were analyzed. 9/20 patients had bilateral involvement. 8/20 had concurrent HIV at presentation with an average CD4 counts of 592.25 ± 411.34cells/microliter. The mean duration of symptoms at time of presentation was 15.45 ± 35.15 weeks. VDRL test was reactive in 45% (9/20) patients whereas, all patients had a reactive TPHA test. Clinical manifestations included outer retinal placoid chorioretinitis lesions (8/20, 40%), followed by retinitis mimicking acuteretinal necrosis as the second most common phenotype (4/20, 20%). Other presenting manifestations noted were panuveitis, miliary retinitis lesions, retinal vasculitis, intermediate uveitis, and anterior uveitis.The clinical phenotypes in immunocompromised included panuveitis, acute retinal necrosis and isolated anterior uveitis. Mean follow up duration was 6.32 ± 6.15 months. An improvement in mean best corrected visual acuity (BCVA) of (0.63 LogMAR, approximately 6 Snellen lines, P < 0.02) was noted at last follow‑up. Phenotypic manifestations of ocular syphilis are varied. Non‑treponemal tests like VDRL may be unreliable when compared with treponemal tests in diagnosing ocular syphilis. Syphilitic uveitis is considered equivalent to neurosyphilis and is treated similar to neurosyphilis.

4 illus, 5 tables, 23 ref

037131   KAWALI A, ZULAIKHA V, SRINIVASAN S, MAHENDRADAS P, KUMAR J, SHETTY R (Narayana Nethralaya, Bangalore, Karnataka, Email: akawali332@ gmail.com) : HLA?B27-related uveitis and seasonal variation–An Indian perspective. Indian J Opthalmol 2020, 68(9), 1863-6.

To study seasonal variation and systemic associations in HLA‑B27 related uveitis (HBU). This was a retrospective, observational chart review conducted in a single, tertiary eye care hospital, from January 2015 to December 2019. New cases presented from January 2017 to December 2019 were studied for incidence patterns (Group X). Cases with ≥1‑year follow‑up were studied for systemic association (Group Y) and cases with ≥4 episodes of active uveitis were studied for recurrence pattern (Group Z). A year was divided into 3 segments of the year (SoY): 1. November–February, 2.March–June, 3. July–October.  We found 157 cases of HBU from January 2015 to December 2019. The incidence in Group X (n = 105) was found to be least in SoY 2 in all 3 years (2017–2019). In Group Y (n = 85), 39 cases (45.88%) were diagnosed as spondyloarthropathies, among which 20 were of ankylosing spondylitis (23.52%). More than 1/2 the total number of episodes occurring in the same SoY(SoY Max), in Group Z (n = 25), was seen in 14 (56%) cases. SoY Max was the first segment (SoY 1) for most of these cases (n = 7). In Group Z, 8 (32%) patients were on immunomodulatory therapy at presentation. Our study confirms seasonal variation in HBU patients by documenting the least incidence from March to June and identifies 56% of patients that can have a maximum number of recurrences ina specific season of the year. Outcomes of surgical interventions planned accordingly, and responsible environmental factors for HBU should be studied further.

5 illus, 14 ref

037128   PATNAIK G, ANNAMALAI R, BISWAS J (Sankara Nethralaya, Chennai- 600 006, Email: drjb@snmail.org) : Intraocular biopsy in uveitis. Indian J Opthalmol 2020, 68(9), 1838-43.

An intraocular biopsy is performed for diagnostic, prognostic and investigational purposes. Biopsies help to confirm or exclude malignancies and differentiate inflammatory from infectious processes.Histopathological analysis is the final verdict in unresponsive uveitis, atypical inflammation, metastases and masquerade syndromes. Advances and refinement of techniques in cytopathology, immunohistochemistry, microbiological and molecular biologic study offer much more than just diagnosis. They provide prognosis based on cell characteristics and are helpful in planning treatment and intervention. Many biopsy procedures have evolved to provide more safety and minimise complications thus improving the quality of specimens or samples available for analysis. The type of biopsy and technique adopted varies based on the clinical suspicion, size and location of lesions. In uveitis, a working diagnosis of intraocular inflammationis made on clinical examination and laboratory investigations and ancillary tests. Malignancy and uveitisis interlinked and masquerade syndromes are among the commonest indications for biopsy and analysis of specimen. The various types of intraocular biopsies include aqueous tap, fine needle aspiration biopsy, vitreous biopsy, iris and ciliary body, and retinochoroidal biopsy. They will be reviewed in this article with respect to current perspective.

2 illus, 63 ref

037127   MAJUMDER P D, MARCHESE A, PICHI F, GARG I, AGARWAL A (Sankara Nethralaya, Chennai- 600 006, Tamil Nadu, Email: drparthopratim@gmail.com) : An update on autoimmune retinopathy. Indian J Opthalmol 2020, 68(9), 1829-37.

Autoimmune retinopathy (AIR) refers to a group of rare autoimmune retinal degenerative diseases presumably caused by cross‑reactivity of serum autoantibodies against retinal antigens. The pathogenesis of AIR remains largely presumptive and there are a significant number of antiretinal antibodies that have been detected in association with AIR. The diagnosis of AIR is largely based on the demonstration of antiretinal antibodies in the serum along with suggestive clinical features and ancillary investigations. A high index of suspicion along with early diagnosis and treatment may play a critical role to lower the risk of irreversible immunological damage to the retinal cells in these patients. A multi‑disciplinary approach for complete management and evaluation is helpful in such conditions. Various therapeutic options have been described for the treatment of AIR, though there is no consensus on standard treatment protocol.

3 illus, 99 ref

037126   MURTHY S I, SABHAPANDIT S, BALAMURUGAN S, SUBRAMANIAM P, SAINZ-DE-LA-MAZA M, AGARWAL M, PARVESIO C (L V Prasad Eye Institute, Hyderabad - 500 034, Telangana, Email: smurthy@lvpei.org) : Scleritis: Differentiating infectious from non-infectious entities. Indian J Opthalmol 2020, 68(9), 1818-28.

Scleritis is a rare painful ocular disorder, associated with severe ocular pain and tissue destruction. Although a majority of these cases are immune mediated and at least half of these are associated with systemic immune‑mediated diseases, a smaller minority are due to infections of the sclera. The two conditions closely mimic each other, and a thorough knowledge of the subtle differences is necessary in order to reach a timely diagnosis. Diagnostic delay can lead to a poor outcome both due to the destruction caused by the uncontrolled infection and also due to propagation of the infection with the use of corticosteroids which may have been started for presumed immune mediated scleritis. In this review, we present the clinical features, etiological agents, and the differentiating features between immune and infectious scleritis. We also present diagnostic and management guidelines for managing scleral infection.

6 illus, 3 tables, 92 ref

037125   TESTI I, AGRAWAL R, MEHTA S, BASU S, NGUYEN Q, PAVESIO C, GUPTA V (Moorfields Eye Hospital, Chandigarh- 160012, Email: vishalisara@yahoo.co.in) : Ocular tuberculosis: Where are we today?. Indian J Opthalmol 2020, 68(9), 1808-17.

Diagnosis and management of ocular tuberculosis (OTB) poses a significant challenge. Mixed ocular tissue involvement and lack of agreement on best practice diagnostic tests together with the global variations in therapeutic management contributed to the existing uncertainties regarding the outcome of the disease. The current review aims to update recent progress on OTB. In particular, the Collaborative Ocular Tuberculosis Study (COTS) group recently standardized a nomenclature system for defining clinical phenotypes, and also proposed consensus guidelines and an algorithmic approach for management of different clinical phenotypes of OTB. Recent developments in experimental research and innovations in molecular diagnostics and imaging technology have provided a new understanding in the pathogenesis and natural history of the disease.

9 illus, 2 tables, 75 ref

037124   AGARWAL M, MAJUMDER P D, BABU K, KONANA V K, GOYAL M, TOUHAMI S, STANESCU?SEGALL D, BODAGHI B (Uveitis Dep, Sankara Nethralaya, Daryaganj, New Delhi- 110 002, Email: agarwalmannii@yahoo.co.in) : Drug-induced uveitis: A review. Indian J Opthalmol 2020, 68(9), 1799-807.

Uveitis maybe induced by the use of various medications known as drug‑induced uveitis (DIU), though rare it is an important cause of uveitis which one needs to be aware of. The drugs may be administered through any route including systemic, topical, and intravitreal. Ocular inflammation can be in the form of anterior, intermediate, posterior or pan uveitis, and rarely may present as episcleritis and scleritis. Identification of drug as the offending agent of uveitis is important as many a times stopping the drug may help recover theuveitis or the concomitant use of corticosteroids. An extensive literature review was done using the Pubmed. An overview of DIU is provided as it is important for us to be aware of this clinical entity.

3 illus, 3 tables, 104 ref

037123   MAHENDRADAS P, KAWALI A, LUTHRA S, SRINIVASAN S, CURI A L, MAHESWARI S, KSIAA I, KHAIRALLAH M (Uveitis and Ocular Immunology Dep, Narayana Nethralaya, Rajajinagar, Bangalore, Email: m.padmamalini@gmail.com) : Post-fever retinitis – Newer concepts. Indain J Opthalmol 2020, 68(9), 1775-86.

Post‑fever retinitis (PFR) is an infectious or para‑infectious uveitic entity caused by bacterial or viral agents and seen mainly in tropical countries. Systemic symptoms such as joint pain, skin rash are common during the febrile stage. On the basis of only clinical presentation, it is difficult to pin‑point the exact etiology for PFR. Serological investigations, polymerase chain reaction, and knowledge of concurrent epidemics in the community may help to identify the etiological organism. Bacterial causes of PFR such as rickettsia and typhoid are treated with systemic antibiotics, with or without systemic steroid therapy, whereas PFR of viral causes such as chikungunya, dengue, West Nile virus, and Zika virus have no specific treatment and are managed with steroids. Nevertheless, many authors have advocated mere observation and the uveitis resolved with its natural course of the disease. In this article, we have discussed the clinical features, pathogenesis, investigations, and management of PFR.

12 illus, 1 table, 130 ref

037121   BALAMURUGAN S, DAS D, HASANREISOGLU M, TOY B C, AKHTER M, ANURADHA V, ANTHONY E, GURNANI B, KAUR K (Ocular Pathology Dep, Aravind Eye Hospital, Pondicherry, Email: drbalamuruganms@gmail.com) : Interleukins and cytokine biomarkers in uveitis. Indian J Opthalmol 2020, 68(9), 1750-63.

Interleukins and cytokines are involved in the pathogenesis of uveitis of heterogeneous origin.Understanding the basics of the ocular immune privilege is a fulcrum to discern their specific role in diverseuveitis to potentially translate as therapeutic targets. This review attempts to cover these elements in uveitis of infectious, noninfectious and masquerade origin. Insights of the molecular targets in novel therapy alongwith the vision of future research are intriguing.

3 illus, 12 tables, 129 ref

037120   RATHINAM S, TUGAL-TUTKUN I, AGARWAL M, RAJESH V, EGRIPARMAK M, PATNAIK G (Ophthalmology Dep, Istanbul Univ, Madurai- 625020 , Tamil Nadu, Email: rathinam@aravind.org) : Immunological tests and their interpretation in uveitis. Indian J Ophthalmol 2020, 68(9), 1737-48.

Uveitis is a complex disorder including both infectious and non‑infectious etiologies. Clinical diagnosisis a challenge because many diseases share common clinical signs. Laboratory support is crucial for confirming the clinical diagnosis. Laboratory diagnosis includes direct tests and indirect tests. For example smear, culture, and molecular diagnostics demonstrate the pathogens, hence they are direct tests. Immunologic tests employ an antigen to detect presence of antibodies to a pathogen, or an antibody to detect the presence of an antigen, of the pathogen in the specimens. The immunological tests used in laboratories are made by producing artificial antibodies that exactly “match” the pathogen in question.When these antibodies come into contact with a sample they bind to the matching pathogen if found in the sample. Hence they are grouped under indirect evidence. There are several investigations in uveitis to reach the confirmed diagnosis including microbiological, immunological, imaging and molecular diagnostic testing. In this section we will discuss immunological investigations of infectious and non‑infectious uveitis.

3 illus, 3 tables, 123 ref

037108   BHARUCHA K M, ADWE V G, HEGADE A M, DESHPANDE R D, DESHPANDE M D, KALYANI V (PBMA’s H V Desai Eye Hospital, Buldana- 443001, Maharashtra, Email: vivek.adwe@gmail.com) : Evaluation of skills transfer in short-term phacoemulsification surgery training program by international council of ophthalmology -ophthalmology surgical competency assessment rubrics (ICO-OSCAR) and assessment of efficacy of ICO-OSCAR for objective evaluation of skills transfer. Indian J Ophthalmol 2020, 68(8), 1573-7.

To evaluate skills transfer in short‑term phacoemulsification surgery training program by International Council of Ophthalmology -Ophthalmology Surgical Competency Assessment Rubrics (ICOOSCAR)and assessment of efficacy of ICO‑OSCAR for objective evaluation of skills transfer. Prospective analysis of total 1300 phacoemulsification surgeries performed by 52 phacoemulsification trainees divided into three groups based on the previous cataract surgical experience. The pretraining and post training average mean scores, independent completion rates (ICR), and complication rates among the groups were calculated and statistically analyzed. Mean age of trainees (N = 52) was found to be 30.98 ± 2.44 years. Mean pretraining scores in the three groups were 42.8 ± 0.2, 46.6 ± 0.2,and 50.1 ± 0.1, respectively, and posttraining mean scores of the groups were 88.4 ± 0.2, 92.3 ± 0.2, and 94.3 ± 0.2, respectively, out of 100. Pretraining independent completion rates (%) were 22.1 ± 2.5, 52.1 ± 2.5,and 62 ± 3.7, respectively, and post training independent completion rates (%) were 74.8 ± 3, 79.7 ± 3, and90.6 ± 3.5, respectively. Learning curves of all groups were noted to be steep. Rate of complications was within acceptable range, overall complication rate being 12.30% (160 out of 1300 cases). OSCAR scorescorrelate significantly (P = 0.0004) with ICR. Steep learning curve for phacoemulsification can be made easy by the use of standardized rubrics, proper techniques, expert guidance, and adequate surgical volume. The previous SICS experience provides smoother learning curve. ICO‑OSCAR is indicator of proficiency and provides constructive feedback and objective evaluation immediately after surgery as well as at the end of training. Short‑term (1 Month) training program is an effective, efficient, and safe approachto progressively master phacoemulsification skills for trainees with SICS experience.

2 illus, 3 tables, 12 ref

037107   RANI K , GROVER A K, SINGH A K, GROVER T, GARG S P (Vision Eye Centre, Sirifort Road, New Delhi- 110 049, Email: 22kirti77@gmail.com) : Correction of preexisting astigmatism by penetrating arcuate keratotomy in femtosecond laser?assisted cataract surgery. Indian J Ophthalmol 2020, 68(8), 1569-72.

To evaluate the astigmatism correcting effect of penetrating arcuate keratotomy (AK) done during femtosecond laser‑assisted cataract surgery (FLACS).  In this nonrandomized prospective study, 80 eyes of 70 patients were studied. The study included patients who underwent combined FLACS and AK, with corneal astigmatism ranging from 0.4 to 1.5 diopters (D). Femtosecond laser‑assisted penetratingarcuate keratotomies were created at 8 mm optical zone at 80% depth and were centered at the limbus.Keratometric astigmatism was measured prior to and 3 months post‑surgery. Vector analysis was performed using Power vector analysis method.  The mean preoperative keratometric astigmatism without accounting for axis was 0.85 ± 0.27 D, which reduced significantly to 0.47 ± 0.27 D at 3‑month follow‑up.The mean astigmatism correction attained without accounting for axis was 0.38 ± 0.32 D. The vector corrected mean preoperative astigmatism was 0.85 ± 0.27 D which reduced significantly to 0.50 ± 0.31 Dpost operatively (P < 0.001, 95% CI). Vector corrected mean astigmatism correction attained was 0.35 ± 0.38D. There were no significant intraoperative or postoperative complications. Preexistingastigmatism can be tackled effectively with penetrating AK during FLACS although under correction is observed with present nomograms. Further refinements may achieve better correction.

2 illus, 1 table, 21 ref

037106   CHAURASIA S, JAKATI S, RAMAPPA M, MISHRA D K, EDWARD D P (LV Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: muralidhar@lvpei.org) : Anterior segment alterations in congenital primary aphakia—A clinicopathologic report of five cases. Indian J Ophthalmol 2020, 68(8), 1564-8.

To report the clinicopathological features of corneal buttons in patients with congenital primary aphakia. Five corneal specimens of five patients with congenital primary aphakia who underwent penetrating keratoplasty (PKP) were studied by light microscopy, and immunohistochemistry with anti‑smooth muscle (SMA) antibody. All patients were born from consanguineous parents. Of the five, two patients were identical twins. All eyes were microphthalmic. In four patients, congenital primary aphakia was bilateral and in one patient (Patient 3), it was unilateral. PKP failed in all eyes due to hypotony. Histologically, Bowman’s layer was absent in all specimens. The corneal stroma was thin;however, the stromal collagen showed thick and irregularly arranged fibers with neovascularization in alleyes. Descemet’s membrane and the corneal endothelium were absent in all specimens. In three specimens,atrophic iris tissue without dilator muscle was adherent to the posterior corneal surface. In addition,anteriorly displaced hypoplastic ciliary body and/or pigmented and non‑pigmented ciliary epithelium were attached to the posterior corneal surface in three of the five specimens. SMA staining demonstrated disorganized ciliary muscle in one case. SMA‑positive stromal keratocytes demonstrated their myofibroblastnature.  The corneal findings in congenital primary aphakia are similar to that seen in other causes of congenital corneal opacification. The anteriorly displaced hypoplastic ciliary body that was partially excised during keratoplasty explains the ocular hypotony in these eyes.

4 illus, 1 table, 14 ref

037103   SINDHUJA K, LOMI N, ASIF M I, TANDON R (Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Email: neiwete@gmail.com) : Clinical profile and prevalence of conjunctivitis in mild COVID?19 patients in a tertiary care COVID-19 hospital: A retrospective cross?sectional study. Indian J Ophthalmol 2020, 68(8), 1546-50.

To find the clinical profile and prevalence of conjunctivitis and other ocular manifestations in mild COVID‑19 positive patients in a nodal COVID-19 hospital.  A retrospective cross‑sectional, single‑center study conducted in 127 mild cases of COVID‑19 positive patients admitted between 27th March and 19th April 2020 in a tertiary care COVID-19 hospital in north India. From the hospital records, demographic data is collected. Ocular history and ocular examinations were done by face‑to‑face survey during ward rounds. A total of 127 patients were included in the study with a median age of 38.8 years. Forty‑eight (37.80%) patients had upper respiratory tract symptoms, 20 (15.75%) patients had systemic illness, 18 (14.17%) patients were using spectacles, and 50 (39.37%) patients had history of hand‑eye contact. Out of 12 (9.45%) patients who had ocular complaints, 11 (8.66%) had ocular manifestation after admission. Among 11 patients, eight (6.29%) had conjunctival congestion. Three (3/8) patients had developed conjunctival congestion even before the manifestation of definite COVID-19 symptoms. Five patients (5/8) patients had no other associated ocular symptoms other than congestion. Six patients (6/8) had symptoms of upper respiratory tract infection. Mild conjunctivitis manifesting as conjunctival congestion is common and is one of the major ocular manifestations in COVID‑19 positive patients even with milder disease.

5 tables, 9 ref

037100   SHUKLA Y (Rajasthan Nursing Home and Eye Centre, Jaipur- 302 015, Rajasthan, Email: dryogeshshukla@yahoo.co.in) : Accommodative anomalies in children. Indian J Ophthalmol 2020, 68(8), 1520-5.

Asthenopic and related symptoms are a major problem in school‑going children. With the inception of computers and other gadgets for near work, the unseen problems arising out of constant and continuous near work, are on the rise. Parents wander from pillar to post, seeking respite from their child’s constant complaints from near work; but despite best spectacle correction and avoidance of excessive near work, the complaints continue. Studies have shown that the majority of these problems arise from defects in accommodation, even in a young child. Therefore, various aspects of accommodation deficiencies have tobe studied clinically, detected, and treated to ameliorate the symptoms.

1 illus, 47 ref

037099   NAIR U, MOHAN A, SHEERA K, INDURKAR A, SOMAN M (Retina and Vitreous Dep, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, Email: research@chaithanya.org) : Macular morphometrics in foveal displacement following full thickness macular hole surgery. Indian J Ophthalmol 2020, 68(7), 1436-40.

To investigate if the ratio of the preoperative nasal and temporal “arms” of the macular hole (MH) can have a predictive value in the magnitude of foveal displacement postoperatively.  This isretrospective interventional case series of eyes of 40 patients with full‑thickness macular hole (FTMH),which underwent vitrectomy with internal limiting membrane (ILM) peeling and had Type 1 closure.All subjects underwent pre and postoperative optical coherence tomography (OCT, Heidelberg, Spectralis, Germany). Their pre and postoperative foveo‑papillary distance (FPD) was measured and the magnitude of shift was calculated. The nasal and temporal arm lengths, their ratio (N/T ratio), and the hole base diameter were measured in the preoperative OCTs.The main outcome measure was the correlation of the N/T ratio with the postoperative foveal displacement. We observed that in 25% (n = 10) the fovea shifted temporally; in 75% (n = 30) it shifted nasally. The shift did not show a significant correlation with either N/T ratio (r = 0.155, P = 0.34) or with base diameter (r = ‑0.008, P = 0.961). The odds ratio (OR) was 4.92 (P = 0.04) and the relative risk (RR) was 3.12 (P = 0.039) for a longer temporal segment to predict a temporal shift. Both nasal and temporal shifts are possible after successful hole closure and temporal shifts can also occur in a significantly high proportion of patients. Temporal shifts are more likely in eyes with a longer temporal segment.

2 illus, 3 tables, 12 ref

037097   PARCHAND S M, AGRAWAL D, CHATTERJEE S, GANGWE A, MISHRA M, AGRAWAL D (MGM Eye Institute, Raipur, Chhattisgarh? 493 111, Email: swapnilp5656@yahoo.co.in) : Post-cataract surgery cluster endophthalmitis due to multidrug?resistant pseudomonas aeruginosa: A retrospective cohort study of six clusters. Indian J Ophthalmol 2020, 68(7), 1424-31.

To analyze clinical presentations, antibiotic susceptibility, and visual outcomes in six clusters of post cataract surgery endophthalmitis caused due to multidrug‑resistant Pseudomonas aeruginosa (MDR‑PA).This was a hospital-based retrospective cohort study.  Our study comprised sixty‑two patients from six nonconsecutive clusters of post cataract surgery endophthalmitis caused by MDR‑PA referred toour tertiary eye care institute. Demographic details, best‑corrected visual acuity (BCVA), clinical features, microbiological findings, and patient management were reviewed.  The interval between onset of symptoms and presentation ranged from 1 to 7 (mean: 4.61 and median: 5) days. The presenting BCVA was no light perception in 17 (27.4%) eyes, light perception in 35 (56.4%) eyes, and hand movement or better in 10 (16.1%) eyes. All patients had hypopyon and vitreous exudates. Corneal infiltrates were noted in 40 (64.5%) eyes. Panophthalmitis was diagnosed in 20 (32.2%) eyes. The surgical intervention included intraocular antibiotics (IOAB) in 8 (12.9%) eyes, pars plana vitrectomy with IOAB in 26 (41.9%) eyes, and evisceration in 23 (37.09%) eyes. At 6 weeks, BCVA of 20/200 or better was achieved in 9 (14.5%) eyes.Pseudomonas aeruginosa was least resistant to colistin (8.3%), piperacillin (31.8%), and imipenem (36.1%).Ceftriaxone and ceftazidime resistance was seen in 80.5% and 70% isolates, respectively. Clusterendophthalmitis due to MDR‑PA has poor visual outcomes with high rates of evisceration. In the setting of cluster endophthalmitis where MDR‑PA is the most common etiology, piperacillin or imipenem can be thefirst drug of choice for empirical intravitreal injection for gram‑negative coverage while awaiting the drug susceptibility report.

3 illus, 4 tables, 36 ref

037094   MURALI K, KRISHNA V, KRISHNA V, KUMARI B (Sankara Eye Hospital, Bengaluru- 560 037, Karnataka, Email: kaushik@sankaraeye.com) : Application of deep learning and image processing analysis of photographs for amblyopia screening. Indian J Ophthalmol 2020, 68(7), 1407-10.

Photo screeners and autorefractors have been used to screen children for amblyopia risk factors (ARF) but are limited by cost and efficacy. We looked for a deep learning and image processing analysis‑based system to screen for ARF. An android smartphone was used to capture images using a specially coded application that modified the camera setting. An algorithm was developed to process images taken in different light conditions in an automated manner to predict the presence of ARF.Deep learning and image processing models were used to segment images of the face. Light settings and distances were tested to obtain the necessary features. Deep learning was there after used to formulate normalized risks using sigmoidal models for each ARF creating a risk dashboard. The model was tested on 54 young adults and results statistically analyzed.  A combination of low‑light and ambient‑light images was needed for screening for exclusive ARF. The algorithm had an F‑Score of 73.2% with an accuracy of 79.6%, a sensitivity of 88.2%, and a specificity of 75.6% in detecting the ARF. Deep‑learning and image‑processing analysis of photographs acquired from a smartphone are useful in screening for ARF in children and young adults for a referral to doctors for further diagnosis and treatment.

2 illus, 3 tables, 18 ref

037093   MADANAGOPALAN V G, GOPAL M R S, SENGUPTA S (JB Eye Care & Retina Centre, Salem, Tamil Nadu, Email: drmadanagopalan@gmail.com) : Perspectives of physicians in general and ophthalmologists in particular about restarting services post?COVID-19 lockdown. Indian J Ophthalmol 2020, 68(7), 1401-6.

To assess the perspectives of physicians in general and ophthalmologists in particular about restarting elective out‑patient (OP) and operating (OT) services after relaxation of lockdown for COVID‑19. An online survey, containing 31 questions, was conducted among medical doctors using a secure Google forms link. The survey was open for 48 hours from 16th‑18th April 2020. Responses were received from 556 physicians (including 266 ophthalmologists). About a third (n = 205) wanted to start OP immediately after lockdown. In OP, mask of any kind for patient (60.8%), 3‑ply for assistants (52.7%) and N95 for doctors (72.7%) were most common preferences. In OP, 31.5% and 46.6% felt full PPE and gloves alone were sufficient respectively. Ophthalmologists were more likely to start immediately after lockdown compared to other specialists (P = 0.004). Among 299 surgeons, an almost equal number (27%) wanted to start routine OT services immediately and 2 weeks post lockdown. A large majority (76.9%) would mandate COVID‑19 tests before elective surgeries. In OT, 34.1% wanted N95 for surgical team and 3‑ply for patient,23.4% wanted 3‑ply masks for everyone. 40.5% felt additional personal protective equipment (PPE) is not required and 33.1% felt that full PPE is required for everyone in OT. Ophthalmic surgeons preferred 3‑plymasks and were less inclined to use full PPE (P < 0.001). Perspectives of doctors vary, especially with regarding to timing of restarting services and precautions to be taken in the OT. Ophthalmologists may tend to err on the side of taking lesser stringent precautions when restarting services post lockdown.

2 illus, 2 tables, 24 ref

037092   DAS A V, NARAYANAN R (eyeSmart EMR and AEye Dep, L V Prasad Eye Institute, Hyderabad? 500 034, Telangana, Email: narayanan@lvpei.org) : Demographics and clinical presentation of patients with ocular disorders during the COVID- 19 lockdown in India: A report. Indian J Ophthalmol 2020, 68(7), 1393-9.

The aim of this study is to describe the demographics and clinical profile of patients with ocular disorders presenting during the novel coronavirus (COVID‑19) lockdown in India.  This cross‑sectional hospital‑based study included patients presenting between March 23, 2020 and April 19,2020. All patients who presented to the emergency department were included as cases. The data were collected using an electronic medical record system.  Overall, 1,192 patients (mean 42.57 per day) presented to the ocular emergency department and were included for analysis. The median age of the patients was 35 (Interquartile range, IQR: 20‑52) years and they were mostly adults (77.85%). The majority of patients were male (62.16%) and presented from the local metropolitan region (56.21%). On triaging based on the ocular disorders at presentation, the majority of the patients were emergency related (65.02%),followed by urgent (8.14%) and routine (26.85%) in nature. The most common emergencies were microbial keratitis (23.74%), followed by corneal trauma (16.39%). There was an increasing trend seen in emergency patients (46.11%; week 1 to 71.78%; week 4) and a decreasing trend seen in routine patients (45%; week1 to21.20%; week 4). A subset of patients (23.49%) underwent surgery where indicated and the most commonly performed procedures were vitreo‑retinal procedures (32.86%) followed by trauma related (31.43%). The enforcement of the nationwide lockdown due to COVID‑19 resulted in a fewer patients presenting to the hospital. The majority of them presented from the local metropolitan region and the common emergencies were microbial keratitis and corneal trauma. About one fourth required a surgical intervention which was most commonly a vitreo‑retinal procedure.

3 illus, 4 tables, 16 ref

037089   CHAURASIA S, DAS S, ROY A (L V Prasad Eye Institute, Vijayawada? 521 134, Andhra Pradesh, Email: aravindroy@lvpei.org) : A review of long-term corneal preservation techniques: Relevance and renewed interests in the COVID-19 era. Indian J Ophthalmol 2020, 68(7), 1357-63.

The growth of eye banking in India was showing positive trends until the nation was hit by unprecedented times as a result of the COVID-19 pandemic. The impact of this has led to a downward spiraling in eye banking activities globally. Several measures had to be implemented to tide over the crisis and strategies planned for future to prepare for the needs of corneal transplantation. While eye banks in India have been practicing short- term and intermediate storage preservation media, there is a definite need to evolve other methods of very long-term preservation. This review discusses various methods of long term corneal preservation, their relevance and applications in the present times. We reviewed relevant medical literature in English from PUBMED with the key words ”Corneal preservation”, “Cryopreservation”, “Glycerolpreservation”, Gamma Irradiation”, “Eye Banking” ,”COVID-19”.

1 table, 69 ref

037088   SHETTY R, LALGUDI V G, KHAMAR P, GUPTA K, SETHU S , NAIR A , HONAVAR S G, GHOSH A , D’SOUZA S (Cornea and Refractive Surgery Dep, Narayana Nethralaya, Bangalore, Karnataka, Email: drsharondsouza@gmail.com) : Potential ocular and systemic COVID-19 prophylaxis approaches for healthcare professionals. Indian J Ophthalmol 2020, 68(7), 1349-56.

The COVID‑19 pandemic has brought with it, innumerable challenges in healthcare, both through the direct burden of morbidity and mortality of the disease, and also by the curtailing of other essential albeit less emergency medical services to reduce the risk of community spread. Reports from around the world are showing mounting number of cases even in healthcare professionals spite of usage of adequate personal protective equipment. There are a number of factors which could account for this, be it the affinity of thevirus to the respiratory and other mucosa or to patient risk factors for developing severe forms of the disease. In view of the growing need for resuming other medical services, it is essential to find newer ways to protect ourselves better, whether by systemic or topical mucosal prophylaxis with various medicationsor lifestyle changes promoting wellbeing and immunity. This article discusses additional prophylacticmeasures including drug repurposing or new indication paradigms to render protection. Certain medications such as chloroquine, trehalose, antihistaminics, and interferons used topically for variousocular conditions with reasonably good safety records are known to have anti‑viral properties. Hence, canbe harnessed in preventing SARS‑CoV‑2 attachment, entry, and/or replication in host cells. Similarly, use of hypertonic saline for nasal and oral mucosa and dietary changes are possible methods of improving ourresistance. These additional prophylactic measures can be cautiously explored by healthcare professionals to protect themselves and their patients.

3 illus, 91 ref

037075   BARDOLOI N, SARKAR S, PILANIA A, DAS H (Chandra Prabha Eye Hospital, Jorhat, Assam, Email: cpehjorhat@rediffmail.com) : Efficacy and safety of dropless cataract surgery. Indian J Ophthalmol 2020, 68(6), 1081-5.

To evaluate the clinical outcome following intraoperative transzonular intravitreal injection oftriamcinolone acetonide and moxifloxacin in patients undergoing phacoemulsification cataract extraction with intraocular lens (IOL) implantation. In this prospective, non‑randomized, clinical,interventional study, a total of 200 eyes were enrolled. Patients who voluntarily gave their consent after being informed about dropless cataract surgery along with its pros and cons were included. Those who had glaucoma or were known steroid responders as well as those who were lost to follow‑up were excluded.0.1 ml each of moxifloxacin (500 mg) and triamcinolone acetonide (4 mg) were injected transzonularly following IOL implantation in phacoemulsification cataract surgery with the help of 27G curved cannula.Slit‑lamp examination was done to detect cells, visual acuity was noted, and intraocular pressure was measured postoperatively on day 1, 7, 30, 60, and 90. Uncorrected visual acuity (UCVA) greater than 6/9 was achieved in 96% of patients at the end of 3 months. The mean IOP was found to be normal in all the cases at every visit. Twenty patients complained of floaters on postoperative day 1 (D1), which decreased to zero after 60 days (D60). None of the patients needed any eye drop during the entire postoperative period.The study demonstrates that this procedure is advantageous and safe.

1 illus, 4 tables, 37 ref

037070   SRAVANI N G, MOHAMED A, NANDYALA S, CHAURASIA S (L V Prasad Eye Institute, Hyderabad? 500 034, Telangana, Email: sunita@lvpei.org) : Outcomes of corneal transplantation using donor corneas retrieved from patients with chronic kidney disease. Indian J Ophthalmol 2020, 68(6), 1054-6.

To report the outcomes of corneal transplantation utilizing corneas retrieved from donors with chronic kidney disease (CKD).  Outcomes of corneal transplantation (optical PK  and EK) performed from Jan 2018 to Dec 2018 utilizing donor corneas retrieved from CKD patients was performed retrospectively.  Of the total of 233 donor corneas retrieved from CKD, 135 (57.9%) were utilized for transplantation after the routine screening protocol of the eye bank. Mean age of the donors was 56.2 ± 13.5 years. The mean endothelial cell density on specular microscopy of the donor corne as used for optical PK was 2685.7 ± 377.6 cells/mm2 (range, 2028–3448 cells/mm2) and for EK was 2731.7 ± 189.1 cells/mm2(range, 2380–3194 cells/mm2). The overall primary graft failure rate was 5.1%. All grafts except 1, cleared in the PK group. In the EK group (6 DMEK and 16 DSAEK), 1 patient had a complete graft detachment and another 1 had a primary graft failure after DMEK.  The donor corneas retrieved from chronic kidney disease patients are safe and suitable for optical keratoplasty provided they meet the criteria for transplantation.

1 table, 7 ref

037069   BASAK S K, BASAK S, GAJENDRAGADKAR N, GHATAK M (Cornea Dep, Disha Eye Hospitals, Kolkata- 700 120, West Bengal, Email: basak_sk@hotmail.com) : Overall clinical outcomes of Descemet membrane endothelial keratoplasty in 600 consecutive eyes: A large retrospective case series. Indian J Ophthalmol 2020, 68(6), 1044-53.

To analyze the overall clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) in 600 consecutive cases. Retrospective, consecutive interventional case series operated by a single surgeon. Six hundred consecutive eyes of 524 patients with endothelial dysfunctions of different etiologies scheduled for DMEK were included in this study. All donor tissues were prepared by the operating surgeon during the procedure, using McCarey Kaufman medium or Cornisol‑preserved cornea with endothelial cell density (ECD) of ≥2500 cells/mm2. Indications, postoperative best spectacle‑corrected visual acuity (BSCVA),ECD, endothelial cell loss (ECL), and complications were analyzed postoperatively between 3 months and 2 years.  The commonest indication was post‑cataract corneal edema/bullous keratopathyin 262 (43.7%) eyes followed by Fuchs′ endothelial corneal dystrophy 218 (36.3%). Vision affected comorbidities were present in 91 (15.2%) eyes. In phakic eyes with cataract (222; 37%), DMEK was combined with cataract surgery (Triple‑DMEK). BSCVA of ≥20/25 was achieved in 41.0%, 46.4%, 49.2%, and 48.7% of eyes at 3, 6, 12, and 24 months, respectively and stabilized at 6 months (P = 0.54). Mean ECD decreased from 2884 ± 178 cells/mm2 (n = 600) before surgery to 2223 ± 321 (n = 597), 2099 ± 354 (n = 524), 1918 ± 373 (n = 374),and 1772 ± 439 cells/mm2 (n = 158) at 3, 6, 12, and 24 months respectively. The corresponding mean ECL was 22.9 ± 11.4%, 27.2 ± 12.4%, 33.5 ± 13.0%, and 38.6 ± 14.3%, respectively (P < 0.05 for all‑time points).The commonest complication was DM detachment in 59 (9.8%) eyes of which 23 (3.8%) eyes required rebubbling. Three (0.5%) eyes had primary graft failure. Endothelial rejection occurred in 7 (1.2%) eyes until the last follow‑up. DMEK is a safe and effective procedure in different types of endothelial diseases with encouraging surgical and clinical outcomes. Complications are less and ECL percentage upto 2 years is acceptable.

11 illus, 4 tables, 35 ref

037067   FAROOQUI J H, ACHARYA M, SCHUNDER I, HINESLEY R, DAS A (Cornea Dep, Dr. Shroff’s Charity Eye Hospital, Daryaganj, New Delhi ? 110 002, Email: jhfarooqui@gmail.com) : Practical use of rubric for assessment of eye bank professionals for eye retrieval and its role in improving eye retrieval process in eye banks: An Indo?American experience. Indian J Ophthalmol 2020, 68(6), 1037-9.

To study the practical use of the Rubric for Assessment of Eye Bank Professionals for Eye Retrieval(RAEPER) as a competency assessment tool by organizing a workshop in two eye banks – one in India and other in America.Two‑day workshop was conducted in two eye banks – named Shroff’s Charity Eye Hospital (SCEH) in India and Miracles in Sight (MIS) in America. Day 1 of workshop comprised of didactic lectures and discussions and day 2 was eye retrieval assessment done on human eyes in a wet lab setting.Assessment was done using RAEPER by two independent senior eye bank managers. MIS had 27participants, 15 males and 12 females (mean age: 38.8 years, range: 28‑55) and SCEH had 11 participants,10 males and 1 female (mean age: 48 years, range: 22–68). All participants were in house technicians, who had a minimal experience of at least 150 eye retrievals. At MIS, step 19 (crystalline lens check) got a score of 3 (Competent) 93.5% of the time. At SCEH, step 6 (conjunctival removal) and step 4 (Irrigation of cornea withsterile saline) were high scoring with 90.11% and 72.7% scoring 3, respectively.  India’s cornea blind population is expected to reach 10 million by 2020. Steps need to be taken to improve cornea retrieval rates inthe country and make various eye banks self‑sufficient. Incorporating such training modules not only improves the cornea utilization rates, but also helps standardize the entire eye banking process.

1 table, 15 ref

037065   SOUNDARYA B, SACHDEV G S, RAMAMURTHY S, DANDAPANI R (The Eye Foundation, Coimbatore- 641 002, Tamil Nadu, Email: sachdevgitansha@gmail.com) : Ectasia after keratorefractive surgery: Analysis of risk factors and treatment outcomes in the Indian population. Indian J Ophthalmol 2020, 68(6), 1028-31.

To analyze the risk factors in eyes developing ectasia following keratorefractive procedures.In addition, the study assessed visual outcomes following various treatment modalities for ectasia. In this retrospective study, data of patients who underwent keratorefractive procedures, presenting to the refractive services of a tertiary eye care hospital in South India between January 2016 and May 2019 was analyzed. Of these, the eyes that developed ectasia were noted and the possible risk factors were determined. Visual outcomes following treatment with corneal collagen cross linking (CXL) with or without intracorneal ring segment implantation (ICRS) or topography‑guided corneal ablation (T‑PRK) were analyzed. Forty eyes of 26 patients developed ectasia following keratorefractive procedures, with a mean interval of 73.1± 45.4 months between primary procedure and ectasia development. Of these, 14 patients hadbilateral presentation. Identifiable risk factors included ablation depth >75 μm (59.25%), percentage of tissue altered (PTA) >40% (48.14%), residual stromal bed <300 μm (22.22%), mean refractive spherical equivalent >8D (25.92%), inferior–superior (I–S) asymmetry >1.4D (7.40%), central corneal thickness (CCT) <500 μm (7.40%),Belin Ambrosio Display (BAD) >2.5 (7.40%), posterior float elevation maximum ≥18 μm (3.70%), and pellucidmarginal degeneration (PMD; 3.70%). Our study shows that only 70% of the eyes demonstrated an identifiable risk factor for the development of ectasia. Ablation depth of >75 μm and the PTA >40% were the most common risk factors. Treatment following CXL with ICRS or T‑PRK demonstrated significantly better visual outcomes in comparison with CXL alone.

1 illus, 3 tables, 27 ref

037062   DAS A V, RANI P K, VADDAVALLI P K (eyeSmart EMR and AEye Dep, L V Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: pravin@lvpei.org) : Tele-consultations and electronic medical records driven remote patient care: Responding to the COVID-19 lockdown in India. Indian J Ophthalmol 2020, 68(6), 1007-12.

To describe the experience of tele‑consultations addressed at the centre of excellence of a multi‑tierophthalmology hospital network in India during the ongoing novel coronavirus (COVID‑19) lockdown. This cross‑sectional hospital‑based study included 7,008 tele‑consultations presenting between March 23rd and April 19th 2020. A three‑level protocol was implemented to triage the calls. The data of patient queries were collected using a Google Form/Sheets and the tele‑calls were returned using the patient information retrieved from the electronic medical record system. Overall, 7,008 tele‑calls were addressed, of which 2,805 (40.02%) patients where a clinical‑related query was answered were included for analysis. The most common queries were related to redness/pain/watering/blurring of vision (31.52%),closely followed by usage of medications (31.05%). The majority of the queries were directed to the department of cornea (34.15%), followed by retina (24.74%). Less than one‑fifth of the patients were from the lower socio‑economic class (16.08%) and one‑fourth were new patients (23.96%). The most common advice given to the patient was related to management of medications (54.15%) followed by appointment related (17.79%). Emergency requests requiring further evaluation by an ophthalmologist accounted fora small percentage (16.36%) of patients.  Tracking of tele‑consultations and access to patient information from the electronic medical records enabled a timely response in an ongoing lockdown due to the COVID‑19 pandemic. The current experience provided valuable insights to the possibility of managing patient follow‑up visits remotely in the future.

4 illus, 20 ref

037061   MISHRA D, NAIR A G, GANDHI R A, GOGATE P J, MATHUR S, BHUSHAN P, SRIVASTAV T, SINGH H, SINHA B P, SINGH M K (Aditya Jyot Eye Hospital, Mumbai- 400 03, Maharashtra, Email: akshaygn@gmail.com) : The impact of COVID-19 related lockdown on ophthalmology training programs in India – Outcomes of a survey. Indian J Ophthalmol 2020, 68(6), 999-1004.

In 2020, in response to the emergence and global spread of the disease COVID-19, caused by a new variant of coronavirus 2019-nCoV, the government of India ordered a nationwide lockdown for 21days, which was then extended to a total of over 50 days. The aim of this study is to assess the effect of the lockdown on ophthalmic training programs across India. An online survey was sent across to trainee ophthalmologists across India through various social media platforms. In all, 716 trainees responded; the average age was 29.1 years. Results showed that majority of the respondents were enrolled inresidency programs (95.6%; 685/716) and the others were in fellowship programs. About 24.6% (176/716) of the trainees had been deployed on ‘COVID-19 screening’ duties. Nearly 80.7% (578/716) of the trainees felt that the COVID-19 lockdown had negatively impacted their surgical training. Furthermore, 54.8% (392/716) of the trainees perceived an increase in stress levels during the COVID-19 lockdown and 77.4% (554/716) reported that their family members had expressed an increased concern for their safety and well being since the lockdown began. In all, 75.7% (542/716) of the respondents felt that online classes and webinars were useful during the lockdown period. Our survey showed that majority ophthalmology trainees across the country felt that the COVID-19 lockdown adversely affected their learning, especially surgical training. While most found online classes and webinars useful, the trainees’ perceived stress levels were higher than normal during the lockdown. Training hospitals should take cognizance of this and reassure trainees; formulate guidelines to augment training to compensate for the lost time as well as mitigate the stress levels upon resumption of regular hospital services and training. Going ahead, permanent changes such as virtual classrooms and simulation-based training should be considered.

7 illus, 26 ref

037060   KHANNAR C, HONAVAR S G, METLA A L, BHATTACHARYA A, MAULIK P K (L V Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: rohit@lvpei.org) : Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India. Indian J Ophthalmol 2020, 68(6), 994-8.

To evaluate the psychological impact of the COVID 19 crisis on ophthalmologists-in-training and practising ophthalmologists during lockdown in India.  An online survey was completed by ophthalmologists and ophthalmology trainees during the lockdown. The information collected included demographics (age, gender), domicile (state, union territory), current professional status (in training orpractising), type of practice (solo, group, institutional, governmental, non-governmental), marital status (married, single), impact of COVID-19 on their training or practice, and impact on income and ability to meet living expenses. Psychological distress was assessed using the Patient Health Questionnaire-9 (PHQ-9). In all, 2,355 ophthalmologists responded. Mean age was 42.5 (range, 25-82 years; SD, 12.05) years. Of these, 1,332 (56.7%) were males; 475 (20.2%) were still not in practice; 366 (15.5%) were single; 1,244 (52.8%) felt that COVID-19 would impact on their training or professional work; and 869 (37%) had difficulty in meeting their living expenses. The mean PHQ-9 score was 3.98 (range, 0-27; SD, 4.65). In terms of psychological impact, 768 (32.6%) had some degree of depression; mild in 504 (21.4%), moderate in 163 (6.9%), and severe in101 (4.3%). Multivariable analysis showed that depression was significantly higher at younger age. The odds of depression decreased by 3% with 1 year increase in age. It was higher in non-practicing ophthalmologists, especially those who were considerably worried about their training or professional growth, and those with difficulty in meeting living expenses. A strikingly high proportion of ophthalmologists are psychologically affected and may require personalized mental health care.

3 tables, 18 ref

037059   VERMA S, AZAD S V, TAKKAR B, TEMKAR S, CHAWLA R, VENKATESH P (AIIMS, New Delhi- 110 029, Email: shoryaazad@hotmail.com) : Posterior segment complications following glaucoma surgeries. Indian J Ophthalmol 2020, 68(6), 988-93.

The present review describes the posterior segment complications following surgical management of glaucoma. Although the majority of glaucoma cases are managed medically, still a large number of patients may require surgery. Moreover, with the advent of newer surgical techniques and adjuncts, encountering retinal complications post‑surgery is not uncommon. The incidence, signs, management, and prognosis of common complications such as anesthesia‑related retinal toxicity, vitreous loss, suprachoroidal hemorrhage,serous choroidal detachment, hypotonic maculopathy, vitreous hemorrhage, retinal detachment and endophthalmitis will be discussed in detail. Awareness of these complications is necessary as their properand timely management can save vision in an already compromised eye.

4 illus, 51 ref

037056   BABU N, KOHLI P, RAMACHANDRAN N O, ADENUGA O O, AHUJA A, RAMASAMY K (Vitreo?Retinal Services Dep, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, Email: cauveryeye@gmail.com) : Comparison of platelet-rich plasma and inverted internal limiting membrane flap for the management of large macular holes: A pilot study. Indian J Ophthalmol 2020, 68(5), 880-4.

To compare the safety and efficacy of 25‑gauge pars plana vitrectomy (PPV) with either platelet‑rich plasma (PRP) or inverted internal limiting membrane (ILM) flap for the treatment of large macular hole. Pseudophakic patients with idiopathic macular holes with a minimum diameter (MD) of 600–1500 μm were randomized into two groups (30 patients each): 25‑gauge PPV with either inverted ILM flap (group A) or PRP (group B). Mean MD in groups A and B were 803.33 ± 120.65 μm and 784.73 ± 120.10 μm, respectively (P = 0.552). Mean base diameter in groups A and B was 1395.17 ± 240.57μm and 1486.90 ± 281.61 μm, respectively (P = 0.180). The median presenting best‑corrected visualacuity (BCVA) was logMAR 0.78 (range 0.78–1.00) and logMAR 0.78 (Range 0.60–1.00) in groups A and B, respectively (P = 0.103). Anatomical closure was achieved in 90% (n = 27/30) and 93.3% (n = 28/30)eyes in groups A and B, respectively (P = 0.158). Type 1 closure was achieved in 76.7% (n = 23/30) and83.3% (n = 25/30) eyes in groups A and B, respectively. Median BCVA at postoperative 3‑month in groups A and B was logMAR 0.60 (range 0.48–0.60) and logMAR 0.60 (range 0.48–0.78), respectively (P = 0.312). The average visual improvement was 2.0 and 2.5 early treatment diabetic retinopathy study (ETDRS) linesin groups A and B, respectively (P = 0.339). None of the patients developed postoperative exaggerated inflammatory reactions. Using platelets for the treatment of large macular holes is as safe and effective as an inverted ILM flap.

2 illus, 2 tables, 41 ref

037053   KUMAR S, ROY R, GOEL S, GARG B, MISHRA S (Vitreo Retina Dep, Kamalnayan Bajaj Sankara Nethralaya, Newtown? 700 156, Kolkata, Email: vrfellow@gmail.com) : Validation of multicolor imaging signatures of central serous chorioretinopathy lesions vis?a?vis conventional color fundus photographs. Indian J Ophthalmol 2020, 68(5), 861-6.

The current study compares the ability of multicolor imaging (MCI) to detect the lesions ofcentral serous chorioretinopathy against conventional color fundus photographs (CFP).  It was a retrospective, observational case series of 93 eyes of 58 patients of central serous chorioretinopathy who underwent MCI and CFP. MCI and spectral‑domain optical coherence tomography (SD‑OCT) were performed using Spectralis SD‑OCT system (HRA + OCT). CFP was obtained using FF 450 Plus fundus camera (Carl Zeiss Meditec, Jena, Germany). SD‑OCT was considered gold standard for subretinal fluid (SRF) and retinal pigment epithelium detachment (PED). CFP was considered confirmatory investigation for fibrin and blue autofluorescence image (BAF) was considered gold standard to detectretinal pigment epithelium (RPE) atrophy. CFP could detect SRF in 41 (44.1%) eyes. MCI detected SRF in 43 (46.2%) eyes. The sensitivity and specificity of MCI to detect SRF were 70.7% and 94.3%,respectively. PED was detected by CFP in 21 (22.6%) eyes and MCI in 27 (29%) eyes. The sensitivity and specificity of MCI to detect PED were 70% and 97.7% respectively. CFP could pick RPE atrophy in 52 (55.9%) eyes whereas MCI was picked it in 78 (83.9%) of eyes.  Both MCI and CFP were inferior to a gold standard in identifying the SRF, PED, and RPE atrophy. However, MCI was better than CFP in comparison with gold standard for these clinical findings in CSC. Thus, MCI seems to be a more valuable imaging tool compared to CFP.

4 illus, 4 tables, 20 ref

037053   KUMAR S, ROY R, GOEL S, GARG B, MISHRA S (Vitreo Retina Dep, Kamalnayan Bajaj Sankara Nethralaya, Newtown- 700 156, Kolkata, Email: vrfellow@gmail.com) : Validation of multicolor imaging signatures of central serous chorioretinopathy lesions vis-a-vis conventional color fundus photographs. Indian J Ophthalmol 2020, 68(5), 861-6.

The current study compares the ability of multicolor imaging (MCI) to detect the lesions ofcentral serous chorioretinopathy against conventional color fundus photographs (CFP).  It was a retrospective, observational case series of 93 eyes of 58 patients of central serous chorioretinopathy who underwent MCI and CFP. MCI and spectral‑domain optical coherence tomography (SD‑OCT) were performed using Spectralis SD‑OCT system (HRA + OCT). CFP was obtained using FF 450 Plus fundus camera (Carl Zeiss Meditec, Jena, Germany). SD‑OCT was considered gold standard for subretinal fluid (SRF) and retinal pigment epithelium detachment (PED). CFP was considered confirmatory investigation for fibrin and blue autofluorescence image (BAF) was considered gold standard to detectretinal pigment epithelium (RPE) atrophy. CFP could detect SRF in 41 (44.1%) eyes. MCI detected SRF in 43 (46.2%) eyes. The sensitivity and specificity of MCI to detect SRF were 70.7% and 94.3%,respectively. PED was detected by CFP in 21 (22.6%) eyes and MCI in 27 (29%) eyes. The sensitivity and specificity of MCI to detect PED were 70% and 97.7% respectively. CFP could pick RPE atrophy in 52 (55.9%) eyes whereas MCI was picked it in 78 (83.9%) of eyes.  Both MCI and CFP were inferior to a gold standard in identifying the SRF, PED, and RPE atrophy. However, MCI was better than CFP in comparison with gold standard for these clinical findings in CSC. Thus, MCI seems to be a more valuable imaging tool compared to CFP.

4 illus, 4 tables, 20 ref

037051   PIYSEANA M M P N , MURTHY G VS (National Eye Hospital, Colombo 10, Sri Lanka, Email: Prabhath_nishantha@yahoo.com) : Availability of eye care infrastructure and human resources for managing diabetic retinopathy in the western province of Sri Lanka. Indian J Ophthalmol 2020, 68(5), 841-6.

Blindness and visual impairment due to diabetic retinopathy (DR) are avoidable by early screening and timely treatment. The western province of Sri Lanka has the highest prevalence of diabetesmellitus (18.6%) in the country. DR had been given less attention in services expansion because of lack of evidence. The aim of this study was to assess the availability of human resources (HR) and infrastructure for DR in eye care facilities. A cross‑sectional survey was conducted in 51 health care institutions by administering a validated questionnaire schedule and through semi‑structured interviews. The dataon infrastructure, HR and level of training, and skills were collected during the site visits by observation, frequency counting, and interviewing. Key findings of the interviews were recorded using categorical responses. Data analysis was done using MS‑Excel® and STATA/IC®‑Version 2‑13.0 packages. The response rate of the survey was 84.3% (43/51). There were 40 board‑certified ophthalmologists and 6 vitreo‑retinal surgeons in the region, of whom 77.5% (31/40) were in Colombo district. The highest population‑adjusted DR‑related infrastructure ratios were recorded from Colombo district. Mid‑level cadres such as medical officers’ mean skill score of DR screening and treatment was low (0.37, 95% CI 0.32‑0.40). There is no systematic DR screening program, and HR and infrastructure distribution was notaligned to the population need in the western province. Urgent attention should be paid to expand the service delivery and mid‑level HR training for DR screening and treatment in this region.

3 illus, 2 tables, 31 ref

037050   DAVE V P, PATHENGAY A, PANCHAL B, JINDAL A, DATTA A, SHARMA S, PAPPURU R R, JOSEPH J, JALALI S, DAS T (LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, Email: avinash@lvpei.org) : Clinical presentations, microbiology and management outcomes of culture-proven endogenous endophthalmitis in India. Indian J Ophthalmol 2020, 68(5), 834-9.

To report the clinical presentation, microbiology, and management outcome of endogenous endophthalmitis in Indian patients. Retrospective chart review of culture‑positive (vitreous/urine/blood) endogenous endophthalmitis cases treated in tertiary eye care facility in India was done. The study included 173 eyes of 117 patients. Mean patient age was 25.41 ± 20.46 years (median 24 years). Pre‑disposing systemic illness could not be elicited in 79 (67.63%) patients. Commonest predisposing systemic condition in patients where it could be detected (n = 79) was pyrexia of unknown origin (25/79 = 32.0%). Following treatment, 45 out of 173 (26.0%) eyes regained vision of ≥20/400.Commonest isolated organism from vitreous was Streptococcus pneumoniae (36 eyes, 20.8%) and fungi were isolated in 24 (13.8%) eyes, the commonest being Candida spp. (8/24, 33.33%). Favorable functional outcome was seen in 26% eyes and favorable anatomic outcome in 43% eyes. Those with an underlying systemic illness were older (P = 0.02), had greater urine culture positivity (P = 0.003), lesser vitreous culture positivity (0.001), greater gram negative etiology (P = 0.0006), and greater fungal etiology (P = 0.01) as compared to those cases without underlying systemic illness.  Endogenous endophthalmitis in India often presents in young immuno competent individuals without any underlying systemic illness and with negative blood or urine microbiologic work up. Underlying systemic illness leads to greater gram‑negative and fungal etiology. Overall visual outcome is poor inspite of prompt management.

6 tables, 30 ref

037043   PRADHAN Z S, DESHMUKH S, DIXIT S, GUDETTI P, DEVI S, WEBERS C A B, RAO H L (Glaucoma Dep, Narayana Nethralaya Foundation, Bengaluru, Karnataka, Email: zedpradhan@gmail.com) : A comparison of the corneal biomechanics in pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and healthy controls using Corvis® Scheimpflug Technology. Indian J Ophthalmol 2020, 68(5), 787-92.

To compare the corneal biomechanical parameters among pseudoexfoliation syndrome (PXF), pseudoexfoliation glaucoma (PXG), and healthy controls using Corvis Scheimpflug Technology (ST). A prospective, cross‑sectional study of 141 treatment‑naïve eyes that underwent Corvis ST was conducted. These included 42 eyes with PXF, 17 eyes of PXF with ocular hypertension (PXF + OHT) defined as intraocular pressure (IOP) >21 mmHg without disc/field changes, 37 eyes with PXG, and 45 healthy controls. Corneal biomechanical parameters, which included corneal velocities, length of corneal applanated surface, deformation amplitude (DA), peak distance, and radius of curvature, were compared among the groups using analysis of variance models. The four groups were demographically similar. The mean IOP was lower in the controls (15.6 ± 3 mmHg) and PXF group (16.0 ± 3 mmHg) compared to the other two groups (>24 mmHg). Corneal pachymetry was similar across the four groups. Mean DA was significantly lower (P < 0.0001) in the PXG group (0.91 ± 0.18 mm) and the PXF + OHT group (0.94 ± 0.13 mm) when compared to the PXF (1.10 ± 0.11 mm) and control groups (1.12 ± 0.14 mm). Corneal velocities were also found to be statistically significantly lower in PXG and PXF + OHT compared to the PXF and control groups.However, after adjusting for age and IOP, there was no difference in any of the biomechanical parameters among the four groups.  Corneal biomechanical parameters measured on Corvis ST are not different between healthy controls and eyes with PXF and PXG. Since PXG is a high-pressure glaucoma,corneal biomechanics may not play an important role in its diagnosis and pathogenesis.

1 illus, 4 tables, 26 ref

037042   SACHDEV G S, SOUNDARYA B, RAMAMURTHY S, LAKSHMI C, DANDAPANI R (The Eye Foundation, Coimbatore- 641 002, Tamil Nadu, Email: sachdevgitansha@gmail.com) : Impact of anterior capsular polishing on capsule opacification rate in eyes undergoing femtosecond laser-assisted cataract surgery. Indian J Ophthalmol 2020, 68(5), 780-5.

To evaluate the impact of anterior capsular polishing on capsule opacification and contraction in eyes undergoing femto second laser‑assisted cataract surgery (FLACS). This prospective interventional comparative analysis included patients undergoing FLACS between August 2016 and May 2017. The eyes were subdivided into three groups based on the extent of intraoperative anterior capsular polishing performed: complete 360‑degree polishing; inferior 180‑degree polishing; and no polishing. Visual acuity, posterior capsular opacification (PCO) score, anterior capsular opacification (ACO) grade, and capsulorhexis diameter were evaluated at 1‑week, 6‑months, and 1‑year postoperative visits.  The study included 99 eyes of 90 patients. No significant differences were observed between the three groups in ACO grade and capsulorhexis contraction at all follow‑up visits.There was a statistically significant difference in PCO grade among the groups at 6‑month and 1‑year follow‑up but it was found to be clinically insignificant. One eye in the no polishing group underwentneodymium:yttrium‑aluminum‑garnet (Nd:YAG) capsulotomy at the 1‑year follow‑up visit. A lower incidence of PCO was demonstrated in the 360‑degree polishing group, although it was visually insignificant. No significant difference in postoperative capsular contraction was demonstrated between the cohorts up to one‑year follow‑up.

4 illus, 1 table, 23 ref

037038   GADDE A K, SRIRAMPUR A, KATTA K R, MANSOORI T, ARMAH S M (Cataract and Refractive Services Dep, North Carolina Univ, North Carolina, USA, Email: agadde@yahoo.com) : Comparison of single-step transepithelial photorefractive keratectomy and conventional photorefractive keratectomy in low to high myopic eyes. Indian J Ophthalmol 2020, 68(5), 755-61.

To compare the visual outcome, safety, safety index, efficacy, efficacy index and corneal transparency between single-step transepithelial photorefractive keratectomy (t-PRK) and conventional photorefractive keratectomy (PRK) with manual debridement of epithelium in eyes with low to high simple myopia and compound myopic astigmatism. In this retrospective ,case control study, we analysed and compared the postoperative uncorrected visual acuity(UCVA), postoperative best corrected visualacuity (BCVA) , safety, safety index, efficacy, efficacy index and the corneal transparency between t-PRK and PRK with 6th-generation Amaris excimer 500E laser (Schwind eye-tech-solutions) in 115 eyes of 59 patients. Preoperative Mean Refractive Spherical Equivalent (MRSE) was - 3.88 + 0.23 Diopters(D) and -4.73 +0.23D in PRK and t-PRK group respectively (p=0.09). In both the groups , none of the eyes lost postoperative BCVA at the end of mean follow-up period of 3.5 months . All the eyes achieved post operative UCVA of 20/40 or better in both the groups. Incidence of trace corneal haze was high in t-PRK group at the end of 3.5 months (P = 0.003).  Single-step t-PRK and PRK provide similar results at the end of mean follow-up period of 3.5 months postoperatively with regards to post-operative UCVA, post operative BCVA,safety, safety index, efficacy and efficacy index. There was high incidence of trace haze in t- PRK eyes. Both the procedures are predictable, effective, and safe for correction of low to high myopia.

6 tables, 24 ref

037036   PATEL N V, MATHUR U, GANDHI A, SINGH M (Cornea Dep, Dr. Shroff’s Charity Eye Hospital, Daryaganj, New Delhi- 110 002, Email: dr.nikunj.v.patel@gmail.com) : Demodex blepharokeratoconjunctivitis affecting young patients: A case series. Indian J Ophthalmol 2020, 68(5), 745-9.

To report clinical characteristics of Demodex blepharokeratoconjunctivitis affecting young patients. This is a retrospective review of 14 patients with the history of chronic red eyes with corneal involvement. All patients were diagnosed with ocular demodicosis based on the results of eyelash sampling. All patients were treated with 50% tea tree oil lid scrubs and two doses of oral ivermectin (200 mcg/kg).The median age of patients at diagnosis was 27 years (range: 11–39 years). The duration of symptoms ranged from 2 months to 20 years. Rosacea was present in only three patients. Four patients had best corrected visual acuity less than 20/60. Allergic conjunctivitis (n = 7) and viral keratitis (n = 5) were the most common misdiagnosis previously made. Cylindrical dandruff was present in only six patients and eyelashes were clean in rest of them. Inferior vascularization was present in eight eyes, superior in seven eyes, and corneal scars were present in 12 eyes. Four patients had steroid‑related complications. All patients, except one responded to tea tree oil treatment and 13 patients were off steroids after 3 weeks of starting the treatment. Demodex infestation of eyelids can lead to chronic blepharokeratoconjunctivitis in healthy pediatric and young adult patients who otherwise have good hygiene, which can often be overlooked or misdiagnosed. Viral keratitis and allergic conjunctivitis are common misdiagnoses and demodicosis can be confirmed by simpleepilation. Early diagnosis and treatment can prevent long‑term steroid use and its related complications.

3 illus, 1 table, 27 ref

037032   KHANNA R C, CICINELLI M V, GILBERT S S, HONAVAR S G, MURTHY G V S (L V Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: rohit@lvpei.org) : COVID-19 pandemic: Lessons learned and future directions. Indian J Ophthalmol 2020, 68(5), 703-10.

Emerging pandemics show that humans are not infallible and communities need to be prepared.Coronavirus outbreak was first reported towards the end of 2019 and has now been declared a pandemic by the World Health Organization. Worldwide countries are responding differently to the virus outbreak.A delay in detection and response has been recorded in China, as well as in other major countries, which led to an overburdening of the local health systems. On the other hand, some other nations have put in place effective strategies to contain the infection and have recorded a very low number of cases since the beginning of the pandemics. Restrictive measures like social distancing, lockdown, case detection,isolation, contact tracing, and quarantine of exposed had revealed the most efficient actions to control the disease spreading. This review will help the readers to understand the difference in response by different countries and their outcomes. Based on the experience of these countries, India responded to the pandemic accordingly. Only time will tell how well India has faced the outbreak. We also suggest the future directions that the global community should take to manage and mitigate the emergency.

4 illus, 1 table, 54 ref

037031   SHETTY R, GHOSH A, HONAVAR S G, KHAMAR P, SETHU S (Narayana Nethralaya, Bengaluru- 560 099, Karnataka, Email: swaminathansethu@ narayananethralaya.com) : Therapeutic opportunities to manage COVID-19/SARS-CoV-2 infection: Present and future. Indian J Ophthalmol 2020, 68(5), 693-702.

A severe form of respiratory disease – COVID‑19, caused by SARS‑CoV‑2 infection, has evolved into a pandemic resulting in significant morbidity and mortality. The unabated spread of the disease is due to lack of vaccine and effective therapeutic agents against this novel virus. Hence, the situation demands an immediate need to explore all the plausible therapeutic and prophylactic strategies that can be made available to stem the spread of the disease. Towards this effort, the current review outlines the key aspects of the pathobiology associated with the morbidity and mortality in COVID‑19 patients, which includes a viral response phase and an exaggerated host response phase. The review also summarizes therapeuticagents that are currently being explored along with those with potential for consideration. The broad groups of therapeutic agents discussed include those that: (i) block viral entry to host cells, (ii) block viral replication and survival in host cells, and (iii) dampen exaggerated host immune response. The various kinds of pharmaceutical prophylactic options that may be followed to prevent COVID-19 have also been discussed.

3 illus, 1 table, 108 ref

037019   SHARMA M, GANESH S, TIBREWAL S, SABHARWAL S, SACHDEVA N, ADIL M, CHAUDHARY J, SIDDIQUI Z (Pediatric Ophthalmology and Strabismus Dep, Dr. Shroff’s Charity Eye Hospital, Daryaganj, New Delhi, Email: sumag@sceh.net) : Accuracy of noncycloplegic photorefraction using Spot photoscreener in detecting amblyopia risk factors in preschool children in an Indian eye clinic. Indian J Ophthalmol 2020, 68(3), 504-9.

To evaluate the accuracy of Spot photoscreener (PS) as a noncycloplegic photorefractor indetecting amblyopia risk factors (ARFs) in preschool children in an Indian eye clinic setting. Also, toderive appropriate cut off values for screening to obtain maximum sensitivity and specificity of the devicein detecting ARF. This was a cross‑sectional study conducted in the outpatient pediatric eye clinic at a tertiary eye care institute. A Spot PS was used to screen all the children between the ages of 6 months and 5 years that presented to the eye clinic from August 2018 to October 2018. This screening was followed by a complete eye examination, including cycloplegic refraction by a masked examiner.The 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines were considered the standard cutoff values for clinically significant refractive error in children younger than 5 years of age. The study comprised of 219 children. The Spot PS diagnosed 135 (61.64%) children with ARF as compared with 124 (56.62%) children detected by clinic examination. For ARF detection,the Spot photoscreeneer had 85.48% sensitivity, 69.47% specificity, 78.52% positive predictive value and 78.57% negative predictive value. The sensitivity for detection of strabismus and hypermetropia was very low (42% and 36%, respectively). The 95% limits of agreement ranged from −5.48 to +5.59 diopters (D) with a bias of 0.06 D for spherical equivalent between noncycloplegic photorefraction and cycloplegic refraction. The Spot PS may be used as a screening tool to detect ARF in children younger than 5 years of age keeping its limitations in consideration. However, the performance can be improved by modifying the cutoff values for the referral.

3 illus, 2 tables, 18 ref

037016   MAHAPATRA S K, KUMARI S (JPM Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttack - 753 014, Odisha, Email: santu_k74@rediffmail.com) : Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema. Indian J Ophthalmol 2020, 68(3), 490-3.

To evaluate the long‑term safety and efficacy of the intravitreal dexamethasone implant in the treatment of diabetic macular edema (DME) as initial therapy. A hospital‑based prospective, non‑comparative case study of recently detected DME patients was conducted between July 2016 and December 2017, in which 30 eyes of 30 patients were studied. Presenting vision, age, gender, duration of diabetes, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, fundusfluorescein angiography, optical coherence tomography (OCT), and blood sugar levels were noted. Patients with increased central macular thickness (CMT) received an intravitreal dexamethasone implant as initial therapy. All were followed up at 1 week, 1 month, 3 months, 6 months, and 1 year, and the findings were recorded and analyzed using SPSS software. 30 eyes of 30 patients were studied which included 22 males and 8 females. The mean age of presentation was 58.7 ± 4.45 years. The mean decrease in CMT following intravitreal dexamethasone was 269.27 ± 112.002, 253.5 ± 108.294, and 286.73 ± 143.395 μm at the end of 3, 6, and 12 months, respectively, and the mean improvement in visual acuity (VA) was 2.27 ± 1.70 lines at 3 months, 2.27 ± 1.83 lines at 6 months, and 1.17 ± 2.00 lines at 12 months. Out of 30 cases, 4 had persistent DME and 6 had recurrence of DME at completion of 1 year of follow‑up. Intravitreal dexamethasone as initial therapy in the treatment of DME is both safe and efficacious in the reduction of CMT and improvement of vision and can be considered as primary therapy for DME.

5 illus, 20 ref

037015   DALAN D, NANDINI P, ANGAYARKANNI N, KAVIARASAN K, THANIKACHALAM S, DAS U N, RATRA D (Vitreoretinal Diseases Dep, Sankara Nethralaya, Chennai- 600 006, Tamil Nadu, Email: dhanashreeratra@gmail.com) : Interchangeability of retinal perfusion indices in different-sized angiocubes: An optical coherence tomography angiography study in diabetic retinopathy. Indian J Ophthalmol 2020, 68(3), 484-9.

To evaluate the differences in vascular indices in different scan sizes of optical coherence tomography angiography (OCTA) images in normal persons versus persons with diabetic retinopathy. OCTAscans of diabetic patients and age‑matched controls were performed by a single operator. Automated quantification of vascular indices of the superficial plexus was analyzed in two angiocubes of 3 × 3 mm and 6 × 6 mm, respectively. The agreement was analyzed with the intraclass correlation coefficient (ICC) and Bland–Altman plots. Forty‑eight eyes with DR, 36 eyes with no diabetic retinopathy (No DR), and 26 eyes of age‑matched normals were scanned. The foveal avascular zone (FAZ) area and perimeter were highly reliable and interchangeable in both angiocubes of the healthy eyes (ICC 0.94, 0.75), No DR (ICC 0.92, 0.85), and DR eyes (ICC 0.97, 0.89). The vessel density (VD) and perfusion density (PD) showed excellent agreement in normal (ICC 0.89, 0.80) and No DR eyes (ICC 0.92, 0.81). But, only fair ICC was observed in DR eyes (0.56,0.42). The FAZ area and perimeter showed excellent reproducibility. The macular perfusion parameters are not interchangeable despite automated estimation. The variability is more with changes in the vascular network like DR. This variability should be considered while comparing different scans.

3 illus, 3 tables, 15 ref

037012   BALAKRISHNAN D, OLI A, PAULOSE R M, ALI H (Biostatistics Dep, L V Prasad Eye Institute, Hyderabad, Telangana, Email: drdivyabalu@gmail.com) : Peripheral iridectomy for preventing iris-related complications in glued intraocular lens surgery in children. Indian J Ophthalmol 2020, 68(3), 466-70.

To assess the role of surgical peripheral iridectomy (PI) in preventing iris‑related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis.Non randomized interventional case series of 34 eyes of 17 children (<15 years of age) whounderwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013–June 2015) were compared with those without surgical PI(July 2015–December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery wasto account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation,or repeat surgery. The secondary outcomes were changes in the best‑corrected visual acuity (BCVA). The mean age at surgery was 8.8 years (range: 3.5–15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture –6; rise in IOP –4; IOL subluxation –4; repeat surgery –5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ≈ 20/200) and post BCVA was 0.40 (±0.50) (Snellen ≈ 20/50). The mean preoperative refraction was − 9 D (±8D) (range: −5 D to −23D) and postoperative was −1 (±1.15) D. The mean follow‑up was 25.4 months. Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic‑capture‑related complications.

1 table, 25 ref

036097   SHUKLA P, VASHIST P, SENJAM S S, GUPTA V (Community Ophthalmology Dep, AIIMS, New Delhi, Email: dr.pallavishukla@gmail.com) : Evaluation of a training program on primary eye care for an Accredited Social Health Activist (ASHA) in an urban district. Indian J Ophthalmol 2020, 68(2), 356-60.

An Accredited Social Health Activist (ASHA) available in community could be a potential primary eye care (PEC) worker. Training programme for ASHAs on PEC was undertaken & evaluated in a district of a capital city. ASHAs selected randomly from a district were imparted one day training on PEC & expected to refer patients to nearby Vision Centres (VC). Their knowledge was assessed before & after training and re-evaluated 1 year later. ASHAs were asked to conduct vision screening of 40+population in their areas and ASHA referrals were noted by Optometrist in VC. Focus Group Discussions(FGD) of ASHAs were held to find barriers & facilitating factors in engaging ASHAs in PEC. Training was evaluated using Kirkpatrick’s evaluation model for measuring reactions, learning, behaviour and results. Mean knowledge score increased from 14.96 (±4.34) pre-training to 25.38 (±3.48) post- training and sustained at 21.75 (±4.16) at 1 year. Monthly average OPD of vision centres increased by 23.6% after ASHA training. FGDs revealed that ASHAs were willing to work in eye care for awareness generation and patient facilitation but were hesitant in conducting vision screening. ASHAs can be trained as PEC workers provided they have adequate support.

2 illus, 2 tables, 15 ref

037038   LI J , JIA X, IVANOVA D (Institute of Chemical Engineering, So?a- 1113, Bulgaria, Email: dianadoc@abv.bg.) : Chemoendocrine metronomic therapy of estrogen receptor-positive breast cancer by taxanes or capecitabine in combination with aromatase inhibitors. J Pharm Res 2020, 17(2), 78-82.

The intense anticancer therapy using conventional cytostatic drugs is accompanied by serious side effects that restrict the application of the cytostatic drugs. Metronomic therapy as a modern method for administration of low doses of cytostatic agents that in combination with other anticancer drugs induce long lasting tumor dormancy with minimal side effects. We aimed our study at investigation of the efficacy of a contemporary chemoendocrine metronomic therapy, including cytostatic drugs, such as paclitaxel or capecitabine, in combination with aromatase inhibitors (AI, anastrozole, letrozole), in the treatment of estrogen recepor-positive breast cancer. The patient (74 years old) was initially diagnosed with advancedstage pT4bpN2Mx of infiltrative ductal breast carcinoma with lymph, lung and bone metastases. Based on high estrogen receptor sensitivity in 67-100 % of the analysed tumor cells, endocrine therapy was applied after mastectomy. However,progression of the disease required involvement of systemic cytostatic agents in the therapy. Following the achievements of the contemporary medicine, chemoendocrine metronomic therapeutical protocols, including combination of anastrozole with taxane or capecitabine, were found to induce rapid and continuous disease remission. This case report demonstrated rapid achievement of continuous remission by a contemporary chemoendocrine metronomic treatment of metastatic ER-positive breast cancer in all stages of the therapy: systemic anticancer treatment with weekly paclitaxel plus anastrozole, followed by anastrozole plus low doses of capecitabine and analogous maintenance therapy. The results can be explored in future clinical trials about synergy between hormone inhibitors and cytostatic agents in combination anticancer therapies.

1 table, 17 ref