Retinal vein occlusion is commonly seen in the elderly.This article aims to comprehensively discuss the etiology,classification,risk factors and latest modalities of management of this condition.

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Smartphone based fundus photography may have a role in teleophthalmology. In this article, we discuss our initial experience with DIYretCAM, a do it yourself smartphone retinal camera attachment, that is a cost-effective alternative to conventional fundus camera.

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Convergence insufficiency is a common disorder of binocular vision in children and young adults. Common symptoms include eyestrain, headache, blurred vision, double vision, etc., Diagnosis of the condition involves a battery of tests for assessment of refraction, convergence, and accommodative functions. Management involves proper refractive correction, prism, and vision therapy. This review stresses on the systematic evaluation of this condition and the common treatment strategies employed.

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Genetic factors are assumed to contribute to determining an individual's risk for the development of DR and for progression to proliferative diabetic retinopathy (PDR). This article aims to review the developments concerned with the genetics of DR.

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Aim: The aim of this study was to evaluate the safety and efficacy of biosimilar intravitreal ranibizumab (Razumab) for the treatment of chorioretinal vascular diseases such as diabetic macular edema (DME), neovascular age-related macular degeneration (nAMD), and macular edema secondary to retinal vein occlusions (RVOs). Methods: A prospective analysis was performed on consented patients with DME (Group 1), nAMD (Group 2), and macular edema secondary to RVO (Group 3). All patients received Razumab at baseline. Snellen visual acuity assessment, anterior segment and fundus evaluation, fundus photo, and optical coherence tomography imaging were done at days 0, 1, 7, and 30, respectively. The International Society for Clinical Electrophysiology of Vision standard electroretinography (ERG) was performed at baseline and day 30 (23 eyes who could afford the investigation). Primary and secondary outcome measures were safety parameters that included signs of clinical and ERG toxicity and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT), respectively. Results: One hundred and twenty-three eyes of 95 patients received biosimilar intravitreal ranibizumab injection between November 2015 and April 2016. No serious drug-related ocular or systemic adverse events were identified. Mean pretreatment BCVA was 0.67 ± 0.41 logMAR with CMT 345.90 ± 128.84 μm and postinjection BCVA at day 30 was 0.57 ± 0.37 logMAR with CMT reducing to 287.66 ± 90.28 μm, indicating statistical significance (P = 0.001 and P< 0.0001, respectively) for all groups. Conclusion: The biosimilar intravitreal ranibizumab for DME, nAMD, and macular edema secondary to RVO was tolerated over a month with improvements in BCVA and CMT without detectable ocular and systemic toxicity. While the long-term safety and efficacy remain unknown, these short-term results suggest that biosimilar ranibizumab could become a safe, low-cost therapy for macular diseases.

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Background: Creating awareness regarding eye donation is the prime factor responsible for promoting voluntary pledging and donation of eyes. Planning awareness campaigns is determined by the prevalence of dearth of understanding of eye donation. Aims and Objectives: To assess the awareness and perception among eye care seekers toward eye donation. Material and Methods: A cross-sectional study was conducted among patients attending ophthalmology outpatient department seeking eye care, using a predesigned, pretested, semistructured, selfadministered questionnaire. Results: The study group included 250 participants. The male to female ratio was 1:1. A total of 94.4% participants had heard about eye donation. A total of 71.7% were willing to donate their eyes; 90.3% had not pledged their eyes; 63.7% were ready to implement eye donation as a family custom. Willingness, consent, and wish to make eye donation as a family custom was more among males (P = 0.049), graduates (P = 0.013), Christians (P = 0.019), those who were aware of the subject (P = 0.00), and who were single (P = 0.00). Only 7.6% had faced discouragement from the society or kith and kin when pledging of eye was considered. A total of 66.1% knew about the existence of a registered eye bank in the institute. Nobility was the main motivation (87.7%). A total of 61.8% felt that donated eye can give vision to the needy. Conclusion: This study revealed that eye care seekers were well aware of eye donation with a favorable attitude towards it; most of them were inclined to pledge their eyes. Counseling of this receptive group and identifying interested candidates among them as volunteers for eye donation is helpful in promoting eye donation among the community.

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A 47-year-old patient with a swelling of the left upper eyelid, redness, proptosis, and defective vision of few days duration was seen in our clinic. The history, examination, and investigations were suggestive of cavernous sinus thrombosis complicating orbital cellulitis. The patient was admitted and treated by a team of specialists including ophthalmology, neurosurgery, and hematology. Patient recovered fully after 3 weeks of treatment. This case report is being presented to highlight the importance of careful clinical examination and high index of suspicion in recognizing such a serious complication.

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Myopic strabismus fixus is a rare condition seen in high myopes and presents with sudden onset of strabismus. This case report describes a high myopic patient who presented with acute onset strabismus and was successfully treated with loop myopexy of superior rectus and lateral rectus muscles.

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Aim: To analyze the demographic and clinical profile of patients attending the low vision clinic of a tertiary eye care facility in Kerala. Materials and Methods: This was a cross-sectional observational study at the low vision clinic of a tertiary eye care facility in Kerala between May 2007 and May 2016. Information regarding the demographic and clinical characteristics of the patients and low vision rehabilitation done were recorded. Results: Out of the total 916 new patients, 51.31% were males and 48.69% were females. Thirty-three percent were above 60 years, 26.24% were between 40 and 60 years, 16.11% were between 17 and 35 years. Mean age was 51.2 ± 23.5 years. Major etiological diseases were age-related macular degeneration (18.51%), diabetic retinopathy (18.1%), optic atrophy (14.2%), retinitis pigmentosa (13.03%), etc. A total of 39.94% were prescribed high plus spectacles, 35.64% stand magnifiers, 15.39% bifocal spectacles, and had 9.01% hand magnifiers. Conclusion: The demographic and clinical characteristics of low vision patients of the study population are similar to that of the developed countries. The barriers to utilization of resources need to be analyzed through further studies.

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Purpose: Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness. Identification of risk factors is essential for its early detection and management. Aim: The aim of this study was to analyze the incidence and risk factors of Retinopathy of Prematurity in preterm babies admitted in neonatal care unit over the period of one year. Materials and Methods: A clinical retrospective study was done among 259 preterm babies referred to our department from October 2014 to September 2015 for screening of ROP. Fundus examination with indirect ophthalmoscope (IDO) was done. Babies with manifestation of ROP were followed-up for progression and managed appropriately. Results: One hundred and forty-two (54.8%) babies were found to have ROP at various stages. In very low birth weight (VLBW) babies (<1000 g; n = 40), 34 (85%) had ROP, out of which 19 (55.9%) had significant disease. Among LBW neonates (<1500 g; n = 165), 108 (65.45%) had ROP, out of which 37 (34.3%) had significant disease (P < 0.05). In neonates less than 28 weeks (n = 33), 25 (75.8%) had ROP, out of which 14 (56%) had significant disease. Out of the 103 babies who had RDS, 61 (59.2%) babies developed ROP, out of which 20 (32.8%) had significant disease. Conclusion: Prematurity and LBW were found to be independent risk factors in development of ROP in neonates.

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Inflammatory macular diseases, a group of disorders, are a major cause of severe visual impairment. They may be caused by primary ocular disease or secondary to systemic or infectious disease. All of them present with almost similar symptoms. The key to successful management is early detection and aggressive treatment with steroids, antimicrobials, and if needed, immunosuppressives. Risk of recurrences and complications, such as choroidal neovascularization, are taken in to account in the management.

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Optical coherence tomography angiography (OCTA) is a non-invasive angiography type without a contrast agent, which provides a detailed assessment of the retinal and choroidal vasculature and visualization of blood flow by detecting motions of erythrocytes, using serial optical coherence tomography B-scans. As compared to gold standard techniques such as fluorescein and indocyanin-green angiography, OCTA offers two major advantages: no dye is required and depth resolution is required is provided. As such OCTA has the potential to improve our abilities to diagnose and monitor ocular vascular diseases.

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Real-time intraoperative optical coherence tomography (iOCT) integrated into the operating microscope can be used for optimizing the outcome of lamellar corneal surgeries. Surgical technique can be modified intraoperatively by its use, and surgical endpoint can be achieved in the operating room itself. We have successfully utilized the use of iOCT for refining the endpoint of surgical procedures such as deep anterior lamellar keratoplasty, descemet stripping automated endothelial keratoplasty, descemet membrane endothelial keratoplasty, and superficial anterior lamellar keratoplasty. Continuous iOCT imaging is a new technique that allows an accurate estimation of the depth of dissection, aiding in the modification of surgical planning.

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Aim: To study the effectiveness of prisms in relieving diplopia in patients with superior oblique palsies. Materials and Methods: This was a retrospective study of all patients with superior oblique palsies who were prescribed prisms for relief of symptomatic diplopia in our institute from September 2013 to March 2015. A detailed analysis was performed of demographic features of the patients; nature, onset, duration, and course of diplopia; measurement of deviation in all gazes; diplopia charting; assessment of torsion; systemic risk factors; and amount and type of prism given. The effectiveness of prisms was measured by an objective score by the examiner as well as a subjective score reported by the patient. Results: Among the total 25 patients, 21 patients had acquired superior oblique palsies and 4 patients had congenital causes. Males outnumbered females. Majority had unilateral involvement. Deviation in primary position ranged from 3 Prism Dioptre to 25 PD with 80% having less than 10 PD. Seventy-six percent had less than 10° torsion in primary gaze. Eighty-eight percent were given less than 10 PD prisms, 12% were given more than 10 PD, of which two were Fresnel Prisms. Seventy-six percent were satisfied with the prisms. Fifty-two percent had spontaneous improvement whereas 16% needed surgery. Conclusion: Prisms were effective in relieving diplopia in most of the acquired unilateral superior oblique palsies where the primary deviation was less than 10 PD and torsion was less than 10°.

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Hepatitis C virus (HCV) is a blood-borne RNA virus that causes hepatitis C, chronic liver disease, and hepatocellular carcinoma. Patients with HCV infection are now treated with a combination of interferon alpha, which has antiviral and immunomodulatory properties, and ribavirin, an antiviral medication included in the family of nucleoside analogs. Recently, a long acting form of interferon alpha (pegylated interferon) has been developed, which has a more sustained antiviral response. One of the ocular side effects of interferon alpha is proliferative retinopathy related to ischemia. Interferon-associated retinopathy is usually mild and resolves completely, but occasionally, it can become severe.

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Background: Eye sight is very important for human life. The World Health Organization (WHO) estimates that every 5 seconds someone goes blind. Globally, 37 million people are blind, and of these nearly 10 lakh blind people are willing for corneal transplantation. Aims: The aim of the study was to assess the knowledge, attitude, and practice regarding eye donation among the students. Materials and Methods: The data were collected by the questionnaire method from medical and paramedical students at Al Ameen Medical College, Bijapur. Data collected from the participants were analyzed using percentage and descriptive statistics. Results: Out of the 250 students, 60.4% were Muslim by religion. The participants were wellaware of eye donation (99.2%) quoting media as a major source of information for their knowledge. Attitude regarding eye donation in few (45.6%) was different as it was against their religious belief, although they said it was a service to the mankind (92%). Out of the 250 students, 48% were willing to pledge and 52% students did not believe in pledging their eyes. Conclusion: The findings of the study showed that overall knowledge about eye donation among students was good, however the attitude and practice showed mixed responses.

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Introduction: Both glaucoma and cataract often coexist in the elderly population. In these patients, a combined surgery has advantages such as improved vision and intraocular pressure (IOP) reduction in a single sitting. Aim: The aim of this study was to evaluate the effectiveness and safety of the combined procedure in patients with coexisting cataract and primary open or closed-angle glaucoma. Materials and Methods: A prospective study was conducted which included 20 eyes of 17 patients planned for phacotrabeculectomy procedure. Preoperative evaluation included detailed ocular examination for the grade of cataract, glaucoma evaluation, and exclusion of ocular comorbidities. A superior trabeculectomy with mitomycin C and temporal phacoemulsification with in the bag intraocular lens implantation was performed. Postoperatively, improvement in the best corrected visual acuity, IOP control, and reduction in the number of antiglaucoma medications was evaluated. Patients were followed for a 6-month period. Results: Postoperatively, all the patients had significant improvement in best corrected visual acuity (P < 0.0001) and significant reduction in IOP. The usage of antiglaucoma medication was lower (P < 0.0001) and 85% percent (17 eyes) had no complications. Conclusion: Combined phacoemulsification and trabeculectomy is an effective and safe procedure to provide good visual acuity and control of intraocular pressure at the same time.

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Purpose: To determine whether preoperative cone outer segment tips (COST) line, ellipsoid zone (EZ), and external limiting membrane (ELM) defects is significantly related with postoperative recovery of photoreceptors and vision after type 1 macular hole closure. Materials and Methods: A retrospective observational study was conducted on 28 eyes of 28 patients with surgically closed macular holes. Heidelberg's Spectralis optical coherence tomography (OCT) was used to obtain images of the foveal area, and lengths of COST line defect, EZ defect, and ELM defect were measured preoperatively and at 1 month, 3 months, and 6 months after surgery. The pattern of recovery of the photoreceptor layers was observed as complete recovery, incomplete recovery, or disrupted. Results: It was observed that 13 out of 28 eyes with a mean preoperative length of foveal COST line defect 303.8 microns, showed a significant visual improvement in the range of 0.17 logMAR units (6/9-6/6) with complete or incomplete recovery of the EZ and ELM. Twelve patients with mean preoperative length of foveal COST line defect 632 microns showed only slight visual improvement by one or two lines in the range of 0.47 logMAR units (6/18), with an incomplete pattern of photoreceptor recovery. However, 3 patients with a mean preoperative COST line defect of 815 microns did not show any visual improvement of 0.61 logMAR units (6/36) with EZ and ELM disruptions postoperatively. Conclusion: The length of preoperative COST line defect is predictive of the recovery and arrangement of photoreceptors and best corrected visual acuity after type 1 macular hole closure. Eyes with complete and incomplete recovery of COST, EZ, and ELM were associated with significantly better visual acuity as compared to eyes with a disrupted pattern of photoreceptor recovery.

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Neuroimaging has progressed from plain X-ray to magnetic resonance imaging, noninvasive angiography, and special sequences. Utilization of the appropriate investigation can save the sight and sometimes life of the patient. This article attempts to guide the ophthalmologist in choosing the most suitable modality in the different clinical scenarios.

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Retinoblastoma is the most common intraocular malignancy in childhood. It usually presents before 3 years of age and can be germinal or nongerminal. There has been a paradigm shift in the classification and management of retinoblastoma. This review provide the international retinoblastoma classification, latest classification of vitreous seeds, and current and newer treatment modalities such as intra-arterial and intravitreal chemotherapy.

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Purpose: To study the tomographic features of idiopathic polypoidal choroidal vasculopathy (IPCV) diagnosed on indocyanine green (ICG) angiogram using spectral domain optical coherence tomography (SDOCT). Design: This was a retrospective observational case series. Materials and Methods: Spectral domain optical coherence tomography (SD OCT) features of 50 eyes of 50 consecutive patients diagnosed as idiopathic polypoidal choroidal vasculopathy (IPCV) between January 2013 to January 2015 on ICG angiograms were studied. A qualitative analysis based on various tomographic features corresponding to the polypoidal lesions and branching vascular network on Spectrailis OCT was studied. Polyps were localized to subfoveal and juxtafoveal areas. These were later compared with SDOCT features of 15 eyes of 15 consecutive patients newly diagnosed as occult choroidal neovascular membrane (CNVM) on FFA/ICG. Results: Of the 50 eyes, sharp peak pigment epithelial notch (PED) was present in 49 eyes (98%); PED notch in 49 eyes (98%); a visible hyporeflective lumen with hyperreflective lesions adherent to the outer surface of the RPE in 48 eyes (96%), multiple PED in 44 eyes (80%), and diffuse PED in 44 eyes (80%); intraretinal hyperreflective dots representing hard exudates were seen in 44 eyes (88%). Surrounding OCT features such as intraretinal hyperreflective dots represent hard exudates, Cystoid macular edema and subretinal fluid were seen in 44 eyes (88%). Sub-RPE features such as PED with sheaths of internal reflectivity – branching vascular network in 19 eyes (38%) and prominent Bruchs membrane and surfacing of choroidal vessels was seen in 18 eyes (36%). At least 3 of the abovementioned OCT features were seen in all of the eyes diagnosed as PCV. The height of the PED ranged from 138–1300 μ (median = 422.2 μ). Of the 15 eyes, 80% showed presence of FVPED; multiple PED were seen in 33.3%; intraretinal hard exudates in 66.7%, and notch PED in 6.7%. Hyporeflective lumen with hyperreflective lesion under RPE was not seen in any of the eyes. The height of PED ranged from 118–339 μ (median = 164.28 μ). Conclusions: SDOCT-based features mentioned above allows detection of IPCV and differentiate it from occult CNVM. Our results suggest that SDOCT may be a useful noninvasive tool compared to ICG in detecting PCV, especially in places where ICG is not available or is contraindicated.

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