Polymerase chain reaction (PCR) is a revolutionary innovation involving enzymatic amplification of nucleic acid sequences in repeated cycles of denaturation, oligonucleotide annealing, and DNA polymerase extension. It is a unique molecular biologic tool that allows the rapid production of analytic quantities of DNA from small amounts of starting material. PCR can be performed on any ocular specimen or biopsy. The most common application of the PCR is human leukocyte antigen (HLA) typing. A universal bacterial PCR can be very helpful for the diagnosis of bacterial endophthalmitis at an early stage of the disease. There are also several advances in the application of PCR in the recent time, and this technology has opened a new era in the diagnosis and treatment of uveitis, enabling ophthalmologists to establish new clinical entities of uveitis caused by infectious microorganisms, identify pathogens in the eyes of many patients with uveitis, and determine prompt diagnosis and appropriate therapy.

Cataract surgery requires the use of multiple topical eye drops application in the pre and postoperative period. Certain strategies offer the patient and surgeon assured drug delivery without topical eye drop instillation avoiding the pitfalls of patient drug compliance, incorrect instillation, and topical drop-associated side effects. The aim of the current review is to evaluate the aspects of drop-free cataract surgery starting from intraoperative pupil dilation to intravitreal drug instillation.

Aim: To evaluate the damage pattern of retinal ganglion cells at different stages of glaucoma in patients with primary open-angle glaucoma (POAG) by observing peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell layer-inner plexiform layer (GCL-IPL) thickness measured by spectral domain optical coherence tomography (SD-OCT) and their correlation with visual field (VF) changes. Materials and Methods: Descriptive cross-sectional study done on patients with POAG presenting to a tertiary eye center in Eastern India. Peripapillary RNFL thickness and macular GCL-IPL thickness were measured using SD-OCT. VF assessment was done using the Humphrey Field analyzer. Patients were divided into early, moderate, and advanced (severe) groups following Hodapp, Parrish, and Anderson's criteria. Results: Seventy-seven eyes of 40 patients with POAG were included in the study. The average age of the patients was 59.23 ± 9.56 years. Early, moderate, and advanced glaucoma changes were seen in 34 (44.15%), 23 (29.87%), and 20 (25.98%) eyes, respectively. Superior peripapillary RNFL thinning was noted in early glaucoma. As the disease progressed, inferior peripapillary RNFL showed significant thinning in the advanced glaucoma group as compared to early and moderate groups. Inferior macular GCL-IPL thickness showed more thinning as the severity of the disease progressed. In all stages of glaucoma, peripapillary RNFL and GCL-IPL thickness showed positive correlation with the VF mean deviation. Conclusion: Both peripapillary RNFL and macular GCL-IPL thicknesses should be assessed along with VF defects to monitor the severity of the disease in POAG. Macular GCL-IPL thickness changes are well correlated with changes in visual function and RNFL structure in glaucoma.

Purpose: This study aims to analyze the different etiologies of ectropion and entropion and helps in understanding the anatomical abnormalities responsible for the occurrence of entropion and ectropion, which is key to planning a successful surgical procedure. Methodology: It is a prospective study of 40 patients with ectropion and entropion studied for 17 months. Detailed slit lamp examination of lid abnormality, keratinization, trichiasis, corneal exposure was performed and axial length was measured. Results: The prevalence of ectropion and entropion put together was 0.064%. Paralytic ectropion ranks first among the different etiologies occupying 65.38%. The senile cause is the highest (78.57%) among the etiologies of entropion. The mean axial globe length of affected eyes in senile ectropion is 21.96 mm and in senile entropion is 20.73 mm. Conclusion: Eyelid malpositions have a low prevalence of 0.064%. The difference in the mean axial globe length between senile ectropion and entropion for this small sample size was found to be statistically significant. The overall percentage of conjunctival and corneal complications was found to be significantly higher in ectropion than in entropion.

Aim: This study aims to assess the various ocular and systemic complications of peribulbar block in supine posture among patients undergoing cataract surgery in a tertiary care center in Chennai. Materials and Methods: A retrospective analysis of complications that occurred in 880 patients who had been given peribulbar block in supine posture, during 36 months between January 2016 and January 2019 among patients who underwent cataract surgery at a tertiary care hospital. Patients with uncontrolled diabetes mellitus, hypertension, bronchial asthma, and cardiac illness were excluded from the study. The other exclusion criteria were pediatric age group and trauma. The data thus collected from the records were entered and analyzed using descriptive analysis. Results: Out of 880 patients operated in a 36-month period at Government Medical College Hospital who received peribulbar block in the supine posture, 42 (4.77%) patients had block-related systemic complications; bradycardia and vasovagal attack-40 (4.54%) patients; brainstem anesthesia and syncope-2 (0.22%). The incidence of orbital complications was 82 (9.31%). Out of the orbital complications, the most common complication was periorbital hematoma occurred in 50 (5.68%), followed by retrobulbar hemorrhage occurred in 32 (3.63%). Conclusion: The observation-based conclusion is various ocular and systemic complications can occur in peribulbar block. Hence, the operation theatre should be equipped with appropriate instruments and trained personnel to deal with all kinds of emergencies.

Purpose: The aim of this study is to assess spontaneous healing of the conjunctival donor site after primary pterygium surgery and its implications. Materials and Methods: This was a prospective study of one hundred primary pterygium surgeries with superior conjunctival autografting. Ninety nasal pterygia, eight double-headed pterygia, and two temporal pterygia were included. The conjunctival epithelialization in the donor harvest site, corresponding superior limbal pigmentation, presence of any visible scarring, and mobility of the conjunctiva were documented after the surgery. The patients were reviewed on day 1, day 4, at 1 week, and 1 month after surgery, and then followed up every 4 months for a minimum of 2 years. Mean with standard deviation, percentages, and paired sample t-test were the statistical methods employed in the study. Results: Progressive pterygium with corneal involvement (87%) was the most common indication for surgery. Conjunctival epithelization was complete at the donor site within a week of surgery in all cases. At 1 month, there was no scarring or vascularization at the donor site in any of the cases. The limbus appeared intact with its pigmentation. The healed conjunctiva showed good mobility in all the cases. These were confirmed on anterior segment optical coherence tomography. There were no donor site-related complications. These findings remained stable over 2 years. Conclusion: Not closing the donor harvest area seems to allow spontaneous donor site healing in uncomplicated primary pterygium excision surgery with a superior conjunctival autograft. This avoids in-folding of unequal tissues and resultant scarring. An undisturbed Tenon's layer at the donor site acts as a scaffold for smooth conjunctival healing. The healed conjunctiva remains mobile with an intact limbus.

Purpose: Phacoemulsification has gained its importance with time due to its various benefits; however, it has one worrisome side effect which results due to endothelial pump failure, following surgery being corneal edema. This manifests as changes in central corneal thickness (CCT) which may further lead to falsely elevated intraoperative pressure (IOP) and ultimately hampering the vision; hence, the purpose of the study was conducted to find out the changes in CCT value following surgery. Materials and Methods: Randomly, 50 patients were considered for the study. It was a prospective hospital-based study, wherein patients were evaluated over a period of 1 month. Patients with right eye cataract considered as the case and left eye serving as the control were taken for the study. CCT measurements were recorded using pachymeter preoperatively, 1 h postoperatively, and on day 1, day 7, day 14, day 21, and day 30 postoperatively, and the findings were recorded. Surgical Procedure: Patients with right eye cataract grading of 2–3 nuclear sclerosis were taken for phacoemulsification cataract surgery. Before taking for the surgery, the preoperative CCT measurements using pachymeter were taken in all the quadrants and noted. Phacoemulsification was performed using the bevel-down phaco tip. Machine used was Oertli phacoemulsification catarhex. Sodium hyaluronate 1.4% was used as the viscoelastic substance. Phacoemulsification of the nucleus was performed with the help of phaco chop technique, with a 0° 20-gauge phaco tip. The nucleus was stabilized with phacoemulsification tip bevel down. The nucleus was broken down into several pieces and was aspirated and irrigated. Incision was secured with stromal hydration and eye was patched. Postoperatively, patients were advised to put topical antibiotic and steroids. After an uneventful phacoemulsification surgery, CCT was measured by the same surgeon immediately 1 h postoperatively, and patients were followed up on postoperative day 1, day 7, day 14, day 21, and day 30. Results: The CCT measured with the mean value of 606.04 ± 6 μm in postoperative day 1; on day 14, the CCT mean value was 553.81 ± 4 μm, and over a period of 1 month, the CCT value mean value was 544 ± 2 μm. It can be observed that the CCT measurement gradually decreases with time and returns to near-normal state on day 30. Conclusion: In our study, it was noted that the CCT value decreases gradually and returns back to near-normal value on day 30.

Endophthalmitis due to Bacillus species can be associated with devastating consequences. In the present case series, two-each cases of postoperative and traumatic endophthalmitis were included. Prompt surgical intervention was done in all cases. Bacillus cereus and Bacillus subtilis were isolated in 3 cases and 1 case, respectively. All isolates showed 100% sensitivity to vancomycin, ciprofloxacin, and clindamycin. In spite of early intervention, final functional and anatomical outcomes were poor in all four cases.

Marcus Gunn Jaw Winking Ptosis is a congenital ptosis associated with synkinetic movements of upper lid on masticating movements of the jaw. It is usually unilateral but rarely presents bilaterally. In this study, ten cases of unilateral ptosis since birth with moderate to severe degree movement of lids along movement of jaws (MGJW-Marcus Gunn Jaw Winking) presenting to Oculoplasty department were evaluated and managed according to the degree of jaw winking phenomenon and their outcomes were observed. The amount of jaw winking is the excursion of the upper lid in mm with the opening of the mouth. Ocular associations include strabismus (50-60%), anisometropia (5-25%) and amblyopia (30-60%). The cause for underlying amblyopia could be secondary to strabismus, anisometropia, or occlusion by the ptotic lid. It is graded into mild (maximum 2 mm), moderate (2 mm-5 mm) and severe (higher than 5 mm). Persistence of minimal jaw-winking phenomenon post-operatively after levator detachment. Frontalis sling is the most common procedure used to correct the ptosis following the obliteration of levator action. MGJWS mostly presented as moderate to severe jaw winking synkinesis of upper eyelid and accompanied by moderate to severe blepharoptosis. Eyelid excursion of jaw winking has direct correlation with ptosis and levator dysfunction. Unilateral levator aponeurosis excision with frontalis suspension is an effective surgical approach in the management of unilateral MGJWS, which achieved both satisfactory symmetrical outcome and resolution of jaw winking with eye movement.

The adverse reactions of high-dose exogenous steroid administration are well documented, and central serous chorioretinopathy (CSCR) is one among them. Steroid-induced CSCR has a different clinical profile when compared to idiopathic CSCR and poses a unique clinical challenge, especially when encountered during the management of posterior-segment inflammation such as optic neuritis and posterior uveitis. The clinical course of steroid-induced CSCR is variable and is not dose dependent. Management options include observation, cessation of steroids when permissible, focal laser, photodynamic therapy, and switching to alternative immunosuppressive therapy. We describe a case of steroid-induced recurrent bilateral CSCR during the treatment of unilateral isolated retrobulbar neuritis in a young male, its clinical course, and management. Our case emphasizes the importance of obtaining prior informed consent explaining the possible side effects of high-dose steroid therapy, and documentation is very important for the management of these complex case scenarios.

Hansen's disease is a chronic granulomatous disease caused by Mycobacterium leprae which is known to affect the cooler regions of the body. Posterior segment involvement is very rare. We present a case of a leprosy patient with a posterior segment manifestation, panuveitis, and anterior uveitis. The disease is still a significant health problem in developing countries like India. Even completion of anti-leprosy multidrug therapy does not seem to prevent the development of disabilities. Hence, early recognition with proper management is essential.

We report a case of bilateral keratoconus with posthydrops scarring in a 40-year-old female denying perception of light (PL) in both eyes. She underwent corneal tattooing in the left eye for cosmetic purpose. Preoperative corneal thickness at the site of scar was 374 μ. Corneal tattooing was carried out using stromal puncture technique with microneedling device and triple black dye (Dynamic color co, USA). One-month postoperatively cosmetic results were promising. Cases with corneal thinning carry a risk of corneal perforation with dye diffusion into the anterior chamber causing hypotony and severe uveitis. With well-adjusted needle length and technical expertise, we can give excellent cosmetic results even in cases with minimal corneal thickness.

We report the case of a 73-year-old woman who sustained left orbital injury following a fall over a bush, 2 days ago. Computed tomography (CT) of the orbit demonstrated preseptal soft tissue swelling along with a low-attenuation streak of air density focus abutting inferior rectus muscle, mimicking emphysema. The presence of a wooden foreign body was suspected, and magnetic resonance imaging (MRI) was advised. Subsequently, a wood splinter measuring 26 mm × 6 mm was removed on surgical exploration. Low-density signals relative to surrounding orbital fat on CT scan should evoke suspicion of a retained wooden foreign body. Early clinical suspicion and adjunctive MRI scan would help in recurrence-free treatment.

Laissez-faire is a technique of natural healing of raw wound. It has not become popular or not considered as the first-line treatment in view of the unexpected cosmetic outcomes. However, this technique is being advised regularly for certain lesions where the regular reconstruction techniques are not feasible. We present this case in which the regular reconstruction failed and as a blessing in disguise during the pandemic natural healing happened in a beautiful way.

A 58-year-old male came to the ophthalmology outpatient department with complaints of blackish discoloration in both eyes, which he noticed 6 months back. He had a history of bilateral knee pain and stiffness for 6 months, for which he was admitted in the orthopedics ward and planned for total knee replacement, since he was diagnosed to have bilateral OA knee. On examination, his BCVA was 6/9 in both eyes. In the interpalpebral area, there was a grayish conjunctival and scleral pigmentation seen in both the eyes in the perilimbal area at the lateral rectus insertion, which showed typical Osler's sign suggestive of alkaptonuria. Cornea was clear with a quiet anterior chamber. The pupil was round and reacting to both direct and indirect light reflexes, and there were early cataractous changes in the lens. Fundus examination with an indirect ophthalmoscope showed normal optic disc and vessels in both eyes. This is a classic case of alkaptonuria having typical signs. Many cases of alkaptonuria were diagnosed only after the development of symptoms. Scleral pigmentation usually starts during the mid-twenties; hence, being aware of this, ocular sign in alkaptonuria can lead to an early diagnosis and better outcome.

Systemic hypersensitivity reactions to topical ophthalmic treatment occur rarely, but when they do, they can be severe as highlighted by this case. A postoperative cataract surgery patient developed a severe and generalized hypersensitivity reaction following topical treatment with moxifloxacin eye drops. This case report emphasizes the importance of a thorough drug and ABS allergy history when patients are seen at preassessment or checked in for surgery.

A 35-year-old female presented with severe headache and left-sided hemifacial spasm to the ophthalmic outpatient department. Ocular examination revealed normal visual acuity and color vision, with a presumably normal posterior pole in OU, except for parafoveal central serous chorioretinopathy (CSCR) in OD. Infrared imaging of both fundi revealed generalized retinal pigment epithelial (RPE) mottling, despite the color fundus appearing apparently normal in OU. Complete history taking, systemic workup, and hematological workup was performed and was normal, except for severe Vitamin B12 deficiency. Visual evoked potential was performed and showed delayed latency in OU, diagnosing subclinical demyelinating optic neuropathy. The patient was then started on methylcobalamin 1500 mcg and was reviewed. Signs resolved completely at 1 month follow-up. RPE disturbance (due to severe Vitamin B12 deficiency) may be a possible indirect contributor for CSCR. Hence, Vitamin B12 deficiency manifesting as bilateral optic neuropathy with extensive RPE mottling should be closely monitored for the evolution of CSCR.

Ocular trauma is one of the leading causes of ocular morbidity all over the world. The most dreaded among this is penetrating trauma, one that can scare even the most experienced of eye surgeons. It requires immense skill on the part of the surgeon to restore the structure and function of the globe. Most penetrating traumas that affect the eyelid also penetrate the globe. It is very rare for an object to penetrate the lid and spare the globe. In this case series, we would like to present two cases of penetrating injury, wherein a fish hook in one case and glass shard in another, pierced the eyelid and missed the globe by a whisker. We would also want to discuss our line of management in tackling this case.

Among the umbrella of drugs postulated for COVID-19 treatment, chloroquine and hydroxychloroquine (HCQ) are currently being used in the management of COVID-19–positive patients in India. Hydroxychloroquine (HCQ) retinopathy is a known but a rare adverse effect when used in autoimmune diseases. However, advanced age, comorbidities (such as diabetes, obesity and cardiovascular disease), and patients taking subsequent comedications could be potentially more susceptible. We present a unique case history of patient suffering from reversible blurred vision probably due to HCQ in a COVID-19 patient.

A 35 years old presented with complaints of distortion of vision since 1 week and difficulty in night driving since 1 month in both the eyes(OU). BCVA was 6/6, N6 slit lamp was normal OU. Fundus showed multiple white lesions, glistening retinal reflex. Optical coherence tomography revealed incomplete foveolitis with sensorineural detachment. On further enquiry, patient gave history of dengue fever 1.3 years back which was treated. Fundus reports revealed placoid lesions OU without hemorrhage change. Fundus fluorescent angiography confirmed the findings. Thus a diagnosis of acute multifocal placoid pigment epitheliopathy with residual post dengue foveolitis was made. A course of steroids was started following which the symptoms improved.

Ocular trauma is among the common causes of dislocation of lens. An eleven year old male child having history of getting operated on his right eye for congenital cataract with implantation of intraocular lens as well as for subsequent retinal detachment in later phase of life, presented with complains of decreasing vision and pain in right eye after having encountered a blunt trauma. Alongside an anteriorly dislocated IOL and herniated silicone oil bolus in the anterior chamber gave the appearance of a polypseudophakia. Complete clinical examination along with a detailed history is the way for avoiding gross clinical misdiagnosis and thus employing appropriate management.

Ocular trauma is a disabling but preventable cause of blindness which can lead to disproportionate personal, social and economic handicaps. This snapshot deals with individuals belonging to different cohorts: a young child and an elderly lady who inadvertently injured their eyes by thorns. Peculiarity about the thorns' trajectory was such that the large-sized thorns pierced the outer coats of the eye without actually puncturing them. Rapid diagnosis and management ensured the quick anatomic restoration and visual recovery.