Context: Inferior oblique (IO) weakening is one of the commonest surgical procedures on the oblique muscles. Purpose: To compare the results of two IO weakening procedures, myectomy, and anterior transposition, done for IO over-action and dissociated vertical deviation (DVD). Setting and design: Tertiary eye-care center. Retrospective review Materials and Methods: Patients operated for IO over-action and DVD were studied. All patients had undergone a comprehensive ocular examination with full orthoptic evaluation and cycloplegic refraction. In the anterior transposition of IO, the IO muscle was recessed from its insertion and placed lateral to the insertion of the inferior rectus. In myectomy, the IO tendon was cut at two sites 5 mm apart and the cut ends cauterized and left free. The outcome measure was pre and post-operative IO action measurement. Statistical analysis: T-test. Results: Eighty six children (128 eyes) underwent IO weakening procedures, 81 (62.4%) were myectomy and 47 (36.2%) were anterior transpositions. The average age was 8.9 years (standard deviation, SD 3.51), 53 (61.6%) were girls. Twenty-three had DVD and 42 patients had bilateral IO surgeries. Thirty-eight (44.2%) had esotropia and 47 (54.6%) had exotropia co-existent; one had only primary IO over-action. The pre-and post-operative IO over-action was 1.61 and 0.59 for myectomy and 1.61 and 0.29 for anterior transposition, respectively. On comparing the pre- vs post-IO action, P < 0.001 for both techniques, but post-operative anterior transposition versus myectomy had P = 0.156 by the t-test. Conclusion: Both techniques were effective and the difference between the two techniques was not statistically significant.

Aim: To identify cause, demographic and clinical profile, and evaluate final visual outcome of ocular trauma in pediatric age-group (= < 15 years) patients attending casualty. Materials and Methods: Prospective interventional study was carried out in rural area of Marathwada during July 2012-June 2013 where children up to 15 years with history of ocular trauma attending the casualty were included. Demographic details like age and sex, activity at time of injury, identifiable objects causing injury, presence or absence of supervision during injury were noted with follow-up period of 60 days. Results: In our study, total 79 patients with 94 eyes were enrolled. The age-group more affected was 5 years and above (65%, i. e., 61 eyes) than 5 years and below (35%, i. e., 33 eyes). Boys (57%) were affected more than girls (43%). Adnexal injuries found in 51% eyes, whereas closed and open globe injuries in 41% and 8%, respectively. Most of children reported to casualty within 24 hours (86% eyes), remaining after 24 hours (14% eyes). The objects causing injury were projectile objects (20%), blunt objects (14%), household objects (10%). The other causes of injury were sports (16%), accidental fall (15%), chemical and road traffic accidents (RTA) (8% each), burn (4%), animal bite (3%), and assault (2%). Best corrected visual acuity (VA) of more than 6/18 achieved in 68% eyes, 6/18-6/60 in 12% eyes, < 6/60-counting finger close face (CFCF) in 8% eyes, projection of light (PL) + perception of rays (PR), and no PL in (1%) each eyes. Most of the ocular injuries occurred at home (53%), at playground (16%), accidental fall (14%), and others. Conclusion: The age-group affected was 5 years and above. Boys were affected more than girls. The time of reporting to casualty was within 24 hours. Projectile objects, blunt objects, and household objects were common causes of injury. The places of injury were home, playground, and others. Most of the children achieved best corrected visual acuity (BCVA) more than 6/18.

Purpose: This study was initiated to assess the impact of outside environmental humidity on the refractive and visual outcome of laser-assisted in situ keratomileusis (LASIK) in myopic eyes. Materials and Methods: One thousand and fifty-two eyes of 1,052 consecutive myopic patients (419 males and 633 females; mean age at surgery 35.0 ± 9.0 years) with mean preoperative refractive spherical equivalent (SE) of −3.88 ± 1.85 diopters (D) were studied. Two subgroups were defined, which had undergone surgery either during meteorological winter or summer. Result: By 1-month (33.0 ± 5.0 days) follow-up, a mean postoperative SE of −0.18 ± 0.44 D was obtained. Bivariate comparison showed that statistically significant better safety index (SI) was obtained for high outside environmental humidity. Robust regression methods indicated high humidity to be associated with significant better SI and postoperative SE. No change of more than one line on logMar scale was obtained. Conclusion: Although being statistically significant, there is no clinically relevant difference in outcome of LASIK, which demonstrates its highly standardized quality. However, we observed a tendency that high outside environmental humidity at the day of LASIK and during early perioperative time, tends to produce better refractive outcome. Prospective, longitudinal studies are warranted to address meteorotropic reactions through evaluating individual risk profiles.

Context: Pregnancy-induced hypertension (PIH) is one of the common complications met with pregnancy and contributes significantly to maternal and fetal mortality and morbidity. Aims: To grade the ocular fundus changes in patients of pre-eclampsia and eclampsia. Settings and Design: Hospital-based prospective observational study. Materials and Methods: Hospital-based prospective observational study conducted over a period of 2 years. One hundred patients of pregnancy having pre-eclampsia and eclampsia were included. Statistical analysis used: Chi-square test. Results: Out of 100 cases, 32 (32%) had mild pre-eclampsia while 50 (50%) had severe pre-eclampsia. Eighteen (18%) patients had eclampsia. Out of 100 cases examined in this study, 54 presented with ocular symptoms and 46 were asymptomatic. Arteriolar attenuation was the most common retinal change observed and it was seen in 44 (44%) cases. Exudative retinal detachment was seen in 7 (7%) cases and macular edema was present in 12 (12%) cases of PIH. Conclusions: Cases of severe pre-eclampsia and of eclampsia showed higher grades of retinal changes. Visual disturbances and symptoms like headache were commonly associated with retinal changes. It is essential to examine each and every patient of pre-eclampsia and eclampsia for ocular manifestations, which should be helpful for obstetrician in the management of patient.

Introduction: Systemic diseases such as hypertension and diabetes mellitus (DM) have been identified as the risk factor for glaucoma. However, there is minimal knowledge on the impact of systemic diseases on severity of glaucoma. This study aimed to determine the association between systemic disease and systemic treatment and severity of glaucoma. Materials and Methods: A cross-sectional study was conducted involving 298 primary open-angle glaucoma (POAG; 169 high tension glaucoma (HTG) and 129 normal tension glaucoma (NTG)) patients presented at the eye clinic of two tertiary hospitals in Malaysia between March and August 2012. The severity of POAG was based on Hodapp-Parrish-Anderson'(HODAPP) classification on Humphrey visual field 24-2 analysis. Only the right eye was selected when both eyes were eligible. Systemic diseases and treatment were retrieved from medical record or traced from the private practitioner or health clinic. Results: Systemic hypertension was the commonest systemic disease (56.4%) among POAG. There was no significant association between systemic diseases and severity of POAG. More than two systemic diseases were found in43.8% of patients with mild glaucoma. There was also no significant association of systemic treatment such as systemic antihypertensive drugs with severity of glaucoma. Conclusion: Systemic diseases such as systemic hypertension are not associated with severity of POAG. In fact, the presence of systemic disease (sick body) may lead to early detection of glaucoma (sick eye).'Sick body' may prevent 'sicker eye'.

Total ophthalmoplegia can occur due to malignancy, inflammation, infection, and trauma. Nasopharyngeal carcinoma is a tumor arising from epithelium of nasopharynx which can spread locally as well as metastasize to distant sites. We report a case of total ophthalmoplegia in a 15-year-old girl which resolved following chemotherapy. She was diagnosed as stage IV B nasopharyngeal carcinoma with left-sided intraorbital extension leading to proptosis and total ophthalmoplegia with preserved optic nerve function. Following 2 months of chemotherapy, a reduction in the size of cervical lymph nodes, proptosis, and total resolution of extraocular movements was noted.

Idiopathic intracranial hypertension (IIHT) is a headache syndrome characterized by elevated intracranial pressure with normal cerebrospinal fluid (CSF) content, normal neuro imaging with optic disc edema. Optic disc drusen (ODD) presents a diagnostic challenge as it can mimic disc edema. Although the appearance of ODD and disc edema can at times appear similar, the etiology and treatment of these two conditions differ. We report a case of young non-obese female who was referred for headache and on imaging had coexistence of ODD and IIHT.

We report a novel management technique in case of advanced vitreomacular traction which avoids deroofing of macula and prevent the formation of iatrogenic macular hole. The primary treatment modality in the management of such cases is pars plana vitrectomy with posterior vitreous detachment (PVD) induction and with or without membrane peeling. We performed pars plana vitrectomy with minimal induction of PVD and release of traction all around the macula. No membrane peeling was done due to risk of deroofing of the macula and formation of iatrogenic macular hole. Postoperative course was stable with improvement in visual acuity (VA) and flattening of macula. This technique marked an alternative surgical approach in treatment of advanced vitreomacular traction.

Thrombolytic therapy has been a major advance in the treatment of acute myocardial infarction to achieve coronary reperfusion and improve survival. Bleeding is the most common complication following thrombolytic therapy which can occur spontaneously and at multiple sites. We report a case of orbital and subsequent intracranial hemorrhage in a 55- year old male who had undergone thrombolytic therapy for suspected myocardial infarction. He presented with severe proptosis and visual loss 6 hours after thrombolysis. Urgent orbital decompression in the form of lateral canthotomy and cantholysis resulted in visual recovery. The possibility of orbital hemorrhage should be considered in any patient presenting with proptosis and visual loss after administration of systemic thrombolytic agents. Also, Ophthalmologists and emergency physicians should be familiar with the technique of lateral canthotomy and cantholysis for orbital decompression since prompt treatment is essential to prevent permanent visual loss.

Slit lamp photography has become more accessible and popular after the advent of digital cameras and smart phones. We describe a simple homemade adapter to provide hands-free smart phone slit lamp photography. The cost of the adapter is nominal and the image quality is very good and can be used for academics and patient education.