Glaucoma drainage devices (GDD) occupy an important place in the surgical management of glaucoma that is not responding to medications and trabeculectomy operations. In certain conditions, such as neovascular glaucoma, pediatric glaucoma, iridocorneal endothelial syndrome, penetrating keratoplasty with glaucoma, glaucoma following retinal detachment surgery, it has become the preferred operation. GDD create an alternate aqueous pathway from anterior chamber by channeling aqueous out of the eye through a tube to subconjunctival space. Glaucoma drainage implants that have been used extensively include the non-restrictive and restrictive drainage devices. This article outlines history of implants, types of implant, surgical technique of implantation, various complications following GDD insertion and their management.

Objectives: To study the susceptibility patterns of clinical isolates of Aspergillus species to amphotericin B and voriconazole. Materials and Methods: Fifty isolates of Aspergillus species (21 A. flavus, 14 A. fumigatus and 15 A. niger) from keratitis cases were tested for their susceptibilities to amphotericin B and voriconazole by a broth microdilution method, standardized in our laboratory. The relative MIC ₅₀ units were calculated from the absolute MIC ₅₀ (μg/ml) upon topical prescription dose in gm/100 ml. Results: The MIC values of amphotericin B for A. fumigatus and A. niger ranged between 0.2 mg/L to 6.25 mg/L (MIC _50; 1.56 mg/L and MIC _90; 6.25 mg/L) and for A. flavus between 0.78-6.25 mg/L (MIC ₅₀ and MIC _90; 6.25 mg/L). MICs of voriconazole for A. fumigatus were in the ranges of 0.1 to 0.2 mg/L, for A. niger 0.05 to 0.2 mg/L (MIC ₅₀ and MIC _90; 0.2 mg/L for both fungi) and against A. flavus 0.05 to 0.39 mg/L (MIC ₅₀ ; 0.2 mg/L and MIC ₉₀ ; 0.39 mg/L). The relative MIC ₅₀ of voriconazole against all the three Aspergillus species was 0.002, compared to those of amphotericin B which were 0.104 against A. fumigatus and A. niger and 0.416 against A. flavus. Conclusion: Voriconazole had lower MIC values and relative MICs than amphotericin B against Aspergillus species, the commonest fungi causing keratitis in this part of the country. Combined with its reported higher bio-availability, it appears far superior to amphotericin B for the treatment of fungal keratitis.

Purpose: To compare the conjunctival epithelial morphology after two types of pterygium excision procedures. Materials and Methods: Twenty-seven eyes of 22 patients with primary pterygium were randomly assigned to bare-sclera with intra-operative mitomycin C (MMC 0.02% for 60 seconds; group I) and pterygium excision with conjunctival autografting (group II). Controls were healthy eyes of age- and sex-matched subjects. Impression cytology was performed preoperatively, and at 2 weeks, 1, 3, 6, and 12 months after surgery. At each visit, any recurrence or complications were looked for. Result: There was no recurrence with conjunctiva lautograft. Though one eye had recurrence in MMC group, none showed any serious complications like corneal or scleral melting, glaucoma, or cataract. Pterygium excision wounds healed in a similar four-stage process in both the groups, but at different rates and with different final results. The nucleus-to-cytoplasm (N/C) ratio was highest at about 1 month postoperatively in group 1 and at 2 weeks in group 2, before gradually returning to control levels. Preoperatively, the goblet cell density (GCD) in treated eyes was almost twice than that in control eyes (P = 0.001), but fell to zero immediately postoperatively. Goblet cells first appeared (with rapidly increased density) in group II. At 12 months, the mean GCD in group II was not significantly different from those in controls, whereas the mean GCD in group I was still less than that of control (p = 0.02). Conclusion: A single application of mitomycin c after pterygium excision in the concentration of 0.02% for duration of 60 seconds is not associated with serious complications. Conjunctival autograft prevents corneal recurrence more effectively than MMC. Goblet cell density is markedly reduced by mitomycin c. Even 1 year after surgery, the ocular surface remains abnormal with respect to epithelial phenotypes in eyes treated by any of the two techniques.

Though, Conjunctivo-limbal auto-graft is the most accepted adjuvant to prevent recurrence of pterygium, has its own limitations like difficulty to cover large defect and to preserve for future glaucoma surgeries, necessiating to find an alternative especially, in young patients. The outcomes between amniotic membrane transplantation (AMT) and conjunctivo-limbal auto graft transplantation (CLAT) as an adjuvant following excision of primary pterygia from Jan. 2010 to Dec.2010 were compared. Twenty four patients had AMT and 28 patients had CLAT after pterygium excision and followed for minimum of 12 months; evaluated in terms of recurrence or complications. We had 44% young (<40yrs) with 58% female. Epithelial healing occurred within a week. AMT cases showed 8% recurrence, nil in CLAT but, with 2 cases of pyogenic granuloma. We conclude that, AMT as an adjuvant would be a viable option reserving CLAT for those with recurrence or as a last resort especially, in younger patients.

We report a case of 56-year-old female who had undergone left eye small incision cataract surgery 2 months earlier with history of no visual gain uncorrected after surgery. On examination, she had a superior scleral tunnel incision with 6.5 mm optic poly methyl metha acrylate (PMMA) posterior chamber intraocular lens (IOL) in the bag. Her manifest refraction was -5.0 diopter sphere and -3.0 diopter cylinder (DC) at 180°. Her visual acuity improved from 20/200 to 20/20 after correction. The patient underwent explanation of the PMMA IOL with implantation of 23.5 D Acriol EC-T4 toric IOL through temporal clear corneal incision. Postoperatively, at 6 months, the patient had 20/20 (p) visual acuity uncorrected improving to 20/20 after correction by -0.25DC at 40°. Postoperative ammetropia and high cylindrical power can be simultaneously corrected by placement of the toric IOL.

We report a case of 61-year-old male who presented with scleral abscess, an unusual complication following intravitreal bevacizumab and triamcinolone injection. Patient was presented with redness, pain, foreign body sensation, and swelling in left eye 1 week post-intravitreal injection for second opinion. We treated him with topical and oral antibiotics. In our case, the small, localized abscess was confined to the site of the intravitreal injection, required no surgical intervention, and resolved on oral and topical antibiotics. To the best of our knowledge, scleral abscess has not been reported in literature as complication post-intravitreal injection, hence we report this case.

In our retinopathy of prematurity (ROP) screening program we found that babies tended to show poor, erratic and variable response to mydriatic drug instilled prior to ROP screening. We compared the adult Single-lid Retraction by Thumb Method (SRTM) with two-thumb-retraction-method (TTM) and the two-bud-instillation-method (TBM). Thirty instillations each for the three methods were studied using computerized randomization. Neonates with plus disease, Iris neovascularization and threshold ROP were excluded from study. Instillations were carried out by nurses and residents, who rated the ease of administration on a 5 point Likert Scale administered as a visual analog scale (5 = fully satisfied and 1 = fully dissatisfied). The instillation was rated as successful if the drop was instilled in the cul de sac and unsuccessful if delivered outside it in the first attempt. Second attempts and change of technique were considered unsuccessful. The percentage of successful instillations in the first attempt was 36.7% in SRTM, 70.0% in TTM and 83.3% in TBM (χ² = 14.928, P = 0.001; Chi-square test). The mean ranks for the ease of administration were 43.02, 57.00, and 36.48 for the SRTM, TTM, and TBM methods respectively (H(2) =10.367, P = 0.006; Kruskal-Wallis test). SRTM failed in most cases on first attempt (67.3%). TBM was significantly more difficult than TTM or the SRTM. SRTM should not be recommended for infants and neonates in pediatric ophthalmology practices and ROP screenings in nurseries. However, larger studies are required to validate the findings of present study.

The basics of orbital magnetic resonance imaging (MRI) has been discussed in the previous issue. This article is in continuation of the previous article, and deals with the systematic approach towards the diagnosis of various orbital pathological lesions. It starts with the concept of various compartments in the orbit with their boundaries, followed by the mention of different lesions occurring in those compartments. The representative pictures of MRI orbit is also being provided with their main features on MRI of some commonly occurring pathologies of orbit. The purpose of this article is to impart the skill amongst ophthalmologists of interpreting orbital MRI.

Tissue glue is increasingly becoming a choice of material as an adjuvant to surgical wound closure in ophthalmology. Each of the type of glue is unique in terms of its advantages as well as limitations and so is used in different indications. Although the presently available tissue adhesives are good enough for the procedures mentioned, there is still a demand for newer adhesives. The increasing acceptance of these adhesives by the clinicians promises this to be a standard procedure for surgical wound closure. The existing cyanoacrylate glue is mainly used as a corneal patch to seal acute corneal perforations and improve visual outcomes, with reduced enucleation rates and need for tectonic keratoplasty in many situations. Fibrin glue is a biological adhesive, which reduces the total surgical time. The multiple advantages has extended its use in all the superspeciality fields of ophthalmology like corneal and conjunctival surgeries; strabismus, cataract, refractive, glaucoma, and even retinal surgeries. A newer tissue adhesive like biodendrimers and photocrosslinkable ones has better biocompatibility, rapid sealing properties and increased binding forces. It promises to overcome the drawbacks and risks associated with the existing ones but still under research. The increasing acceptance of all these promises it to be a standard procedure for surgical wound closure and probably will introduce a newer modality for drug delivery. In this article, we tried to review the literature with internet and medlines search for the available adhesives, as well as the upcoming ones with promising applications in ophthalmology.

The continued development of new intraocular lens (IOL) material and design has provided cataract surgeons more lens-based options than ever before. Surgeons must carefully evaluate, which IOLs may be the best for their patients and their practices. The roles of refractive index, water content, optic coloration (blue- or violet-light-blocking), and design of acrylic IOLs are widely debatable among surgeons. Ease of use, availability, cost, and surgeon preference are also important factors that influence surgeons' IOL selection.

Clinical examinations section is a whole different ball game as compared to theory examinations. Often most students find it rather easy to score in a theory examination, but when it comes to a clinical case examination it seems a tough cookie to crack. In this article, we would like to share a few tips and some dos and don'ts with respect to taking a clinical examination successfully.