Purpose. To compare the long-term clinical outcomes of cultivated limbal epithelial transplantation (CLET) in children and adults with limbal stem cell deficiency. Design. Retrospective case series. Methods. Case records of patients with limbal stem cell deficiency (LSCD) who underwent CLET from April 2004 to December 2014 were studied. Outcome measures were compared in terms of anatomical success and visual improvement. Parameters for total anatomical success were avascular, epithelized, and clinically stable corneal surface without conjunctivalization, whereas partial anatomical success was considered when mild vascularization (sparing centre of cornea) and mild conjunctivalization were noted along with complete epithelization. Results. A total of 62 cases underwent the CLET procedure: 38 (61.3%) were children and 24 (38.7%) were adults. Patients with unilateral LSCD (33 children and 21 adults) had autografts and those with bilateral LSCD (5 children and 3 adults) had allografts. Amongst the 54 autografts partial and total anatomical success were noted in 21.2% and 66.6% children, respectively, and 19.0% and 80.9% in adults, respectively (p value 0.23). Visual improvement of 1 line and ≥2 lines was seen in 57.5% and 21.2% children, respectively, and 38% and 38% in adults, respectively (p value 0.31). Conclusion. Cultivated limbal epithelial transplantation gives good long-term results in patients with LSCD and the outcomes are comparable in children and adults.

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To evaluate the impact of death-to-preservation time (DPT) on effective utilisation of donor corneas. In a prospective observational study conducted at our tertiary eye centre, donated corneas received over a 15-month period from November 2011 to January 2013 were evaluated. Donor age, donor refrigeration (done or not), DPT, endothelial cell density (ECD), corneal grading, clinical utilisation and surgical outcome after graft transplantation were noted. To analyse the impact of different DPT on donor cornea transplantation, primary outcome measures (corneal grading and endothelial cell density) and secondary outcome measures (primary graft failure and graft infection) were analysed. A total of 990 corneas were assessed. Primary outcomes showed no significant difference for higher DPT ( P > 0.01). ECD, where DPT was >12 h, was better for refrigerated corneas ( P < 0.001). Prolonged DPT had no significant effect on primary graft failure ( P = 0.131) and graft infection ( P = 0.137) in the first month after transplantation. We find that DPT should not be the only criteria to assess the cornea quality; other donor characteristics should be considered equally important. Donor refrigeration should be encouraged in cases where early retrieval is not possible.

BackgroundKeratoglobus closely resembles buphthalmos and anterior megalophthalmos.FindingsA 45-year-old man presented with gradually progressive, painless, diminution of vision in both eyes since childhood. On examination, visual acuity of right (RE) and left eye (LE) was 20/60 and 2/20 respectively. Clinical pictures of the patient are shown in panel A, B, C, D. Keratometry values were 46.47/47.94 D at 42/132° in RE and 46.90/47.23 D at 174/84° in LE, signifying steep, ectatic cornea. Axial lengths, anterior chamber depth and corneal thickness in RE/LE was 23.53/27.12 mm, 5.18/4.48 mm and 413/420 μm respectively. Iridodonesis was noted in left eye. Retinal evaluation of LE revealed retinal detachment (RD) with posterior staphyloma due to high myopia, hereas RE was within normal limits. Intraocular pressure was normal in both eyes. Final diagnosis was keratoglobus with LE myopic RD. The patient improved to 20/30 in right eye with no improvement in LE with scleral contact lens.ConclusionKeratoglobus, Megalophthalmos and Buphthalmos are exceedingly close entities and it is very essential to make correct diagnosis, as management options differ significantly for all three diseases.

Purpose:To study the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) changes on optical coherence tomography in early multiple sclerosis (MS) patients.Methods:A prospective cohort study was conducted at a tertiary care center. Patients of early MS (expanded disability status scale <3) with or without optic neuritis (ON) and idiopathic ON were included. Twenty age-matched individuals were taken as controls. Changes in RNFL and GCL thickness were evaluated along with the correlation with visual function parameters such as visual acuity, contrast sensitivity, and visual evoked response at first visit and again at six months.Results:Forty-four patients of MS with or without ON (24 and 20 patients respectively), 29 patients with idiopathic ON, and 20 healthy controls constituted the cohorts. Mean LogMAR best-corrected visual acuity was found to be significantly reduced in all groups except fellow eyes (FE) of ON group. Mean values of average RNFL thickness and values in superior, temporal, and inferior quadrant were significantly reduced. Similarly, overall mean values of average GCL-inner plexiform layer (IPL) thickness and values in superior, superonasal, superotemporal, inferonasal, and inferotemporal quadrant were significantly reduced in all groups except FE of ON group (P < 0.05). All the visual parameters significantly correlated with GCL + IPL thickness.Conclusion:GCL + IPL thickness is a more sensitive clinical structural marker than RNFL in early MS with/without ON and ON patients and correlates with all the visual parameters better than RNFL thickness.

Purpose: To evaluate the progression of corneal endothelial changes in patients with Parkinson disease (PD) on long-term oral amantadine therapy. Methods: A prospective comparative longitudinal observational study of 90 patients (180 eyes) with PD on more than 6 months of oral amantadine therapy, 30 amantadine naive patients with PD, and 30 healthy controls (age and gender matched). Corneal endothelial cell parameters (endothelial cell density, percentage hexagonality of the cells, and coefficient of variation) and corneal subbasal nerve fiber layer changes were studied over a follow-up period of 1 year. Results: The amantadine patients with PD group had a statistically significant decrease in endothelial cell density (1.51% vs. 0.94% vs. 0.55%) (P = 0.04), decrease of percentage hexagonality of the cells (4.98% vs. 3.56% vs. 2.31%) (P = 0.01), and increase of coefficient of variation (6.12% vs. 4.80% vs. 3.30%) (P = 0.03) compared with amantadine naive patients with PD and controls, respectively. Analysis of changes in the patients with PD based on the daily dosage of amantadine showed greater change in endothelial parameters in patients who were on 400 mg amantadine. Conclusions: Long-term amantadine therapy seems to effect changes on corneal endothelium.

The third cranial nerve is a motor nerve chiefly involved in execution of movements of the eye. The paresis or paralysis of the one or more of these muscles due to oculomotor nerve palsy, leads to ptosis, anisocoria and ocular motility defects. This article highlights the origin and course from nuclear level to terminal branches along with associated clinical symptoms and signs that help in localizing the site of lesion and planning appropriate management.

Ischemic optic neuropathies could be a result of inflammatory and non inflammatory small vessel disease and have been classified as arteritic and non-arteritic anterior ischemic optic neuropathy respectively. This review has been intended to elucidate the epidemiology, etiology, pathogenesis, clinical picture and management of NAION and the literature search was completed using the published data in Pubmed, Medline, and Ovid over the last five decades.