Purpose:To report results of a novel technique for sutureless, glueless intrascleral fixation of three-piece posterior chamber intraocular lens (IOL) using 26-G needle for management of aphakia.Methods:In this prospective series, 30 eyes of 20 patients with aphakia, subluxated IOL, or crystalline lens were included. 26-G-needle-guided intrascleral fixation of three-piece posterior chamber IOL was performed according to the described technique. The patients were evaluated on day 2, 1 week, 6 weeks, and 3 months postoperatively for change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, and any other complications. The postoperative tilt of the IOL was indirectly measured by determining the lenticular astigmatism which in turn was calculated by the difference between net corneal astigmatism and refractive astigmatism. Paired t-test was used to determine the significance of any association between the preoperative and postoperative BCVA and IOP. P < 0.05 was considered significant.Results:Of 30 eyes (n = 30 patients), 18 were surgical aphakia, 6 traumatic aphakia, 5 subluxated IOL, and 1 ectopia lentis (Marfan syndrome). The mean preoperative BCVA was 1.37 ± 0.37 (logMAR) and postoperative BCVA at 3 months was 0.37 ± 0.29 (logMAR). A significant improvement in the mean BCVA (P < 0.05) was observed after the procedure. The mean IOP preoperatively was 13.33 ± 4.18 and postoperatively at 3 months was 12.82 ± 3.97 (P > 0.05), which was not significant. None of the eyes developed any intraoperative and postoperative complications. The IOLs had appropriate centration and stability.Conclusion:We have developed this new technique for intrascleral IOL fixation which is quite simple, cost-effective, minimally invasive, neither requires glue nor suture and gives consistent outcome.

Purpose: Mucormycosis is a life-threatening infection that has made sudden comeback in COVID-19 era. We conducted this study to determine demography, site of involvement, management, and outcome in these patients. Methods: All cases presenting with signs and symptoms of mucormycosis were thoroughly evaluated and confirmed diagnosis was made on demonstration of fungi in the tissue (or body fluids) either by direct microscopy and/or culture. Patients underwent computerized tomography scan for paranasal sinuses and magnetic resonance imaging scan with contrast orbit and brain to know extent of disease. Results: 540 proven cases of mucormycosis were included. Most common age group affected was 41–50 years with male preponderance (69%). Sinonasal was the most common site of involvement in mucormycosis (100%), followed by orbital (51.85%), cerebral (9.44%), cutaneous (1.85%), and pulmonary (0.18%). Most common presentation was periocular and facial swelling (28%). 97.96% patients had associated diabetes and 89.44% patients had history of COVID-19 with concurrent steroids use (84.85%), higher antibiotics (82.59%), oxygen therapy (52.40%), remdesivir (28.89%), and biological agents (2.56%). Duration from COVID-19 positivity to presentation of mucormycosis was 22.56 days, while 4.44% patients had coexisting COVID-19 with mucormycosis. The mortality rate was 9.25% (50/540). Conclusion: Timely diagnosis and appropriate management can ameliorate the consequences of mucormycosis. With the third wave of COVID-19 coming, epidemiological study to identify risk factors and possible management options can help physicians to develop the treatment strategy.

Purpose: To evaluate and compare the efficacy of autologous platelet-rich plasma (aPRP) eye drop and artificial tear (AT) eye drop in moderate to severe symptomatic dry eye disease (DED). Methods: This prospective interventional study included 121 eyes of 61 patients of moderate to severe DED. Patients were divided into aPRP (31 patients) and AT (30 patients) group. Ocular Surface Disease Index (OSDI) score, tear film breakup time (TBUT) (s), corneal fluorescein staining (CFS) score, and Schirmer test score (mm) of both the groups were evaluated and compared pre-treatment and post-treatment at the end of 3 months. Results: The mean age of the aPRP group and AT group was 52.8 ± 12.8 years and 55.5 ± 13.4 years, respectively. At the end of 3 months, OSDI score reduced more in the aPRP group as compared to AT group, and the mean difference (−22.7) was statistically significant ( P < 0.001). There was no significant difference in post-treatment Schirmer test score between the two groups ( P = 0.44). Post-treatment improvement in TBUT and CFS score in the aPRP group was significantly higher in the aPRP group as compared to that in the AT group ( P < 0.05). Bruising at the site of blood withdrawal was noted in two patients in the aPRP group. Conclusion: aPRP is safe and more effective than AT in treating patients with moderate to severe symptomatic DED.

Purpose: To study facial nerve palsy (FNP) in post-COVID-19-mucormycosis patients and its ocular complications, report different presentations of FNP in such patients, and propose its etiopathogenesis based on presentation and clinico-radiologic localization. Methods: A prospective cohort study was carried out in patients of post-COVID-19-mucormycosis who presented at our tertiary center, over a period of 3 months. Motor and sensory examination of the facial nerve was done to diagnose FNP and localize the lesion clinically. Slit-lamp examination was done for grading corneal involvement. MRI brain, orbit, and paranasal sinuses (PNS) with contrast were studied to find involvement along the facial nerve. It was assessed whether this site of lesion corresponded with clinical localization. Data were analyzed using the percentage of total cases and Fisher’s test. Results: A total of 300 patients with post-COVID-19 mucormycosis were examined, of which 30 (10%) patients were found to have FNP. All were lower motor neuron (LMN) type and were associated with corneal complications. The most common site clinically was distal to the chorda tympani (66.66%) and radiologically was infratemporal (IT) fossa (63.4%). The clinical localization significantly correlated with the radiological findings ( P = 0.012). Twenty percent of patients showed incomplete involvement of facial muscles Conclusion: FNP was found to be of LMN type. The most common site of insult was IT fossa. There was a good clinico-radiological correspondence of lesions. Isolated lesions were also found along the peripheral nerve course, presenting as incomplete facial palsy. Recognition of FNP in post-COVID-19 mucormycosis, in all its variable forms, is important to manage corneal complications.

: Due to the surge of post COVID mucormycosis in India there has been a significant patient load seen in hospitals we have observed that mucor is not the only culprit and there has been other fungi like aspergillus and candida, who have led to increased morbidity and mortality.: To conduct a retrospective analysis on laboratory reports of specimens sent after surgical intervention of patients admitted with mucormycosis and to identify the weightage of different fungal infections in the post COVID era.: It is a hospital based retrospective review of mycology and histopathology reports of post COVID rhino orbital mucormycosis patients referred from ophthalmology, ear nose throat surgery, oral maxillofacial surgery, neurosurgery department of mahatma gandhi memorial medical college, Indore, Madhya Pradesh from 1 June to 7 July 2021. : Out of 240 samples sent for histopathology examination, 1.6% samples showed mucormycosis with secondary aspergillosis while 98.33% samples showed primarily mucormycosis likewise 270 KOH mount reported around 8.51% mucormycosis with secondary aspergillosis, 4.81% reported primary aspergillosis, 72.15% reported primarily mucormycoses.: We acknowledge that aspergillus and candida has contributed significantly in post covid mycoses and that mucor is not the only culprit.

Recurrence is a significant problem after pterygium excision. Therefore in this study its risk factors and management is discussed. This study was conducted to observe recurrence after conjunctival limbal autograft (CLAU) & to evaluate different factors related with recurrence of pterygium and assessing its different management methods. Hundred & seven patients with primary pterygium were examined, excised by CLAU and histopathology sample sent. The outcomes were assessed in terms of clinically significant recurrence till 6 months follow-up. Early topical mitomycin-C (MMC) 0.02% QID for a week was given to avoid resurgence of clinically significant pterygium, however if developed then excised by CLAU (if &#60;4mm) or AMG (Amniotic membrane grafting) (if &#62; 4mm). Out of total cases, 57% were females. Histopathology findings includeEpithelial Hyperplasia (80.4%), vascularity overwhelms fibrosis (39.1%), vascularity similar to fibrosis (28.3%), fibrosis overwhelms vascularity (34.8%), perivascular stromal inflammation (54.3%), diffuse stromal inflammation (37.0%). The following variables were significantly associated (p&#60;0.05) with the recurrence: age, redness & thickness, higher vascularity, diffuse inflammation. Factors such as younger age group, higher redness and thickness of pterygium, more vascularity, and diffuse inflammation on histopathological examination can be considered as a risk factor for recurrence. However, occupation, location, and type of pterygium were found not to be related to recurrence. Although no clinically significant recurrence was seen after mitomycin c eyedrops, but no significant correlation can be made. Young patients having pre-operative features like red and fleshy pterygium, along with vascularity more than fibrosis and diffuse inflammation on histopathological examination should be followed strictly and managed intensely.

Purpose: This purpose of this study was to find the association between severity of visual impairment and retinal nerve fiber layer (RNFL) thickness loss in different demyelinating diseases using optical coherence tomography (OCT) and, simultaneously, assess the fellow eye for subclinical RNFL thickness loss. Methods: This cross-sectional, observational study included 60 eyes of 30 patients above the age of 20 years with diagnosed cases of multiple sclerosis (MS), neuromyelitis optica (NMO), and clinically isolated syndrome (CIS) who had history of (h/o) optic neuritis (ON) attack were included. Participants included in the study group underwent best-corrected visual acuity (BCVA) measurement, color perception, swinging flashlight test, slit-lamp examination, and dilated fundus examination (DFE). RNFL thickness was measured using spectral domain OCT (SD-OCT) (Optovue RTVue-V6.11 A Fourier). Intergroup analysis of RNFL thickness was done using a Chi-square test ( P < 0.05 was considered significant). Spearman’s rank correlation coefficient (Spearman’s ρ) was used for association (ρ < 0.963 was considered significant). Results: RNFL thickness was significantly reduced in patients with NMO than MS, while all patients of CIS had the highest RNFL thickening ( P = 0.00048). Lower visual function scores correlated with reduced average overall RNFL thickness, and this association was statistically significant in affected ( R = 0.942) and fellow eyes ( R = 0.963). Conclusion: The severity of visual impairment significantly correlated with the severity of axonal loss in affected as well as the fellow eye. NMO is associated with more widespread axonal injury in the affected optic nerve. Hence, RNFL thickness is an indicator of the progression of visual impairment in demyelinating diseases and OCT can help distinguish the etiology and, therefore, may be useful as a surrogate marker of axonal involvement in demyelinating diseases.

Immunologic corneal allograft rejection represents one of the main cause for graft failure. This study was conducted to observe and comparing the beneficial effect of topical 0.03% tacrolimus on corneal graft survival. To compare the effect of topical 0.03% tacrolimus plus 1% topical prednisolone with 1% topical prednisolone alone in preventing rejection after PK. 40 patients were randomly allocated into two groups:Group A: patients received 0.03% topical tacrolimus ointment twice daily for a month plus 1% prednisolone acetate eye drops 2 hourly and tapered monthly. Group B: patients received 1% prednisolone acetate eye drop only 2 hourly and tapered monthly.The clinical outcomes were assessed in terms of post-op complications, graft rejection, and visual acuity after 6 months of follow-up. SPSS software, 20.0 version, IBM, Chicago were used for statistical analysis. Out of 40 patients, 29 (72.5%) were male and 11(27.5%) were female. Type of surgery and continuous suture closure was found to be statistically significant (p-value &#60; 0.05) with post-op visual acuity in both groups. Types of graft rejection were found to be statistically significant (p-value &#60; 0.05) with enucleation transplantation time(hours) in both groups and with secondary glaucoma (p = &#60;0.001) in group A. We conclude that 0.03% topical tacrolimus ointment along with 1% topical prednisolone shows promising results and can be considered as an effective modality for preventing complications like secondary glaucoma, graft rejection, and getting the better visual outcome, where p-value (&#60;0.05) was statistically significant. All patients should be instructed with regards to the reasonable use of topical tacrolimus to avoid any side effects.