Laser-in-situ-keratomileusis (LASIK) has become a popular technique of refractive surgery because of lower postoperative discomfort, early visual rehabilitation and decreased postoperative haze. Compared to photorefractive keratectomy (PRK), LASIK involves an additional procedure of creating a corneal flap. This may result in complications related to the flap, interface and underlying stromal bed. The common flap-related complications include thin flap, button holing, free caps, flap dislocation and flap striae. The interface complications of diffuse lamellar keratitis, epithelial ingrowth and microbial keratitis are potentially sight threatening. Compared to PRK, there is less inflammation and faster healing after LASIK, but there is a longer period of sensory denervation leading to the complication of dry eyes. The refractive complications include undercorrection, regression, irregular astigmatism, decentration and visual aberrations. Honest and unbiased reporting is important to understand the aetiology and redefine the management.

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PURPOSE: To describe the ocular manifestations of congenital rubella syndrome (CRS), a common cause of congenital cataracts in developing countries. METHODS: Retrospective analysis of case records of 46 sero-positive infants under 12 months of age who presented at Aravind Eye Hospital, Madurai between July 1993 and February 2001. The ocular and systemic examination details were recorded. RESULTS: Both eyes were affected in 41 (89%) patients. Cataract was present in 81 (93.1%) eyes; most of them were nuclear cataract (79, 97.5%). Other common ocular presentations included microphthalmos in 74 (85.1%) eyes, iris abnormalities in 51 (58.6%) eyes, and pigmentary retinopathy in 33 (37.9%) eyes. Cataract, microphthalmos and iris hypoplasia was a common combination present in 49 (56.3%) eyes. Systemic manifestations included cardiac anomalies in 23 (50%) and neurological anomalies in 16 (34%) children. Multi-system involvement was present in 32 (70%) children. Low birth weight (below 2 kg) was seen in 30% infants. CONCLUSION: CRS may present with a wide spectrum of ocular and systemic findings and requires a high index of suspicion for diagnosis. Any sick infant with unilateral or bilateral congenital cataract should be investigated thoroughly for CRS.

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Computed tomography (CT) has revolutionised the diagnosis and management of ocular and orbital diseases. The use of thin sections with multiplanar scanning (axial, coronal and sagittal planes) and the possibility of three-dimensional reconstruction permits thorough evaluation. To make the most of this technique, users must familiarize themselves with the pertinent CT principles and terminology. The diagnostic yield is optimal when the ophthalmologist and radiologist collaborate in the radiodiagnostic workup. In this article we describe a systematic approach to the interpretation of ocular and orbital CT scans.

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The capsular tension ring (CTR) was originally introduced to reinforce the zonule in eyes with zonular dehiscence and to prevent capsular phimosis in eyes at risk for postoperative capsular shrinkage. Since then, other designs and applications have been developed and described. Modified CTRs with shields can be used in eyes with iris coloboma. A CTR with loops is intended for scleral fixation. Studies are underway to determine if the presence of the CTR helps avoid or limit capsular opacification. A number of different insertion techniques with the aid of manipulators, injectors and traction sutures have been described. We have developed a technique that is particularly effective in cases of zonular dehiscence due to its low solicitation to the damaged bag.

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Purpose: To review the possible aetiological factors, ocular complications and their management in patients of Stevens-Johnson syndrome with ocular involvement, seen at a tertiary eye care centre. Methods: We retrospectively reviewed the medical records of patients with Stevens-Johnson syndrome seen between 1987-1998 at L V Prasad Eye Institute. The demographic and possible aetiological factors data causing Stevens-Johnson syndrome were collected. The details of the ocular examination and treatment were collected and examined to determine the pattern of presentation, complications, treatment response and outcome. Results: A total of 95 patients, 40 males (42.10%) and 55 females (57.89%), were identified during the 11-year period. A majority of the patients (n=53; 55.78%) were between 20 and 40 years of age. All patients had bilateral involvement and most (n=93; 97.89%) had bilateral symmetrical presentation. The duration from the onset of symptoms to the time of presentation at the institute varied from 6 days to 18 years with most patients presenting after one year (n=39; 41.05%). The most commonly identified possible causative factor was drugs (n=55; 51.89%). No definitive cause was identified in 37 (38.94%) patients, and 3 (3.15%) patients had a history of viral fever preceding the onset of Stevens-Johnson syndrome. The best corrected visual acuity at initial presentation was 6/12 or better in 32 (33.68%) patients. Lid abnormalities were observed in 87 (91.51%) patients, conjunctival abnormalities in 92 (96.84%) and corneal complications in 93 (97.89%). All patients were managed medically and 26 (27.36%) patients underwent surgery. Conclusion: Stevens-Johnson syndrome remains an important cause of severe visual loss and ocular morbidity, both of which significantly affect the quality of life. Not many medical or surgical options are available even in tertiary eye-care centres. Future advances in immune modulation techniques may prevent many of the sequelae that continue to occur despite the best possible medical care.

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PURPOSE: To study the microbial agents, chiefly Chlamydia trachomatis and other bacteria, in neonatal conjunctivitis. METHODS: Conjunctival specimens from 70 newborns with conjunctivitis were subjected to bacterial culture and sensitivity testing, monoclonal antibody based C. trachomatis antigen detection test and species-specific Chlamydia antibody detection in the sera of babies and their mothers, by micro-immunofluorescence assay. RESULTS: Bacteria were isolated from 35 (50%) babies; the majority (20, 57.14%) were Staphylococcus epidermidis. C. trachomatis antigen was detected in conjunctival smears of 17 (24%) babies, and 6 (35.29%) of them were positive for other bacteria. Six babies and their mothers tested positive for C. trachomatis Ig G antibodies. At follow-up after 14 weeks, 6 (35.29%) of the Chlamydia antigen-positive babies were found to have developed recurrent conjunctivitis. CONCLUSION: C. trachomatis is responsible for almost a quarter of all cases of neonatal conjunctivitis, with recurrences in 35% of cases. Bacteria could be isolated from 50% of the patients though the exact role of Staphylococcus epidermidis, isolated from 28.65% of the neonatal conjunctivitis cases, remains unclear.

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PURPOSE: To evaluate the cytological changes in conjunctiva following regular contact lens wear and to determine the correlation, if any, between severity of cytological alteration and symptoms related to contact lens wear. METHODS: One hundred eyes (50 normal asymptomatic subjects) who served as a control group were studied by conjunctival impression cytology (CIC). These subjects were fitted with rigid gas permeable (RGP) or soft contact lenses and were followed up at the end of 3 and 6 months. At each follow-up visit the CIC was repeated. A filter paper with the impression specimen was stained with periodic acid schiff (PAS) and haematoxylin stain to study goblet cell loss. Papanicolaou stain was done to study squamous metaplasia. The cytological changes were graded using the system described by Natadisastra et al. RESULTS: Severity of cytological changes increased with the duration of contact lens wear (P = 0.00001). At the end of 6 months, 60% of symptomatic eyes wearing soft contact lens and RGP lens showed abnormal CIC changes. None of the asymptomatic RGP contact lens wearing eyes showed abnormal CIC changes whereas 33.4% of the asymptomatic soft contact lens wearing eyes showed abnormal CIC changes (P = 0.033). Epithelial changes occurred within 3-6 months of contact lens fitting. CONCLUSION: Severity of cytological changes increased with duration of lens wear (P = 0.00001). Prevalence and severity of cytological alteration is more in symptomatic contact lens wearers. Soft contact lens wearers although asymptomatic showed severe CIC changes.

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The Gomoris methanamine silver impregnation technique is a highly reliable and archiveable method of detecting fungal filaments, but the staining procedure is time consuming and laborious. A technique using microwave energy to reduce the duration of Gomori's silver staining is described.

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This first report from India describes 5 cases of Bietti's crystalline dystrophy without corneal involvement

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PURPOSE: This study aimed to investigate the safety and efficacy of trabeculectomy with intraoperative mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: Fifteen eyes of 14 patients with NVG were included in the study. NVG was secondary to central retinal vein occlusion (3 eyes), hemiretinal vein occlusion (2 eyes), proliferative diabetic retinopathy (8 eyes), branch retinal vein occlusion (1 eye) and idiopathic (1 eye). Preoperative retinal ablation was performed in eyes with evidence of posterior segment ischaemia. Following this, all eyes underwent trabeculectomy with intraoperative MMC (0.4 mg/ml for 3 minutes). Clinical outcome assessment included visual acuity, intraocular pressure (IOP), bleb appearance, identification of complications and antiglaucoma medications required to control IOP. RESULTS: The mean IOP decreased from 38.6 +/- 12.9 mmHg (range, 15-64 mmHg) to 17.4 +/- 9.33 mmHg (range, 4-34 mmHg) (P = 0.001). Preoperative visual acuity ranged from light perception to 6/9 in the affected eye. Thirteen (86.6%) of 15 eyes improved vision or retained preoperative vision, one (6.7%) eye lost light perception and one (6.7%) eye developed tractional retinal detachment two years after trabeculectomy. Ten (66.7%) of 15 eyes were classified as surgical success with a mean follow-up of 28.6 +/- 26.3 months (range, 2-82 months). None of the patients developed choroidal haemorrhage, hypotony maculopathy, late onset bleb leak or endophthalmitis. CONCLUSION: Trabeculectomy with intraoperative MMC is a good treatment modality in the management of eyes with NVG.

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We report the first described association of natal teeth with congenital hydrocephalus and congenital glaucoma, anterior segment dysgenesis with nonattachment of the retina. The clinical findings support a diagnosis of Walker-Warburg syndrome. The forkhead 7 transcription factor gene is proposed as a candidate gene for this syndrome.

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A rare case of optic nerve entrance coloboma associated with situs inversus is reported.

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A case of progressive outer retinal necrosis (PORN) caused by Cytomegalovirus (CMV), and diagnosed by polymerase chain reaction (PCR) is reported.

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High altitude retinopathy with various manifestations is common after exposure to high altitude. Inadequate autoregulatory response of the retinal vascular system is thought to be responsible for this. We report a case of anterior ischaemic optic neuropathy following exposure to high altitude.

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Purpose: To prospectively analyse the efficacy and safety of peribulbar anaesthesia for penetrating keratoplasty through a noncomparative, consecutive series. Methods: One hundred twenty-four (91.1%) of 136 patients undergoing penetrating keratoplasty (PK) from January 1997 to December 2001, were administered peribulbar anaesthesia. The anaesthetic mixture consisted 5ml of lignocaine, bupivacaine, and hyaluronidase (to avoid evaluation bias) in the peribulbar space. A repeat injection of 3 ml was used if the primary injection was inadequate. Digital ocular compression was done for 10-15 minutes after the first injection. Each patient was analysed for degree of akinesia, subjective patient comfort, analgesia, subjective surgeon comfort, and types of surgical conditions. Results: The age ranged from 19 to 86 years. Forty-nine of 124 patients (39.5%) received PK only and remaining 75 patients (60.5%) received additional procedures. A single injection was sufficient to achieve adequate akinesia (grade II and III) in 114 (92%) patients and 120 (97%) of patients were satisfied (graded pain as ≤ grade II). During surgery, 6 (5%) phakic eyes developed episodes of positive intraocular pressure and 5 eyes (4%) developed chemosis. There were no other local or systemic adverse events. The surgeon level comfort was (grade II or more) 98% (122 of 124). Conclusion: One-point, low volume, peribulbar anaesthesia for penetrating keratoplasty is safe and efficacions.

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Simultaneous occurrence of frosted branch angiitis and immune-mediated rapidly progressive glomerulonephritis is reported. The two diseases possibly share a common immune mechanism. Patients of frosted branch angiitis should undergo complete systemic evaluation including renal function tests even if the patient is systemically asymptomatic.

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