A wide spectrum of pediatric orbital disorders can occur in the pediatric age group. Cross-sectional imaging plays an important role in the diagnosis and management of these patients. We reviewed our imaging record and collected representative cases of pediatric orbital pathology. The purpose of this pictorial essay is to illustrate the imaging features of various orbital lesions encountered in children.

Purpose: Candidal endophthalmitis is a sight-threatening ocular infection that most frequently occurs as a complication of candidemia. Fluconazole has been effective against Candida albicans in various animal models. Our objective was to evaluate retinal toxicity of plain and liposome formulation of fluconazole at various dose levels after intravitreal injection. Materials and Methods: Twelve New Zealand albino rabbits weighing 2-2.5 kg were used. Two rabbits were used for every dose level. Liposome formulation containing 100 and 200 µg of fluconazole in sterile phosphate buffer solution and plain fluconazole at concentrations of 100, 200, 400 and 800 µg in 0.1 ml of sterile normal saline were injected intravitreally into the right eyes. The left eyes received 0.1 ml normal saline or 0.1 ml of liposome formulation without fluconazole. One week later, the animals were sacrificed, their eyes enucleated and processed for light microscopy and scanning electron microscopy. Results: It showed that plain fluconazole at a concentration of 100 µg and above caused retinal changes, with disorganization of the photoreceptor outer segments. However, liposome formulation of fluconazole (200 µg/0.1 ml) did not show any significant microscopic changes of the retina. Conclusion: The liposome formulation decreased the retinal toxicity of fluconazole up to the studied concentration of 200 µg/0.1 ml.

Background: To identify the effect of infliximab, cyclosporine A and recombinant IL-10 in experimental autoimmune uveitis. Materials and Methods: Sixty male rats were assigned to five groups of 12 each. All the groups (except the control group) were administered 30 µg retinal-S antigen intraperitoneally. On the 14th day, after confirmation of uveitis with histopathological study, daily cyclosporine A injection was given in cyclosporine A treatment group and physiological serum in the uveitis-induced placebo treatment and control groups. In the infliximab treatment group, infliximab was administered on the 14th, 15th, 17th, 19th and 21st days. In the recombinant IL-10 treatment group, three doses of recombinant IL-10 were given four hours and a half hours before and eight hours after retinal-S antigen administration. On the 21st day of the study, all rats were sacrificed and vitreous cytokine levels (IL-1, IL-6, IL-8 and TNF-a) were studied with ELISA. Results: In the treatment groups, cytokine levels (IL-1, IL-6 and TNF-a) were significantly lower than the uveitis-induced placebo treatment group. Compared with the control group, there was no significant difference with respect to TNF-a and IL-8 in the infliximab treatment group; IL-8 in the cyclosporine A treatment group; IL-6 and IL-8 in the recombinant IL-10 treatment group. The drugs used did not significantly differ in respect to their effects on vitreous IL-6, IL-8 and TNF-a levels. Conclusion: Cyclosporine A, infliximab and recombinant IL-10 reduce the vitreous cytokines levels. Among these drugs, recombinant IL-10, which is still in its experimental phase, might be considered as a new therapeutic agent.

Aim: To evaluate the six months follow-up outcome of combined intravitreal triamcinolone acetonide (IVTA) and photodynamic therapy (PDT) for subfoveal choroidal neovascularization compared to PDT alone. Study design: Prospective interventional pilot study. Materials and Methods: Patients with six months follow-up of IVTA following PDT (Group I, eight eyes) and PDT alone (Group II, eight eyes) were included. Four mg/ 0.1 ml of IVTA was injected 7-10 days following PDT. The patients were reevaluated every month for the first two months and every three months thereafter in both the groups. Results: Group I: The mean age was 65.8±11.8 years (range: 47-79 years). Five patients were male. The total treatment sessions in six months were 11 (mean: 1.36). At six months, one eye had ³ 10 letters gain and three eyes had > 10 letters loss. Four eyes had stable vision. Two eyes (25%) developed increased intraocular pressure (>40 mmHg) during follow-up. Group II: The mean age was 58.7±11.7 years (range: 46-76 years). Five patients were male. The total treatment sessions in six months were 17 (mean: 2.13). At six months, six eyes had ³ 10 letters gain and none had > 10 letters loss. Two eyes had stable vision. Conclusion: The mean number of treatment sessions following combination therapy of IVTA (4 mg) and PDT appears relatively less (1.36 at six months) compared to PDT alone (mean: 2.13). ( P =0.02)

Purpose: To evaluate the efficacy, safety, predictability and stability of implanting a polymethylmethacrylate phakic intraocular lens (PIOL) in high myopia. Materials and Methods: A retrospective analysis of the data of patients who underwent Artisan phakic IOL implantation between 2002 and 2003 with a follow-up of at least 24 months. Results: An Artisan myopia lens was implanted in 60 eyes of 36 patients with preoperative myopia ranging from -5.0 to -24.0 D. Mean patient age was 22.6 years. Mean spherical equivalent of manifest refraction stabilized by the first postoperative week. At three months follow-up, 54 eyes (90%) had a postoperative refraction within ± 1D emmetropia and 45 eyes (75%) had uncorrected visual acuity of 20/40 or better. Seven eyes (11.6%) had loss of one Snellen line and none had loss of two Snellen lines or more at three months. The mean endothelial cell loss was 3.8% at three months, 5.2% at six months, 5.25% at 12 months and 6.38% at two years, which was not significant. Postoperative complications included anterior chamber reaction in two eyes (3.3%), rise in intraocular pressure in six eyes (10%) and dislocation of PIOL in two eyes (3.3%). Conclusion: Implantation of Artisan myopia lens to correct high myopia resulted in a stable and fairly predictable refractive outcome with few complications. Significant endothelial damage was not detected in two years of follow-up.

Materials and Methods: This was a retrospective consecutive case series analysis of children treated for amblyopia at a tertiary care center. All children received full time occlusion (FTO) for the dominant eye. Results: Eighty-eight children older than 6 years at the time of initiation of therapy were included. Age at initiation of therapy ranged from 6 to 20 years (9.45 ± 3.11 years). Forty-two children (47.7%) had strabismic amblyopia, 37 (42.0%) had anisometropic amblyopia and 9 (10.2%) had a combination of strabismic and anisometropic amblyopia. Eighty out of 88 eyes (90.0%) had improvement in visual acuity following FTO. Visual acuity (VA) improved from 0.82 ± 0.34 at presentation to 0.42 ± 0.34 ( P < 0.001) after FTO. In children with strabismic amblyopia, VA improved from 0.81 ± 0.42 to 0.42 ± 0.39 ( P < 0.001). In children with anisometropic amblyopia, visual acuity of the amblyopic eye improved from 0.82 ± 0.24 to 0.36 ± 0.29 ( P < 0.001) following FTO. Out of 13 children older than 12 years, only 6 children (46.1%) had improvement in VA. Mean follow-up after complete stoppage of occlusion was 8.37 ± 1.78 months. Conclusion: Occlusion therapy yields favorable results in strabismic and/or anisometropic amblyopia, even when initiated for the first time after 6 years of age. After 12 years of age, some children may still respond to occlusion of the dominant eye.

Purpose: This study was conducted to compare the intraocular pressure (IOP) measurements by the Goldman applanation tonometer (GAT), non contact tonometer (NCT) and the ocular blood flow (OBF) pneumotonometer in different IOP ranges in glaucomatous eyes. The effect of central corneal thickness (CCT) on IOP measurement in chronic glaucomatous eyes using the three different tonometers was also evaluated. Materials and Methods: IOP measurements of 130 eyes of primary glaucoma patients were performed using GAT by an ophthalmologist while NCT and OBF-pneumotonometer measurements were performed by an experienced optometrist. The IOP values were compared amongst the three instruments in the three different IOP ranges (0-18 mmHg, >18 to 25 mmHg, > 25 mmHg). CCT was also measured in all patients. Results: The mean of paired difference between GAT and NCT was 0.9 ± 3.1 mmHg while that between GAT and OBF-pneumotonometer was 0.3 ± 3.4 mmHg. The OBF-pneumotonometer and NCT were more affected by corneal thickness (0.41 mmHg and 0.4 mmHg / 10 µ corneal thickness respectively) while GAT was the least affected by corneal thickness (0.3 mmHg / 10 µ corneal thickness) though the difference was not statistically significant ( P =0.42). Conclusion: With appropriate correction for corneal thickness the NCT and OBF-pneumotonometer can be used as reliably as GAT in following up glaucomatous patients.

We report an unusual case of angle closure glaucoma in a 78-year-old highly myopic female patient. The patient did not show any preoperative signs of subluxation of lens. However, the capsular bag was noted to be unstable during surgery. The patient was managed with phacoemulsification of lens using a novel method of iris hooks for stabilization of capsular bag during surgery.

We describe here a case of bilateral chemical injury (with an expansive mortar which is being used in recent times to cut the rocks). On examination limbal ischemia was more in the left eye (9 clock hours) than the right eye (2 clock hours). The case was managed by bilateral removal of foreign bodies, along with conjunctival resection and amniotic membrane transplantation in the left eye. At six-month follow-up, patient had best corrected visual acuity of 20/30 and 20/60 in the right and left eyes respectively. Since this being an occupational hazard, proper eye protection gear should be used by persons using this expansive mortar.

A 16-year-old girl had decrease in vision following dapsone overdose. This case demonstrated optical coherence tomography (OCT) evaluation of macular infarction following dapsone poisoning. OCT showed characteristic serial changes as Stage 1: Cystic macular edema, Stage 2: Resolving cystic change and Stage 3: Foveal atrophy. Hence, OCT could show the progression of foveal atrophy from cystic macular edema following dapsone poisoning.

The aim of this communication was to report the fundus fluorescein angiography findings in three patients with choroidal tubercles. In all cases, there was a marked peritubercular inflammation. The tubercles themselves showed an initial hypofluorescence or minimal hyperfluorescence that increased in the late phases. Clinicians need to be familiar with these new findings as they may help in the diagnosis of ocular tuberculosis.

We describe a rare case of pupillary-iris-lens membrane with goniodysgenesis, a unilateral neurocristopathy. The membrane represents ectopic iris on the lens with abnormal iris stroma and anterior chamber angle from aberrant induction, migration or regression of neural crest cells. The membrane can be progressive. Catastrophic vision loss from angle closure can occur and may be controlled with surgery. This subject needed treatment for amblyopia.

The purpose of this article is to report an edge defect in single-piece hydrophobic acrylic intraocular lens (IOL) observed during a routine phacoemulsification procedure. The chip was successfully removed intraoperatively with a McPherson's forceps. However, six months postoperatively patient complained of a disturbing glare due to posterior capsular folds originating from the site of IOL defect. Patient was advised, however refused to undergo Nd:Yag laser capsulotomy to relieve the symptoms. This case highlights the necessity to check each foldable IOL under the microscope before loading it into the cartridge, for possible edge defects.

With an expanding awareness of ocular tuberculosis, ophthalmologists are increasingly required to participate in the care of these patients. We conducted a survey of published ophthalmic literature to identify whether the regimens of antitubercular medications prescribed conform to current guidelines. A Medline search for publications (1995-2005) was done and the data were systematically analyzed with respect to demographic features, clinical findings and the antitubercular therapy prescribed. Of the 34 papers (82 patients) available, 33 papers described the prescribed antitubercular therapy. Eighteen papers (54.5%, 46 patients) conformed to guidelines versus 15 papers (45.4%, 32 patients) did not, suggesting that a large proportion of papers do not conform to current guidelines. Wider dissemination of therapeutic guidelines is necessary to encourage rational therapy and minimize therapeutic failures, drug resistance or relapse.