Purpose: To study the epidemiological characteristics and laboratory diagnosis of fungal keratitis seen at a tertiary eye care referral centre in South India. Methods: A retrospective review of all culture-proven fungal keratitis seen over a 3-year period, September 1999 through August 2002. Results: Fungal aetiology were confirmed in1095(34.4%) of 3183 corneal ulcers. The predominant fungal species isolated was Fusarium spp (471; 42.82%) followed by Aspergillus spp (286; 26%). Males (712; 65.08%) were more often affected (P< 0.0001). A large proportion of the patients (732; 66.85%) were in the younger age group (21 to 50 years). A majority (879; 80.27%) came from rural areas (P<0.0001), and most patients (709; 64.75%) were farmers (P<0.0001). Ocular trauma (1009; 92.15%) was a highly significant risk factor (P<0.0001) and vegetative injuries (671; 61.28%) were identified as a significant cause for fungal keratitis (P<0.0001). 172 (15.71%) patients had concurrent diabetes mellitus. The sensitivity of 10% potassium hydroxide (KOH) wet mount preparation was higher (99.23%) than Gram-stained smear (88.73%) (P<0.0001). Incidence of fungal keratitis was higher between June and September. Conclusion: Agricultural activity and related ocular trauma were principal causes of mycotic keratitis. A potassium hydroxide (KOH) wet mount preparation is a simple, and sensitive, method for diagnosis.

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Purpose: To report our experience with the diagnosis and management of Familial Exudative Vitreoretinopathy (FEVR) in a predominantly older Indian population.. Methods: This prospective interventional non-comparative case series included 38 patients of FEVR and their 23 family members. The diagnosis was established by clinical examination, fluorescein angiography and family screening. Prophylactic photocoagulation/cryotherapy or surgical treatment was done depending on the severity of the disease. Results: The mean age of the patients was 23.6 years. The fundus/fluorescein angiographic findings in 116 eyes of our 61 patients (6 eyes phthisical) were as follows: forty eight (41.4%) eyes had only peripheral avascular zone, 8 (6.9%) eyes had peripheral new vessels, and 35 (30.1%) eyes had retinal detachments (RD) - 10 (8.6%) exudative, 5 (4.3%) tractional and 20 (17.2%) rhegmatogenous. Prophylactic photocoagulation or cryotherapy was done in 34 eyes for retinal holes, local exudative detachments and bleeding new vessels. All the eyes retained stable vision over a mean follow-up of 16 months. Only 14 RDs were suitable for surgery: scleral buckling, vitrectomy or both. The reattachment rate was 85.7% (12 of 14) and the best-corrected visual acuity (BCVA) improved to 5/60 or better in 50% of these eyes over a 2-year follow-up. Conclusions: FEVR appears to be more common than reported. Timely diagnosis and intervention is essential in view of the lifelong progression of the disease, late exacerbations, frequent involvement of family members, and poor surgical results. A high index of suspicion, family screening and early prophylaxis are recommended to prevent avoidable blindness from this under- diagnosed disease.

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Infective isolated posterior scleritis is rare. We report a case of isolated posterior scleritis associated with histopathologically documented systemic tuberculosis, a hitherto unreported association. The patient responded well to a combination of oral corticosteroids with antituberculosis therapy.

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Purpose: To report the progression of ocular hypertension (OHT) to primary open angle glaucoma (POAG) during a 5-year follow up of a population-based sample. Methods: Twenty-nine patients diagnosed to have OHT and 110 randomly selected normals from a population-based study in 1995 were invited for ocular examination in 2000. All patients underwent a complete ophthalmic examination; including the daytime diurnal variation of intraocular pressure (IOP) and measurement of central corneal thickness (CCT). The "corrected" IOP was used for analysis. Progression to POAG was based on typical optic disc changes with corresponding field defects on automated perimetry. Results: Twenty-five of the 29 persons with OHT who could be contacted were examined. After correcting for CCT, two persons were reclassified as normal. Four of 23 (17.4%; 95% CI: 1.95 - 32.75) had progressed to POAG. One person amongst the 110 normals progressed to normal tension glaucoma (NTG). The relative risk of progression amongst OHT was 19.1 (95% CI: 2.2 - 163.4). All those who progressed had bilateral OHT. The mean and peak IOP in those who progressed was 25.4 mm Hg and 29.3 mm Hg compared to 23.9 mm Hg and 25.7 mm Hg in those who did not. Those who progressed had more than 8 mm Hg diurnal variation. The diurnal variation was less than 6 mm Hg in those who did not progress. No patient developed blindness due to glaucoma. Conclusion: The 5-year incidence of POAG amongst OHT in this population was 17.4% (3.5% per year). Bilateral OHT, higher peak IOP and large diurnal variation may be the risk factors for progression.

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Purpose: To study the prevalence, manifestations and severity of ocular involvement in Indian patients with Behcet's disease. Method: Prospective analysis of all patients of suspected Behcet's disease between 1997 and 2001. Results: A total of 19 patients were diagnosed to have Behcet's disease. Ocular manifestations were seen in 36% patients. The commonest manifestation was conjunctival ulcer (26.3%), followed by iridocyclitis (10.5%). None of the patients had posterior segment involvement or visual loss. Response to topical corticosteroids was good. Conclusion: The prevalence and severity of ocular lesions in Behcet's disease is relatively low in Indian patients. Conjunctival ulcers was a common finding, which is rarely reported in the world literature.

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Purpose: To compare and evaluate Teller Acuity Cards (TAC) and Cardiff Acuity Cards (CAC) to assess vision in children below the age of two. Methods: The study evaluated TAC and CAC to assess visual acuity in 90 normal children divided into three age groups, 0 - 6 months (group I), 6 - 12 months (group II) and 12 - 24 months (group III). 30 cases of unilateral amblyopiogenic conditions, 10 cases each of unilateral refractive error, unilateral esotropia, and unilateral cataract, were also examined. Trained optometrists carried out binocular testing followed by monocular testing, and recorded the test time in each case. Results: The mean visual acuity (in Snellen units) and standard deviation (in octaves) in the three age groups of normal children, I, II, III respectively were 6/44 ± 0.54, 6/21 ± 0.37 and 6/21 ± 0.41 (binocularly by TAC) and 6/46 ± 0.80, 6/21 ± 0.59 and 6/14.5 ± 0.84 (binocularly by CAC). Although the time taken for testing with CAC was less, its coefficient of variance was greater for all age groups as compared to TAC. Diminution of visual acuity could be assessed correctly by both the tests in cases of strabismus and cataract, but not in some cases of refractive error. Conclusion: CAC is a useful and child-friendly test. It can be used clinically but may miss some cases of visually significant refractive errors. TAC is a more dependable test to assess amblyopiogenic conditions despite the use of gratings.

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Before the turn of the 20th century, eyes with a retinal detachment were considered doomed. Contrary to other branches of ophthalmology, such as cataract extraction, the surgical treatment of retinal detachment was still in its infancy, and the surgical success rates were less than five percent. From 1902 to 1921 Jules Gonin almost single handedly changed the landscape of retinal detachment surgery forever. He recognised that the retinal break was the cause - and not the consequence as it was largely believed at the time - of the retinal detachment, and that the treatment had at all costs to comprise the closure of the break by cauterisation. He named the procedure ignipuncture , as he cauterised the retina through the sclera with a very hot pointed instrument. Despite rigorously detailed clinical observations and increasing success rates, his discovery was not readily accepted and sometimes openly opposed by a large part of the ophthalmic establishment. It was not until 1929 that he received worldwide acclaim at the International Ophthalmological Congress in Amsterdam for his surgical technique. His legacy lives on in the eye hospital in Lausanne that bears his name, in the Gonin Medal awarded by the International Council of Ophthalmology every four years for the highest achievement in ophthalmology, and in a street named after him, the very street that he used to walk from his home to the hospital every day.

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Submacular haemorrhage is an important cause for sudden visual loss needing immediate intervention. We report a case of submacular haemorrhage causing profound visual loss, which resolved after intravitreal injection of perfluoropropane (C3F8) gas followed by strict prone positioning

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An unusual case of posterior scleritis mimicking macular serpiginous choroiditis is reported

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Optical coherence tomographic documented progression of foveal pseudocyst in a vitrectomised eye to full thickness macular hole is reported. Muller cell alteration and other centrifugal forces are possible pathomechanisms.

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It is a long - accepted dogma in ophthalmology that the lens is a tumour-free tissue. Yet, in the lens, there is lifelong mitotic activity in the subcapsular epithelium. Therefore, these subcapsular epithelial cells must have the potential for cellular transformation. How then can we explain the fact that no scientist has ever seen a naturally occurring primary tumour of the lens in vivo ? This review discusses the early work of Mann, von Hallermann, Courtois and others who addressed the issue of tumour resistance of the lens.

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Purpose: To report the clinical and microbiological profile of endophthalmitis caused by Acinetobacter calcoaceticus . Methods: A retrospective study of case series of Acinetobacter calcoaceticus endophthalmitis. Outcome measures included ability to sterilise the eye, anatomical result (clear media and attached retina) and visual recovery (visual acuity > 6/60). Results: Of the 20 cases studied, 10 were cases of postoperative endophthalmitis, 3 were posttraumatic, 6 were endogenous and one was bleb-related endophthalmitis. Specific features of interest observed were relative chronicity of presentation and absence of any obvious predisposing factor in endogenous endophthalmitis cases. All cases could be sterilised except one, which needed evisceration. Cases with postoperative endophthalmitis had better anatomical outcome (7/10 with attached retina and clear media) and visual outcome (4/10 regained vision > 6/18). Higher smear positivity was seen in vitreous samples (72.2%) compared to aqueous samples (37.5%). Culture positivity was higher from the vitreous cavity compared to aqueous. The organism was sensitive to ciprofloxacin in a high percentage (88.9%) of cases. Conclusions: Visual recovery in Acinetobacter calcoaceticus endophthalmitis is modest. Ciprofloxacin is the antibiotic of choice

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A case of congenital glaucoma with developmental delay and several dysmorphic features showing 22p+ chromosomal variant is reported.

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Unilateral papillitis is a rare manifestation of ocular toxoplasmosis. However, other causes of papillitis need to be ruled out before concluding the diagnosis

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