Serious complications following orbital regional anesthesia are rare, but occur following both needle and blunt cannula (sub-Tenon's) techniques. Each technique of orbital regional anesthesia has its own risk/benefit profile. This article reviews the etiology, risk factors, treatment and prevention of complications of commonly used akinetic orbital blocks. Ophthalmologists and ophthalmic anesthesiologists must be prepared to deal with rare, but serious complications, that can occur with any technique of orbital regional anesthesia.

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Diabetic retinopathy is fast emerging as a leading cause of newly diagnosed legal blindness amongst the working population. Macular edema, as it is commoner, accounts for more vision impairment than neovascular proliferation in diabetic patients. Laser photocoagulation, which is the standard treatment of macular edema, is associated with significant complications and an improvement in visual acuity is unsatisfactory. Intravitreal injection of corticosteroids (especially triamcinolone acetonide) is an emerging treatment modality in the management of diabetic macular edema. This article presents an overview of the principles, technique and complications associated with this procedure.

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Toxoplasma gondii is a protozoan parasite that infects up to a third of the world's population. Infection is mainly acquired by ingestion of food that is contaminated with oocysts. We report an outbreak of ocular toxoplasmosis, which is an acute acquired type rather than reactivation of congenital toxoplasmosis. Our preliminary investigation points to municipal water contamination. This outbreak only proves the need of an effective public health system and health education in curtailing any outbreak.

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Purpose: To compare the intra-patient incidence of posterior capsular opacification (PCO) and their post operative course, in children with bilateral cataract, following implantation of acrylic (Group 1) and polymethyl methacrylate (PMMA) (Group 2) intraocular lenses (IOLs). Materials and Methods: This was a prospective, interventional intra-patient case series. Twenty-five children with bilateral cataract, 5 years and older, underwent cataract surgery and implantation of an acrylic (AcrySof MA30BA, Alcon, Fortworth, TX) in one eye and PMMA (Indo Am IAB 203, Ocular Vision, Inc.) IOL in the other eye of each patient. They were followed up for an average of 11.1 ± 9.5 months to assess the incidence of clinically significant PCO and occurrence of postoperative complications. Results: Twenty-three children (46 eyes), were included in this study. Post-operatively, 22(95.6%) patients with acrylic IOLs and 20 (86.9%) patients with PMMA IOLs, either maintained or improved their vision. In the acrylic and PMMA IOL groups respectively, the incidence of clinically significant PCO was 21% (4) and 75% (12) ( P =0.002), with a median onset at 2.9 months and 0.7 months. Other complications included pupillary capture in 2 (8.7%) eyes and uveal prolapse in 1 (4.3%) eye in the acrylic group and increased uveal inflammation in 6 (26.1%) eyes and presumed noninfectious endophthalmitis in 2 (8.7%) eyes in the PMMA group. Conclusion: Incidence of PCO and post operative uveal inflammation is significantly less with acrylic lenses and were safe to use in pediatric eyes.

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Purpose: To report the outcome of a retrospective study of the Pintucci Biointegrable Keratoprosthesis (PBIKP) in Asian eyes. Materials and Methods: This was a retrospective analysis of 31 eyes of 31 consecutive patients, who underwent surgery with implantation of the PBIKP. The age ranged from 7 years to 65 years, with a mean age of 34 years. The indications for the PBIKP were chemical burns (11 cases); highly vascularized failed grafts (11 cases); severe dry eyes with total vascularized cornea (6 cases); miscellaneous (3 cases). Twenty eight bilaterally blind Asian patients, with vision not exceeding hand motion close to face in the better eye, underwent the classical two-stage procedure to implant the PBIKP. In another three patients, the PBIKP was implanted as a one-stage procedure. All 31 eyes were unsuitable for keratoplasty or had repeated failed keratoplasties. All patients were followed up for periods ranging from 6 months to 7 years, with a mean of 3.2 years. Results: No eye had infection or retro prosthetic membrane, which were common complications in other Keratoprostheses designs. Twenty-four of 31 eyes improved to greater than finger counting at 1.5 metres, enabling the patients to function independently. Four of 31 eyes (13%) improved to 20/200 or better. Twelve of 31 eyes had significant complications. However only a few were vision- threatening. Conclusion : With careful patient selection, the PBIKP could prove to be a useful modality of treatment for bilaterally corneally blind Asian patients, whose vision cannot be improved with conventional medical or surgical treatments.

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Purpose: (1) To find out the relationship of the depth of amblyopia with the degree of anisometropia, in untreated cases of anisometropic amblyopia without strabismus, for both myopic and hypermetropic individuals. (2) To find out the relationship between various ocular parameters, such as axial length and corneal curvature, with the degree of anisometropia between the two eyes. Materials and Methods: This prospective study was conducted between January 2001 and March 2003, in 85 cases of untreated anisometropic amblyopia, who attended the author's out patient department. All these patients were subjected to a meticulous ocular examination, with special emphasis on (1) refraction under cycloplegia (2) best corrected visual acuity (3) measurement of axial length by A Scan (4) keratometry . The depth of amblyopia was calculated in two ways: (1) By finding out decimal visual acuity for each eye and subsequently calculating their difference. (2) By converting the Snellen acuity into Log MAR units, which was calculated by finding the Logarithm of the reciprocal of the decimal visual acuity for the two eyes, followed by calculating the difference between the two. The difference in refraction between the two eyes as a measure of anisometropia, was determined by the difference in spherical equivalent between the refraction for each eye. Results: On comparing hypermetropic and myopic cases, a significant correlation was found between depth of amblyopia and the degree of anisometropia, in both myopic and hypermetropic patients. The correlation coefficients were however, found to be greater for hypermetropic than myopic individuals. It was observed that the difference between the axial length of the two eyes contributed to a major part of anisometropia, more so in myopic cases. Conclusions: The depth of amblyopia correlates with the degree of anisometropia in previously untreated anisometropic amblyopia patients.

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Context: Vitreous surgery has been advocated as an alternative treatment of selected retinal detachments with choroidal colobomas. Aim: To study the long term anatomical and visual outcome of choroidal coloboma with retinal detachment managed by pars plana vitrectomy with silicone oil tamponade. Setting and Design: Retrospective study conducted in a tertiary eye care hospital. Materials and Methods: Fourty two eyes of 40 patients with retinal detachments related to coloboma of the choroid without any peripheral breaks were analyzed. All eyes underwent pars plana vitrectomy with internal tamponade using silicone oil. Endolaser was performed along the coloboma border. Silicone oil was removed in 50% of patients. The main outcome measures were retinal reattachment and visual recovery. SPSS (Statistical Package for the Social Science), version 10.0 was used for analysis. Results: The retina in all cases (100%) undergoing vitrectomy were completely reattached intra-operatively. After a mean follow-up of 14 months, 37 (88.1%) eyes had attached retina. The best corrected visual acuity was 10/200 or better in 33 (78.4%) eyes. The best corrected visual acuity improved from a preoperative median of counting fingers (range 20/40 to perception of light) to median best corrected visual acuity of 20/200 (range 20/40 to perception of light) at the end of 6 months. Of the 50% (21) cases that underwent silicone oil removal, two eyes had re-detachment of retina. Conclusion: Pars plana vitrectomy along with silicone oil tamponade for retinal detachment related to choroidal coloboma improves the long-term anatomical and visual outcome.

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Purpose: To study the efficacy and safety of low dose topical Mitomycin C (MMC) in severe Vernal keratoconjunctivitis (VKC). Design: Placebo controlled double masked randomized clinical trial. Materials and Methods: Twenty-eight patients with severe VKC were randomly assigned to receive either topical MMC (0.01%) (n=17) or distilled water (n=11) three times daily for a period of two weeks. Signs and symptoms were recorded on day of presentation and at the end of treatment period (2 weeks). Mann Whitney test was used to analyze the signs and symptoms in the two groups. Results: No statistically significant difference was observed in terms of severity of symptoms at presentation. At two weeks patients in the MMC group showed significant decrease in tearing, foreign body sensation, discharge, hyperemia, punctate keratitis, limbal edema and trantas spots. No adverse effect of MMC was observed. Conclusion: Short term low dose topical MMC is an effective and safe drug to control acute exacerbations in patients of severe VKC refractory to conventional treatment.

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Congenital unilateral fibrosis, blepharoptosis and enophthalmos syndrome is one of the rare forms of congenital fibrosis of extraocular muscles. The nature and cause of such unilateral inflammation leading to fibrosis is unknown. Prenatal orbital penetration has been proposed as a cause of this syndrome. We report a case of this rare syndrome associated with an adjacent sinus tumor.

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Various trans-conjunctival ophthalmic procedures are reported to cause inclusion cyst of conjunctiva, due to the accidental inclusion of viable conjunctival epithelium, under intact conjunctiva. We report a case of histopathologically confirmed inclusion cyst of the cornea following filtering surgery. There was no recurrence in 24 months of postoperative period.

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Metallic iris intra ocular foreign body (IOFBs) with minimal ocular damage pose an interventional challenge. We report safe removal of metallic intraocular foreign bodies embedded on the iris, in three cases by use of intraocular magnets. Two eyes had a clear lens with best corrected visual acuity (BCVA) of 20/20, while the third eye had a BCVA of 20/200 with siderotic cataract. Ultrasound biomicroscopy confirmed the superficial impaction of IOFB into the iris. Foreign bodies were successfully removed via the limbal route with a 20 g intravitreal magnet atraumatically in all 3 cases with preservation of their pre-operative BCVA. Case series highlights the usefulness and safety of intraocular magnet for removal of metallic iris foreign bodies in selected cases. Prior ultrasound biomicroscopy to know the actual depth of penetration of IOFB into the iris and preoperative confirmation of magnetic property of IOFB are essential.

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A 45-year-old woman, complaining of sudden visual loss in the right eye (best-corrected visual acuity: 17/200), was suspected of having a malignant melanoma of the choroid. Fundus examination revealed a massive pale-colored subretinal mass temporal to the fovea, with adjoining choroidal folds and exudative retinal detachment. Ultrasonography was suggestive of posterior scleritis. Systemic evaluation was unremarkable. The patient was treated with high-dose systemic corticosteroids. The mass lesion resolved completely, with visual recovery to 20/20. Posterior scleritis should be suspected when evaluating subretinal mass-lesions, even when large and without overt inflammation. Early treatment may improve the visual prognosis and avoid misdirected management, including enucleation.

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Purpose: To evaluate the measure of intraocular pressure (IOP) in patients with scarred corneas obtained from the affected and non-affected areas. Materials and Methods: Eighteen patients with small maculo-leucomatous corneal opacity following microbial keratitis were prospectively included in the study. Goldmann applanation tonometry was done first on the non-affected corneal surface. ProTon tonometry (PT) was then carried out on the same eye, to obtain IOP measurements from the non-affected (PT1) and the affected area (PT2) of the cornea. The IOP measurements were compared using a two-tail paired t test. Results: The mean of IOP measurements of PT 2 and PT1 was 22 mm of Hg (SD ± 5.2) and 14.8 mm of Hg (SD ± 5.4), respectively. The higher reading of PT2 was statistically significant ( P <0.001). The mean Goldmann applanation tonometry was 14.6 mm of Hg (SD 5.4) and it did not differ significantly ( P = 0.86) from the PT1 readings of 14.8 mm of Hg (SD 5.4). Conclusion: In patients with maculo-leucomatous corneal opacity, determination of IOP by ProTon tonometer varies from the affected to the non-affected area. The ProTon tonometer overestimates the level of IOP when it is applied to a leucomatous corneal opacity.

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Corneoscleral cysts are a rare entity. We report a case of spontaneous corneoscleral hematic cyst, which was treated by cyst excision and lamellar corneal patch graft. No recurrence of cyst was noticed during the 6 years of followup.

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An Internet browser-based annotation system can be used to identify and describe features in digitalized retinal images, in multicentric clinical trials, in real time. In this web-based annotation system, the user employs a mouse to draw and create annotations on a transparent layer, that encapsulates the observations and interpretations of a specific image. Multiple annotation layers may be overlaid on a single image. These layers may correspond to annotations by different users on the same image or annotations of a temporal sequence of images of a disease process, over a period of time. In addition, geometrical properties of annotated figures may be computed and measured. The annotations are stored in a central repository database on a server, which can be retrieved by multiple users in real time. This system facilitates objective evaluation of digital images and comparison of double-blind readings of digital photographs, with an identifiable audit trail. Annotation of ophthalmic images allowed clinically feasible and useful interpretation to track properties of an area of fundus pathology. This provided an objective method to monitor properties of pathologies over time, an essential component of multicentric clinical trials. The annotation system also allowed users to view stereoscopic images that are stereo pairs. This web-based annotation system is useful and valuable in monitoring patient care, in multicentric clinical trials, telemedicine, teaching and routine clinical settings.

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