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Background To study the relation between interdigitation zone (IDZ) and right-angle vessel (RAV) in Macular Telangiectasia Type-2 (MacTel). Methods A total of 43 eyes of 38 patients with presence of definite RAV on color fundus photograph (Gass and Blodi-only stage-3) were confirmed on multimodal imaging. The relation of IDZ changes and associated ellipsoid zone (EZ) alterations on spectral-domain-OCT with RAV were studied at baseline and these OCT changes were followed up in 15 eyes over a mean of 3.86 years. Results A total of 58 RAVs were found in the 43 eyes and 53/58 (91.3%) RAVs were associated with IDZ alterations in 39 eyes. On follow-up, IDZ attenuation progressed to IDZ loss and subsequent EZ attenuation and loss. A pre-existing IDZ loss was associated with subsequent EZ defect (P = 0.002). In 36 eyes that had OCT-A, eyes with RAV showed deep capillary plexus telangiectasia in all 36 (100%) eyes and 32/36 (89%) eyes showed IDZ changes with or without EZ loss. Conclusions IDZ attenuation and/or loss are associated with RAV and may serve as predictor of EZ loss in MacTel.

To evaluate the diagnostic accuracy of ultrawide pseudocolor retinal photography (pseudocolor UWF) compared to wide field fundus fluorescein angiography (WFFFA) in the detection of retinal neovascularization (NV) and NV of the disc (NVD) in patients with diabetic retinopathy (DR). Diagnostic accuracy observational study evaluating pseudocolor UWF as the index test. The reference standard was WFFFA. Single retinal centre in India. People with severe non-proliferative DR (sNPDR), early proliferative DR (ePDR) or high-risk proliferative DR (HR PDR). Sensitivity and specificity of pseudocolor UWF in the detection of NV. A total of 176 eyes of 94 subjects with sNPDR, ePDR or HR PDR underwent pseudocolor UWF and WFFFA. The sensitivity and specificity of pseudocolor UWF in detecting NVE were 92.5% (95% CI 86.2–96.5) and 81% (95% CI 64.8–92.0), respectively, with moderate interobserver agreement of 0.722 (p value 0.001). The positive predictive value and negative predictive value were 83.0 (71.4–90.5) and 91.5 (84.9–95.3), respectively. Compared to WFFFA as the gold standard, pseudocolor UWF has high sensitivity and specificity in detection of NV in all retinal quadrants and NVD. Therefore, pseudocolor UWF may be used as a non-invasive tool for screening and managing DR.

Macular telangiectasia type 2 (MacTel) is bilateral disease with characteristic alterations of the macular capillary network along with decreased macular pigment in the parafoveal area. The purpose of this study was to highlight that some eyes show microvascular changes which precede any visible neuronal changes on spectral-domain optical coherence tomography (SD-OCT). This observational study was conducted at a tertiary eye institute. From a registry of 630 patients with MacTel, we identified 4 patients with typical MacTel characteristics in only one eye with no visible changes on colour photographs or SD-OCT in the fellow eye. These 4 patients had findings of MacTel documented by colour fundus photograph, multicolour imaging (MCI), fundus autofluorescence (FAF), confocal blue reflectance (CBR), SD-OCT, and OCT-Angiography (OCT-A) in one eye. OCT-A was performed in MacTel patients using the High-resolution Spectralis (Heidelberg Engineering) module with a full-spectrum probabilistic approach and we employed a 30° x 15° (~8.8 mm × 4.4 mm) scan pattern covering the macula. MCI was done at the end so as to avoid fading the confocal blue reflectance hyperreflectivity seen in MacTel. On OCT-A, all 4 fellow eyes showed telangiectasia and foveal avascular zone changes in the superficial and deep capillary plexuses with no changes on SD-OCT. None of the eyes showed typically increased reflectance on CBR around the foveal area. These findings show that microvascular changes on OCT-A may occur before visible neurodegenerative changes on OCT, providing new insights into the course of the disease.

To determine the associations of predominant peripheral lesions (PPLs) with systemic comorbidities in individuals with diabetic retinopathy.This is a multicenter cross-sectional observational study conducted across three tertiary eye care centers in south India between January 2019 and July 2021. Ultra-widefield fundus images of consecutive patients with varying severity of diabetic retinopathy with data on systemic comorbidities were classified based on the presence or absence of PPL. Systemic comorbidities (hypertension, diabetic kidney disease, coronary artery disease, dyslipidemia, and anemia) were compared between the two groups.A total of 879 participants (70.1% males) were included in the study, of which 443 (50.4%) patients had PPL. The mean age of the study participants was 56 ± 10 years, mean age of onset of diabetes was 41.24 ± 11.6 years, and mean duration of diabetes was 15.39 ± 7.6 years. The number of PPL increased with increasing severity of DR. Of all the systemic comorbidities analyzed, we found that coronary artery disease (CAD) had a significant association with PPL (Odds ratio [OR]-1.69; 95% confidence interval [CI], 1.12-2.55; P = 0.013) after adjusting for diabetic retinopathy severity, duration of diabetes, and age of onset of diabetes.The presence of PPL is a marker for coronary artery disease and early referral to cardiology is warranted.

The retina practice has changed in such a way that diagnosis is incomplete without an optical coherence tomography (OCT) image. This article gives a brief update on the emerging spectrum of retinal diseases and newer terminologies in the spectral domain OCT to keep pace with the rapid advancements in the field of imaging.

To report characteristics of outer foveal defects (OFDs) in type-2 macular telangiectasia (MacTel) on spectral domain optical coherence tomography.This was a single-center observational study. From a registry of 745 patients with MacTel, patients with OFDs were characterized. All patients underwent multimodal imaging including color fundus photography, confocal blue reflectance, fundus autofluorescence, and spectral domain optical coherence tomography. Staging of eyes was done using the Gass and Blodi classification. Spectral domain optical coherence tomography characteristics in the central 1 mm of the macula in eyes with OFD are reported.Outer foveal defect was observed in 21 eyes of 15/745 (2%) patients with MacTel. These defects were bilateral in 6/15 (40%) patients and seen in stage 2 MacTel eyes. In order of prevalence, foveal parameters seen in OFD included hyper-reflective dots in outer retina in 19/21 (90%), ellipsoid zone loss in 18/21 (86%) eyes, interdigitation zone loss in 17/21 (81%) eyes, outer retinal hyporeflective cavitation in 14 (67%) eyes, hyporeflective cavitation at foveal pit in 8 (38%) eyes, and loss of external limiting membrane in 1 (5%) eye. The mean baseline length of the foveal ellipsoid zone loss was 240.17 ± 117.249 µm. The mean baseline central subfield thickness was 155.43 ± 17.215 µm. A total of 8/11 eyes (73%) showed an increase in size of OFD on follow-up.Outer foveal defect in MacTel eyes is characterized predominantly by foveal loss of ellipsoid zone and interdigitation zone with relative preservation of external limiting membrane.

Purpose: The purpose is to study the clinical features of acute acquired comitant esotropia (AACE) in children and analyze the course and outcome. Materials and Methods: A retrospective, clinical study of all patients under the age of 18 years with acute onset, nonaccommodative comitant esotropia in a tertiary eye care center from September 2013 to December 2016. Parameters studied were age, sex, visual acuity, eye involved, age of onset, precipitating event, amount of deviation, presence or absence of amblyopia, cycloplegic refraction, systemic involvement, surgical or nonsurgical intervention, course, and outcome. All patients underwent magnetic resonance imaging of brain and orbits, and systemic evaluation was done in suspicious cases. Minimum follow-up period was 6 months. Results: Out of 12 patients, 8 were male. Average age of the patients was 7.9 years. The mean esodeviation was 33.75 PD, and mean age of onset was 6.14 years (range: 2–15 years). There was left eye preponderance. Three patients (25%) had a history of a precipitating event. Cycloplegic refraction ranged from +0.50 DS to −6.75 DS, with majority having

PURPOSE To evaluate the earliest spectral-domain optical coherence tomography markers in fellow eyes of asymmetric Type-2 macular telangiectasia (MacTel). METHODS A multicentered case-control study of spectral-domain optical coherence tomography images captured on Spectralis Heidelberg Engineering, Germany, comparing features of fellow eyes of patients with asymmetric clinical presentation of MacTel with 50 age-matched control subjects. RESULTS Of 649 patients, 28 (4.3%) with MacTel presented with asymmetric features. The mean age of the MacTel patients was 63.5 (12.4) years with female predilection (4:1). Mean best-corrected visual acuity of the unaffected eye was 0.2 logarithm of the minimum angle of resolution (20/32 Snellen equivalent). The mean central subfoveal thickness in the unaffected MacTel eyes was 194 (SD, 38) µm, and the temporal retinal thickness was 204 (SD, 43) µm. These parameters were significantly thinner than those of control subjects in whom mean central subfoveal thickness was 273 (SD, 26) µm (P = 0.001). Presence of hyperreflective outer retinal dots was found in 92.8% of the unaffected MacTel eyes. These hyperreflective dots were scattered, punctate, nonconfluent, and confined to the outer retinal layers of foveal and parafoveal region. CONCLUSION Although these cases presented with advanced presentation of MacTel features in only one eye, temporal retinal thinning and presence of hyperreflective outer retinal dots in the fellow eye can be considered as the earliest signs of MacTel.

Purpose To develop a deep learning (DL) system that can detect referable diabetic retinopathy (RDR) and vision-threatening diabetic retinopathy (VTDR) from images obtained on ultra-widefield scanning laser ophthalmoscope (UWF-SLO). Design Observational, cross-sectional study. Participants A total of 9392 UWF-SLO images of 1903 eyes from 1022 subjects with diabetes from Hong Kong, the United Kingdom, India, and Argentina. Methods All images were labeled according to the presence or absence of RDR and the presence or absence of VTDR. Labeling was performed by retina specialists from fundus examination, according to the International Clinical Diabetic Retinopathy Disease Severity Scale. Three convolutional neural networks (ResNet50) were trained with a transfer-learning procedure for assessing gradability and identifying VTDR and RDR. External validation was performed on 4 datasets spanning different geographical regions. Main Outcome Measures Area under the receiver operating characteristic curve (AUROC); area under the precision-recall curve (AUPRC); sensitivity, specificity, and accuracy of the DL system in gradability assessment; and detection of RDR and VTDR. Results For gradability assessment, the system achieved an AUROC of 0.923 (95% confidence interval [CI], 0.892–0.947), sensitivity of 86.5% (95% CI, 77.6–92.8), and specificity of 82.1% (95% CI, 77.3–86.2) for the primary validation dataset, and >0.82 AUROCs, >79.6% sensitivity, and >70.4% specificity for the geographical external validation datasets. For detecting RDR and VTDR, the AUROCs were 0.981 (95% CI, 0.977–0.984) and 0.966 (95% CI, 0.961–0.971), with sensitivities of 94.9% (95% CI, 92.3–97.9) and 87.2% (95% CI, 81.5–91.6), specificities of 95.1% (95% CI, 90.6–97.9) and 95.8% (95% CI, 93.3–97.6), and positive predictive values (PPVs) of 98.0% (95% CI, 96.1–99.0) and 91.1% (95% CI, 86.3–94.3) for the primary validation dataset, respectively. The AUROCs and accuracies for detecting both RDR and VTDR were >0.9% and >80%, respectively, for the geographical external validation datasets. The AUPRCs were >0.9, and sensitivities, specificities, and PPVs were >80% for the geographical external validation datasets for RDR and VTDR detection. Conclusions The excellent performance achieved with this DL system for image quality assessment and detection of RDR and VTDR in UWF-SLO images highlights its potential as an efficient and effective diabetic retinopathy screening tool.

Purpose: To analyze whether photoscreening can effectively detect amblyogenic risk factors in children with neurodevelopmental disability. Methods: A prospective study of 52 children attending a special school for children with neurodevelopmental disability from December 2017 to May 2018. All were initially tested with a photoscreening device: Welch Allyn® Spot® Vision Screener: model VS100 (Spot®) and further evaluated at a later date by a pediatric ophthalmologist, with a complete ocular evaluation including squint assessment, cycloplegic retinoscopy, and dilated fundus examination. The key parameters studied were demographic features, type of neurodevelopmental disability, refraction, ocular alignment, media clarity, any other ocular morbidity, and time taken for examination. The presence of amblyogenic risk factors (ARF) was analyzed as per the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus. Results: The mean age was 10.5 years (range: 1–17.5 years). Males (73.1%) outnumbered females (26.9%). The most common neurodevelopmental disability was cerebral palsy. Simple myopic astigmatism was the most common type of refractive error. Presence of ARF in our study was 73.1%. The sensitivity and specificity of photoscreening in detecting ARF were 96.5% and 63.61%, respectively, with a positive predictive value of 80% and negative predictive value of 92.31%. The predictive ability of photoscreening was 79.9% as per the area under curve. The average time taken for photoscreening was less than 60 s. Conclusion: Photoscreening can detect ARF with high sensitivity and reasonable specificity and is a handy, useful, and time-saving tool in screening children with neurodevelopmental disability.

Purpose: To explore novel Optical Coherence Tomography (OCT) biomarkers and precursor lesions in Polypoidal Choroidal Vasculopathy (PCV). Methods: This retrospective cohort study included 76 treatment naïve fellow eyes of PCV. Focus was given to analyse the various morphological changes in the clinically unaffected fellow retina during the follow-up period. Results: 11 fellow eyes (14.47%) developed disease activity in the form of Sub Retinal Fluid (SRF) or Intra Retinal Fluid (IRF) within a mean follow-up of 17 months. All 11 eyes (100%) showed the presence of flat irregular pigment epithelial detachment (FIPED) and a peculiar property of lateral elongation of FIPED during disease activity. A positive correlation with the disease progression was found for the same (P < 0.0001). The mean horizontal dimension of the flat irregular PED at the enrolment was 1984 ± 376u and the mean expansion of FIPED at SRF formation was 461 ± 152u. ICG taken at the time of disease activity in the fellow eye revealed branching vascular network (BVN) in 9 (81.8%) eyes, polyps in 7 (63.6%) eyes, a combination of both in 5 (45.4%) eyes. Type one BVN with interconnecting channels showed faster disease progression than type two BVN. Eye tracking ICG illustrated that BVN corresponded to the FIPED in OCT and polypoidal lesions developed at the end of expanding FIPED. Conclusion: Flat irregular pigment epithelial detachment with its characteristic property of lateral elongation may be considered as a precursor lesion for PCV and as a novel OCT biomarker for the disease activity. Fellow eyes with FIPED need close monitoring to identify development of disease activity at the earliest.

PURPOSE To evaluate changes in macular choroidal thickness in eyes with ischemic and nonischemic diabetic maculopathy. METHODS Cross-sectional study of enhanced depth imaging optical coherence tomography of patients with diabetes. The diabetic eyes were divided into 3 groups: 1) eyes with no diabetic retinopathy (NDR); 2) those with diabetic retinopathy without macular ischemia (DR/MI-); and 3) those with diabetic retinopathy and macular ischemia (DR/MI+). RESULTS This analysis included 261 eyes of 160 patients. Eighty-eight eyes belonged to the NDR, 90 to the DR/MI-, and 83 to the DR/MI+ group. The choroidal thickness was significantly reduced in the DR/MI+ group as compared with the other 2 groups in the subfoveal region (NDR: 285.94 ± 80.38 μm, DR/MI-: 311.22 ± 94.55 μm, DR/MI+: 216.06 ± 58.41 μm; P < 0.001), nasally and temporally (P < 0.01). Between the NDR and DR/MI- groups, the choroidal thickness was significantly reduced nasally (P = 0.02) in the NDR group, but not subfoveally (P = 0.1) and temporally (P = 0.2). Notably, no statistically significant difference in central macular thickness was found between the DR/MI- (328.68 ± 103.28 μm) and DR/MI+ (341.99 ± 130.63 μm) groups (P = 1), although it was found to significantly increase in both these groups as compared with the NDR group (264.03 ± 27.74 μm; P < 0.001). CONCLUSION In diabetic maculopathy, an overall significant reduction was observed in macular choroidal thickness in eyes in ischemic stage as compared with nonischemic stage. In vivo evaluation of choroidal structural changes in the form of choroidal thickness may possibly be intuitive in understanding the pathogenesis of progression of diabetic maculopathy from nonischemic to ischemic stage, and associated functional damage.

PURPOSE To compare outcomes of macular hole surgery using sulfurhexafluoride (SF6) versus perfluoropropane (C3F8) gas. METHODS This is a retrospective, interventional, comparative study. A total of 177 eyes of 166 patients operated over a 3-year period for idiopathic macular holes were included. Sixty-seven eyes had tamponade with SF6 gas (Group 1), whereas 111 eyes received C3F8 (Group 2) as the tamponading agent. The primary outcome measure was the macular hole closure rate. Statistical analysis was done using SPSSv16. RESULTS Spectral domain optical coherence tomography-based stagewise distribution of macular holes were similar across both groups (P = 0.99). The hole closure rate was 57/66 (86.4%) with SF6 and 96/111 (86.5%) with C3F8 gas (P = 0.98). Subanalysis demonstrated no significant difference in closure rates regarding macular hole size, stage, or duration. Best-corrected visual acuity improved by a mean of 0.28 logMAR in the SF6 group (P = 0.00) and 0.42 logMAR in the C3F8 group, corresponding to 3 lines and 4 lines of improvement, respectively, on the Early Treatment Diabetic Retinopathy Study chart (P < 0.05). The difference was not significant (P = 0.06). Rise in intraocular pressure was higher in the C3F8 group (P < 0.05). Progression of cataract was also greater in the C3F8 group (83.3 vs.73.9%), but it was not statistically significant (P = 0.20). Resurgery was done in 9/177 eyes. The closure rate with C3F8 and SF6 reinjections was 3/4 (75%) and 1/5 (20%). Moreover, anatomical hole closure after resurgeries was better in Group 1 (4/5 eyes) than in Group 2 (0/4 eyes). CONCLUSION The macular hole closure rate was similar with sulfurhexafluoride and perfluoropropane, irrespective of hole size, stage, or duration. However, sulfurhexafluoride exhibited a decreased incidence of cataract and ocular hypertension with shorter tamponade duration. Perfluoropropane may have a role as the preferred endotamponading agent in failed primary surgeries.

Purpose To report spectral domain optical coherence tomography features in central serous chorioretinopathy associated with subretinal fibrin. Method Retrospective observational case series of patients with central serous chorioretinopathy with subretinal fibrin imaged with spectral domain optical coherence tomography. Result Twenty-three eyes of 23 patients (19 males and 4 females), with mean age of 39.09 ± 5.8 years were included in the study. Subretinal fibrin clinically ranged from localized well-defined areas to extensive ill-defined areas. Along with the presence of subretinal hyperreflectivity (n = 23, 100%), corresponding to fibrin, spectral domain optical coherence tomography also revealed the presence of the retinal pigment epithelial (RPE) defects (n = 23, 100%) in all eyes with an adjacent well-defined hyporeflective vacuole. In 19 eyes wherein fundus fluorescein was performed, the RPE defects and vacuoles corresponded to the site of RPE leak. Serous pigment epithelial detachments (n = 18, 78.2%), multiple RPE defects in the same eye (n = 5), and multiple RPE defects in same pigment epithelial detachment (n = 1) were few other interesting features observed. Conclusion The presence of a hyporeflective vacuole amid the hyperreflective fibrin adjacent to RPE defects probably indicates the site of constant fluid egress and is an important sign of disease activity especially in cases where fundus fluorescein angiography is not possible.

Purpose: The aim of this study was to evaluate the association of morphological features of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA) and scar formation in eyes with neovascular age-related macular degeneration (neovascular AMD) and to compare with controls of neovascular AMD without SHRM. Methods: Retrospective analysis of 157 wet AMD eyes with SHRM and 50 eyes without SHRM treated with Anti-VEGF. Baseline spectral domain-OCT characteristics (SHRM location, height, width, area, reflectivity, border definition) were collected and were correlated with VA at baseline, 3, 6, 12 months and looked for development of scar and geographical atrophy (GA) and were compared to the control group. Results: When compared to the control, baseline parameters with a significant predictive value of 12-VA were presence of SHRM, foveal involvement of SHRM, high reflective SHRM, well-defined SHRM borders and thick SHRM. VA was decreased with greater SHRM height, width and area (P < 0.001). Decreasing reflectivity of SHRM lesions and disappearance of SHRM correlated with better VA at 12 months (P < 0.05). At 12 months, scar and GA was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved and those without SHRM in the control group. Conclusion: SHRM can be considered as a surrogate OCT biomarker in predicting final visual outcome in neovascular age-related macular degeneration. Baseline parameters predicting poorer vision at 12-follow-up were presence of SHRM involving the fovea, well-defined SHRM borders, greater SHRM height, width and area and persistence of SHRM with Anti-VEGF therapy.

Purpose: The purpose of the study was to analyse the fundus fluorescein angiographic (FFA) and Spectral domain Optical coherence tomographic (SD- OCT) patterns of myopic CNVM and to evaluate their response to anti-VEGF. Materials and Methods: This is a retrospective analysis of 24 treatment naive eyes diagnosed with myopic CNVM. Eyes with age related macular degeneration, coexisting diabetes mellitus, inflammatory CNVM, idiopathic CNVM and Pseudophakia were excluded.Analysis of degree of myopia, the best corrected visual acuity (BCVA) at presentation and one year after treatment, FFA features, SD-OCT images and the response to intravitreal anti VEGF injections were carried out. Results: 24 eyes of 21patients ( 6 males, 15 females) were included in the study Mean age of the patients was 44.78 ± 17.40 years.Degree of myopia ranged from -2.5D to -22 D. Fundus fluorescein angiography showed classic CNVM in all eyes with subfoveal location in 19 eyes and juxtafoveal in 5 eyes. SD-OCT imaging showed subretinal hyperreflective material with intraretinal oedema in all eyes. Intravitreal bevacizumab (1.25mg in 0.5ml) was given in 18 eyes and ranibizumab (0.5 mg in 0.5ml) in 6 eyes. Mean number of injections taken was 1.83 (range 1 to 5). At 1 year follow up,13 eyes showed improvement in BCVA (54.16%), 6 worsened (25%), 5 remained stable (20.83%). Conclusion: Myopic CNVM responds to finite number of anti-VEGF injections anatomically and visually with no associated complications. The worsening is due to degenerative changes rather than recurrence of CNVM.

Purpose: To evaluate the efficacy and optimum timing for resurgery in case of persistent macular hole (MH). Materials and Methods: Nineteen eyes of 19 patients who underwent fluid air exchange with intravitreal C3F8 for persistent MH after vitrectomy + internal limiting membrane peeling + SF6 were included in the study. Best corrected visual acuity (BCVA), optical coherence tomography (OCT) features including base diameter and configuration of MH, and time duration between two surgeries were noted. Results: Patients who underwent resurgery within 3 months of the first surgery had better anatomical closure rate compared to those who underwent resurgery after 3 months (P < 0.05).Significant improvement was seen in BCVA in eyes with closed MH. Eyes having MH with irregular edges on OCT had better anatomical closure rates compared to round edges. Conclusion: Patients undergoing repeat gas injection within 3 months of primary surgery for persistent MH have better anatomical closure rates compared to late intervention (>3 months).

Case report of a 70-year-old male who developed full thickness macular hole (MH) following vitrectomy for vitreomacular traction syndrome. The further intervention was deferred due to the unwillingness of the patient for the second surgery. Periodic follow up of the patient, revealed improvement in visual acuity with the closure of the MH after 28 months.

The COVID-19 pandemic has brought new challenges to the health care community. Many of the super-speciality practices are planning to re-open after the lockdown is lifted. However there is lot of apprehension in everyone's mind about conforming practices that would safeguard the patients, ophthalmologists, healthcare workers as well as taking adequate care of the equipment to minimize the damage. The aim of this article is to develop preferred practice patterns, by developing a consensus amongst the lead experts, that would help the institutes as well as individual vitreo-retina and uveitis experts to restart their practices with confidence. As the situation remains volatile, we would like to mention that these suggestions are evolving and likely to change as our understanding and experience gets better. Further, the suggestions are for routine patients as COVID-19 positive patients may be managed in designated hospitals as per local protocols. Also these suggestions have to be implemented keeping in compliance with local rules and regulations.

A 72-year-old phakic male with immature cataract underwent vitrectomy with silicone oil injection in his left eye for rhegmatogenous retinal detachment. The surgery was uneventful except for lens touch during vitrectomy. Two weeks postoperatively, he presented with circumcorneal congestion, hypopyon, and absent fundal glow suggestive of postoperative endophthalmitis. The patient was managed conservatively as he refused further intervention. Five weeks later, ocular inflammation subsided following posterior dislocation of the cataractous lens, thus revealing the error in our initial diagnosis. Following surgical intervention, the inflammation gradually settled. However, the eye progressed to the prephthisical stage. Phacoantigenic reaction following lens touch during vitreoretinal surgery is very rare. Hence, surgeons should maintain a high index of suspicion in similar case, and prompt intervention is warranted to prevent further complications.

To evaluate the efficacy and optimum timing for resurgery in case of persistent macular hole (MH).Twenty-five eyes of 25 patients who underwent fluid-air exchange with intravitreal C3F8 for persistent MH after vitrectomy + internal limiting membrane peeling + SF6 were included in the study. Best-corrected visual acuity, optical coherence tomography features including base diameter and configuration of MH, and time duration between the two surgeries were noted.Patients who underwent resurgery within 3 months of the first surgery had better anatomical closure rate compared with those who underwent resurgery after 3 months (P0.05). Significant improvement was seen in best-corrected visual acuity in eyes with closed MH. Eyes having MH with irregular edges on optical coherence tomography had better anatomical closure rates compared with the eyes having MH with round edges.Patients undergoing repeat gas injection within 3 months of the primary surgery for persistent MH have better anatomical closure rates compared with late intervention.

Purpose: To report a case of occlusive retinal vasculopathy following varicella zoster infection in an immunocompetent adult.Design: Observational case report.Methods: A patient with defective vision following chickenpox was evaluated with fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence.Results: Fundus showed multiple cotton wool spots and a well-demarcated zone of retinal ischemia in the posterior pole with normal optic disc without any evidence of anterior or posterior uveitis. Fluorescein angiography, spectral domain optical coherence tomography and fundus auto fluorescence findings revealed occlusive vasculopathy as the cause of defective vision.Conclusions: We report a hitherto undescribed case of purely occlusive vasculopathy following varicella zoster infection without features of vasculitis or anterior and posterior uveitis in an immunocompetent individual.

Aim: To provide the normative data of macular and retinal nerve fiber layer (RNFL) thickness in Indians using spectral domain OCT (Spectralis OCT, Heidelberg Engineering, Germany) and to evaluate the effects of age, gender, and refraction on these parameters. Design: Observational, cross-sectional study. Materials and Methods: The eyes of 105 healthy patients aged between 20-75 years, with no ocular disease and best corrected visual acuity of 20/20, were scanned using standard scanning protocols by a single examiner. Exclusion criteria included glaucoma, retinal diseases, diabetes, history of prior intraocular surgery or laser treatment. The mean macular and RNFL thickness were recorded, and the effects of age, gender, and refraction on these parameters were evaluated. This data was compared with published literature on Caucasians to assess the ethnic variations of these parameters. Results: The normal central foveal thickness in healthy Indian eyes measured using Spectralis OCT was 260.1 ± 18.19 ΅m. The nasal inner quadrant showed maximum retinal thickness (338.88 ± 18.17 ΅m).The mean RNFL thickness was 101.43 ± 8.63 ΅m with maximum thickness in the inferior quadrant. The central foveal thickness showed a gender-based difference ( P = 0.005) but did not correlate significantly with age ( P = 0.134), whereas the parafoveal, perifoveal thickness, macular volume, and RNFL thickness showed significant negative correlation with age. Conclusions: Our study provides the normative database for Indians on Spectralis OCT. It also suggests that age should be considered while interpreting the macular thickness and RNFL, whereas gender should also be given consideration in central foveal thickness.

PURPOSE To report the occurrence of macular telangiectasia (Mac Tel) Type 2 in a 28-year-old lady. METHODS Retrospective case report. RESULTS A 28-year-old obese diabetic lady presented with mild blurring of vision and reading difficulty for 2 months. Clinical examination revealed the presence of myopic refraction and features suggestive of macular telangiectasia Type 2 on fundus evaluation. Fundus fluorescein angiography and optical coherence tomography confirmed the diagnosis of Mac Tel Type 2, Stage 3. As there was no evidence of subretinal neovascular membrane, she was advised to follow-up regularly. CONCLUSION Mac Tel Type 2 or idiopathic juxtafoveal telangiectasia is a condition commonly reported in middle age or elderly people. Presentation in a young individual alerts us to the possibility of this condition occurring at an early age and also stresses on the need for meticulous examination to detect subtle signs of the condition in the young.

To analyse whether the size of internal limiting membrane peeling influences the outcome of macular hole surgery.Prospective, comparative, interventional study. Fifty eyes were included. Twenty-five eyes had smaller (3-mm) peel (Group 1), whereas the other 25 had larger (5-mm) peel (Group 2). Outcome measures were macular hole closure rate, improvement in best corrected visual acuity, retinal nerve fiber layer, and ganglion cell layer thickness (0.5 mm, 1.5 mm, and 2.5 mm temporal and medial to the fovea), external limiting membrane, inner segment outer segment layer, and cone outer segment tip restoration.Both the groups were matched for demographic parameters, spectral-domain optical coherence tomography-based macular hole staging and dimensions. Hole closure rates were similar, 80% and 65% in Group 1 and 2, respectively (P = 0.20). No difference was observed in anatomical success rate, irrespective of size, stage, or duration of hole. Visual improvement was better in Group 1 (4 lines vs. 2-line Early Treatment Diabetic Retinopathy Study equivalent; P = 0.04); the retinal nerve fiber layer was thinner at all locations in Group 2, with the difference being significant, 2.5 mm temporal to the fovea (P0.05), whereas the ganglion cell layer was thicker in the 3-mm group, significantly so at the location, 1.5 mm temporal to the fovea (P = 0.01). Outer layer restoration rates were also similar in both the groups.Macular hole closure rate was similar in both the groups; however, smaller (3-mm) peel group demonstrated better functional improvement and nerve fiber layer preservation.

PURPOSE Spectral domain optical coherence tomography-based analysis of retinal architecture after internal limiting membrane peeling for macular hole surgery. METHODS Prospective, interventional study. Fifty eyes underwent the surgical procedure with minimum internal limiting membrane peel of 3 mm diameter. Automatic segmentation software was used to assess individual layers preoperatively and postoperatively, 1.5 millimeters medial and lateral to fovea at 3 months postoperative visit. Main outcome measures were final central macular thickness and variation in individual retinal layer thickness. RESULTS Mean central macular thickness postoperatively was 201 microns. Retinal thickening was observed, 1.5 mm medial to fovea (P < 0.01) with significant increment in thickness of inner nuclear layer (P < 0.01), whereas significant retinal thinning was observed 1.5 mm temporal to fovea (P < 0.01) with maximum thinning observed in ganglion cell layer (P < 0.01). Ganglion cell and inner plexiform were the only layers to demonstrate thinning on both sides of the fovea. External limiting membrane (ELM), inner segment outer segment junction (ISOS) and cone outer segment tips zone (COST) restoration was seen in 100%, 69%, and 17% of eyes. Best corrected visual acuity (BCVA) improved significantly with mean postoperative BCVA of 0.7logMAR (6/30 Snellens equivalent) (P < 0.001). Anatomical closure rate of 72% was achieved (P < 0.001). CONCLUSION Internal limiting membrane peel is associated with significant alteration in inner retinal architecture, especially in ganglion cell layer, which can adversely influence functional outcome of the surgery and makes it imperative to avoid peeling internal limiting membrane over a larger surface area.

Context: Ocular complications due to diabetes mellitus (DM) were on the rise despite good literacy levels in South India. Aims: To assess the knowledge and attitude toward DM and diabetic retinopathy of the general population in a suburban town of South India. Settings and Design: Door-to-door population survey in suburban town of South India in May 2013. Materials and Methods: A 30-point questionnaire was prepared and the data were collected and analyzed to determine statistically the knowledge, attitude, and practice (KAP) scores of the general and diabetic population and also to determine significant demographic associations. Results: In this study, 6211 people (3528 [56.8%] women and 2683 [43.2%] men) with a mean age of 55.6 ± 11.7 years (range 21-98 years) were included. Good knowledge and positive attitude were observed in 3457 (55.6%) and 3280 (52.8%) people. Among 1538 (25.4%) people known to have DM, only 619 (40.7%) had good knowledge, 828 (53.8%) had a positive attitude, and 886 (57.6%) had good practice patterns. Although half of them followed general diabetic care, only 9.6% had undergone screening for retinopathy. Literacy showed a significant association with good KAP (P < 0.001 each) in general population and those with DM. Overall, women had significantly better knowledge (P < 0.001). Conclusions: Better literacy, especially among women, is contributory to better public awareness; however, the trend for poor practice patterns needs to be radically changed with aggressive public motivation emphasizing on the necessity of retinopathy screening and periodic follow-ups.

Purpose: The aim of this study is to review the pattern of visual disability and the type of low vision rehabilitation done in patients who attended the low vision clinic at a tertiary eye care referral center in Kerala between May 2015 and April 2016. Materials and Methods: This is a retrospective, hospital-based review of 200 medical records of patients who attended a tertiary eye care center in Kerala between May 2015 and April 2016. Criteria for low vision were defined as best-corrected visual acuity binocularly (BCVA) for distance by logarithm of minimum angle of resolution chart was> 0.4 and for near was N8 with + 4.00 DS addition with near vision test types. The data collected included age, gender, diagnosis, BCVA for distance and near, improvement of near vision after low vision aid (LVA), and the type of LVA preferred by the patient. Results: Two hundred patients were reviewed. Of these, 64% were males and 36% were females. The age group was between 5 and 90 years. Fifty-one percent low vision was because of proliferative diabetic retinopathy (PDR) with or without maculopathy, 5% central serous retinopathy, 1% venous occlusions, 12% age-related macular degenerations, 6% retinal detachment, 3% macular hole, 19% other retinal diseases, 1% glaucoma, and 2% others. BCVA binocularly for distance was between 0.4 and 0.7 in 46%, 0.8–1 in 44%, and> 1 in 10% and near vision with +4.00 add was between N8–N12 in 56% and N18–N36 in 44%. With LVA, 62% improved to N6, 35% N8–N10, and 3% N12–N18. Nearly 61% of patients preferred prismatic spectacles. Conclusion: Patients with PDR with or without diabetic maculopathy who had low vision in spite of maximum treatment formed the largest group in our study. The BCVA for near improved to N6 in 62% of the patients. Prismatic spectacles were the LVA most commonly preferred for near vision.

The purpose of the study was to review the current evidence and design a diabetic macular edema (DME) management guideline specific for India. The published DME guidelines from different organizations and publications were weighed against the practice trends in India. This included the recently approved drugs. DME management consisted of control of diabetes and other associated systemic conditions, such as hypertension and hyperlipidemia, and specific therapy to reduce macular edema. Quantification of macular edema is precisely made with the optical coherence tomography and treatment options include retinal laser, intravitreal anti-vascular endothelial growth factors (VEGF), and implantable dexamethasone. Specific use of these modalities depends on the presenting vision and extent of macular involvement. Invariable eyes with center-involving macular edema benefit from intravitreal anti-VEGF or dexamethasone implant therapy, and eyes with macular edema not involving the macula center benefit from retinal laser. The results are illustrated with adequate case studies and frequently asked questions. This guideline prepared on the current published evidence is meant as a guideline for the treating physicians.

Purpose: To investigate the safety and efficacy of pneumatic displacement of submacular hemorrhage without the use of intravitreal tissue plasminogen activator (tPA). Methods: In a prospective, consecutive, single-center, noncomparative, interventional case series, 20 consecutive patients with submacular hemorrhage due to various etiologies (duration, 1–30 days; visual acuity, hand movements to 20/125) were treated with intravitreal perfluoropropane gas injection followed by prone positioning for 5 days to 7 days. Patients were observed 1 day, 7 days, 30 days, 3 months, 6 months, and 1 year after the procedure. Results: Submacular blood was completely or partially displaced from the fovea in 16 of 20 eyes within 7 days after the injection. Mean best-corrected visual acuity improved from 1.6 to 0.72 logarithm of minimum angle of resolution, which was statistically significant (Wilcoxon signed rank test, P = 0.001). Final visual acuity was 20/63 or better in 10 eyes (50%). The change in proportion of eyes with best-corrected visual acuity of 20/63 or better after treatment was statistically significant (McNemar test, P = 0.002). Four patients developed nonresolving vitreous hemorrhage, which necessitated vitrectomy. Conclusion: The results of pneumatic displacement of submacular hemorrhage using perfluoropropane gas are encouraging, thus questioning the role of tPA in the management of such cases.

Importance Optic disc pit with associated maculopathy is a known entity. However, controversy exists regarding the source of subretinal fluid in these cases. In our series, we attempted to analyze the morphologic changes seen in the optic disc pit and evaluate the source of subretinal fluid. Observations In this prospective observational case series of 4 patients with optic pit maculopathy, a complete ophthalmic evaluation, with fundus color photography and enhanced depth imaging spectral-domain optical coherence tomography scanning of the optic disc, was carried out between January 2013 and November 2013. The optical coherence tomographic section was mapped with infrared image and color photography, and the characteristics of the retina and optic nerve head were analyzed. All the cases had outer layer retinal schisis; 2 of them had associated serous macular detachment while inner retinal schisis was present in 3 cases. A hyporeflective tract was observed in our study connecting the retinal schisis cavity and gap in the lamina cribrosa corresponding to the optic pit. Conclusions and Relevance In our study, we demonstrated the connectivity between retinal schisis and the gap in the lamina cribrosa present in the optic disc pit, supporting the hypothesis of cerebrospinal fluid as the source of subretinal fluid.

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.