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Purpose: To compare the corneal biomechanical parameters, visual outcome, and epithelial remodeling after small-incision lenticule extraction (SMILE) and photorefractive keratectomy (PRK) for low to moderate myopia., Design: Prospective, interventional, randomized, comparative study., Methods: Eighty eyes of 40 patients undergoing bilateral SMILE or PRK for low to moderate myopia (<-5 D SE) were included. They were divided into two groups based on the planned refractive surgery. Visual acuity, corneal biomechanics using Corvis-ST, epithelial mapping via anterior segment optical coherence tomography, and higher-order aberrations were recorded both preoperatively and postoperatively at 6 months and compared., Results: At 6 months follow-up, the corrected distance visual acuity as well as the postoperative spherical equivalent of both the groups were comparable (P = 0.13 and P = 0.32, respectively). The biomechanical parameters like deformation amplitude ratio (P < 0.01), inverse concave radius (P = 0.006), integrated ratio (P < 0.01), stress-strain index (P < 0.01), Ambrosio's relational thickness (ArTH) (P < 0.01), and corneal biomechanical index-laser vision correction (P = 0.02) were altered more in the SMILE group than in the PRK group, while the biomechanically corrected intraocular pressure (P = 0.16) was comparable. Epithelial remodeling (P = 0.59), higher-order aberrations (P = 0.53), and stromal keratocyte loss (P = 0.16) in both the groups were comparable., Conclusion: Both SMILE and PRK are comparably effective procedures for correction of low to moderate myopia in terms of visual outcomes; however, the corneal biomechanical stability in PRK is superior than that in SMILE., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To compare the visual outcomes of implantable Collamer lens (ICL) with small incision lenticule extraction (SMILE) in cases of moderate-high myopia., Methods: A prospective comparative study was conducted on 60 eyes of 30 patients with moderate-high myopia (-3D to -8D with astigmatism ≤1 D) at a tertiary eye care center. Patients underwent either SMILE or ICL in both eyes and had a postoperative follow-up of 1 year., Results: The manifest refractive spherical equivalent was -5.22 ± 1.05 D and -5.4 ± 1.17 D in the SMILE and ICL groups, respectively (P = 0.53). The mean sphere and cylinder were comparable between the groups. The mean uncorrected visual acuity improved from 1.18 ± 0.19 logMAR to 0.03 ± 0.07 logMAR in SMILE and 1.14 ± 0.25 logMAR to 0.011 ± 0.04 logMAR in the ICL group. The efficacy for SMILE was 83.3% and that for ICL was 93.3%. Safety and predictability (±0.5D) for both was 100%. A significant increase was observed in ocular aberration with a decrease in modular transfer function in the eyes that underwent SMILE, whereas no significant change in the eyes that underwent ICL. A significant difference was observed in all parameters of ocular aberration except corneal trefoil, corneal astigmatism, and PSF between the two groups at the final follow-up. The contrast sensitivity at final follow-up was higher in ICL cases when compared to SMILE. The quality of vision (QoV) score suggested a better QoV with ICL; however, the difference was not statistically significant., Conclusion: Both SMILE and ICL are safe in patients with moderate-high myopia. The efficacy, contrast sensitivity, and postoperative ocular aberration profile are better in cases undergoing ICL., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

We describe and assess the efficiency of a novel technique of placing implantable collamer lens (ICL) footplates in the sulcus in poorly dilated pupils utilizing perioptic holes and two instruments simultaneously (Sinskey hook and ICL manipulator). Twelve eyes of 10 patients underwent ICL implantation through this technique. The technique employs a bimanual approach engaging perioptic holes in the eyes with intraoperative miosis. Perioptic holes were engaged with a Sinskey hook and pulled slightly back, while the footplates were tucked under the iris by using an ICL manipulator. All patients had uneventful surgery. At 1 week follow-up, uncorrected distance visual acuity (UCDVA) was -0.01 ± 0.04 logMAR with a mean vault of 606.17 ± 108.33 microns. No complications were noted. However, too small a pupil is a limiting factor; this technique can be of use in up to mid-dilated pupils. Bimanual placement of haptics of ICL may represent a safe and effective technique in insufficient mydriasis or intraoperative pupillary miosis., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To compare the clinical outcomes and surgical safety between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in vitrectomized eyes., Methods: A prospective interventional comparative study was conducted at a tertiary eye care center. Sixty consecutive cases requiring cataract surgery following pars plana vitrectomy were allocated into Group 1 ( n = 30), who underwent FLACS with intraocular lens implantation, and Group 2 ( n = 30), who underwent CPCS with intraocular lens implantation, and followed up for 3 months. Primary outcome measures were intraoperative ultrasonic cumulative dissipated energy (CDE) and intraoperative and postoperative complications. The secondary outcome measures were postoperative changes in endothelial cell count (ECC) and central corneal thickness (CCT)., Results: Baseline corrected distance visual acuity (CDVA), ECC, and CCT were comparable. Intraoperative CDE was significantly less in the FLACS group (8.11 vs. 15.83 percentage seconds; P = 0.012) with no intraoperative complication in either group. The postoperative CDVA was comparable between the groups with a trend toward earlier visual recovery in the FLACS group. The postoperative day (POD) 1 endothelial cell loss was higher in the CPCS group (7.54% vs. 2.05%), with the mean endothelial cell density being significantly higher in the FLACS group throughout the follow-up period ( P < 0.05). POD-1 corneal edema was higher in the CPCS group compared to FLACS with no significant difference on follow-up. Intraoperative migration of silicone oil to the anterior chamber was observed in 40% versus 0% in the CPCS versus FLACS groups, respectively., Conclusion: FLACS can be safely performed in post-vitrectomy eyes with lesser intraoperative ultrasonic energy used, postoperative endothelial cell loss, and change in CCT compared to CPCS., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To compare the changes encountered in corneal biomechanics and aberration profile following accelerated corneal collagen cross-linking (CXL) using hypo-osmolar and iso-osmolar riboflavin in corneal thicknesses of <400 and >400 microns, respectively., Methods: This is a prospective, interventional, comparative study involving 100 eyes of 75 patients with progressive keratoconus. Eyes were divided into two groups based on corneal thickness: group 1 included eyes with a corneal thickness of <400 microns who underwent hypo-osmolar CXL, and group 2 included eyes with a corneal thickness of >400 microns who underwent iso-osmolar CXL. Corneal biomechanical and aberration profiles were evaluated and compared between groups., Results: In group 1, all higher-order aberrations (HOA) except secondary astigmatism significantly decreased from baseline; however, in group 2, only coma and trefoil decreased. The corneal resistance factor and corneal hysteresis significantly improved in both groups, which was significantly greater in group 2 than in group 1. The change in inverse radius, deformation amplitude, and tomographic biomechanical index was significantly improved in group 2 as compared to group 1., Conclusion: Improvement in corrected distance visual acuity and decrease in HOA were significantly better in the hypo-osmolar CXL group; however, the improvement in biomechanical strength of the cornea was significantly better in the iso-osmolar group., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country., Competing Interests: None

Collagen vascular disorders (CVDs), also known as connective tissue diseases (CTDs), are a heterogeneous group of entities that affect the connective tissues and are capable of causing end-organ damage to multiple systems, primarily cardiopulmonary and musculoskeletal. However, the occurrence and severity are highly variable among patients. Ocular involvement occurs in a significant number of these disorders and may precede the onset of other extraocular features, thereby serving as an important marker in the diagnosis of these diseases. A timely and accurate diagnosis enables the management of complications. CTDs are primarily immune-mediated inflammatory diseases; however, classifications have encompassed heritable disorders affecting collagen-containing structures and disorders of vascular development. A review of literature published until 25 January 2022 and collected from various databases using the relevant keywords was conducted. All publications (original articles, review articles, as well as case reports) describing the ocular features in CTDs were studied in detail. The objective of this review is to recognize the common ophthalmic presentations of various autoimmune and heritable CTDs, distinguish them from overlapping diseases, elaborate on the prognosis and management of these varied eye presentations, and deliberate on their impact on other ophthalmic surgeries., Competing Interests: None

High burden of acute malnutrition among children less than 5 years is a major public health problem in India. A "Two-days National Consultation on Addressing Acute Malnutrition" was organized to gather experiences and evidence from 13 states of India on prevention and management of acute malnutrition among children and documenting viewpoints from experts and government counterparts on the same. The consultation centered around five key themes of addressing acute malnutrition; 1) capacity building, 2) strengthening screening, 3) nutritional care of wasting, 4) tracking progress, and 5) scale-up. The paper highlights the experiences and key recommendations around the above key themes. It emerged that there is a need to further accelerate the efforts toward strengthening existing platforms and services to address acute malnutrition among children. Regular trainings of the frontline workers, increased convergence, regular monitoring, and continued service delivery during the pandemic should be undertaken for better outcomes., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Community Medicine.)

Purpose: The aim of the study was to evaluate the outcomes of cataract surgery in patients of the pediatric age group with systemic comorbidities., Methods: Medical records of 54 eyes (30 patients) of the pediatric age group with systemic comorbidities who had undergone cataract surgery in a tertiary-care center were reviewed. The following parameters were recorded: systemic comorbidity; toxoplasmosis, rubella, cytomegalovirus, herpes simplex, HIV (TORCH) profile, best spectacle-corrected visual acuity (BSCVA), strabismus, nystagmus, and cataract morphology., Results: Thirty patients with a mean age of 55 months (9 months-14 years) were included. On average, every child was seen by three physicians, and the mean duration between the first visit to a physician and presentation to our center was 2.23 ± 0.67 years. The various causes for delay in referral include multiple referrals due to a lack of general anesthesia services in 78% of cases, a long waiting list at the referral hospital in 35% of cases, and a lack of awareness at the primary-care physician level in 50% of cases. The mean BSCVA at presentation was 1.4 logMAR (0.3 to 3 logMAR). The most common cataract morphology was that of zonular cataract (31.48%; 17/54). Strabismus and abnormal eye movements were observed in 27.7% (15/54) and 33.3% (18/54) of eyes, respectively. Various systemic associations were periventricular leukomalacia (12/30), Down's syndrome (6/30), seizure disorder (6/30), cardiac valvular anomalies (6/30), Marfan's syndrome (4/30), hypothyroidism (4/30), rubella (3/20), cytomegalovirus (3/20), cerebral palsy (2/30), nephrotic syndrome (2/30), Type 1 diabetes mellitus (1/30), microcephaly (1/30), cryptogenic West syndrome (1/30), congenital rubella syndrome (1/30), and Tourette syndrome (1/30). The mean postoperative corrected distance visual acuity (CDVA) at 2-year follow-up improved to 1.0 logMAR (0 to 3 logMAR). No postoperative complications were reported at the final follow-up. Around 70% of the parents reported improvement in their child's psychomotor skills., Conclusion: Intellectually impaired pediatric patients with cataract should be operated upon whenever there is a presence of infrastructure, and unnecessary delay in surgery should be avoided by referring the patient to higher centers. Even though objective improvement in visual acuity was suboptimal, there was definitely an improvement in the psychomotor skills of the patients.

Purpose: To evaluate the outcomes of surgical intervention in cases of ectopia lentis., Methods: This retrospective study included all cases of ectopia lentis that presented between June 2015 and March 2019 in a tertiary care center. They were reviewed retrospectively. The corrected distance visual acuity (CDVA), severity of lens subluxation, type of surgery, intra-operative and post-operative complication, and specular count were recorded., Results: Seventy-eight eyes of 57 cases with a mean age at surgery of 14.73 years were analyzed. Intra-lenticular lens aspiration was the most common (n-62/78; 79.5%) surgical procedure followed by lens aspiration, intra-capsular cataract extraction, phaco-aspiration, and pars-plana lensectomy. Simultaneous intra-ocular lens (IOL) implantation was performed in 46.2% (n-32/78) of the eyes. The mean CDVA improved from 0.85 ± 0.55 logMAR to 0.44 ± 0.29 logMAR at 6 weeks follow-up. The post-operative CDVA was significantly better in the pseudo-phakic group compared to the aphakic group (p-0.02). The patient's age at the time of surgery and the degree of subluxation did not impact the final visual outcome. Intra-operative complication included vitreous hemorrhage (n-1) and lens matter drop (n-1). Post-operative complications were noted in 26.9% of the eyes (n-21/78) with a higher complication rate in the pseudo-phakic group (p-0.00). A second intervention was required in 7.7% of the eyes (n-6/78)., Conclusion: Age and degree of subluxation at the time of surgery do not influence the final visual outcome in cases of ectopia lentis undergoing lens extraction surgery. IOL implantation results in better visual outcomes but is associated with a high complication rate., Competing Interests: None

Mucopolysaccharidosis (MPS) is a group of genetic disorders with seven types and 13 subgroups which are characterized by an inherent deficiency of the enzymes responsible for the degradation of glycosaminoglycans (GAGs). Defective breakdown of GAG products leads to their widespread accumulation within the lysosomes of various organs involving the eye, central nervous system, skeletal, ocular, nervous, respiratory, cardiac, and the gastrointestinal systems. Clinical spectrum varies from mild systemic and ocular abnormalities with a normal life span to severe phenotype, fatal in the first few months of life. Visual disability due to corneal clouding, retinopathy, and optic nerve involvement causes additional impairment of physical and cognitive functions. Treatment modalities such as bone marrow transplantation and enzyme replacement therapies help in increasing the life span as well as the quality of life of the affected patients. For patients with significant corneal clouding, keratoplasty is the answer. The decision to proceed with keratoplasty is governed by various factors such as the motivation of the patient and his family, other systemic affections and anesthesia concerns. A detailed preoperative counseling should be done regarding the expected visual outcomes in the presence of other ocular comorbidities and the postoperative complication such as graft re-opacification, rejection and glaucoma. Future treatment options such as targeted gene therapy and substrate reduction therapy hold promise to reverse corneal clouding, thereby obviating the need for corneal transplantation. These treatment therapies are still in the experimental stages and human trials are needed to validate their outcomes., Competing Interests: None

Purpose: To analyze the pattern of bacterial pathogens causing infective keratitis and their resistance to the recommended antibiotics over six years., Methods: It was a retrospective study of 9,357 cases of bacterial keratitis from January 2015 to December 2020, at a tertiary care ophthalmic center. A total of 9,547 corneal specimens were obtained from the study subjects. Demographic details of the patients, pathogenic bacteria isolated, and their antimicrobial susceptibility were noted and analyzed., Results: Bacterial pathogens were identified in 23.52% of the specimens. The most common isolates were coagulase-negative Staphylococci (60.75%), followed by Pseudomonas aeruginosa (14.23%), Staphylococcus aureus (13.92%), gram negative bacilli of the family Enterobacterales (8.64%), Streptococcus spp. (1.72%), Acinetobacter spp. (0.13%), and other non-fermenting gram-negative bacilli (0.57%). In Staphylococci, 55-80% of isolates were resistant to erythromycin, and 40-70% to fluoroquinolones, while no resistance was observed against vancomycin. 40-60% of isolates of P. aeruginosa were resistant to cephalosporins, 40-55% to fluoroquinolones, and 30-60% to aminoglycosides. Also, 40-80% of isolates of Enterobacterales were resistant to cephalosporins, and 50-60% to fluoroquinolones. Most gram-negative isolates were susceptible to carbapenems and polymyxin B., Conclusion: To the best of our knowledge, our study is the largest compilation of microbiological profile of bacterial keratitis from North India. It highlights the current trend of the bacterial pathogens that cause infectious keratitis. Staphylococci and Pseudomonas were found to be the most common pathogens. Increased resistance was seen against some of the commonly prescribed empirical antibiotics. Such evidence is useful for restructuring the empirical prescription practices from time to time., Competing Interests: None

Purpose: To formulate a treatment algorithm for the management of descemetocele., Methods: This was a prospective interventional study that was conducted at a tertiary eye-care center. All consecutive cases of descemetocele during the study period (April 1, 2017-March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated., Results: The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow-up duration was 6.79 ± 3.97 months (3-12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non-perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic (P = 0.07) and visual (P = 0.34) outcomes were noted in subjects with non-functional fellow eye., Conclusion: PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred., Competing Interests: None

Infectious endophthalmitis is a serious and vision-threatening complication of commonly performed intraocular surgeries such as cataract surgery. The occurrence of endophthalmitis can result in severe damage to the uveal and other ocular tissues even among patients undergoing an uncomplicated surgical procedure. If the infections result from common factors such as surgical supplies, operative or operation theater-related risks, there can be a cluster outbreak of toxic anterior segment syndrome (TASS) or infectious endophthalmitis, leading to several patients having an undesirable outcome. Since prevention of intraocular infections is of paramount importance to ophthalmic surgeons, the All India Ophthalmological Society (AIOS) has taken the lead in the formation of a National Task Force to help ophthalmic surgeons apply certain universal precautions in their clinical practice. The Task Force has prepared a handy checklist and evidence-based guidelines to minimize the risk of infectious endophthalmitis following cataract surgery., Competing Interests: None

Obstetrical forceps-induced Descemet membrane tears (FIDMT) are usually encountered during complicated forceps-assisted deliveries. The condition may lead to significant visual debilitation in young children and is frequently ignored due to its low incidence. Undue stretch on the Descemet's membrane during the process of forceps-assisted delivery results in their vertical/oblique tear (s), which usually leads to corneal edema in early neonatal life. On its resolution, these residual tears result in visually disabling astigmatism that can lead to dense and recalcitrant amblyopia. Slit-lamp examination, anterior segment optical coherence tomography, specular microscopy, confocal microscopy, and corneal topography and tomography can be employed for its accurate diagnosis. While these can be prevented by improved perinatal care, once diagnosed, they mandate prompt refractive correction and amblyopia therapy to prevent disabling visual deterioration in affected children. In adulthood, medical and surgical management may be planned for symptomatic patients based on coexistent amblyopia as this is the major factor guiding visual prognosis. There is limited comprehensive literature in this regard, and the present review discusses the pathogenesis, clinical features, and recent developments in investigations, management, and outcomes of FIDMT during the last three decades., Competing Interests: None

Purpose: In India, COVID-19 infected more than 10 million and caused more than 148,000 fatalities during 2020. Due to "lockdown" eye banks were shuttered in March, 2020 and reopened for operations in the month of May, 2020. This study assesses the immediate impact of the pandemic on eye banking and cornea transplantation in India., Methods: Data was gathered through an online survey of the eye banks and cornea surgeons in India. The questionnaire collected information on the vital statistics of eye bank operations and cornea transplants for the period from March to June for the years 2019 and 2020., Results: 47 eye banks responded to the survey. Collectively in the March-May 2020 period, corneas collected and transplanted declined by 78.27% and 79.14%, respectively, compared to the same period of 2019. In June 2020, the first full month after operations restarted, the collection and transplants were respectively, 82.10% and 81.82%, lower than June, 2019. Long-term glycerine preservation of corneas in the period from March to June 2020 increased by 124.5% compared to same period in 2019, but overall only 5.26% of the corneas recovered were preserved in this way. 44.44% of the eye banks collected corneas only from donors with negative COVID-19 diagnosis. 36.11% of the respondents rejected all suspicious cases, such as donors with respiratory pathologies, and 2.78% of the respondents accepted donations from medico legal cases only. 19.44% of the responding eye banks did SARS-CoV-2 nasal swab test for the deceased donor. 79.5% of the eye banks reported that staff were willing to work during the pandemic, and 82.05% eye banks gave special training to staff before restarting services., Conclusion: Due to the steep decline in collections and transplants, 2020 can be termed as a lost year in Indian eye banking. Attention to Hospital Cornea Recovery Programs, continuous situation monitoring, and ongoing staff training programs are recommended., Competing Interests: None

Purpose: To assess the ophthalmic practice pattern among ophthalmologists in India amidst the COVID-19 pandemic., Methods: An online questionnaire-based analysis was performed among members of the All India Ophthalmological Society (AIOS) and results were analyzed using SPSS software version 20., Results: A total of 2253 responses were received. The majority of the participants (72.6%) were between 30 and 60 years of age and were into private practice (64.7%). During the lockdown, over one-third of participant ophthalmologists reported not attending any OPD patients, whereas a majority (64%) provided only emergency ophthalmic services. During the COVID-19 pandemic, <15% surgeries were performed compared to the pre-COVID-19 era by 81% of participants, whereas elective surgeries were performed by only 4.3%. The proportion of participants utilizing telemedicine in ophthalmology showed a two-fold rise from the pre-COVID-19 era (21.9%) to the COVID-19 pandemic (46%). Over half of the participants reported following the AIOS guidelines, reducing clinic hours, use of screening questionnaires, minimizing staff, and use of breath shield on a slit lamp as precautionary measures to reduce the exposure. Over 95% of ophthalmologists were satisfied (score > 5/10) by the AIOS guidelines for ophthalmic practice during COVID-19., Conclusion: COVID-19 pandemic has adversely affected the ophthalmic care services across India with telemedicine emerging as a major rescue. The majority of practicing ophthalmologists are satisfied with guidelines provided by AIOS for ophthalmic care during the COVID-19 pandemic and have implemented the same in their setup., Competing Interests: None

Purpose: To compare the physical and microbiological characteristics of McCarey-Kaufman (MK), Cornisol, and Optisol-GS media and evaluate the outcomes of keratoplasty performed using corneas stored in these three media., Methods: The study involved 60 donor corneas which were distributed in 3 groups: MK, Cornisol, and Optisol-GS. Corneas in these groups were further analyzed based on the type of keratoplasty performed (full thickness versus endothelial keratoplasty). At baseline, the endothelial cell density and death to preservation time of donor corneas were recorded. Following keratoplasty, patients were evaluated on day 1, at 1 month, 3 months, and 6 months follow-up. Outcomes were assessed in terms of corrected distance visual acuity (CDVA), endothelial cell density, percentage endothelial cell loss, and corneal thickness. The storage media were also assessed for their physical quality and their microbiological characteristics., Results: Physical characteristics of all three media were found to be within normal limits. Mean CDVA was comparable among the 3 groups at 6-month follow-up. The absolute endothelial cell count values were significantly lower for corneas stored in MK medium (1873.7 ± 261.1 cells/mm 2 ) compared to the Cornisol (2085.0 ± 230.3 cells/mm 2 ) and Optisol-GS media [(2180.3 ± 217.2 cells/mm 2 ) (P = <0.001)]. Corneas stored in Optisol-GS medium were significantly thinner at 1-month follow-up with no significant difference at 6 months (P = 0.66)., Conclusion: Optisol-GS and Cornisol media were found to preserve endothelial cell density better and stabilize corneal thickness earlier as compared to the MK medium. However, the functional outcomes were comparable among the three groups., Competing Interests: None

Purpose: A survey was conducted by the All India Ophthalmological Society (AIOS) to document the initial coronavirus disease 2019 (COVID-19)-related financial impact on ophthalmology practice in India. It also assessed various measures taken by ophthalmologists and the possible role of AIOS in mitigating the economic crisis., Methods: An online questionnaire-based cross-sectional survey was conducted among its registered members from July to August 2020. The prevalidated questionnaire contained 25 items related to the impact of COVID-19 on patient volume, the extent of financial distress faced by the ophthalmologists, and various proactive measures taken by them. All valid responses were tabulated and analyzed., Results: Out of 1,026 respondents, more than 90% ophthalmologists faced a 25% or more reduction in outpatient and surgical volume. Nearly 59% reported that they can suffer from serious financial distress in near future due to COVID-19 pandemic-related losses. Those who are young (P < 0.0005), salaried (P < 0.0005), and practicing in private sector (P < 0.0005) and Tier 1 cities (P < 0.0005) are reported to be more vulnerable to become financially unstable. The major concerns were revenue losses (70%), preexisting debts (39%), and increased operating costs (27%). The majority (90%) believed that AIOS can help in alleviating the distress. There was also hesitancy regarding the adoption of teleophthalmology and home-based care., Conclusion: COVID-19 has significantly affected the financial sustainability of ophthalmologists practicing in India. Identification of vulnerable groups and timely advocacy efforts by AIOS can help in mitigating this financial crisis., Competing Interests: None

Purpose: Lamellar corneal grafts have revolutionized the management of corneal blindness by replacing only the disease specific corneal layers. To the best of our knowledge, there is no study in literature describing the outcomes of bilateral lamellar keratoplasty in the Indian population. The aim of this work was to study the demographic profile, surgical outcomes, and quality of life in patients who underwent bilateral lamellar keratoplasty and to assess the correlation between these three., Methods: An observational cross-sectional study was conducted on 47 patients who underwent bilateral deep anterior lamellar keratoplasty (DALK) (n = 31) or descemet stripping automated endothelial keratoplasty (DSAEK) (n = 16) with a minimum follow-up of 6 months after the second surgery. Demographic parameters were collected by interview, surgical outcomes by clinical examination, and quality of life by a questionnaire., Results: A total of 47 patients were evaluated, women 42.56%, (n = 20) and men 57.44% (n = 27) with 38.3% being in 18-30 years age group and 23.4% above 60 years; 17.02% patients had a good socioeconomic status (score >60) and 61.70% had poorer socioeconomic status (score <50). Quality of life score (VR-QoL) was ≥50 in 82.9% patients and ≥70 in 14.89%. No significant association existed between VR-QoL scores and demographic factors. However, statistically significant association existed between VR-QoL and age of patient (P < 0.05), postoperative vision (P ≤ 0.05), and contrast sensitivity (P ≤ 0.01)., Conclusion: Bilateral lamellar corneal grafts provide satisfactory visual outcomes compatible with day-to-day functioning. VR-QoL has a direct correlation to the age, visual acuity, contrast sensitivity, and inverse correlation with lenticule thickness in DSAEK and residual bed thickness in DALK., Competing Interests: None

Purpose: The aim of this study was to study the perception of residency trainers about an optimum residency program., Methods: A survey, using a pre-validated questionnaire, was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2019-20 with questions directed to teachers in medical colleges and national board of examination's ophthalmology residency programs on demography, teaching experience, imparting clinical and surgical skills, ideal academic schedule and dissertation in the post-graduate residency program., Results: The response rate in the survey was 47.6%. Valid responses were obtained from 309 residency trainers. Of these, 132 of 309 (42.7%) were females. The mean age was 45.3 ± 9.5 years, range 26-68 years. The trainers believed that on a scale of 0-10, clinical skills teaching should be taught, mean ± SD: slit lamp 9.8 ± 0.7; indirect ophthalmoscopy 9.3 ± 1.3; gonioscopy 9.2 ± 1.5; perimetry 8.9 ± 1.5; OCT 8.4 ± 1.9; applanation tonometry 9.5 ± 1.2 and orthoptic evaluation 8.1 (±1.9). A resident should ideally perform independently surgeries (median, inter-quartile range IQR): SICS 50 (IQR 40-100); phaco 50 (20-60); pterygium excision 20 (10-40); DCR 10 (5-20); chalazion 20 (10-50), trabeculectomy 7 (5-15); strabismus 5 (2-10), LASIK and retinal detachment 0. Ideally there should be four lectures, four seminars, four case presentations, five journal clubs and four wet labs every month., Conclusion: Teachers expected their wards to become competent professionals. There was near unanimity about the content of clinical skills training, non-medical skills and academics, but there was a significant variation on extent of surgical training that should be imparted to the residents., Competing Interests: None

Purpose: Therapeutic contact lenses (TCL) are known to help in epithelial healing and decreasing pain after various corneal surgeries. However, literature lacks any data describing their use following Descemet's stripping automated endothelial keratoplasty (DSAEK) where intraoperative epithelial debridement is commonly performed. Here we study the efficacy and safety of TCL in patients undergoing DSAEK., Methods: In this prospective, randomized, controlled clinical trial. 40 eyes of 40 patients of pseudophakic bullous keratopathy undergoing DSAEK were enrolled and randomized into two groups, control (no TCL) and test (TCL). Primary outcome was time taken for epithelial healing and secondary outcomes were postoperative pain score, graft attachment, best spectacle-corrected visual acuity, and endothelial cell loss at 3 months., Results: Average time taken for epithelial healing was 3.35 ± 0.49 days in the test group and 4.95 ± 1.05 days in the control group (P < 0.001). Average pain scores in first operative week were significantly lower in the test group as compared to control (P < 0.001). Graft detachment occurred in eight patients in control group and two in test group (P = 0.03). Both rebubbling rates and average endothelial cell loss at 3 months were higher in the control group with P = 0.07 and 0.06 respectively. No contact lens-related adverse effects were noted during the study period., Conclusion: Use of TCL in DSAEK leads to faster epithelial healing and lesser postoperative pain. In addition, it may also contribute to lower rebubbling rates and endothelial cell loss., Competing Interests: None

As the COVID-19 pandemic rages on, India is recording a very high number of new cases daily; even as the country prepares to gradually "unlock", after months of lockdown. While elective eye surgeries such as uncomplicated cataract surgeries, blepharoplasty and eyelid procedures and refractive surgeries can be planned at a later date; emergency cases pertaining to ocular trauma cannot be deferred. This manuscript gives a brief overview of the general guidelines for the management of ocular trauma during the COVID-19 pandemic., Competing Interests: None

Purpose: To compare surface quality and endothelial cell viability of descemet stripping automated endothelial keratoplasty (DSAEK) donor lenticules prepared with femtosecond laser (FSL) or microkeratome (MK)., Methods: Experimental ex-vivo evaluation of 15 DSAEK donor lenticules prepared from optical quality donor corneas using 200 KHz FSL (9 eyes) or MK (6 eyes). Surface quality and smoothness of the cut were assessed using atomic force microscopy and endothelial cell viability was assessed using transmission electron microscopy., Results: Mean lenticule thickness was 121.89 ± 17.13 μm in FSL group and 112.67 ± 5.89 μm in MK group (P = 0.33). Average roughness of stromal surface (RMSavg) [FSL- 30.51 ± 4.55 nm, MK-22.37 ± 1.83 nm; P = 0.02] and root mean square roughness (RMSrough) [FSL-31.39 ± 5.75 nm, MK-23.08 ± 0.40 nm; P = 0.012] was significantly more in FSL group. Increased granular and linear irregularities were observed in the FSL group. Endothelial cell disruption was more in FSL group (FSL- 29.49 ± 6.91% MK-13.28 ± 3.62%; P < 0.001) with decreased mean nucleus length (FSL-5.56 ± 0.17 μm, MK-7.52 ± 0.65 μm; P < 0.001)., Conclusion: Automated MKs are still the standard of care for donor lenticule preparation and MK-assisted donor lenticules have smoother surface with less endothelial cell disruption than FSL. Further research is mandatory before FSL platforms can be considered a viable alternative to the MK., Competing Interests: None

Purpose: To evaluate the visual outcomes of bilateral implantation of a new hydrophobic foldable extended depth of focus (EDOF) IOL., Methods: All cases undergoing phacoemulsification with bilateral implantation of Supraphob Infocus IOL between December 2017 and July 2018 at a tertiary eye care center were recruited in this prospective interventional study. The primary outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Postoperative follow-up was done on day 1, 1 week, 1 month, and 3 months., Results: One hundred and four eyes of 52 patients with a mean age of 58.4 ± 9.3 years were included. The mean UDVA improved from 0.84 ± 0.32 logMAR preoperatively to 0.11 ± 0.08 logMAR at 3 months following surgery. At the final follow-up, the binocular UDVA, UIVA, and UNVA was 0.03 ± 0.07, 0.14 ± 0.06, and 0.36 ± 0.05 logMAR, respectively. The mean CS was 1.47 ± 0.06 logCS. The distance and near stereopsis was 90.2 ± 24.8 s of arc (arcsec) and 62.5 ± 19.4 arcsec, respectively. The mean total higher-order aberration (HOA), point spread function, and modulation transfer function were 0.30 ± 0.13, 0.07 ± 0.08, and 0.26 ± 0.07, respectively., Conclusion: The Supraphob Infocus EDOF IOL provides good unaided visual acuity for distance, intermediate, and near along with a high quality of vision as assessed by contrast sensitivity, HOAs, and stereoacuity. It may be a potential alternative to the currently available EDOF IOLs in providing good visual acuity at variable distances., Competing Interests: None

Objective: The study was conducted to identify associated factors of severe wasting among mothers., Methodology: A prospective 12 months' study was conducted in 30 randomly selected villages of Khutpani Block of West Singhbhum with a sample of 600 households with children between 0 and 3 years of age using the prevalence of wasting in West Singhbhum district National Family Health Survey, precision of 0.05, design effect of 2 and accounting for error of 10%. Data on socioeconomic status, maternal anthropometry mid-upper arm circumference (MUAC), water, sanitation and hygiene (WASH) practices, gender-based violence, and food security were collected. Data collection was done between July 2017 and June 2018., Results: Wasting and severe wasting prevalence using MUAC criteria among mothers were found to be 60% and 17%, respectively. The study showed higher rate of severe maternal wasting among households facing poverty, food insecurity, poor WASH practices especially related to hand washing and toilet use and women who faced gender-based violence., Conclusion: Nonnutritional interventions addressing poverty, household food insecurity, gender violence, and WASH practices are required to address maternal wasting, in addition to existing nutritional programs., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Community Medicine.)

The COVID-19 pandemic has threatened the humanity at a global level to a large extent by the burden of the disease with significant mortality and to a certain extent as a byproduct of the necessary efforts to contain the same. There is a significant impact on the health care system, as we not only have to contain pandemic, but continue to treat our non-COVID-19 patients in a safe and responsible manner. Ophthalmology practice in general and glaucoma in particular needs certain modifications and additional precautions while examining as well as managing these patients keeping their and our safety in mind. As the lockdown relaxations are in vogue we need to learn how to deal with our regular patients as well in addition to emergency care. This paper presents the consensus-based guidelines by an expert panel on how to restart glaucoma practice during this COVID-19 time. These guidelines will be applicable across the country and should help ophthalmologists and glaucoma specialist to restart their practices while safeguarding the patients and their own selves from getting infected., Competing Interests: None

Coronavirus pandemic has strained the healthcare system with mortality and morbidity. A number of elective surgeries have come to standstill due to lockdown and movement restrictions. Refractive surgery being a purely elective procedure and quite a fresh subset of ophthalmology, there is a lack of unanimity as to what precautions should be followed to resume the practice of same. This article attempts to highlight simple guidelines in accordance with an expert panel, which can be followed by all those involved directly or indirectly in refractive surgery services while addressing safety of doctors, supporting staff as well as patients as a primary concern., Competing Interests: None

The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has disrupted our society on an unprecedented scale since its inception in December 2019. As the health-care system is finally re-organizing to mitigate the impact of the pandemic, it was necessary to re-structure primary eye care (PEC) activities as well on the same lines. A consensus meeting was held with leading eye-care experts on 2 nd May 2020 to prepare a roadmap for PEC in the days to come. Guidelines are needed for PEC activities like vision testing, refraction, optical dispensing, counseling, etc., Some of the activities at vision centers (VCs) may be postponed or modified in light of the current pandemic situation. PEC workers need to strictly follow social distancing norms (minimum 3 feet) for minimizing risk of exposure and need access to appropriate personal protective equipment (PPE), like gloves, masks and shields while examining beneficiaries. For optometrists, sterilization of instruments and encouraging the people to remain silent during the examination is recommended. Because conjunctivitis may be an early sign which can present at VCs, extra precautions in the form of PPE has to be ensured while examining such patients. This is also an opportunity to start running telemedicine clinics for all emergent cases that cannot be managed at the primary level. The guidelines also need to be updated based on the context of the working environment and changes in government directives from time to time., Competing Interests: None

The COVID-19 pandemic has brought with it the huge burden of mortality and morbidity across the world and the added effects of the mandatory lockdown measures to try and control the spread. A number of aspects of healthcare including eye donation and eye collection require adequate safety precautions in place to keep both the involved healthcare workers and patients safe. This paper highlights the consensus-based guidelines by an expert panel on how to restart eye banking and eye collection services and carry out emergency corneal surgeries during this COVID-19 time. These guidelines will be applicable to all eye banks across the country and should help ophthalmologists and eye banking staff to restart eye banking while safeguarding themselves and their patients., Competing Interests: None

Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI., Competing Interests: None

The COVID-19 Pandemic has prompted substantial changes in the way ophthalmology is practiced globally. General guidelines on safe ophthalmic practice have been issued by various bodies across the globe including the All India Ophthalmological Society. While these are suitable to ophthalmology overall, they are not entirely suitable to a subspecialty practice, particularly pediatric ophthalmology, strabismus and neuro-ophthalmology, which entails dealing with children, surgery under general anesthesia and managing possible life threatening situations. A group of sub-specialists and anesthetists met virtually and arrived at a consensus with regard to practice and general anesthesia protocols pertaining to these subspecialties of ophthalmology. The recommendations made by the expert group are specific yet can be universally followed to ensure the best and safest outcome for the practitioner and patient alike. The recommendations pertain to listing conditions which need emergency or urgent care in the fields of pediatric ophthalmology and neuro-ophthalmology, precautions and technique of pediatric and neuro-ophthalmic eye examination and a protocol for delivering a safe general anesthesia for a pediatriceye surgery., Competing Interests: None

Context: Electronic health record (EHR) has the potential to make available the real-time data of the patient to the healthcare professionals by connecting all levels of the public health system, irrespective of their geographical boundaries., Aim: This study aims to test the capturing and sharing of real-time patient data at primary, secondary, and the tertiary level., Settings and Design: The cloud-based EHR system developed earlier was used to capture real-time data of the patient visiting a primay health center (PHC) in Udupi District of Karnataka., Subjects and Methods: About 100 patient records including laboratory and pharmacy data have been captured into the EHR system. The confidentiality of patient data is assured., Results: The result of the study indicated no errors while capturing and sharing the patient data in real time. The system also evidenced the availability of vital statistics about the patient visiting PHCs. The system also allowed the professionals at referral level to view patient data for providing quality healthcare., Conclusion: EHR plays a vital role in capturing, storing, and sharing patient data for providing quality healthcare and it should be made mandatory by the central health agencies in the provision of patient care and reporting of notifiable communicable diseases at all levels., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Community Medicine.)

Purpose: To evaluate the clinical factors associated with repeat Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty (PKP) in cases of failed DSAEK., Methods: Retrospective observational study of cases with failed DSAEK admitted to our center for a repeat keratoplasty over 5 years (January 2013-Decemeber 2017) was undertaken. Demographic and perioperative details of all cases and type of repeat keratoplasty were recorded. Logistic regression analysis was performed to analyze the factors affecting the type of repeat keratoplasty., Results: total of 94 eyes with failed DSAEK were evaluated. Repeat DSAEK was performed in 66% and PKP in 34% of cases. Significantly increased odds for requiring PKP were observed in association with stromal scarring [odds ratio (OR) = 2.9, P = 0.018)], trainee surgeons (OR = 4.05, P = 0.008), intraoperative complications (OR = 4.58, P = 0.003), scleral fixated intraocular lens or anterior chamber intraocular lens in situ (OR = 33.8, P < 0.001), secondary glaucoma (OR = 3.02, P = 0.015), peripheral anterior synechiae (OR = 8.6, P < 0.001), preoperative corneal thickness (OR = 1.01, P < 0001), time to primary surgery (OR = 1.03, P = 0.03), post-DSAEK host thickness (OR = 1.01, P < 0.001), and time interval from graft failure to regraft (OR = 1.18, P < 0.001). All eyes with congenital hereditary endothelial dystrophy, bee-sting-induced corneal decompensation, Axenfeld-Rieger syndrome, and multiple failed grafts underwent secondary PKP. All cases (nine eyes) that required surgical intervention for secondary glaucoma underwent secondary PKP (P < 0.001)., Conclusion: Repeat DSAEK is feasible in up to two-third of cases of failed DSAEK. A PKP is required in one-third of cases, and various preoperative, intraoperative and postoperative factors are associated with unsuitability for repeat DSAEK., Competing Interests: There are no conflicts of interest.

Purpose: To compare the outcomes of two techniques, for preparation of microkeratome-assisted ultrathin grafts for Descemet's stripping automated endothelial keratoplasty (DSAEK)., Methods: The study involved 20 eyes of 20 patients with pseudophakic bullous keratopathy, randomized into two groups. Group 1 eyes underwent microkeratome-assisted DSAEK using the single-pass technique for lenticule preparation, whereas group 2 eyes underwent microkeratome-assisted DSAEK using the double-pass technique. Patients were followed up till 6 months, postoperatively. Best-corrected visual acuity (BCVA) at final follow-up was considered as the primary outcome measure, whereas graft thickness (GT) contrast sensitivity and endothelial cell loss were considered as the secondary outcome measures. A P value of <0.05 was considered as statistically significant., Results: Baseline characteristics of two groups were comparable. The mean central GT was comparable in both groups at 6 months follow-up [group 1: 98 ± 24.46 μm, group 2: 129 ± 31.46 μm (P = 0.18)]. Both groups fared equally in terms of BCVA (P = 0.33). Contrast sensitivity was significantly better in group 1 eyes (P = 0.045). A statistically significant negative correlation was found between postoperative BCVA and postoperative GT (R = -0.728, P = 0.016). The percentage endothelial cell loss was slightly higher in group 2 eyes, although not statistically significant. Two eyes in group 2 experienced complications during lenticule preparation. None of the eye experienced any complication in the postoperative period., Conclusion: Both techniques provided grafts with comparable thickness and endothelial cell loss and were associated with comparable BCVA, at final follow-up visit. The contrast sensitivity was, however, better in eyes receiving grafts prepared with the single-pass technique., Competing Interests: There are no conflicts of interest among the authors.

Objectives: Prevalence of under-nutrition is very high in India. Under-nutrition is a result of interplay between different immediate, underlying, and basic causes. The study was conducted with the objective to identify significant predictors of stunting, wasting, and underweight., Methods: Cross-sectional studies with 2299 children from five high-burden pockets of four Indian states were conducted. Primary data on their anthropometric measurements along with their households' demographic and socioeconomic characteristics were collected. Binary logistic regression analyses were performed to examine the predictors of stunting, wasting, and underweight., Results: Results show very high prevalence of stunting, wasting, and underweight in all five regions covered in the study. Multivariate analyses show that food security, use of toilets, and low body mass index status of mothers were the major predictors of stunting and underweight among children. Acute respiratory infection disease was the major predictor of underweight and diarrhea was the major predictor of stunting. Younger children (<24 months) had lower odds of underweight and stunting compared to older children (24-59 months). The analyses showed higher odds of wasting among male children. Regional variations were also seen in the study with higher odds of underweight and wasting in Khuntpani block and higher odds of stunting in Naraini block., Conclusion: The above findings indicate that for comprehensively addressing child under-nutrition, it is very important to address maternal nutrition, improve food security, and reduce poverty status, provide better water and sanitation facility to the community, control infections, and address regional disparity., Competing Interests: There are no conflicts of interest.

Background: The World Health Organization recommends weight-for-height Z-score (WHZ) or mid-upper arm circumference (MUAC) and bilateral pitting edema to diagnose acute malnutrition among children aged 6-59 months. WHZ and MUAC identify different sets of children with acute malnutrition, and overlap between their prevalence varies greatly among countries., Objective: The objective of the study was to determine the degree of overlap and agreement between WHZ and MUAC to diagnose children with acute malnutrition in India., Methods: Five nutrition surveys using Standardized Monitoring and Assessment of Relief and Transitions methodology were conducted in four Indian states. A total of 2127 children aged 6-59 months were analyzed. All anthropometric indices were calculated using emergency nutrition assessment software and analyzed in Epi-Info 3.5.4., Results: Of total global acute malnutrition (GAM) cases, 96% and 28.4% cases were diagnosed with WHZ and MUAC, respectively. Similarly, of total severe acute malnutrition (SAM) cases, 95.1% were identified using WHZ and 30% using MUAC. The proportion of overlap between the two criteria for GAM and SAM cases was 24.5% and 25.2%, respectively. The analysis showed that MUAC was comparatively more sensitive to identify acute malnutrition among 6-23-month aged children and females., Conclusion: One-fourth of GAM and SAM cases were identified with both criteria. MUAC identified approximately 30% of the total SAM cases which was lower than other countries. MUAC identified more number of females and younger children, who may have higher mortality risk and would result significantly smaller caseload (68% smaller) that requires intervention compared to when using WHZ., Competing Interests: There are no conflicts of interest.

Context: Asian countries have to confront with the global burden of cancer and various environmental factors predisposing the incidence. Geoinformatics can assist in spatial autocorrelation and statistical analysis in determining environmental and demographic correspondence to endemicity. What is of prime importance is the availability of the spatial datasets of cancer cases., Aims: The aim of this study was to reveal the distribution pattern of cancer and its magnitude in the eight panchayats of Sulthan Bathery Taluk of Wayanad district. The present study also attempted to develop and implement a data frame facilitating better data collection., Settings and Design: This was a taluk-level cross-sectional retrospective analysis and interventional study., Subjects and Methods: A retrospective survey created a geodatabase with 547 cancer cases registered along the timeline of 2015-2016. Input datasets were geocoded using Google Earth Pro software., Statistical Analysis Used: The analysis was performed using ArcMap-10.2 version., Results: Registration revealed the high breast cancer incidences and temporal increment mainly in town areas. The incidence depicted male predominance and prevalence along the age group of 30-69 years. The pattern showed cancer incidence at a proximity to state borders and forest regions (Noolpuzha) which are high population density regions, instantiated relation of geographic variables, and cancer incidences. The implementation of data frame ensured structured data collection., Conclusions: This study concluded the spatial association of cancer incidence demonstrating the high-risk regions with male predominance and role spatial risk analysis in cancer database management., Competing Interests: There are no conflicts of interest.

Background: Cataract surgery when performed under general anesthesia, especially without neuromuscular blocking agents, eccentric position of the eye has been reported. However, no evidence exists for the need and optimal dose of neuromuscular blocking agents for surgical reasons when the anesthetic management may be done without its need. We hypothesize that the minimal dose atracurium may accomplish the surgical requirement of cataract surgery in children., Materials and Methods: After ethical committee approval, this double-blind, prospective, randomized study was conducted in children scheduled for cataract surgery under general anesthesia. Anesthesia was induced in a standardized manner and using laryngeal mask airway. The patients were randomized into four groups of 55 patients each and atracurium was administered as per group allocation: Group 0: No atracurium was administered; Group 50: Received atracurium at 50% dose of ED95; Group 75: Received atracurium at 75% dose of ED95; Group 100: Received atracurium of 100% dose of ED95. Surgeon was asked to grade surgical condition just after the stab incision in the cornea. The primary outcome variable included the need of atracurium supplementation based on grading of surgical conditions by the operating surgeon who was blinded to the randomized group., Results: The need of atracurium due to unacceptable surgical conditions based on surgeon satisfaction score was statistically significant when compared among the groups being maximum in Group 0 (P < 0.001). Also, the surgeon satisfaction score was statistically significant among the groups (P < 0.0001) with the least satisfaction in Group 0. The laryngeal mask airway (LMA) insertion score was statistically significant in the four groups (P - 0.001). However, number of attempts for LMA placement was comparable among the four groups (P - 0.766)., Conclusion: We conclude that a balanced anesthetic technique including atracurium provided better surgical condition for cataract procedures in children. The surgical condition improved with increasing dose of atracurium from 25% to 100% ED95 dose.

Aim: To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK)., Design: Retrospective study., Materials and Methods: A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively. STATISTICAL SOFTWARE: STATA-9.0., Results: The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 ( P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen's acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was -5.37 ± 4.83 diopters (D) and -0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK., Conclusion: LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap.

Recurrence of Salzmann's nodular degeneration following corneal transplantation is uncommon. The earlier reports of recurrence of Salzmann's degeneration were based on clinical evidence. We report two histopathologically proven cases of recurrence of Salzmann's nodular degeneration following keratoplasty; one recurring after lamellar keratoplasty and the other following penetrating keratoplasty. Two male patients (40 yrs and 24 yrs) presented to us with a clinical picture of Salzmann's nodular degeneration. One patient had undergone lamellar keratoplasty in both eyes for Salzmann's degeneration, 22 years ago. A repeat lamellar keratoplasty was performed in the right eye (7.5 mm/8 mm). In the other patient, penetrating keratoplasty was performed in the left eye, 6 years ago for the same. Lamellar keratoplasty was performed in the left eye (8 mm/8 mm). The histopathologic evaluation of the host button in both the cases, showed features very much suggestive of a recurrence of Salzmann's nodular degeneration.

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.