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Purpose: To evaluate the correlation of Meiboscale with symptom score (Ocular Surface Disease Index [OSDI]) and meibomian gland dysfunction (MGD) sign score. Methods: We performed a cross-sectional hospital-based study of 53 patients of primary MGD who filled the OSDI questionnaire form and underwent complete ocular examination. The MGD sign score was calculated in both eyes using the sum of six grading systems proposed by Arita et al. in 2016. The participants underwent imaging of the upper and lower eyelids of both eyes (212 eyelids) by specular microscope. The area of meibomian gland loss (MGL) was visually assessed and scored using the Meiboscale photographic card. Correlation between these three values – OSDI score, sign score, and MGL score based on Meiboscale - was calculated using Spearman's correlation analysis and Jonckheere–Terpstra (J–T) test. Correlation coefficient rs > 0.5 was considered clinically significant. Results: Associations between MGL score and OSDI score, as well as between OSDI and sign score were statistically significant, but not clinically significant (rs = 0.3684, P < 0.001 and rs = 0.41179, P < 0.001, respectively). The association between MGL score and MGD sign score was statistically as well as clinically significant (rs = 0.8392, P < 0.001). J–T test revealed large effect size (P < 0.001, r-effect = 0.93). Conclusion: The Meiboscale card had not been tested for utility in the Indian outpatient setting yet. Meiboscale can be used for reliable assessment and grading of MGD, and has clinical utility similar to the sum of six MGD sign scores. Additionally, assessment of symptoms using OSDI or a similar questionnaire is also recommended.

Purpose: Pterygium is a triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the cornea. It is now considered to be a result of uncontrolled cellular proliferation as overexpression of p53 protein and Ki-67 nuclear protein was found in the epithelium. This study was done to find the expression of p53 and Ki-67 with the severity and duration of the pterygium to explain the etiopathogenesis. Methods: Data were analyzed from 43 Indian participants of all age groups. All patients were divided according to the severity of pterygium (mild, moderate, and severe groups) and according to the duration of pterygium (4 years). The samples were studied by immunohistochemistry by using antibodies against p53 and Ki-67 proteins considering >5% expression as significant. Results: Of 43 cases, p53 and Ki-67 expression were positive in 33 cases. In mild, moderate, and severe cases p53 positivity was 33.3%, 78.4%, 100%, respectively. P53 expression increased with duration, 79.3% positive in 4 years. With increasing severity of pterygium, mild, moderate, and severe cases, Ki-67 positivity was 66.7%, 78.37%, 66.7%, respectively. Ki-67 expression with duration, 79.3% positive in 4 years of the duration of pterygium with no statistical significance. Conclusion: Our study revealed that with increasing duration and severity of pterygium, p53 expression was observed to be increasing. Ki-67 expression increased with the duration of pterygium but not with the severity.

Purpose: The purpose of the study was to compare the choroidal thickness in normal population and hypertensive patients and to assess the possible effect of hypertension on choroidal thickness using Spectral Domain Optical Coherence Tomography (SD-OCT). Methods: This was a comparative cross-sectional study. A total of 68 eyes of 34 individuals in the age group of 40–60 years were included in both the hypertensive group and control group. Individuals with refractive error beyond ± 3 D and posterior segment pathology were excluded. The choroidal thickness was measured at the sub-foveal region, 500 μm nasal and 500 μm temporal to the fovea on SD-OCT with enhanced depth imaging (EDI) mode. Systolic blood pressure (SBP), Diastolic blood pressure (DBP), and Mean arterial pressure (MAP) were recorded in all individuals. Duration of hypertension was also noted in hypertensive individuals. Results: The choroidal thickness at all locations was significantly lower in the hypertensive group (subfoveal, nasal, temporal and mean choroidal thickness 253.24 ± 63.96 μm, 249.35 ± 63.57 μm, 250.01 ± 63.37 μm, 250.87 ± 63.38 μm, respectively) as compared to the control group (subfoveal, nasal, temporal and mean choroidal thickness 301.25 ± 55.79 μm, 298.97 ± 57.07 μm, 299.49 ± 55.06 μm, 299.90 ± 55.50 μm, respectively). The choroidal thickness in the hypertensive group also had a significant negative correlation with the SBP (Spearman correlation coefficient, rho = –0.35, P = 0.003) and the duration of hypertension (rho = -0.25, P = 0.037). Conclusion: The study demonstrated decreased choroidal thickness in systemic hypertensive subjects as compared to age-matched healthy individuals. The choroidal thickness in hypertensive subjects also had a significant but weak negative correlation with SBP and duration of hypertension.

Purpose: This study aimed to share our experience in the hospital cornea retrieval program as a new eye bank. Methods: This was a retrospective study conducted in a tertiary care institute from August 26, 2019 to March 22, 2020. The medical and eye bank records were analyzed for hospital mortality, mortuary records, and donors approached. The corneal collection was divided between Voluntary (received from voluntary calls), HCRP (cornea received from hospital deaths), and Medico-Legal Cases (received from MLC deaths in hospital) to see the trend of donation and utilization over time. Results: During the study period, 154 corneas (77 pairs) were collected. The HCRP provided a major source of corneas 58.4% (90 corneas) as compared to voluntary 19.5% (30 corneas) and MLC 22.1%(34 corneas). There were younger tissues in MLC than HCRP donors, and older tissues in Voluntary donors, and the difference was statistically significant. There was no significant difference in the quality of optical grade tissues and the utilization of corneas for transplants between the three groups. Post hoc analysis showed more non-optical tissues in the voluntary donations (P = 0.004), maximum donors with medical contraindications in the HCRP group (P = 0.001), and time-lapse in corneal retrieval in MLC cases (P = 0.0001). Of these 154 corneas, 78 (50.6%) were assessed as suitable for transplantation, of which 59 (75.6%) tissues were optical grade tissues. The overall utilization was 39.6%. Conclusion: HCRP is indeed challenging for a new eye bank, but proper understanding and implementing strategies may help for good utilization of tissues.

Purpose: Due to the COVID-19 pandemic, most of the eye banks have limited/stopped corneal collection, as this is a highly contagious disease. This has led to shortage of donor corneas worldwide. Glycerol preservation of tissue remains a viable option in this scenario. The objective is to compare fresh corneal tissue (FCT) with glycerol-preserved cornea (GPC) in emergency corneal transplantation. Methods: This was a retrospective cohort study conducted in a tertiary care centre of Uttarakhand. Medical records of the patients who underwent therapeutic penetrating keratoplasty (TPK) were reviewed. FCT group included patients who underwent TPK with fresh corneal tissue and GPC group included patients who underwent TPK with glycerol preserved cornea. The indications and outcomes of TPK in the terms of therapeutic success were analysed and compared between both the groups. Results: A total of 94 eyes of 91 patients underwent TPK from October 2011 to August 2017. FCT group included 60 eyes of 57 patients and GPC group included 34 eyes of 34 patients. The primary indication of TPK was infectious keratitis in both the groups (FCT-81.6%; GPC - 91.2%) There was no significant difference in the therapeutic success in both the groups (P = 0.741, Odds ratio- 1.59 with 95% CI- 0.39-6.44). Complications included glaucoma (FCT-21.7%; GPC- 35.2%) graft infection (FCT- 18.33% GPC- 2.9%); graft rejection (FCT-11.66%, GPC- 0%); and graft failure (FCT-88.33%, GPC-100%). Conclusion: The GPC is comparable to FCTs in therapeutic transplant and can be a useful interim procedure in saving the eyes in cases of infective keratitis in the time of crisis.

Purpose: The aim of this study was to carry out blue light photography of fluorescein-stained corneas using a novel smartphone attachment. Methods: A smartphone attachment known as the cobalt blue light unit (C-BLU) was developed. It can filter out all wavelengths of light except the blue light emerging from the flashlight of a smartphone. A pilot study was carried out wherein the images captured with the C-BLU system were compared with slit-lamp photographs of the same patients. This setup was then used to photo document fluorescein-stained corneas in various clinical settings assembled at point-of-care. Results: Many pathologies of the fluorescein-stained cornea were captured using the C-BLU filter. It was used effectively in various settings (remote eye camps, intensive care units (ICU), pediatric group, corneal trauma triaging, etc.). C-BLU was assembled and used by optometrists and ophthalmology residents. The images captured were used for documenting, assisting in the treatment, and also for telecommunication of the patients' findings. Conclusion: C-BLU is a low-cost pocket-size filter which is easy to use with a modern smartphone without any technical expertise needed to obtain a clear image of fluorescein-stained pathological corneas.

Purpose: This study was carried out to see the results of glycerol-preserved cornea (GPC) in emergency situation when fresh corneal tissue was not available. The aim was to study the outcome of corneal transplantation using GPC. Methods: This was a retrospective study. The medical records of all the patients were reviewed, who underwent keratoplasty using “GPC” during the period from October 2011 to December 2015. The indication of keratoplasty, duration of preservation of the GPC, and its outcome were analyzed. Descriptive statistics were applied. Results: Out of the 222 penetrating keratoplasty (PKP) performed over the study period, the GPC was used in 34 patients (males = 31, 91.2%) aged 15–74 years. Therapeutic keratoplasty was performed in all cases in this cohort except one in which tectonic keratoplasty was done. The primary indication of PKP (91.2%) was infectious keratitis. Of these, 20 (64.5%) patients presented with perforated corneal ulcers. Post-PKP, ocular anatomy was preserved in 91.2%, and visual acuity of perception of light positive and accurate projection of rays in all the quadrants was obtained in 76.5% cases. Complications included glaucoma (n = 12, 35.1%), phthisis bulbi (n = 2, 5.9%), and graft reinfection and endophthalmitis after PKP (n = 1, 2.9%). The secondary procedure post-GPC and PKP were trabeculectomy with mitomycin C (n = 7, 58.3%) in patients not controlled on topical antiglaucoma medication. Optical keratoplasty was performed in (n = 3) 8.8% patients and triple procedure in (n = 2) 5.8% patients with good visual acuity postprocedure. Conclusions: Acellular GPCs are useful in emergency keratoplasty to avoid loss of vision and can save the eye.