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Purpose: To evaluate the results of intravitreal phacoemulsification with torsional hand piece in eyes with posteriorly dislocated lens fragments., Methods: In this prospective, interventional case series, 15 eyes with retained lens fragments following phacoemulsification were included. All patients underwent standard three-port pars plana vitrectomy and intravitreal phacoemulsification using sleeveless, torsional hand piece (OZiL™, Alcon's Infiniti Vision System). Patients were followed up for a minimum of six months to evaluate the visual outcomes and complications., Results: The preoperative best-corrected visual acuity (BCVA) ranged from light perception to 0.3. No complications such as thermal burns of the scleral wound, retinal damage due to flying lens fragments, or difficult lens aspiration occurred during intravitreal phacoemulsification. Mean post-operative BCVA at the final follow-up was 0.5. Two eyes developed cystoid macular edema, which was managed medically. No retinal detachment was noted., Conclusion: Intravitreal phacoemulsification using torsional hand piece is a safe and effective alternative to conventional longitudinal phacofragmentation.

Background and Objectives: To evaluate retinal neuropathy in patients with diabetic macular edema (DME) with multifocal electroretinograph (mfERG), and to evaluate the simultaneous impact of retinal neuropathy and vasculopathy on visual acuity in subtypes of DME., Patients and Methods: This prospective, controlled, investigative study conducted at a tertiary eye care center of Northern India included 79 eyes of 50 treatment-naïve patients with DME (Group 1), 94 eyes of 50 diabetic patients without diabetic retinopathy (Group 2), and 100 eyes of 100 normal volunteers as controls. Comprehensive ocular evaluation along with mfERG and optical coherence tomography (OCT) were performed for all patients. N1 and P1 mfERG waveforms in the two central-most rings of macula were evaluated for amplitudes and implicit time. OCT was used to sub-classify types of DME and evaluate macular thickness, ellipsoid zone (EZ), and external limiting membrane (ELM) disruption. Best-corrected visual acuity (BCVA) relative to other variables was the primary outcome measure. The three groups were compared for all the parameters inclusive of OCT and mfERG patterns. Further, OCT subtypes of DME were analyzed for mfERG waveform patterns., Results: All mfERG values were significantly lower in Group 1 and Group 2 as compared to Group 3 (P < .05). BCVA strongly correlated with central macular thickness, EZ, and ELM disruption scores in Group 1 (P = .001), but correlated modestly with mfERG waveform amplitudes in Group 1 patients with intact EZ and ELM only. BCVA correlated with mfERG amplitudes in patients with neurosensory detachment, but not in those with cystoid macular edema., Conclusions: Neural changes set in before the clinical changes related to vasculopathy manifest in diabetic patients. Neuroretinopathy in patients with DME affects all retinal layers symmetrically in early stages, but impacts the middle retinal layers severely in advanced disease form. BCVA correlates with electrophysiological changes till the time morphological features are visible when stronger correlation is seen with anatomical disruption. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:626-631.]., (Copyright 2016, SLACK Incorporated.)

Background and Objective: To evaluate efficacy and safety of pars plana vitrectomy (PPV) and in vivo cyst lysis for intraocular cysticercosis., Patients and Methods: Retrospective analysis of the records of 15 patients undergoing PPV for intraocular cysticercosis at a tertiary eye care center was done. All patients had undergone in vivo cyst lysis. Of these 15 patients, one had intravitreal cysticercosis (IVC) with vitritis, two cases had IVC with vitritis with tractional retinal detachment (TRD), four cases had subretinal cysticercosis (SRC), four cases had SRC with extensive fibrosis without TRD, and five cases had SRC with fibrosis with TRD. Postoperative visual acuity at 3 months of follow-up was analyzed as the primary outcome measure., Results: Mean age of patients was 26 years ± 12.27 years. Four out of 15 patients were female. Mean preoperative best-corrected visual acuity (BCVA) was 1.55 logMAR units ± 0.62 logMAR units, whereas mean postoperative BCVA at last follow-up (3 months) was 1.26 logMAR units ± 0.65 log-MAR units. Mean visual gain (0.29 logMAR units) post-surgery was statistically significant (P = .018). The final visual acuity correlated with preoperative BCVA with Pearson's coefficient being 0.78 (95% CI, 0.44-0.92; P = .001). Anatomical success was achieved in 13 of 15 (87%) cases. In one case the cyst was dead and calcified and could not be removed. TRD was associated with poor visual gain., Conclusion: Intravitreal cyst lysis is a safe and successful approach for managing intraocular cysticercosis. Visual results depend on preoperative condition. TRD implicates poor visual prognoses. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:665-669.]., (Copyright 2016, SLACK Incorporated.)

Persistent fetal vasculature and fundal coloboma are important congenital vitreoretinal disorders that can severely affect a child's visual acuity. Each disorder has its own set of potential complications. We discuss the case of a visually challenged child who presented with a combination of both these disorders, along with inferior lens subluxation., (Copyright © 2016 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Toxoplasma retinochoroditis is one of the commonest causes of infectious posterior uveitis and may lead to occlusive retinitis. We present a case of a patient with Toxoplasma retinochoroditis who developed macular infarction after initial improvement on pharmacotherapy. The potential aetiology and outcome are described., (2016 BMJ Publishing Group Ltd.)

Small intraocular foreign body in the outer coats of the eye may be wrongly interpreted as optic nerve head on ultrasound imaging. Such errors can be avoided by performing multiple sonography scans in different axes.

Intraocular cilia, though a rare condition, has been previously reported in cases of open globe injury. We discuss a unique case of intravitreal cilia, found incidentally during vitrectomy for intravitreal foreign body removal.

Aim: To describe a new surgical technique for managing dislocated sclerotic cataractous lens., Methods: Six patients with advanced posteriorly dislocated cataracts were operated at a tertiary care centre and analyzed retrospectively. After standard 3 port 23 G pars plana vitrectomy and perfluorocarbon liquid (PFCL) injection, the dislocated white cataract was held with occlusion using phaco fragmatome and then chopped into smaller pieces with a sharp tipped chopper using 25 G chandelier endoilluminator. Each piece was emulsified individually. Following aspiration of PFCL, Fluid Air Exchange was done in all the cases and surgery completed uneventfully., Results: Best corrected visual acuity (BCVA) in all the patients was better than 6/12 after one month of follow up. No serious complications were noted till minimum 6mo of follow up., Conclusion: Four port posterior segment nucleotomy with a chandelier endoilluminator, fragmatome and a chopper appears to be a safe, easy and effective procedure for managing dislocated sclerotic cataractous nuclei. Ultrasonic energy used and adverse thermal effects of the fragmatome on the sclera may be lesser.

Background: We report a case of an occult retained intraocular foreign body detected four years after "forgotten" trauma., Case: A 23-year-old male presented with exodeviation and was referred as a case of epiretinal membrane. The anterior segment and adnexa were normal. Fundus examination revealed macular epiretinal membrane. An occult foreign body was localized in the retinal periphery. Imaging confirmed the diagnosis., Observation: Squint and epiretinal membrane may develop in cases of occult foreign bodies and may be the presenting sign years after trauma., Conclusion: A careful history of ocular trauma and thorough examination, complemented by radio imaging when needed, should be done in atypical cases., (© NEPjOPH.)

Purpose: The aim of this study was to evaluate the effect of vitreous surgery on the corneal endothelium., Methods: A total of 113 eyes undergoing pars plana vitrectomy for variable indications at a tertiary care center were included prospectively. The mean age was 41 years (range, 9-84 years), and 60% were male. The endothelial cell count was measured preoperatively and on postoperative day 1, 30, 90, and 180. The rate of endothelial cell loss was measured and analysis performed based on gauge of surgery, lens status, and vitreous substitute used., Results: About 7.6% of endothelial cells were lost at postoperative day 1. This rate had decreased to 2.5% in the first 30 days, 1.5% between days 30 and 90, and 1.4% between days 90 and 180. Significant difference in endothelial cell loss was noted on day 1 between phakic (7.2%), pseudophakic (6.4%), and aphakic (11.4%) eyes with similar results at 6 months. There was no significant difference between the gauges of surgery (20 G vs. 23 G) or the vitreous substitutes used (air vs. gas vs. silicone oil) on day 1 or at 6 months., Conclusions: Endothelial decompensation is an important complication of vitreoretinal surgery. Precautions should be taken in aphakics and patients requiring anterior segment manipulation. Although there is immediate cell loss, the rate of cell loss approaches normative values with time.

Posterior microphthalmos with macular folds is a very uncommon condition. We report such an unusual late-presenting case of posterior microphthalmos where macular folds uncovered the diagnosis and discuss the possibility of worsening of macular folds with advancing age.

Spontaneous posterior capsule rupture is a very rare entity and its association with lens-nucleus dislocation even more. Herein we report such a case of spontaneous posterior capsule rupture with lens dislocation in a case of Pseudoexfoliation Syndrome.