Search

Introduction: There is a need to incorporate innovative teaching methods other than conventional didactic lectures to generate interest of medical undergraduates in learning Pharmacology. Game-based Learning (GBL) is a new strategy in medical education that can create a fun based atmosphere for learning. Aim: To assess the effectiveness of GBL as a tool in learning process and in memory retention of the knowledge acquired in pharmacology using treasure hunt competition. Materials and Methods: The quasi-experimental study was conducted on 4th semester MBBS students of Kanachur Institute of Medical Sciences, Mangaluru, Karnataka, India, from February to March 2019, as a part of the Advanced Course in Medical Education (ACME) project work, Medical Council of India. Entire phase II students (N=150) were included in the study. Students were divided into the GBL group and the Facilitated Learners (FL) group. Both groups were exposed to their respective GBL and FL based learning. Before and after the respective GBL and FL sessions, a pretest and two post-test multiple choice questions based tests were conducted. The second post-test was conducted one month later as a surprise one. Thereafter, a questionnaire was given to pen down the perceptions about GBL. Pretest and post-test marks were analysed by one-way Analysis of Variance (ANOVA) followed by the Tukey-Kramer test. Perceptions about GBL were entered in percentage. Results: The mean scores of the GBL group were significantly more (p-value

Introduction: In the recent years, there has been an increasing trend in self-medication with nonprescription (over-the-counter) drugs available in pharmacies and retail outlets. There are both advantages and disadvantages of self-medication. Data pertaining to the prevalence of self-medication among dental students in India is scarce. Aim: To determine the level of self-medication among the dental students. Materials and Methods: Descriptive cross-sectional questionnaire study was conducted on 548 dental students from I BDS to IV BDS, interns, and postgraduate students, in classroom setting in census type, hand delivery of questionnaires was done. Out of that, 494 questionnaires were returned duly filled and analyzed. Data analysis were done using SPSS software (v 22.0, IBM). Results: A total of 40.9% of respondents indulged in self-medication. Both male and female dental students equally had a habit of taking medicines on their own. The most common drugs used for self-medication were antipyretics (46.56%), followed by analgesics (40.08%), and cough syrups (18.02%). Cold (19.43%) was the major indication for self-medication, followed by (18.02%) a cough, and (16.19%) was a fever. Most common reason not to see a doctor was that there is no need to see a doctor because of a simple disease (31.58%) followed by the need for a quick relief (20.45%). The predominant guiding sources of information for students was media (magazines and internet) (38.06%) and books (39.88%). Conclusion: The majority of students indulged in the practice of self-medication though they had poor knowledge of the benefits and risks.

Background: The population of older people as well as the number of dependent older people is steadily increasing. Those unable to live independently at home are being cared for in a range of settings. Practical training for nurses and auxiliary care staff has frequently been recommended as a way of improving oral health care for functionally dependent elderly. Aim: To evaluate an oral health education program for the caretakers of institutionalized elderly. Materials and Methods: The study was a cluster randomized intervention trial with an elderly home as the unit of randomization. Seven out of 65 elderly homes accommodating a total of 78 caretakers and 462 elderly residents were selected in Bangalore city, India, out of which 3 elderly homes were assigned to the intervention group and 4 to the control group. Oral health knowledge of caretakers was assessed using a pre-tested proforma; later, oral health education was provided to the caretakers of the intervention group. Oral health education was given at the end of 6 months to the caretakers of the control group. Chi-square test, Fisher exact test, and paired proportion test were used for statistical analysis. Results: There was signiicant improvement in the oral health knowledge of the caretakers from baseline in the interventional group. Conclusion: The results of the present study showed that there was a signiicant improvement in the oral health knowledge among the caretakers. Educating the caretakers for assisting or enabling residents for maintaining oral hygiene is essential. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the nature and frequency of use of Traditional Eye Medicine (TEM) for corneal ulcer in patients from predominantly rural background. Methods: We documented the the use of TEM by corneal ulcer patients presenting to a tertiary eye-care centre in South India during two months of 1996. Results: Of 283 patients enrolled in the study, 135 (47.7%) of the patients used TEM. There was no difference with regard to age and sex distribution of patients using TEM and those who did. Patients with history of trauma were more likely to use TEM. Common forms of TEM used were human breast milk 61(45.2%), leafy matter 40(29.6%), castor oil 16 (11.9%), and hen′s blood 8 (5.9%). Conclusion: Though the awareness of intraocular lens implantation for cataract surgery is very high in this segment of the population, it is still tragic that an awareness of primary eye care following trauma has not been created. Health education is mandatory to prevent this avoidable cause of blindness.

Fungal keratitis is an important cause of corneal disease in the tropical world. We report a rare presentation of simultaneous bilateral corneal ulceration caused by different fungi.

Purpose: Investigate trends in keratoconus (KCN) treatment patterns and diagnosis age from 2015 to 2020 and evaluate sociodemographic associations with the treatment approach., Design: Retrospective cohort study., Participants: Patients with a new KCN diagnosis from 2015 to 2020 were identified in the Academy IRIS® Registry (Intelligent Research in Sight)., Methods: Associations between sociodemographic factors and treatment were evaluated using multivariable logistic regression., Main Outcome Measures: Outcomes included percentages and rates of each treatment (collagen crosslinking [CXL], keratoplasty, or no procedure) from 2015 to 2020, age at diagnosis during this period, and sociodemographic factors associated with treatment type., Results: A total of 66 199 patients with a new diagnosis of KCN were identified. The percentage of patients undergoing CXL increased from 0.05% in 2015 to 29.5% in 2020 (P = 0.008). The average age (standard deviation) of KCN patients decreased from 44.1 (±16.9) years in 2015 to 39.2 (±16.9) years in 2020 (P < 0.001). In multivariable analyses comparing CXL versus no procedure and keratoplasty versus no procedure, patients undergoing CXL tended to be younger with the odds of having CXL decreasing with increasing age, for example, comparing CXL and no procedure patients, using ages 0-20 years as reference, the odds ratio (OR) (95% confidence interval [CI]) decreased from 0.62 (0.57-0.67; P < 0.0001) for patients aged 21-40 years to 0.03 (0.02-0.04; P < 0.0001) for patients aged > 60 years. Men were more likely than women to have CXL (OR, 1.31; 95% CI, 1.23-1.40; P < 0.0001) and keratoplasty (OR, 1.30; 95% CI, 1.19-1.42; P < 0.0001). Black patients were less likely than White patients to have CXL (OR, 0.70; 95% CI, 0.63-0.77; P < 0.0001) and more likely to have keratoplasty (OR, 2.24; 95% CI, 2.01-2.50; P < 0.0001). Likewise, Hispanic patients had higher odds of CXL (OR, 1.12; 95% CI, 1.00-1.24; P < 0.05) and keratoplasty (OR, 1.29; 95% CI, 1.12-1.50; P < 0.001) compared with non-Hispanic patients. Collagen crosslinking and keratoplasty also varied by region and insurance status., Conclusions: A significant increase in use of CXL was noted from 2015 to 2020. Sociodemographic differences in treatment among KCN patients may reflect differences in access, use, or care patterns, and future studies should aim to identify strategies to improve access for all patients., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Infectious keratitis secondary to fungus or acanthamoeba often has a poor outcome despite receiving the best available medical therapy. In vitro Rose Bengal Photodynamic therapy (RB-PDT) appears to be effective against fungal and acanthamoeba isolates. 22,23 In one published series RB-PDT reduced the need for therapeutic penetrating keratoplasty in severe bacterial, fungal, and acanthameoba keratitis not responsive to medical therapy., Methods: This international, randomized, sham and placebo controlled 2-arm clinical trial, randomizes patients with smear positive fungal and acanthameoba and smear negative corneal ulcers in a 1:1 fashion to one of two treatment arms: 1) Topical antimicrobial plus sham RB-PDT or 2) Topical antimicrobial plus RB-PDT., Discussion: We anticipate that RB-PDT will improve best spectacle corrected visual acuity and also reduce complications such as corneal perforation and the need for therapeutic penetrating keratoplasty. This study will comply with the NIH Data Sharing Policy and Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical Trials Registration and Results Information Submission rule. Our results will be disseminated via clinicaltrials.gov website, meetings, and journal publications. Our data will also be available upon reasonable request., Trial Registration: NCT, NCT05110001, Registered November 5, 2021. https://www.clinicaltrials.gov/study/NCT05110001., Competing Interests: Competing Interests There are no conflicts of interest to report.

Purpose: This study sought to identify the sources of differential performance and misclassification error among local (Indian) and external (non-Indian) corneal specialists in identifying bacterial and fungal keratitis based on corneal photography., Methods: This study is a secondary analysis of survey data assessing the ability of corneal specialists to identify acute bacterial versus fungal keratitis by using corneal photography. One-hundred images of 100 eyes from 100 patients with acute bacterial or fungal keratitis in South India were previously presented to an international cohort of cornea specialists for interpretation over the span of April to July 2021. Each expert provided a predicted probability that the ulcer was either bacterial or fungal. Using these data, we performed multivariable linear regression to identify factors predictive of expert performance, accounting for primary practice location and surrogate measures to infer local fungal ulcer prevalence, including locality, latitude, and dew point. In addition, Brier score decomposition was used to determine experts' reliability ("calibration") and resolution ("boldness") and were compared between local (Indian) and external (non-Indian) experts., Results: Sixty-six experts from 16 countries participated. Indian practice location was the only independently significant predictor of performance in multivariable linear regression. Resolution among Indian experts was significantly better (0.08) than among non-Indian experts (0.01; P < 0.001), indicating greater confidence in their predictions. There was no significant difference in reliability between the two groups ( P = 0.40)., Conclusion: Local cornea experts outperformed their international counterparts independent of regional variability in tropical risk factors for fungal keratitis. This may be explained by regional characteristics of infectious ulcers with which local corneal specialists are familiar., (Copyright © 2024 Copyright: © 2024 Indian Journal of Ophthalmology.)

Purpose: To assess clinical applicability of automatic image analysis in microbial keratitis (MK) by evaluating the relationship between biomarker measurements on slit-lamp photography (SLP) and best-corrected visual acuity (BCVA)., Methods: Seventy-six patients with MK with SLP images and same-day logarithm of the minimum angle of resolution (logMAR) BCVA were evaluated. MK biomarkers (stromal infiltrate, white blood cell infiltration, corneal edema, hypopyon, epithelial defect) were segmented manually by ophthalmologists and automatically by a novel, open-source, deep learning-based segmentation algorithm. Five measurements (presence, maximum width, total area, proportion of the corneal limbus area affected, centrality) were calculated. Correlations between the measurements and BCVA were calculated. An automatic regression model estimated BCVA from the measurements. Differences in performance between using manual and automatic measurements were evaluated using William's test (for correlation) and the paired-sample t-test (for absolute error)., Results: Measurements had high correlations of 0.86 (manual) and 0.84 (automatic) with true BCVA. Estimated BCVA had average (mean ± SD) absolute errors of 0.39 ± 0.27 logMAR (manual, median: 0.30) and 0.35 ± 0.28 logMAR (automatic, median: 0.30) and high correlations of 0.76 (manual) and 0.80 (automatic) with true BCVA. Differences between using manual and automatic measurements were not statistically significant for correlations of measurements with true BCVA (P = .66), absolute errors of estimated BCVA (P = .15), or correlations of estimated BCVA with true BCVA (P = .60)., Conclusions: The proposed algorithm measured MK biomarkers as accurately as ophthalmologists. Measurements were highly correlated with and estimative of visual acuity., Translational Relevance: This study demonstrates the potential of developing fully automatic objective and standardized strategies to aid ophthalmologists in the clinical assessment of MK.

We propose a fully-automatic deep learning-based algorithm for segmentation of ocular structures and microbial keratitis (MK) biomarkers on slit-lamp photography (SLP) images. The dataset consisted of SLP images from 133 eyes with manual annotations by a physician, P1. A modified region-based convolutional neural network, SLIT-Net, was developed and trained using P1's annotations to identify and segment four pathological regions of interest (ROIs) on diffuse white light images (stromal infiltrate (SI), hypopyon, white blood cell (WBC) border, corneal edema border), one pathological ROI on diffuse blue light images (epithelial defect (ED)), and two non-pathological ROIs on all images (corneal limbus, light reflexes). To assess inter-reader variability, 75 eyes were manually annotated for pathological ROIs by a second physician, P2. Performance was evaluated using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). Using seven-fold cross-validation, the DSC of the algorithm (as compared to P1) for all ROIs was good (range: 0.62-0.95) on all 133 eyes. For the subset of 75 eyes with manual annotations by P2, the DSC for pathological ROIs ranged from 0.69-0.85 (SLIT-Net) vs. 0.37-0.92 (P2). DSCs for SLIT-Net were not significantly different than P2 for segmenting hypopyons (p > 0.05) and higher than P2 for WBCs (p < 0.001) and edema (p < 0.001). DSCs were higher for P2 for segmenting SIs (p < 0.001) and EDs (p < 0.001). HDs were lower for P2 for segmenting SIs (p = 0.005) and EDs (p < 0.001) and not significantly different for hypopyons (p > 0.05), WBCs (p > 0.05), and edema (p > 0.05). This prototype fully-automatic algorithm to segment MK biomarkers on SLP images performed to expectations on an exploratory dataset and holds promise for quantification of corneal physiology and pathology.

Purpose: To evaluate the reliability of manual annotation when quantifying cornea anatomical and microbial keratitis (MK) morphological features on slit-lamp photography (SLP) images., Methods: Prospectively enrolled patients with MK underwent SLP at initial encounter at 2 academic eye hospitals. Patients who presented with an epithelial defect (ED) were eligible for analysis. Features, which included ED, corneal limbus (L), pupil (P), stromal infiltrate (SI), white blood cell (WBC) infiltration at the SI edge, and hypopyon (H), were annotated independently by 2 physicians on SLP images. Intraclass correlation coefficients (ICCs) were applied for reliability assessment; dice similarity coefficients (DSCs) were used to investigate the area overlap between readers., Results: Seventy-five MK patients with an ED received SLP. DSCs indicate good to fair annotation overlap between graders (L = 0.97, P = 0.80, ED = 0.94, SI = 0.82, H = 0.82, WBC = 0.83) and between repeat annotations by the same grader (L = 0.97, P = 0.81, ED = 0.94, SI = 0.85, H = 0.84, WBC = 0.82). ICC scores showed good intergrader (L = 0.98, P = 0.78, ED = 1.00, SI = 0.67, H = 0.97, WBC = 0.86) and intragrader (L = 0.99, P = 0.92, ED = 0.99, SI = 0.94, H = 0.99, WBC = 0.92) reliabilities. When reliability statistics were recalculated for annotated SI area in the subset of cases where both graders agreed WBC infiltration was present/absent, intergrader ICC improved to 0.91 and DSC improved to 0.86 and intragrader ICC remained the same, whereas DSC improved to 0.87., Conclusions: Manual annotation indicates usefulness of area quantification in the evaluation of MK. However, variability is intrinsic to the task. Thus, there is a need for optimization of annotation protocols. Future directions may include using multiple annotators per image or automated annotation software.

Purpose: To investigate the sources of measurement variability when quantifying the morphology of microbial keratitis (MK) from slit-lamp photography (SLP) images using a semiautomated, image-analysis algorithm., Methods: Prospectively enrolled patients with MK underwent SLP to obtain images of their epithelial defects (ED). Eyes were stained with fluorescein and imaged multiple times under blue light, at low and high magnifications. A masked research assistant chose the 3 best images and annotated each 3 times to provide seed regions corresponding to ED and healthy cornea. The algorithm returned the ED area for each seeded image. Eyes without EDs and algorithm failures were excluded. Variance components were estimated with a random effects model and intraclass correlation coefficients estimated with intragrader reliability., Results: A total of 42 eyes from 42 MK participants were photographed. After excluding poor quality images, eyes with no EDs, and algorithm failures, 34 patients with 92 images and 274 seeds were analyzed. No significant differences in the average ED area were found between seedings or high- versus low-SLP magnifications (all P > 0.5, paired t tests). Minimal measurement variability was because of image (0.9%), magnification (0.2%), or seed (0.1%). Most variability was attributable to differences in ED sizes between patients (85.2%). 13.7% of variability was unexplained. Multiple iterations of the algorithm on the same image showed good consistency (intraclass correlation coefficient = 0.98, 95% confidence interval, 0.97-0.99)., Conclusions: Image-analysis algorithms showed good reliability for measuring the ED area from SLP images. Most measurement variability was because of between-patient differences, not imaging settings or application of the algorithm by the user.

Purpose: To study the trends in collection, storage and utilization of donor corneas in eye banks in India., Methods: The data was collected from 12 eye banks in India that collected more than 1000 corneas per year. The retrospective analysis of the parameters like characteristics of the donor and the host, storage media used, number of eyes collected, number of eyes utilized, causes of non-utilization of the tissue and the procedures performed was done., Results: A total of 20,564 eyes were collected by the 12 eye banks during the year 2013-2014. Voluntary eye donation (VED), and hospital cornea retrieval program (HCRP) contributed to 59.6% and 40.4% of tissue procurement respectively. Whole globe enucleation (52.3%) was more commonly performed as compared to in-situ excision of the donor corneas. The most commonly used storage media at all eye banks was McCarey-Kaufman (MK) media (83.3%). The utilization rate of the donor eyes was 50.5%. The most frequent indication for corneal transplantation was infection (active infection - 33.13%, healed infection - 10.78%) followed by Pseudophakic bullous keratopathy (PBK) (13.57%). Full thickness keratoplasty (optical penetrating keratoplasty - 47.23%, therapeutic penetrating keratoplasty - 31.74%) was performed most often followed by endothelial keratoplasty (12.41%) in the developing country., Conclusion: VED still contributes to majority of the donor tissue retrieval in India. The majority of the eye banks still utilize whole globe enucleation technique and store tissues in MK media. Trends from previous years showed a change towards HCRP, in-situ excision technique and preservation in the long-term storage media., Competing Interests: None

Competing Interests: There are no conflicts of interest

Context: Haller cells are extensions of ethmoid cells which can be seen in several imaging modalities. Literature search has shown that idiopathic orofacial pain is associated with the presence of Haller cells. Hence, a simple cost-effective imaging modality for displaying the presence of Haller cells is desirable., Aims: This study aims to determine the prevalence of Haller cells in panoramic radiography., Subjects and Methods: The retrospective study comprised of 403 individuals of both genders. Panoramic radiograph was taken for every individual and interpreted for the presence of Haller cells. Factors incorporated in the interpretation were prevalence of Haller cells, distribution of Haller cells among genders, site predilection, unilocular or multilocular variant, and most common shape prevalent among the individuals., Statistical Analysis Used: Chi-square test with SPSS software., Results: Among 403 individuals, the Haller cells were present in 92 (22.8%) individuals. Of 92 (22.8%) individuals with Haller cells, 40 (18.5%) were males and 52 (27.8%) were females. Seventy-four individuals (80.4%) were unilocular and 18 (19.6%) were multilocular. Forty-five individuals had (48.9%) tear-shaped Haller cells, 27 (29.3%) had round-shaped Haller cells, and 20 (21.8%) had oval-shaped Haller cells. Forty (43.5%) were on the right side, 29 (31.5%) were on the left side, and 23 (25%) were on both sides., Conclusions: The present study assessed the prevalence of Haller cells as 22.8%, and this was done in a cost-effective way using panoramic radiographs., Competing Interests: There are no conflicts of interest.

P. aeruginosa and S. pneumoniae are major bacterial causes of corneal ulcers in industrialized and in developing countries. The current study examined host innate immune responses at the site of infection, and also expression of bacterial virulence factors in clinical isolates from patients in south India. Corneal ulcer material was obtained from 49 patients with confirmed P. aeruginosa and 27 patients with S. pneumoniae, and gene expression of Toll Like Receptors (TLR), cytokines and inflammasome proteins was measured by quantitative PCR. Expression of P. aeruginosa type III secretion exotoxins and S. pneumoniae pneumolysin was detected by western blot analysis. We found that neutrophils comprised >90% cells in corneal ulcers, and that there was elevated expression of TLR2, TLR4, TLR5 and TLR9, the NLRP3 and NLRC4 inflammasomes and the ASC adaptor molecule. IL-1α IL-1β and IFN-γ expression was also elevated; however, there was no significant difference in expression of any of these genes between corneal ulcers from P. aeruginosa and S. pneumoniae infected patients. We also show that 41/49 (84%) of P. aeruginosa clinical isolates expressed ExoS and ExoT, whereas 5/49 (10%) of isolates expressed ExoS, ExoT and ExoU with only 2/49 isolates expressing ExoT and ExoU. In contrast, all 27 S. pneumoniae clinical isolates produced pneumolysin. Taken together, these findings demonstrate that ExoS/T expressing P. aeruginosa and pneumolysin expressing S. pneumoniae predominate in bacterial keratitis. While P. aeruginosa strains expressing both ExoU and ExoS are usually rare, these strains actually outnumbered strains expressing only ExoU in the current study. Further, as neutrophils are the predominant cell type in these corneal ulcers, they are the likely source of cytokines and of the increased TLR and inflammasome expression.

Purpose: The purposes of this study were to describe the clinical characteristics of corneal patients with mutations in the SLC4A11 gene and to determine if these characteristics could be correlated with specific genetic mutations., Methods: A retrospective case series review was conducted. Baseline demographic data, including gender, age at diagnosis of congenital hereditary endothelial dystrophy, family history, and pedigree information, were obtained. Information from clinical examination, including intraocular pressure, ultrasonic pachymetry, best spectacle-corrected visual acuity, axial length, and slit-lamp biomicroscopic evaluation, including corneal diameter and fundus examination, were also documented from the notes. History of corneal surgery was also recorded. Hearing loss was assessed by audiometry. Genetic analysis was performed by polymerase chain reaction amplification and sequencing., Results: Seven patients were identified. Four of the seven had associated hearing loss; all of the patients had undergone or were awaiting penetrating keratoplasty to one or both eyes. No correlation could be reached between the ocular phenotype and the gene mutation in this small sample. Individuals with the same mutation had different degrees of hearing loss within their respective families., Conclusions: Corneal endothelial cells are more vulnerable to defects in the functional activity of SLC4A11 than cells of the striae vascularis of the inner ear. Both congenital hereditary endothelial dystrophy 2 and Harboyan syndrome have similar ocular phenotypes, ie, diffuse bilateral corneal edema present at birth or within the neonatal period; hence, audiometry must be performed to differentiate the two conditions.

Congenital hereditary endothelial dystrophy (CHED) is a heritable, bilateral corneal dystrophy characterized by corneal opacification and nystagmus. We describe seven different mutations in the SLC4A11 gene in ten families with autosomal recessive CHED. Mutations in SLC4A11, which encodes a membrane-bound sodium-borate cotransporter, cause loss of function of the protein either by blocking its membrane targeting or nonsense-mediated decay.

Purpose: To report a case of suppurative keratitis caused by Rhodococcus ruber in a healthy 31-year-old male patient., Methods: Ocular examination of the patient revealed a central corneal epithelial defect following trauma, with severe anterior chamber reaction hypopyon. Corneal scrapings were performed from the base of the ulcer and were subjected to routine microbiologic investigation including direct microscopic techniques (Gram stain and 10% KOH), and culture was done on blood agar and potato dextrose agar. Biochemical analysis and antibiotic sensitivity testing were done on the isolate, and additional confirmation was done by DNA sequencing., Results: The isolate was identified as Rhodococcus ruber, an uncommon cause of suppurative keratitis. The isolate was found to be sensitive to augmentin, erythromycin, co-trimoxazole, tobramycin, amikacin, ciprofloxacin, ofloxacin, and sulfamethoxazole., Conclusion: We present a case of Rhodococcus ruber, which was successfully treated. Even if the clinical picture of ulcer is nonspecific, the need of a routine microbiologic examination and sequencing proves to be confirmatory in cases of suppurative keratitis, where the causative organisms are varied in nature.

Purpose: To assess the changing trends in the antibiotic susceptibility of Pseudomonas spp . isolated from bacterial keratitis over a nine year period with special emphasis on fluoroquinolone susceptibilities., Methods: All corneal scraping cultures positive for Pseudomonas spp. (n=585) isolated from patients with bacterial keratitis at the Aravind Eye Hospital, Madurai from 1995-2003 were evaluated. Cultures were performed in liquid and solid media and susceptibility testing was done against amikacin, gentamicin, tobramycin, ciprofloxacin and ofloxacin by Kirby-Bauer disc diffusion method., Results: The susceptibility of Pseudomonas spp. was over 90% from 1995-1998 to ciprofloxacin which decreased to 83% from 1999-2003. The total number of isolates resistant to ciprofloxacin was 51 (9.4%). No statistically significant increase in the number of isolates resistant to ciprofloxacin was noted. Ofloxacin showed 54% susceptibility from 1995-1998 but increased to 64% from 1999-2003. Analysis of in vitro activity of amikacin reveals that there was 43% sensitivity from 1995-1998 but later it increased to 76% from 1999-2003. In case of gentamicin, the sensitivity decreased marginally from 80% to 70% through the years. Tobramycin showed 45% sensitivity from 1995-1998 but increased to 75% from 1999-2003., Conclusions: The fluoroquinolones remain a good choice in the treatment of ocular infections, with high susceptibility of Pseudomonas spp. Among the aminoglycosides, gentamicin was found to be highly effective against Pseudomonas corneal ulcers when compared to amikacin and tobramycin. The results show a need for continuous monitoring of bacterial resistance trends.

The authors report a case of a 40-year-old female who had sustained a blunt ocular trauma resulting in anterior scleral rupture and subconjunctival dislocation of the crystalline lens. Anterior segment ultrasound aided in the diagnosis. Surgical exploration revealed a 6 mm long anterior scleral rupture which was repaired. Postoperatively the patient had a best corrected visual acuity of 6/18.