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Amar Pujari, Sujeeth Modaboyina, Rajeswari Thangavel, Monika Yadav, Swati Phuljhele, Rohit Saxena Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar Pujari, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comPurpose: To describe novel Y splitting procedure of inferior oblique muscle to mitigate the anti-elevation syndrome.Methods: A pilot, prospective interventional study was undertaken to assess the effect of inferior oblique muscle Y-splitting in patients with unilateral 3+ or more overaction. To correct primary gaze hypertropia and the excyclotorsion, a Y-splitting procedure was performed (along with routine horizontal muscle surgery as per the deviation) in 14 subjects. The effect of surgery was assessed at baseline and at 6 months post-intervention.Results: The mean age of 14 subjects was 25.14± 7.70 years. The mean pre-operative hypertropia, excyclotorsion and inferior oblique muscle over-action was 18.42± 3.50 PD, 14.14± 2.65 degrees, and +3.21± 0.42 respectively. Following surgery, this was reduced to 1.57± 1.74 PD of residual hypertropia (a net correction of 16.85± 2.31 PD, p = 0.005), 3.85± 1.46 degrees of residual excyclotorsion (a net correction of 10.28± 1.72 degrees, p < 0.05), and +0.28± 0.46 of residual inferior oblique over-action (a net correction ∼+3) at the end of 6 months. Amongst fourteen patients, three patients still experienced residual/variable anti-elevation effect, and during the study period none of them experienced any adverse event and none of them required any additional surgeries.Conclusion: While anteriorizing the inferior oblique muscle to correct primary gaze hypertropia and the excyclotorsion, a novel “Y splitting” procedure can be followed to achieve the desired results with mitigated anti-elevation effect.Keywords: inferior oblique muscle surgery, anti-elevation syndrome, Y-splitting of the inferior oblique

Amar Pujari, Vinay Patil, Nidhi Chauhan, Rajeswari Thangavel, Swati Phuljhele, Rohit Saxena Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar Pujari, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comPurpose: To describe the clinical role of swept-source anterior segment optical coherence tomography in extraocular muscle imaging in various strabismic conditions.Study Design: Prospective observational study.Participants: A total of 1104 extraocular muscles of 150 subjects were imaged. Normal eyes (640 muscles), eyes undergoing re-operation (240 muscles), paralytic strabismic eyes (16 muscles), non-paralytic strabismic eyes (20 muscles), post-traumatic strabismic eyes (64 muscles), eyes with thyroid disease (64 muscles), and other atypical cases (60 muscles) were imaged. In all cases, up to four recti muscles were evaluated in a given eye depending on the need.Results: The mean age was 38.15 ± 16.25 years. Overall, muscle insertion was identified in over 90% of the subjects. Apart from normal muscles (n = 860, 93.68%), the location was identified in previously operated eyes (n = 54, 90%), in traumatic muscle slippage (n = 2, 11.11%), in ocular coat ectasia (n = 11, 91.66%), in thyroid muscle hypertrophy, in operated scleral fixated intraocular lens with strabismus, and other challenging cases. In all circumstances, clinically useful information was obtained from the anterior 4– 14 millimetres of the rectus muscle, which in turn helped in active surgical planning and overall management.Conclusion: The SS-ASOCT with its wider and deeper scanning abilities was able to locate the extraocular muscle insertion in a variety of strabismic conditions. Therefore, this tool can be used in the preoperative periods for optimal surgical planning and management.Keywords: swept source anterior segment imaging, extraocular muscle imaging, imaging in strabismus, ASOCT imaging of extraocular muscles

Priya Battu,1,* Kaushal Sharma,1,* Rajarathna Thangavel,2 Ramandeep Singh,3 Suresh Sharma,4 Vinod Srivastava,5 Akshay Anand1 1Neuroscience Research Lab, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India; 2Department of Ophthalmology, Vasan Eye Care, Chennai, India; 3Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India; 4Department of Statistics, Panjab University, Chandigarh, India; 5College of Health and Behavioral Sciences, Fort Hays State University, Hays, KS, USA*These authors contributed equally to this workCorrespondence: Akshay Anand, Neuroscience Research Lab, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India, Tel +911722756094, Email akshay1anand@rediffmail.comBackground: Optical coherence tomography (OCT) parameters like subretinal fluid (SRF), intra retinal fluid (IRF) and retinal detachment (RPED) etc are routinely accessed by ophthalmologists in patients with retinal complaints. Correlation of OCT findings with genotype and phenotype of AMD patients is relatively unexplored. Here, we have investigated the association of OCT parameters’ with genetic variants along with protein expressions and examined their clinical relevance with AREDS (Age-Related Eye Disease Study) criteria in AMD patients.Methods: For this study, samples were recruited from Advanced Eye Centre, PGIMER, Chandigarh, India. Case-only analysis of anonymous imaging data (OCT/Fundus) acquired during the routine clinical evaluation of patients was done to examine the OCT findings in the AMD patients. TaqMan genotyping assays were used to analyze the single nucleotide polymorphisms in these patients. ELISA (enzyme linked immunosorbent assay) was used to estimate the protein levels of these genes in serum. Information pertaining to lifestyle/habits was also collected by administering a standard questionnaire at the time of recruitment of the patients.Results: Intra-retinal fluid (IRF) was associated significantly with the LIPC genotype (p=0.04). Similarly, smoking status and early AMD were also associated with the APOE genotype (p=0.03). Additionally, variants of IER-3 and SLC16A8 were also found to be associated with co-morbidities (p=0.02) and males (p=0.02), respectively. RPED has shown a significant association with AREDS criteria, which demonstrated an area under AUROC around 72%.Conclusion: Results of genotype–phenotype association can give a precise impression of AMD severity and can be beneficial for the early diagnosis of AMD cases.Keywords: age-related macular degeneration, RPE detachment, OCT parameters, TIMP-3, HTRA1, IPC, APOE, anti-VEGF therapy, AREDS

Amar Pujari, Sujeeth Modaboyina, Divya Agarwal, Gunjan Saluja, Rajeswari Thangavel, Vaishali Rakheja, Rohit Saxena, Namrata Sharma, Jeewan S Titiyal, Atul Kumar Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar PujariDr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room no. 212, RPC-1, AIIMS, New Delhi, India, Email dramarpujari@gmail.comAbstract: India is a culturally and geographically diverse nation. Its vast demographic nature does not allow a single definition for any of the given medical conditions in its territory. One important clinical condition which has created an uproar in the rest of the world is myopia. Its cause, prevalence, etiopathogenesis and other factors are being explored constantly; however, data with respect to Indian subcontinent are genuinely missing. Hence, in this review, we enumerate the country’s myopia journey from last 4 decades. The epidemiology, genetics, ocular/systemic association, quality of life, imaging, and management in myopia with necessary future directives are discussed to augment the overall management in future.Keywords: myopia, India, myopia in India, atropine therapy in myopia, genetics and myopia, retinopathy of prematurity and myopia, imaging in myopia, management of myopia

Amar Pujari, Sujeeth Modaboyina, Deepsekhar Das, Asmita Mahajan, Rajeswari Thangavel, Swati Phuljhele, Rohit Saxena, Namrata Sharma, Pradeep Sharma Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, IndiaCorrespondence: Amar PujariDr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 212, RPC-1, AIIMS, New Delhi, IndiaTel +91 8447226221Email dramarpujari@gmail.comBackground: To characterize the diagnostic role of swept source anterior segment optical coherence tomography (SS-ASOCT) in strabismus re-operations with lost surgical details.Methods: Patients presenting to our outpatient services for strabismus care from February 2020 to March 15th 2021 were systematically evaluated. Those willing to undergo re-operation were included in the study. A total of 30 patients were identified and out of this a total of 10 eyes of 10 patients with lost surgical details were finally included in the study. Demographic details, preoperative deviation, ocular findings, orthoptic measurements, detailed SS-ASOCT findings, intraoperative measurements, and post-operative outcomes were recorded.Results: The mean age of 10 patients was 23.7± 5.75 years. Seven were male and three were female. The mean pre-operative SS-ASOCT measured distance from angle to insertion was 8.90± 1.85 mm and the mean intraoperative distance was 9.12± 2.14 mm. A mean difference of 0.21± 1.31 mm was noted, and this difference was statistically insignificant (paired t test, p = 0.57). In addition, SS-ASOCT unraveled novel signs to differentiate operated eyes from the un-operated eyes, and recessed muscle from the resected muscle.Conclusion: In strabismus re-operation with lost surgical details, the pre-operative SS-ASOCT can provide reliable muscle details with respect to its type of surgery and amount surgery.Keywords: extraocular muscle, swept source anterior segment optical coherence tomography and strabismus re-operation