A 47-year-old Asian woman with myopia presented with a recent onset of blurred near vision, initially attributed to presbyopia. Best-corrected visual acuity was 6/6 bilaterally, with intraocular pressures (IOPs) of 15 mmHg (right) and 12 mmHg (left), and open angles on gonioscopy. Fundus examination revealed crowded optic discs and a wedge-shaped retinal nerve fiber layer defect in the right eye. Standard optical coherence tomography (OCT) appeared normal, but OCT angiography demonstrated loss of superior temporal radial peripapillary capillaries. Automated perimetry confirmed an inferior hemifield defect, consistent with moderate normal tension glaucoma (NTG) in the right eye. Treatment with once-daily omidenepag isopropyl 0.002% reduced IOP by 33% to 10 mmHg, sustained at 1 year without progression or adverse effects. This case underscores the diagnostic challenges of NTG in crowded discs, highlights the value of multimodal imaging, and supports selective EP2 receptor agonists as effective therapy.
The shorter-wavelength electromagnetic radiation known as blue light occupies an increasingly prominent position within contemporary eye health and vision science research. This heightened attention is attributable to the exponential growth in artificial sources emitting blue wavelengths, prominently including modern light-emitting diode lighting technologies embedded in digital displays, personal communication devices, and ambient indoor lighting systems. Although blue light performs an important physiological function in circadian rhythm regulation and the pupillary response, excessive or prolonged exposure has been associated with ocular discomfort, visual fatigue, and even possible photochemical retinal injury. This review highlights the biological mechanisms underlying the interaction between blue light and ocular tissues, its short- and long-term impacts on eye health, and related preventive strategies. These conclusions are further reinforced by findings from experimental and clinical studies.
Objectives: This study aimed to determine the relationship between refractive error and ocular biometry, axial length (AL), corneal curvature (CR), central corneal thickness (CCT), and AL/CR ratio, among Malaysian Indian schoolchildren aged 7–11 years. Given the limited biometric evidence for this ethnic group, the study sought to generate population-specific baseline data to support early myopia control strategies. Materials and Methods: A cross-sectional analysis was conducted on 179 Malaysian Indian children (358 eyes) recruited from the REKLIS study in Kuala Lumpur. Ocular biometry was obtained using A-scan ultrasound (AL), keratometry (CR), and corneal topography (CCT). The spherical equivalent refraction (SER) was determined using cycloplegic refraction. Participants were categorized into myopic and nonmyopic groups for comparative and correlational analyses. Results: The mean SER was −0.70 ± 1.81 D, with a myopia prevalence of 28.9%. This prevalence is higher than that reported in earlier school-based assessments from the same population. Myopic eyes showed longer AL, steeper CR, and higher AL/CR ratios. SER showed negative correlations with AL ( r = −0.40) and AL/CR ratio ( r = −0.55). AL positively correlated with CR ( r = 0.59). In the myopic group, both AL and AL/CR ratio increased with age. No significant gender differences were observed within refractive groups. Comparison with historical data indicated an approximate 1.5 D myopic shift over three decades, accompanied by increases in AL and AL/CR ratio. Conclusions: This study establishes the first ocular biometric norms for Malaysian Indian children, revealing AL and AL/CR ratio as key correlates of refractive error and evidence of a 30-year myopic shift in this population.
Purpose: To evaluate the anatomical and functional outcomes of combining scleral imbrication with pars plana vitrectomy (PPV) and gas tamponade as a primary surgical approach for myopic traction maculopathy (MTM). Methods: Video 1 presents a patient with MTM associated with high myopia who underwent primary surgery combining scleral imbrication, PPV, and intraocular gas tamponade. The surgical technique involves removal of the vitreous with posterior hyaloid detachment, followed by placement of posteriorly located scleral imbrication sutures to reduce axial length and modify the posterior curvature. SF6 gas was used as tamponade. Pre- and postoperative outcomes, including best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (OCT) imaging, were analyzed over a 6-month follow-up period. Results: The operated eye demonstrated resolution of macular detachment on OCT. The mean axial length was reduced postoperatively. BCVA improved, with no major intraoperative or postoperative complications. The posterior pole showed reconfiguration with improved foveal contour. Conclusion: Scleral imbrication combined with PPV and gas tamponade appears to be a safe and effective primary surgical strategy for MTM in highly myopic eyes. This approach addresses both vitreoretinal traction and posterior staphyloma, facilitating anatomical restoration and functional recovery.
Purpose: The purpose of this study was to evaluate the oncologic, functional, and esthetic outcomes of Mustardé cheek rotation flap reconstruction following excision of basal cell carcinoma (BCC) involving the lower eyelid and medial canthus. Design: Prospective, interventional, single-center clinical study. Materials and Methods: Fifty-two patients with histopathologically confirmed lower eyelid or medial canthal BCC underwent wide local excision with a 4 mm clinical margin at a tertiary care center in northern India between December 2023 and December 2024. All defects were reconstructed using Mustardé’s cheek rotation flap. Patients were evaluated postoperatively at 1 week, 1 month, 3 months, 6 months, and subsequent follow-up visits, with a mean follow-up duration of 11.2 ± 1.8 months. Oncologic safety, functional recovery, postoperative complications, and esthetic outcomes were assessed using the Visual Analog Scale (VAS) and Patient and Observer Scar Assessment Scale (POSAS). Results: The mean age of the study cohort was 64.2 ± 9.8 years. The cohort included 30 males and 22 females, corresponding to a male-to-female ratio of 15:11, or approximately 1.36:1, with males comprising 57.7% and females 42.3% of the study population. Histopathologically tumor-free margins were achieved in all cases, with no clinical recurrence observed during follow-up. Mean wound healing time was 18.5 ± 4.2 days. Postoperative complications included distal flap necrosis (3.8%), mild ectropion (1.9%), and wound infection (1.9%), all managed conservatively. Mean VAS scores improved progressively, reaching 9.1 ± 0.7 at final follow-up. Observer and patient POSAS scores improved to 12.4 ± 3.2 and 13.1 ± 2.9, respectively. Conclusion: Mustardé cheek rotation flap provides a reliable single-stage reconstructive option for periocular BCC, with favorable short-term oncologic control, satisfactory functional recovery, and acceptable cosmetic outcomes.
Duane retraction syndrome (DRS) is a congenital eye movement anomaly characterized by variable horizontal duction deficits, usually accompanied by narrowing of the palpebral fissure, globe retraction, and shoots. A 25-year-old male presented with right eye (RE) exotropia with full abduction but limitation of adduction with a downshoot on attempted adduction. In the left eye (LE), there was a limitation of both adduction and abduction. We did lateral rectus (LR) recession and Y-splitting along with transposition of the nasal half of the superior rectus (SR) tendon adjacent to the medial rectus in the RE. Postoperatively, the eye was orthotropic with significant improvement in adduction and downshoot. In exotropic DRS with a downshoot in adduction, LR is usually tight. However, in our case, it was lax. We did LR recession with Y-split and got satisfactory results. Downshoot on attempted adduction is primarily due to an innervational anomaly. Partial tendon transposition of the SR tendon was performed to improve adduction. As LE was orthotropic, no surgical intervention was done. Lax LR should not change the surgical plan in DRS with shoots on adduction.
Purpose: The study was conducted to evaluate the functional and anatomical outcomes of intravitreal injection of bevacizumab in patients with treatment-naïve center-involving diabetic macular edema (CI-DME), as measured by best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and multifocal electroretinogram (mfERG). Materials and Methods: A prospective observational study comprising 52 CI-DME patients receiving intravitreal injection of bevacizumab (1.25 mg/0.05 mL) for 3 months. BCVA, central macular thickness (CMT), and mfERG amplitudes were measured at baseline, 1 month, and 3 months. Statistical analysis was done using SPSS v27 and Excel. Results: A significant improvement reported in BCVA which improved to 0.65 ± 0.10 (P < 0.001) at 3 months and to 0.62 ± 0.10 at 1-month follow-up from the baseline value of 0.47 ± 0.11. CMT reduced to 330.1 ± 31.8 µm (P < 0.001) at 3 months and 338.6 ± 34.1 µm at 1 month from the baseline value of 399.6 ± 83.5 µm. mfERG amplitude improved to 21.6 ± 1.3 nV/deg² (P < 0.001) at 3 months and to 20.9 ± 1.2 nV/deg at 1 month from the baseline value of 20.0 ± 1.3 nV/deg. There was a strong correlation between mfERG improvement and CMT reduction (r = −0.52, P < 0.001). Conclusion: Injections of intravitreal bevacizumab significantly improves BCVA, CMT, and mfERG within 3 months follow-up. mfERG complements OCT to evaluate the treatment response.
Aim: The aim of the study was to compare pars plana vitrectomy (PPV) with PPV combined with scleral buckle (SB) in the treatment of rhegmatogenous retinal detachment (RRD) in a tertiary care hospital of central India. Materials and Methods: A randomized controlled trial was conducted to compare surgical outcome of PPV + SB versus PPV in patients of RRD. A sample of 36 patients with RRD were included in the study and were divided into two groups: PPV with SB (PPV + SB, n = 19) and PPV (PPV, n = 17). All eyes had 3 months of follow-up. Results: Between the groups, there was a significant difference in eyes with inferior breaks (P = 0.001). Single surgery anatomical success (SSAS) was 94.7% in the PPV + SB group, whereas it was 94.1% in the PPV group. Improvement in visual acuity (logMAR score) was comparable in both the groups at the end of 3 months (P = 0.433). Furthermore, the SSAS in phakic patients in both the groups was 100%, whereas for pseudophakic patients, PPV + SB had a SSAS of 83.3%, and in the PPV group, it was 85.7%. Conclusion: We did not find significant differences in SSAS, final anatomical success, or change in visual acuity when comparing PPV with PPV/SB in the RRD.
Purpose: To report 24-month outcomes of anti-vascular endothelial growth factor (VEGF) treatment 2 mg Aflibercept in patients with cystoid macular edema (CME) due to central retinal vein occlusion (CRVO) in routine clinical practice. Methods: In this observational single-center study, 46 treatment-naive CRVO eyes with CME that completed aflibercept treatment over 24 months were analyzed. In addition, eyes were categorized according to baseline visual acuity (VA). The primary outcome was the mean change in VA from baseline to 24 months. Secondary outcomes included changes in central subfield thickness (CST), intraocular pressure, median number of injections and visits, time to additional laser therapy, and adverse events. Results: Overall, mean VA and CST (mean ± standard deviation) changed by +24 (±28) letters and −234 (±242) µm, respectively, from baseline to 24 months. With a median of 18 visits, 13 injections were administered. Eyes with a VA of ≤35 letters at baseline showed a mean VA increase of 34 letters. Eyes with a baseline VA between 35 and 70 letters had a mean change of + 13 letters. In eyes with a baseline VA of ≥70 letters, the mean improved by 8 letters. Conclusion: Anti-VEGF treatment with 2 mg Aflibercept achieves notable visual improvements in eyes with macular edema secondary to CRVO within 2 years. In particular, patients with poor baseline VA experience a substantial increase in vision due to intensive Aflibercept injections.
