Abstract: Spontaneous conjunctival blebs are rare in children, with no clear treatment guidelines. We describe a 16-year-old boy with a gradually enlarging conjunctival bleb in the left eye, extending onto the cornea, years after blunt ocular trauma. In the absence of standard therapy, topical gentamicin was used empirically to induce localized fibrosis, capitalizing on its known adverse effect of conjunctival scarring. The bleb gradually regressed and completely resolved over 9 months, leaving subconjunctival fibrosis with no recurrence. This outcome suggests a potential therapeutic role for intentionally using drug-induced fibrosis in select cases. To the best of our knowledge, we found no previously published pediatric reports describing the deliberate use of topical gentamicin to induce conjunctival fibrosis for the treatment of a spontaneous conjunctival bleb. This report demonstrates a novel, nonsurgical management strategy and raises the possibility of repurposing ocular drug toxicities for therapeutic benefit in ophthalmology.
Abstract: BACKGROUND: To evaluate the effectiveness and safety of manual small incision cataract surgery (MSICS) compared to phacoemulsification in managing dense brown or black cataracts at a large tertiary teaching eye hospital in the United Kingdom. METHODS: We included eyes operated by MSICS (Gr1) and phacoemulsification (Gr2) in this cohort study. Before and 6 weeks after surgery, uncorrected visual acuity and best-corrected visual acuity (BCVA) were noted. Refractive status was compared after 6 weeks. The Effectiveness index-1 was defined as BCVA >6/18. The Effectiveness index-2 was also described as postoperative spherical equivalent refraction ±1D of the target. Safety was defined as the intraoperative and postoperative complication rates in the two groups. RESULTS: Gr1 and Gr2 had 17 and 56 eyes, respectively. Effectiveness 1 of Gr1 (59%) was significantly lower than that of Gr2 (84%) ( P = 0.043). However, the Effectiveness index-2 was not significantly different between the two groups ( P = 0.4). The residual astigmatism in the eyes of Gr 1 was significantly higher than in the eyes of Gr 2 ( P < 0.001). The Gr1 eyes had a higher safety index than the Gr2 eyes ( P < 0.001). The long-term visual prognosis was guarded in six of the seven eyes with BCVA <6/12 in Gr 1 due to significant ocular comorbidities. CONCLUSIONS: MSICS is safer than phacoemulsification for managing dense brown or black cataracts but less effective at achieving an excellent visual prognosis and minimal residual astigmatism. Both could achieve similar refractive outcomes. MSICS was associated with fewer intraoperative complications than phacoemulsification in managing dense brown or black cataracts, although excellent visual outcomes were achieved less frequently, and residual astigmatism was greater. Refractive predictability was comparable, suggesting that MSICS remains a valuable alternative for appropriately selected dense cataracts.
Abstract: PURPOSE: The aim of the study was to compare the accuracy of the Digital Ishihara Chart (DIC) to the Traditional Handbook Ishihara Chart (HIC) at 75 cm and to look for the amount of alteration in results on doing HIC at 75 cm and 40 cm. METHODS: In this study, a total number of 66 male patients of the age of 18–40 years were recruited. After taking the signed consent from the patients, the HIC test was done by the secondary investigator (SI) at 75 cm and 40 cm. After that, the DIC test was done by the primary investigator (PI) at 75 cm. Once both tests were performed, the patient was send to the ophthalmologist for full eye examination to rule out any exclusion criteria. During the whole process, both PI and SI were blinded from each other’s findings. RESULTS: Out of 66 patients recruited, two were excluded, and rest 64 were included in the study. The mean age of the patients included in the study was 26.17 years ± 6.29. The average vision for the right eye (RE) and left eye (LE) was 0.00 logarithm of the minimum angle of resolution, respectively. The correlation between HIC at 75 cm and 40 cm for RE was 0.998 ( P < 0.001) and for LE was 0.995 ( P < 0.001). The specificity, sensitivity and accuracy between DIC and HIC at 75 were 100%, respectively. CONCLUSION: The DIC can be used as an alternative testing instead of the HIC for color vision testing. The testing distance does not affect the results.
