PURPOSE:To evaluate the early postoperative safety and long-term efficacy of Ologen augmented trabeculectomy (Olo-trab) with releasable scleral flap suture in eyes with advanced primary open/closed angle glaucoma. METHODS:This was a single-center, prospective, interventional, and noncomparative study of patients who underwent Olo-trab for advanced glaucoma (cup disc ratio > 0.8), in whom target pressure could not be met despite maximum permissible medical therapy. Postoperatively, patients were followed up for 12 months and evaluated for early postoperative complications within 1 month. The primary surgery success rate was assessed at 6 months and 1 year. RESULTS:The study cohort comprised 31 eyes of 27 patients. The mean age of the population was 59.48 ± 10.41 years. Eight cases were on two-drug antiglaucoma medications (AGMs), 13 on three drugs, and 10 were using four AGMs. The mean preoperative intraoperative pressure (IOP) of the cohort was 30.5 ± 9.1 mmHg. A total of 15 cases underwent combined phacoemulsification and trabeculectomy. Early postoperative hypotony was the only complication observed in 2/31 eyes (6%). Twelve months post surgery, 27 out of 31 eyes (87.10%) had a complete success, and the remaining 4 (12.9%) achieved a qualified/partial success. Mean postoperative IOP readings at all follow-up visits were significantly lower than those at preoperative levels ( P < 0.001). CONCLUSIONS:Olo-Trab with a releasable scleral flap suture has shown encouraging results for IOP control with a marginalized risk of postoperative hypotony in advanced cases of primary glaucoma.

PURPOSE:To describe the clinical presentation, treatment response, and surgical management of anterior segment ocular helminthic infections. METHODS:This single-center case series included patients diagnosed with helminthic anterior uveitis based on the presence of a characteristic triad: anterior uveitis, elevated intraocular pressure (IOP), and corneal edema. All patients were initially treated with topical corticosteroids and antiglaucoma medications. Definitive treatment consisted of surgical extraction of the intraocular helminth after adequate control of inflammation and IOP. RESULTS:All cases presented with Uveitis, raised IOP (Glaucoma), and corneal Edema (UGE) triad, which significantly impacted initial visualization and diagnosis. A non-touch surgical technique using viscoelastic-assisted dissection and capsulorhexis forceps was employed to extract the intraocular worms. Microscopic identification confirmed the organisms as Gnathostoma spinigerum, Wuchereria bancrofti, and Loa loa. CONCLUSION:Helminthic infestation of the anterior segment, although rare, may present as a distinct clinical entity characterized by uveitis, secondary glaucoma, and corneal edema. Early recognition of this triad can raise clinical suspicion. Controlled inflammation and IOP normalization, followed by non-traumatic surgical extraction, are key to favorable outcomes.

Purpose: The COVID-19 pandemic led to increase in near work and digital devices use among children mounting to increased development of myopia. Our study aimed to look for change in the incidence and clinical profile of newly diagnosed myopes who presented to six tertiary eye care centers in post-COVID period as compared to pre-COVID period. Methods: A retrospective observational multicentric study was conducted in two periods: pre-COVID (February 2019–January 2020) and post-COVID (August 2021–July 2022). All newly diagnosed myopes aged ≤18 years with cycloplegic spherical equivalent (SE) ≤−0.5 D who presented to the hospital during study periods were included. Patients with simple myopic astigmatism were excluded. Demographic data and clinical parameters, including type and severity of myopia, were compared between the two periods. Results: The study showed 937 newly diagnosed myopes in the pre-COVID and 1396 in the post-COVID period. The myopia incidence increased from 1.98% to 3.03% (P < 0.001). The gender distribution and mean age were comparable. There was a significant rise in myopia cases among children aged >5–≤10 years in the post-COVID period (P = 0.000). The average presenting SE was more myopic in the post-COVID period (P = 0.010). Moderate myopia showed a higher proportional increase in the age group >15–≤18 years, and severe myopia observed a higher proportional increase in the >5–≤10 years age group. Conclusion: The study reflects a higher incidence and severity of myopia at presentation in the post-COVID period, mainly in children aged >5–≤10 years. It emphasizes the urgent need for interventions to mitigate the rising burden of myopia.

PURPOSE:To evaluate the correlation and independent associations between ocular biometric parameters and central corneal thickness with the severity of myopia in children.  Methods: This multicentric retrospective cross-sectional study included children ≤18 years of age with simple axial myopia or compound myopic astigmatism. Ocular biometry was performed using an optical biometer (IOL master, Zeiss). The data collected was age, gender, height, weight, body mass index (BMI), cycloplegic refraction (Spherical Equivalent, SE), best corrected visual acuity (BCVA), axial length (AL), anterior chamber depth (ACD), lens thickness (LT), corneal power (K), central corneal thickness (CCT), and AL/Corneal curvature (CR) ratio. The various demographic and biometric parameters were compared between the myopia categories [low (≥-3.00 D), moderate (-3.25 to ≥-6.00D), and severe (<-6D)].  Results: A total of 1095 children (2174 eyes), 579 males and 516 females, were included. Out of 1095, 16 patients had one eye myopic while the other was emmetropic. The mean age was 11.61 ± 3.73 years. Low, moderate, and severe myopia was observed in 35.53%, 29.13%, and 35.34% of children with a mean SE of -1.93±0.71, -4.35±0.84, and -10.22±3.70, respectively. The severe myopia group showed the lowest mean values for age, height, weight, BMI, and the poorest mean BCVA (p < 0.001). Axial length demonstrated a strong association with SE, with increasing AL corresponding to higher degrees of myopia (estimate = -2.53, p < 0.001). Steeper mean keratometry (estimate = -1.01, p < 0.001), reduced ACD (estimate = 2.73, p < 0.001), and greater LT (estimate = -1.63, p = 0.001) were also significantly associated with more severe myopia. In contrast, CCT did not show an independent association with SE (p = 0.743). Among demographic variables, height showed a modest but significant relationship, with taller children associated with slightly lower degrees of myopia (estimate = 3.70, p < 0.001). Parental myopia and other covariates did not retain statistical significance after multivariable adjustment. CONCLUSION:In this large multicentric cohort of Indian children, ocular biometric parameters, particularly AL, CR, ACD, and LT were independently associated with the severity of myopia. The CCT showed no significant relationship. These findings underscore the importance of comprehensive ocular biometric profiling beyond SE alone for understanding myopia severity. Population-specific biometric data may aid in improved risk stratification and individualised myopia management.

PURPOSE:To compare the efficacy and safety of one-time povidone-iodine (PovI) administration followed by a course of tobramycin-dexamethasone eye drops versus artificial tears in acute viral conjunctivitis (AVC). METHODS:This was a single-centre, randomized controlled trial. Patients with AVC were instilled with PovI (5%) after proparacaine and then divided into two groups using a computer-generated random number table. Group A received combination drops of tobramycin(0.3%) and dexamethasone(0.5%), and group B received carboxymethylcellulose(0.5%) eyedrops. Both groups administered one drop four times daily for at least three days and until complete symptom resolution. A symptom score (SS) encompassing the five symptoms (redness, lid swelling, foreign body sensation, pain, watering; max score 15) was calculated at baseline, day 3, and day 7. RESULTS:The study included 230 eyes (120 in group A, 110 in group B). There was a significant reduction in mean total SS at day 3 (2.16 ± 2.42) and day 7 (0.56 ± 1.14) in all eyes compared to at presentation (8.33 ± 2.46). At day 3, there was a lower mean total SS in group A (1.97 ± 2.31) compared to group B (2.36 ± 2.54) which was marginally significant (p = 0.086). At day 7, the proportion of eyes that were symptom-free was similar between groups (70.9%, p = 0.881). A multivariate analysis found that group B (OR = 2.08, p = 0.036) and a higher pain score (OR = 1.50, p = 0.046) were associated with a lack of clinical resolution by day 3. CONCLUSION:A course of tobramycin-dexamethasone combination eyedrops after PovI may lead to early symptomatic relief, but recovery was similar to artificial tears by day 7. No significant/sight-threatening complications were observed in any groups.

OBJECTIVES Microphthalmos, Anophthalmos, and Coloboma (MAC) are common causes of childhood blindness. In 1996, World Health Organisation (WHO) proposed night blindness (NB) as a functional indicator of Vitamin A deficiency (VAD). We aimed to investigate the association of maternal antenatal NB, environmental risk factors and socioeconomic determinants with MAC. METHODS A case-control study was conducted between 2018 to 2021 comparing risk factors between MAC and control cases. Data regarding maternal antenatal NB, birth order, consanguinity, family history, maternal dietary habits during pregnancy, history of spontaneous abortions, and father’s income were collected retrospectively and through telephonic interviews with mothers. Bilateral anophthalmos, severe microphthalmos or a combination defined a severe MAC phenotype. RESULTS 220 children with MAC and 219 normal controls aged 0–3 years were included. Antenatal maternal NB was observed in 33.2% of MAC and 3.2% of controls (p < 0.001). A higher birth order (2nd or more), parental consanguinity, and a history of prior spontaneous abortions were also more common in MAC. A history of antenatal maternal NB was more common in severe MAC (67.3%) as compared to the less severe MAC (22.6%) (p < 0.001). CONCLUSIONS The study identified antenatal maternal NB, higher birth order, parental consanguinity, and history of spontaneous abortions as significant risk factors for MAC disorders, highlighting the influence of maternal nutrition and genetics. To the best of our knowledge, this is the largest case-control study to show an association of maternal NB and MAC. Maternal NB has been used as a functional indicator of VAD.

Elevated episcleral venous pressure (EEVP) is a rare but important cause of raised intraocular pressure. The resultant glaucoma is often severe and refractory to routine anti glaucoma treatment. Usually it occurs due to arteriovenous fistulas or venous congestion. This entity is important to detect as it may be associated with serious pathologies like retrobulbar tumor, cavernous sinus thrombosis, mediastinal tumor to name a few. EEVP is considered idiopathic after ruling out such disorders. Here, we have described idiopathic EEVP also known as Radius-Maumenee syndrome along with a detailed diagnostic and therapeutic approach of management.

Purpose: To study the clinical profile of patients with microspherophakia and the factors associated with poor vision following lensectomy surgery. Methods: A multicenter, retrospective, cross-sectional analysis was conducted from January 2010 to June 2022 on patients diagnosed with microspherophakia. Results: A total of 102 eyes from 51 patients were enrolled, of whom 24 (47.1%) were male and 27 (52.9%) were female. All patients presented with bilateral involvement. The most common presenting complaint was defective vision, affecting 98 (96.1%) eyes. Patients exhibited varying degrees of lenticular myopia, with a mean refractive error of −13.54 ± 11.92 D. Glaucoma was present in 36 (35.3%) eyes at presentation. Subluxation of the crystalline lens was observed in 50 (49.1%) eyes, dislocation of the lens into the anterior chamber in 24 (23.5%) eyes, and dislocation into the vitreous cavity in 4 (3.9%) eyes. Limbal or pars plana lensectomy was performed in 54 (52.9%) eyes. The mean corrected visual acuity improved from 1.05 ± 0.82 logMAR units to 0.82 ± 0.79 logMAR units after lensectomy (P = 0.029). Poor postoperative visual acuity (less than 20/200) was associated with poor preoperative visual acuity (P = 0.005), presence of glaucoma at the first visit (P = 0.013), and intraocular pressure >30 mmHg (P < 0.001). Conclusion: Microspherophakia is associated with high lenticular myopia, subluxation, and dislocation of the crystalline lens. Significant improvement in postoperative vision was observed after lensectomy. Factors associated with poor postoperative vision included poor preoperative corrected vision, presence of glaucoma, and high intraocular pressure.

We report a rare case of traumatic pseudophacocele in an old patient after suffering trauma from a cow tail. The patient presented to us very late, 5 months after the trauma. The clinical diagnosis was difficult as the entire anterior chamber was filled with blood. The anterior segment optical coherence tomography helped us to reach a diagnosis. Despite providing the best possible surgical treatment, vision remained poor due to the development of glaucoma secondary to trauma. Our case highlights the utility of non-contact diagnostic modalities and the need for early recognition and treatment of such visually devastating conditions.

Purpose: To determine the level of awareness and knowledge about glaucoma surgery and post-surgery counseling amongst paramedical staff at a tertiary eye-care hospital. Methods: This observational cross-sectional study included a random sample of 94 hospital personnel: 37 general nurse midwives, 47 ophthalmic assistants, and 10 patient caretakers (PCTs). Participants were administered a questionnaire about glaucoma surgery and post-surgery counseling of patients. Results: The study included 41 (43.6%) females and 53 (56.4%) males. The mean age of the participants was 24.85 ± 4.54 years. All participants were aware of trabeculectomy surgery in glaucoma (100%). A total of 95.7% knew that surgery helps in controlling IOP, of whom 57 (60.6%) participants got information during their course of learning. Overall 53 (56.4%) believed that surgery is done when medication failure occurs, and 58 (61.7%) knew that surgery helps in preserving vision. A total of 63 (67.0%) participants knew to counsel patients to visit an ophthalmologist when called for and take the treatment as advised, whereas 74 (78.7%) correctly said to visit an ophthalmologist immediately if pain/diminution of vision/discharge occurs. Overall, PCTs were found to be having significantly better knowledge (P = 0.01) compared to others and they also reported ophthalmologists as the chief source of information. Conclusion: This study revealed that paramedical staff had an excellent awareness of trabeculectomy surgery. However, the knowledge and counseling parts of the questionnaire revealed less than satisfactory responses. So, there is a need to continuously educate paramedical staff members so that they can help in propagating information about the role of glaucoma surgery and the importance of proper follow-up.

Purpose:To assess the clinical presentation of pediatric patients having early traumatic glaucoma and to analyze early predictors for the need of filtration surgery.Methods:Patients with early traumatic glaucoma after close globe injury (CGI) from January 2014 to December 2020 were retrospectively reviewed. Clinical features, treatment provided (medical and surgical), and visual outcomes were documented. Patients were divided into two groups based on the management required: group A- trabeculectomy and group B- medication + minor surgery.Results:A total of 85 patients were studied after applying the necessary inclusion and exclusion criteria. Out of these, 46 underwent trabeculectomy for the control of intraocular pressure (IOP) and the remaining 39 were managed with antiglaucoma medications. Significant male predominance of 9.6:1 was observed. Patients presented to the hospital after a mean duration of 8.5 days posttrauma. Wooden objects were most commonly responsible for trauma. Mean best corrected visual acuity at presentation was 1.91 log of minimum angle of resolution (logMAR). Mean IOP at presentation was 40 mmHg. The common anterior segment finding were severe anterior chamber (AC) reaction (63.5%), followed by angle recession (56.4%). Severe AC reaction (P = 0.0001) and corneal microcystic edema (P = 0.04) were significant predictive factors for early need of trabeculectomy.Conclusion:Need of trabeculectomy was higher in patients with severe AC reaction and corneal microcystic edema. The threshold to perform trabeculectomy should be lower, as glaucoma is often relentless, severe, and may result in irreversible vision loss.

PURPOSE:To assess clinical features, visual outcomes, and setting of mobile battery blast-induced eye injuries in children. METHODS:Retrospective case sheets of children with mobile battery blast injuries were reviewed at a tertiary eye care center from January 2015 to March 2022. We noted the mode of injury, battery status, and clinical presentation and analyzed the treatment outcomes. RESULTS:The study included 14 eyes of 11 patients. Three patients (27%) had bilateral ocular injuries. The most common reasons for the blast were wiring a bulb to the battery or charging the battery with a universal mobile charger, seen in four cases each. Three eyes had closed-globe injuries (CGIs), whereas 11 had open-globe injuries (OGIs). Of the 11 eyes with OGI, four also had a retained intraocular foreign body (IOFB). Only four (36%) eyes having OGI could achieve vision better than 6/60. All three eyes with CGIs developed secondary glaucoma, and two underwent trabeculectomy. However, the visual prognosis was better (>6/36) in eyes with CGI. Overall, mean visual acuity at the final follow-up was improved to 1.41 ± 1.14 logMAR from 2.32 ± 0.76 logMAR at presentation. This was also found to be statistically significant with a P value of 0.02. CONCLUSION:Battery blast-induced ocular injuries, although rare, often lead to poor outcomes. Apart from charging, playing with discarded or damaged batteries was a common reason for battery blasts in our series.

Purpose: To evaluate the gonioscopic changes in patients receiving Descemet's stripping endothelial keratoplasty (DSEK) without pre-existing ocular hypertension (OHT) and to report its correlation with post-surgery OHT, graft survival, and visual outcomes. Methods: Adult patients who underwent DSEK surgery from April 2014 to March 2018 with at least 2 years of follow-up were analyzed in this retrospective study. Demographic details, indication of DSEK, necessary anterior and posterior segment findings, and the post-DSEK OHT details were documented. Results: A total of 58 patients (23 males and 35 females) with a mean age of 61.44 ± 8.8 years were included in the study. The most common etiology for DSEK surgery was pseudophakic bullous keratopathy in 47 eyes (81.03%). A total of 22.41% (13/58) eyes showed elevated intra-ocular pressure (IOP) following DSEK surgery. The most common cause of IOP elevation was steroid-induced OHT in seven eyes (12.06%). Gonioscopy examination revealed areas of peripheral anterior synechiae (PAS) in 17 (29.3%) eyes. OHT was found in 4/17 (23.5%) eyes having PAS. Three of these cases required trabeculectomy + goniosynechiolysis (GSL), and the fourth case required GSL alone to control IOP. These four cases also required repeat DSEK for failed grafts. The mean pre-operative best corrected visual acuity was 1.62 logMAR (range 1.17–1.77), which gradually improved to 0.79 logMAR (range 0.3–1.77) after 2 years (p < 0.00001). Conclusion: PAS was found to be an important factor associated with post-DSEK ocular hypertension in our study. OHT in PAS cases required definitive surgical treatments to control IOP. It adversely affected the graft survival and in turn affected visual outcomes also.

Dear Editor, An important component for precise intraocular lens (IOL) power calculation is accurate keratometry (K) readings. Manual keratometer and IOL master have been widely used for this purpose.[123] But in young children and uncooperative adults, such instruments failed to solve the purpose. Portable handheld keratometers are preferred in such cases under general anesthesia (GA)/sedation.[1] To use such an instrument, eyes need to be forcibly opened using hands/speculum, which can be an important aspect leading to errors. Jethani et al.[4] compared the K readings in children (age range 5–16 years) with manual separation of lids and wire speculum. They also measured the K values in awake period. They did not find any significant change in K values. Scleral rigidity is very less in small children, which may lead to significant variation of readings with such manipulations.[5] Hence, such a study needs to be replicated in smaller children. We compared the K readings under GA prospectively using manual separation and wire speculum. Sample size was not calculated, considering this a pilot analytical study. From September 2021 to November 2021, all consecutive cases – 39 eyes of 21 patients (<5 years of age) – being operated for cataract surgery were included. We excluded children with corneal and scleral pathologies. All the readings were taken under GA, first by manual separation of lids and then by appropriate-sized wire speculum. Table 1 shows the results and appropriate statistical analysis. We did not find significant difference between the K readings of eyes separated with the speculum and with hand. The correlation coefficient was also very strong (>0.95), although we observed that in two patients where the K readings were the lowest (<40 D) had 0.8 D steepening with the speculum. An important limitation of our study was that we could not measure the K readings in awake positions due to lack of cooperation.Table 1: Biometric details of patients with analysisTo conclude, manual separation of lids by hand or speculum gives comparable K results. Caution is required while interpreting in patients having lower K values. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Dear Editor, An important complication after pediatric cataract surgery is posterior capsular opacification (PCO), and primary posterior capsulotomy (PPC) is an imperative step to prevent it. Two popular techniques to perform PPC are manual “posterior continuous curvilinear capsulorhexis” (PCCC) using Utrata forceps and “limbal approach retropseudophakic vitrectorrhexis” (LARV) using vitrector.[1] This additional step can potentially worsen postoperative inflammation and endothelial cell damage. Various studies have reported endothelial cell characteristics before and after cataract surgery in children,[2345] but none have so far compared two different techniques of PPC. Each technique has its advantages, such as in PCCC, the viscosurgical device coats the endothelium during PPC, thereby protecting it from damage. LARV is simpler to perform, although endothelium gets continuously exposed to balanced salt solution. The aim of our study was to analyze changes in corneal endothelial cell characteristics in pediatric cataract, comparing manual PCCC before intraocular lens (IOL) implantation and LARV after IOL implantation. A prospective comparative study was done in 60 eyes of 30 patients with bilateral developmental cataract (3–8 years of age) undergoing cataract surgery from April 2017 to September 2017. The same patient underwent PPC via manual PCCC technique in the first eye and via LARV technique in the second eye. Topcon SP3000P non-contact endothelial specular microscopy was used for endothelial analysis. The baseline characteristics of both groups were comparable [Table 1]. Endothelial cell loss was less than 4% after 3 months in both groups, and all other specular microscopic endothelial parameters were also comparable [Table 2]. Surgical time is a known factor in causing endothelial cell loss, which was lesser in the LARV group. In conclusion, our study has shown that endothelial cell loss with conventional PCCC and LARV is comparable. Thus, use of any of these techniques can be left to surgeon’s discretion.Table 1: Comparison of baseline characteristicsTable 2: Comparison of preoperative and postoperative (Day 90) endothelial cell characteristicsFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Purpose: The purpose of the study is to report the hazardous effect of chunna packet (lime) on ocular surface in terms of pattern of presentation and visual outcome in children. Materials and Methods: Children of age <16 years with definitive history of chemical injury with chunna packet were analyzed. Ocular chemical injury was graded according to Modified Roper Hall grading system. Best corrected visual acuity (BCVA) and anterior segment examination evaluation were compared at time of presentation and at 3 months and categorized on the basis of WHO visual disability classification. Likelihood ratio of BCVA with time of presentation and grade of injuries were calculated using Pearson's correlation coefficient. Results: Eighty eyes of 74 children with a history of ocular burns resulting from lime were included in the study. Of these, 6 patients had bilateral burns. Mean age at the time of injury was 8.44 ± 4.29 years. Many children presented late after 3 weeks of injury (n = 24, 32.4%). The most common grade of injury was Grade 4 (n = 31, 38.8%). Clinical presentations were corneal haze (55%), limbal ischemia (65%), lime particle in fornix (36.2%), corneal scar (33.7%), and symblepharon (22.5%). Surgical intervention was advised in 54 eyes (67.5%) in the form of amniotic membrane grafting, symblepharon release, limbal stem cell transplantation, and tectonic keratoplasty. Mean BCVA at presentation was 1.65 ± 0.99 and at 3 months was 1.39 ± 1.03. Conclusion: Grade of injury and time of presentation were strongly associated with visual outcome in cases of chemical injury with chunna packet.

Purpose: This study was performed to compare the rate of progression of myopia before and during the COVID-19 pandemic and to assess the risk factors of hastened progression. Methods: All children with myopia of spherical equivalence ≤ −0.5 D with at least two prior documented refractions 6 months and 1 year before were included. The annual progression rate before COVID-19 and during COVID-19 was calculated. Annual myopia progression was categorized as no progression (0), slow progression (<1 D), and fast progression (≥1 D). Results: A total of 133 children (266 eyes) aged 6–18 years were included in the study. Mean annual myopia progression was found to be statistically significant during COVID-19 as compared with pre-COVID-19 (0.90 vs 0.25 D, P < 0.00001). A total of 45.9% of children showed an annual progression of ≥1 D during the pandemic as compared with 10.5% before the COVID-19 (p < 0.00001). In multivariate analysis, history of rapid progression in pre-COVID-19 era (P = 0.002) and sun exposure <1 h/day (P < 0.00001) were found to be independent risk factors for rapid myopia progression. Conclusion: Parents should consider risk of rapid myopia progression in children during current pandemic and children should be provided with socially distant outdoor activities to increase their sun exposure and diminish the rate of myopia progression.

Purpose: To determine surgical outcomes and risk factors for failure of trabeculectomy with mitomycin C (TMMC) in pediatric traumatic glaucoma. Methods: Children who underwent TMMC post trauma from January 2014 to December 2019 were reviewed. Demographic features, ocular findings, and surgery details were noted. Surgical success was defined as achieving intraocular pressure (IOP) within 6-21 mm Hg. Results: Seventy-one eyes of seventy patients underwent TMMC. The mean age of the patients was 11.28 +/- 3.63 years with a male/female ratio of 13:1. The median time from trauma to IOP rise was 13 days. The majority of the patients (n=64, 90.1%) had close globe injury. Baseline IOP was 39.3 +/- 10.5 mm Hg. Results of the surgery were noted at the last visit. Cumulative success was noted in 51 (71.8%) eyes, while 20 (28.2%) eyes were labeled failures. Mean IOP reduced from 39.3 +/- 10.5 to 14.5 +/- 8.1 mm Hg. Mean visual acuity improved from 2.3 +/- 0.93 to 1.19 +/- 1.08 logMAR. Post surgery, the mean follow-up of the patients was 20.3 +/- 11.4 months. Age <6 years (RR 3.6), elevated IOP at 1 month after TMMC (RR 2.19), and hypotony within a week of surgery (RR 1.81) were found as independent risk factors of surgical failure. Conclusion: TMMC is effective in reducing IOP in traumatic glaucoma. Young age and inability to control IOP within normal ranges in the immediate period after surgery are important risk factors of failure.

Purpose: To evaluate the central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) changes on spectral domain optical coherence tomography (SD-OCT) after cataract surgery with intraocular lens (IOL) implantation in a pediatric population. Methods: This was a longitudinal, prospective, interventional study which included 90 pediatric patients who underwent cataract extraction with IOL implantation. Serial SD-OCT scans were done at postoperative day 1, 1-month, and 3-month follow-up. CMT and SFCT were measured at each visit. Results: A statistically significant increase in CMT was noted at 1 month (from 199.3 μm to 210.04 μm) post surgery, which declined over a 3-month period (202.70 μm, P = 0.0001). In case of SFCT, a constant increase was observed for over 3 months of follow-up (baseline: 296.52 μm; 1 month: 309.04 μm; and 3 months: 319.03 μm, P = 0.0001). The traumatic cataract group showed more pronounced changes in CMT and SFCT than the non-traumatic cataract group. No significant difference was observed regarding these parameters between those who underwent primary posterior capsulotomy (PPC) versus those who did not. None of the patients in the study group developed cystoid macular edema. These posterior segment–related anatomical changes did not affect the final visual outcomes. Conclusion: Cataract surgery induces potential inflammatory changes in the macula and choroid in pediatric patients. Such changes are more pronounced in trauma-related cases; however, they are not significant enough to affect the visual outcomes. Similarly, the additional surgical step of PPC does not induce significant anatomical or functional changes.

PURPOSE:To determine the surgical outcomes of bleb needling and the risk factors of failure of needling after failed filtration surgeries in patients with pediatric glaucoma.METHODS:The medical records of patients who underwent needling with 5-fluorouracil following filtering surgeries (trabeculectomy, combined trabeculectomy, and trabeculotomy) between January 2012 and December 2016 were retrospectively reviewed. At the 1-year follow-up visit, complete success and qualified success were defined as an intraocular pressure (IOP) of less than 18 mm Hg with and without antiglaucoma medication, respectively.RESULTS:Forty-five eyes that underwent needling and fulfilled the study criteria were included in the analysis. The mean age at needling was 9.6 years. The mean time interval between filtration surgery and the first needling procedure was 57.3 days. Thirty-eight of 45 eyes (84.4%) had undergone needling within 3 months after the primary surgery. Cumulative success was achieved in 35 eyes (77.7%) after needling (complete success in 22 eyes and qualified success in 13 eyes). Mean follow-up after needling was 18.9 months. The mean IOP before and after needling was 31.7 ± 9.45 and 16.6 ± 5.68 mm Hg, respectively (P < .00001). Steroid-induced glaucoma (P = .01), high IOP prior to the first filtration surgery (P = .01), and an inability to achieve low IOP (< 9 mm Hg, P = .04) immediately after needling were significant risk factors associated with failure.CONCLUSIONS:Bleb needling is an efficient method for lowering IOP after a failed trabeculectomy or combined trabeculectomy and trabeculotomy in the pediatric population. [J Pediatr Ophthalmol Strabismus. 2021;58(2):118-125.].