The medical management of ectopia lentis involves refractive correction as well as co-management of any associated systemic disease. Surgical management remains a challenge, as inherent defects in the lens capsule make implantation of an intraocular lens (IOL) difficult. Multiple visual rehabilitative measures are available such as aphakic contact lenses or spectacles, capsular bag fixation with implantation of in-the-bag IOL, iris-fixated, and scleral-fixated IOL. It depends on the surgeon’s expertise and discretion whether the capsular bag needs to be preserved or compromised.

Purpose To compare the outcomes of simple limbal epithelial transplantation (SLET) with cultivated limbal epithelial transplantation (CLET) for the management of total limbal stem cell deficiency (LSCD) in eyes with unilateral ocular burns. Design Randomized controlled trial. Methods 100 patients (100 eyes) with unilateral total LSCD following ocular burns undergoing autologous Limbal Stem Cell Transplantation (LSCT) were enrolled and randomized into SLET and CLET groups. Restoration of an epithelized ocular surface was the primary outcome measure. Occurrences of progressive conjunctivalization and persistent epithelial defects postoperatively were considered surgical failures. Results Mean age was 20.2 ± 13.1 years (SLET) and 22.6 ± 14.3 years (CLET) (p = 0.363). Alkali burn was the most common causative factor in both groups and had comparable mean logMAR BCVA at presentation [SLET: 2.33 ± 0.5, CLET: 2.23 ± 1.48 (p = 0.652)]. Median time interval between injury and surgical intervention was 18 months (SLET) and 12 months (CLET) (p = 0.06). 88 % eyes in SLET group maintained a stable ocular surface at 1 year period versus CLET group (86 %) (p = 0.999). Mean logMAR BCVA significantly improved in both groups with SLET having significantly better BCVA versus CLET at 6 months (p = 0.0390), 1 year (p = 0.0001), 2 year (p = 0.0001) and 3 years (p = 0.0001) follow up. Kaplan-Meier survival analysis was statistically insignificant amongst the 2 groups (p = 0.590). Conclusions Compared to CLET, SLET is equally efficacious in restoring and maintaining a stable ocular surface in eyes with total LSCD due to ocular burns, with the added advantage of providing superior visual outcomes.

We describe the hybrid technique of tuck-in Tenon’s patch graft (TPG) and tissue adhesive bandaged contact lens (TABCL) for large corneal perforations (>5 mm) with intact surrounding stroma. Management of large corneal perforation is often challenging, and urgent availability of donor cornea might be difficult; Tenon patch alone does not provide tectonic support; hence, this hybrid technique can be used safely in large perforations. This involves freshening the perforation edges, creating a 3600 stromal pocket, harvesting a Tenon’s graft 1 mm oversized, tucking into the pocket, and suturing. Then areas of leakage were noted, and only those areas were supplemented with minimal cyanoacrylate glue (CG) at the graft edges. This technique was used in two eyes, one with a large corneal perforation and intact surrounding stroma and the other with 4 mm corneal fistula post healed keratitis with a failed primary TPG alone, and led to epithelialization and a smooth corneal surface at 6 weeks. The advantages include autologous tissue, cost-effective, easily available, minimal post-operative inflammation, vascularization, and surface irregularity.

This surgical technique describes a modification of the continuous curvilinear capsulorhexis (CCC) to achieve an adequate-sized capsulorhexis in pediatric cataracts with high intralenticular pressure. Performing CCC in pediatric cataracts is challenging, especially when the intralenticular pressure is high. This technique involves 30 G needle decompression of the lens to reduce positive intralenticular pressure and subsequent flattening of the anterior capsule. This minimizes the chances of extension of CCC without using any special equipment. This technique was used in two eyes of two patients (age 8 and 10 years) with unilateral developmental cataracts. Both surgeries were performed by a single surgeon (PKM). In both eyes, a well-centered CCC was achieved with no extension, and a posterior chamber intraocular lens (IOL) was placed in the capsular bag. Thus, our technique of 30 G needle aspiration could be extremely useful to achieve an adequately sized CCC in pediatric cataracts with high intralenticular pressure, especially for beginner surgeons.

A 30-year-old female presented with diminution of vision in the right eye for 2 months. She was a known case of macular corneal dystrophy and had undergone OD deep anterior lamellar keratoplasty 2 years back. The best corrected visual acuity (BCVA) was 6/18 at 6 months. At presentation, the BCVA was 4/60 and 6/60 in OD and OS, respectively. The graft was clear with no interface haze. An area of graft ectasia with thinning at the inferotemporal (7–9'o clock) graft–host junction was noted clinically and on tomography. Rigid gas permeable contact lenses showed a BCVA of 6/9 and were advised.

Case DesCriptionA female patient, aged 24 years, reported missing to the Department of Periodontics and Oral Implantology, Santosh (Deemed to be University), Santosh Dental College, Ghaziabad, with a complaint of a missing right upper front tooth.She expressed her wishes for a minimally invasive treatment approach.As a part of the investigative procedure, radiographic assessments, including intraoral periapical radiographs and orthopantomography, were performed after the initial clinical assessment.An intraoral examination revealed that the right canine was missing (Fig. 1).Diagnostic impressions of both the arch were taken, and diagnostic casts were prepared.Following a thorough medical history, a complete hemogram was performed, and the implant aim The aim of this article is to present a case of the flapless implant, which sheds light on how the flapless technique can be a better option when compared to the conventional flap technique in terms of esthetics and time-saving for the patient. BaCkgrounDThe most frequent location of tooth loss in the maxillary anterior region can be caused either due to trauma or a congenital defect.This affects the patient's smile by causing both functional and cosmetic concerns.Following tooth extraction, alveolar ridge resorption and loss of tissue morphology are the most common side effects.Lost teeth can be replaced in a variety of ways, including removable partial dentures, resin-bonded bridges, permanent partial dentures, fixed partial dentures, and dental implants can be carried out.The replacement of anterior teeth with implant-supported restorations is a difficult and technique-sensitive procedure. 1Surgeons have recently been interested in "flapless" implant surgery as it offers several benefits, including the preservation of circulation, soft tissue architecture, and hard tissue volume at the surgery site, as well as reduced surgical time, greater patient comfort, and faster recovery.It also permits the patient, after the operation, to immediately continue with normal oral hygiene routines.This method frequently needs significant clinical knowledge and surgical judgments to be successful.In single-unit restorations, the crown can be placed in a more passive position. 2The patient and the surgeon both benefit from the flapless implant placement approach.Maintaining a better blood supply to the region by leaving the periosteum intact on the buccal and lingual portions of the ridge, for example, reduces the risk of bone resorption.Furthermore, it lowers intraoperative bleeding, surgical time, and the need for suturing, as well as reducing complications at the patient level, such as swelling and discomfort.

Dear Editor, The interesting article by Kumar et al.[1] may require further discussion. Neovascularization elsewhere (NVE) is not very common in CRVO, and imaging of the same would be interesting.[2] Moreover, the evidence of neovascular glaucoma (NVG) in the right eye (which did not show anterior segment new vessels) should be elaborated.[1] Burgansky-Eliash et al.[3] reported two patients with hypotony (intraocular pressure/IOP: 2 and 6 mm Hg, respectively) and anterior rotation of the ciliary body (ARCB) on ultrasound biomicroscopy (UBM) after trabeculectomy presumably due to “ocular decompression.” UBM-features improved in the first patient after topical atropine 1% twice daily; however, IOP remained low (3 mm Hg). In the second patient, UBM-findings improved after cataract surgery and pars-plana anterior vitrectomy. This patient had “elevated and pale” (avascular looking) bleb. Final IOP was not reported in both cases.[3] The primary cause of hypotony, shallow anterior chamber (AC), and ARCB might be overfiltration through the bleb or tube (Sherwood-slit), rather than “malignant glaucoma” in both case reports.[13] Because IOP was low, use of glaucoma in “hypotonous malignant glaucoma” (HMG) may be self-contradictory. Existence of such an entity may need research. Overfiltration immediately after trabeculectomy tends to settle over time, and aqueous misdirection should be a diagnosis of exclusion after all efforts of treating overfiltration have been exhausted and IOP is normal or high. The patient’s[1] IOP improved on pressure patch and medical management, suggesting a component of overfiltration. Absent aqueous pockets in the vitreous cavity also point against aqueous misdirection.[1] Other management options (including reducing frequency of steroid, reformation of AC, and ligation of tube) should have been considered before planning anterior vitrectomy. The results of longer follow-up in this patient and the method of using prolene for ligature of tube should be discussed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Infectious keratitis is a significant cause of corneal blindness worldwide. Although less prevalent in the developed world, cases of fungal keratitis account for almost half of all keratitis cases, occurring in the developing countries. These cases are one of the most refractory types of infectious keratitis and present various challenges to the treating physician such as delayed presentation, long waiting time for culture positivity, limited availability effective antifungal drugs, prolonged duration for response to therapy, a highly variable spectrum of anti-fungal drug sensitivity and a high recurrence rate following keratoplasty. The advent of rapid diagnostic tools, molecular methods, in vitro anti-fungal drug sensitivity testing, alternatives to natamycin, targeted drug delivery and most importantly the results of large randomized controlled trials have significantly improved our understanding and approach towards the diagnosis and management of cases with fungal keratitis. Overall, Aspergillus and Fusarium species are the most common causes ones of fungal keratitis. History of antecedent trauma is a significant predisposing factor. Corneal scrapings for microscopic evaluation and culture preparation, is the standard of care for establishing the diagnosis of fungal keratitis. Molecular identification of cultures offers accurate identification of fungal pathogens, especially the rare species. Natamycin is an approved first-line drug. Voriconazole is the best alternative, especially for non-fusarium cases. Management involves administration of drugs usually by a combination of various routes, the treatment regimen being individualized depending upon the response to therapy. Photodynamic therapy is a newer treatment modality, being tried for non-responsive cases, before resorting to a therapeutic graft.

PURPOSE:To compare the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and prednisolone acetate in controlling inflammation and preventing cystoid macular edema (CME) after uneventful phacoemulsification. METHODS:All patients who underwent uneventful phacoemulsification from December 2020 to Feb 2021 were included in the study. These were randomly assigned to receive any one anti-inflammatory agent among topical nepafenac (0.1%) [96 eyes], bromfenac (0.07%) [93 eyes], preservative-free ketorolac (0.4%) [94 eyes], nepafenac (0.3%) [96 eyes], or prednisolone acetate (1%) [91 eyes]. The efficacy of the drugs was evaluated by comparing the grade of anterior chamber (AC) cells, conjunctival hyperemia, pain score, visual acuity, intraocular pressure (IOP), and central macular thickness (CMT) at 1 and 6 weeks after surgery. RESULTS:At 1 and 6 weeks, there was no significant difference in pain score, conjunctival hyperemia, AC cells, change in IOP, and visual acuity between the prednisolone and the NSAIDs groups, though nepafenac 0.3% was most effective. At 6 weeks, there was no significant difference in the number of patients developing subclinical CME in the prednisolone versus NSAID group. The mean increase in CMT was significantly lower in nepafenac 0.3% than prednisolone at 1 and 6 weeks (P = 0.003 and 0.004, respectively). CONCLUSION:NSAIDs used in isolation are comparable to prednisolone in preventing inflammation and pain after uneventful phacoemulsification. However, nepafenac 0.3% is most comparable to prednisolone and more efficacious in reducing the incidence of CME. We recommend that nepafenac 0.3% can be used as a sole anti-inflammatory agent in patients with uneventful phacoemulsification.

Background: Risk of alveolar bone loss & tooth loss increases with the presence of intrabony defects. Anoraganic bovine bone mineral (ABBM) is being used in treatment of intrabony defects.Platelet-rich fibrin (PRF) is an autologous concentrate thathas an important role inpromoting soft and hard tissue healing.This study was done to compare and evaluate the healing of intra-bony defects treated with a combination of ABBM-PRF or ABBM alone.Method: Twelve patients (24 sites) with intrabony defects were selected and divided randomly in 2 groups. Subjects in Group A (Control group ) were treated with ABBM alone & subjects in Group B (test Group ) were treated with ABBM + PRF.Clinical parameters such as PPD(Probing pocket depth), CAL(Clinical attachment level), PI(plaque index), GI(gingival index), WHI(Wound healing index), VBL(Vertical Bone Level)& DD(Defect depth) at baseline, 3 and 6 months using acrylic stent.Result: Significant gain in PPD& CAL( 3.92± 0.67 to 2.00± 0.74) was seen from baseline to 6 months in test group ( p<0.001) as compared to control group.Also vertical bone level wasincreased in test groupi.e from 3.50 ± 0.52 to 3.00± 0.43 (p<0.001) post – operative when compared to control group at 6 months.Conclusion: The addition of PRF to ABBM can augment regeneration and can lead to enhancement of CAL gain.

Objective: This study aimed to clinically evaluate the efficacy of coronally repositioned flap in the treatment of isolated Miller's class I and II gingival recession. Materials and Methods: Twelve patients with Miller's class I and class II recession were selected. Patients were randomly divided into two groups: Group A (control group): coronally repositioned flap and Group B (test group): coronally repositioned flap with bioabsorbable collagen membrane. Clinical evaluation parameters such as probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (WKT), gingival biotype (thickness), recession width (RW), and recession depth (RD) were recorded at baseline and at 1, 3, and 6 months post-operatively using an acrylic stent. Results: A significant gain in CAL (−0.6, −0.78, and −0.60 mm) and WKT (0.25, 0.48, and 0.83 mm) was observed in both the groups from baseline to 1, 3, and 6 months, respectively. However, the gain was more in the test group than the control group. Similarly, a significant decrease in mean RD and RW was more in the test group when compared with the control group (significant P-value <0.001) 6 months post-operatively. Also, no statistically significant change was found in the two groups in terms of PD and gingival tissue at 6 months. Conclusion: The results of this study suggest that collagen can improve the clinical outcomes of the coronally repositioned flap operation in the therapy of localized recession defects.

The Coronally Advanced flap is one of the most commonly used procedures for recession coverage because it is simple to perform and produces good results when compared to other techniques. In this case report, a 40-year-old male patient complained of receding gums and localized sensitivity to hot and cold in the upper left anterior tooth region, as well as aesthetic discomfort in the gingival recession site. The Coronally advanced flap with collagen membrane is used to treat the recession site, follow up of 3 months showed satisfactory results.

Prajna et al1 published a randomized controlled clinical trial of corneal crosslinking (CXL) for the treatment of filamental fungal keratitis. They concluded, "there appears to be no benefit of adjuvant CXL in the primary treatment of moderate filamentous fungal ulcers, and it may result in decreased visual acuity."

OBJECTIVE:To compare the safety and efficacy of intrastromal voriconazole (IS-VCZ), amphotericin B (IS-AMB) and natamycin (IS-NTM) as an adjunct to topical natamycin (NTM) in cases of recalcitrant fungal keratitis.DESIGN:Prospective randomized trial.SETTING:Tertiary eye centre.PARTICIPANTS:Sixty eyes of 60 patients with microbiologically proven recalcitrant fungal keratitis (ulcer size >2 mm, depth >50% of stroma, and not responding to topical NTM therapy for two weeks) were recruited.METHODS:patients were randomized into three groups of 20 eyes, each receiving ISVCZ 50ug/0.1 mL, ISAMB, 5ug/0.1 mL and ISNTM 10ug/0.1 mL (prepared aseptically in ocular pharmacology). The patients in all three groups continued topical NTM 5% every four hours until the ulcer healed. Primary outcome measure was time taken till complete clinical resolution of infection, and secondary outcome measure was best corrected visual acuity (BCVA) at six months.RESULTS:All three groups had comparable baseline parameters. The mean duration of healing was significantly better (p=0.02) in the ISNTM group (34±5.2 days) as compared to the ISVCZ group (36.1±4.8 days) and the ISAMB group (39.2±7.2 days). About 95%, 90% and 95% patients healed successfully in the ISVCZ, ISAMB and ISNTM groups, respectively. In terms of healing, deep vascularization was significantly greater in the ISAMB group (55%, p=0.02) when compared to the ISVCZ and ISNTM groups (31% and 26%, respectively). There were fewer repeat injections in the ISNTM group (7/20 vs 8/20 and 9/20 in the ISVCZ and ISNTM groups, respectively).CONCLUSION:Intrastromal injections are a safe and effective adjunct to conventional therapy in the management of recalcitrant fungal keratitis. ISNTM had a similar visual outcome with faster healing while ISAMB had a higher rate of deep vascularization after healing.

Penetrating keratoplasty is often required in microbial keratitis not responding to the standard treatments available or the development of complications like corneal perforation. Performing keratoplasty in microbial keratitis has several challenges, the major ones being the availability of donor corneal tissue and the poor success of the corneal graft performed in such a setting. For overcoming these challenges, several alternatives to keratoplasty have been described. Broadly, these options could be categorized into autologous tissues such as conjunctival and tenon tissue, synthetic products like tissue adhesives and therapeutic contact lenses, or biological tissues like amniotic membrane graft. These alternative modalities are not universal. They have their specific indications in microbial keratitis. Most of these alternatives are useful only for small corneal perforations. While autologous tissues are cost-effective and readily available, lack of tectonic support is a significant limitation. Tissue adhesives are excellent alternatives in terms of tectonic support, but surface irregularity and tissue reaction are their potential limitations. The amniotic membrane is useful for small corneal perforations, but availability, cost, and poor tectonic support restrict its use. Herein, we discuss these various alternatives to keratoplasty in microbial keratitis, their indications, advantages, disadvantages, and the various techniques of performing these procedures.

Nanotechnology or nanoscience is the research and development of an applied science at the atomic, molecular, or macromolecular levels (i.e., molecular engineering and manufacturing). Periodontitis is one of the most common diseases involving tooth and it's supporting structures. Management of which is important for improving the quality of life of the patient that has it's impact on the overall health of an individual. With upsurge of various treatment methodologies for the treatment of periodontitis, nanotechnology has evolved as a promising mode of treatment. Applications of nanotechnology in medical and dental fields have only approached the horizon with opportunities and possibilities for the future that can only be limited by our imagination. This paper provides an early glimpse of nanotechnology applications in dentistry and also illustrates the potential of different nanomaterials and their impact on clinical practice.

We read with great interest the article written by Siddharthan et al. on “A simple surgical technique for splitting a single donor eye for both deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK) without a microkeratome.”[1] The authors concluded that this technique will allow corneal surgeons in all developing countries to cost-effectively perform more lamellar surgeries thereby reducing the magnitude of corneal blindness without the need for expensive microkeratomes. We agree with the authors that microkeratome expense can be reduced and lamellar keratoplasty can become more effective with this technique.

1Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 2Ocular Pharmacology and Pharmacy Division, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India; 3Department of Ocular Microbiology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Objective: To compare the safety and efficacy of intrastromal voriconazole (IS-VCZ), amphotericin B (IS-AMB) and natamycin (IS-NTM) as an adjunct to topical natamycin (NTM) in cases of recalcitrant fungal keratitis. Design: Prospective randomized trial. Setting: Tertiary eye centre. Participants: Sixty eyes of 60 patients with microbiologically proven recalcitrant fungal keratitis (ulcer size >2 mm, depth >50% of stroma, and not responding to topical NTM therapy for two weeks) were recruited. Methods: patients were randomized into three groups of 20 eyes, each receiving ISVCZ 50ug/ 0.1 mL, ISAMB, 5ug/0.1 mL and ISNTM 10ug/0.1 mL (prepared aseptically in ocular pharmacology). The patients in all three groups continued topical NTM 5% every four hours until the ulcer healed. Primary outcome measure was time taken till complete clinical resolution of infection, and secondary outcome measure was best corrected visual acuity (BCVA) at six months. Results: All three groups had comparable baseline parameters. The mean duration of healing was significantly better (p=0.02) in the ISNTM group (34±5.2 days) as compared to the ISVCZ group (36.1±4.8 days) and the ISAMB group (39.2±7.2 days). About 95%, 90% and 95% patients healed successfully in the ISVCZ, ISAMB and ISNTM groups, respectively. In terms of healing, deep vascularization was significantly greater in the ISAMB group (55%, p=0.02) when compared to the ISVCZ and ISNTM groups (31% and 26%, respectively). There were fewer repeat injections in the ISNTM group (7/20 vs 8/20 and 9/20 in the ISVCZ and ISNTM groups, respectively). Conclusion: Intrastromal injections are a safe and effective adjunct to conventional therapy in the management of recalcitrant fungal keratitis. ISNTM had a similar visual outcome with faster healing while ISAMB had a higher rate of deep vascularization after healing.