Management of subluxated cataracts is challenging, especially in cases with more than 5 clock hours of subluxation. Capsular bag stabilising devices are of utmost importance in these cases. We report two cases of post-traumatic lens subluxation of more than 6 clock hours, in which the bag was stabilised intraoperatively using two capsular tension rings (CTRs) placed diametrically opposite to each other, in place of the conventional Cionni ring. Slow phacoemulsification was done followed by intraocular lens (IOL) implantation. Postoperatively, the IOLs were found to be well centred. Also, the use of two CTRs maintains the shape of the capsular bag and prevents lens epithelial cell migration and capsular cocontraction.

Purpose: To report the clinico-demographic profile of rhino-orbito-cerebral mucormycosis (ROCM) in patients during the “second wave” of the COVID-19 pandemic in eastern India, and their ophthalmic manifestations at presentation to our tertiary institute. Methods: Cross-sectional study amongst patients presenting to our center based on their hospital records. Demographic information, history related to COVID-19, records of detailed ocular examination, and microbiological, radiological, and histopathological investigation were entered into an online worksheet and analyzed using SPSS 26.0. Results: A total of 219 patients with ROCM were treated from May to September 2021, and 110 of these had ocular manifestations at presentation (50.2%). The age of patients ranged from 22 to 83 years and the mean ± standard deviation (SD) age was 49.9 ± 12.9 years. Ninety (81.8%) patients had been diagnosed with diabetes mellitus, 31 (34%) had hypertension, and 10 had other comorbidities. The duration between the onset of COVID-19 and mucormycosis symptoms was 0 to 60 days with a mean ± SD interval of 20.9 ± 12.6 days. Fifty-six (50.9%) patients had a history of steroid use. Unrelenting ocular or facial pain was the most common presenting symptom, ptosis was the most common anterior segment manifestation, and ophthalmic artery occlusion was the most common posterior segment manifestation. Conclusion: Our data from eastern India reinforces the relationship between COVID-19, diabetes, corticosteroid use, and ROCM. Knowledge of various presenting anterior and posterior segment manifestations of the disease as described in the present study will guide clinicians to recognize the disease early and make every effort to prevent complications.

Introduction: Inguinal hernia is a common surgical condition in children. Conventionally, the open approach for inguinal hernia repair has been considered the gold standard. However, in the past two decades, laparoscopic inguinal hernia repair has gained popularity among paediatric surgeons as an alternative to the open approach. Apart from good cosmesis and shorter stay at hospital, laparoscopy offers clear-cut advantages of visualising contralateral site and simultaneous repair if it is patent. Many techniques for laparoscopic inguinal hernia repair have been proposed. In this retrospective observational study, we are comparing outcomes between proximal and distal disconnection of hernia sac. Materials and Methods: Ninety-five patients with inguinal hernia were studied in two groups. Group A included 50 patients in which hernia sac was disconnected from the peritoneal cuff proximal to deep inguinal ring (DIR). Group B included 45 patients in which hernia sac was disconnected distal to DIR. Various sociodemographic parameters and intraoperative findings were compared. Outcomes were analysed in terms of post-operative pain, duration of stay at the hospital and recurrences. Results: In group A, there were 46 males and four females with mean age of 4.01 years with standard deviation (SD) of 2.96. Group B included 37 males and eight females with mean age of 5.09 years with SD of 3.56. Excess post-operative pain was observed in 33 patients in Group A with proximal disconnection of hernia sac whereas it was seen in only three patients in Group B with distal disconnection of sac. The P was 0.001 which was highly significant. The duration of stay in the hospital was more in Group A (2.36 ± 1.22 days) as compared to Group B (1.8 ± 0.66 days) with a P of 0.0076 which was significant. Hernia recurrence was seen in four out of 50 patients in Group A (8%) as compared to no recurrence in Group B. However, the difference was not significant. Conclusion: The disconnection of hernia sac distal to DIR is associated with less post-operative pain and shorter duration of hospital stay. There is less recurrence seen in distal disconnection of hernia sac as compared to proximal disconnection; however, to achieve the level of significance, a large cohort study is required.

Primary vaginal calculi are uncommon in children. Urethral duplication in females is seen to occur in association with complex congenital malformations. We report the case of perianal persistent urogenital sinus with a hypertrophied clitoris with phallic urethra, scrotum-like pouch, uterus didelphys with obstructed hemivagina, and giant colpolithiasis in 46XX female. A 16-year-old presented with pain abdomen and cyclic passage of blood clots per rectum. She had a tender lump in left iliac region, a phallus like protrusion and a ruggous sac below it. Vaginal opening was absent. Computed tomography showed two uterine horns with a separate cervix and distended non-communicating hemivaginas with a large calcified oval mass in the left hemivagina. On exploration, calculus was extracted from the left hemivagina. The large calculus found in the left hemivagina appears to be the cause of all presenting symptoms. It obstructed the left hemivagina, filling the left uterine horn with menstrual blood causing its gradual enlargement and secondary infection. The early diagnosis and prompt referral of such an anomaly can only be ensured in institutional deliveries. For a significant proportion of newborns in the developing world, the ability to afford or even be referred to institutes which deal with such cases is a luxurious affair. We hope to bridge bridging the knowledge, attitude and practice gap that exists in our health-care system with this report.

Autologous blood transfusion is defined as the collection of blood from the patient, either preoperatively or intraoperatively, and its transfusion back to the same patient as and when required. We report a case of a 23-year-old pregnant female, G3P1L1A1, presenting with severe Rh alloimmunization, along with a baby requiring intrauterine transfusion for fetal anemia, planned for elective cesarean section and autologous blood transfusion.

Pelvic magnetic resonance imaging (MRI) is the latest addition to already existing tools for evaluation of anorectal malformation (ARM). It provides detailed information about pelvic floor musculature as well as position of rectal pouch. However, lack of knowledge about normal pelvic floor anatomy can lead to misinterpretation of pelvic MRI which can create confusion and change in approach for surgery. A 14-month-old male child with diagnosis of ARM was evaluated with pelvic MRI. There was finding of abnormal protrusion of fat through the ischiorectal fossa which was misinterpreted as Currarino syndrome which created confusion immediately before posterior sagittal anorectoplasty. Pelvic MRI is highly informative while evaluating a case of ARM. However, a detailed knowledge of pelvic floor anatomy is mandatory to avoid wrong interpretation and misdiagnosis.

The COVID 19 pandemic has brought about a change in the lifestyle of one and all with the healthcare workers being no exception. The objective of this review is to discuss the problems faced during the COVID19 pandemic especially by the ophthalmological community owing to the close contact with the patient during examination which is inevitable. The text has been written after a thorough literature search of articles on Pubmed using relevant keywords. It discusses and brings forth the ways of ophthalmological practices to minimize the risk of exposure being followed across the world as laid down by the ophthalmological societies of various countries and regions. The importance of social distancing and the role of tele-ophthalmology which formed the cornerstone of treatment during this hour of crisis has also been discussed.

Intraoperative Floppy iris syndrome(IFIS) remains a challenge for surgeons during phacoemulsification. Initially, it was related to the use of tamsulosin, an alpha adrenergic receptor blocker used in benign prostatic hyperplasia. Subsequently, other alpha adrenergic receptor such as alfuzosin, terazosin and doxazosin alongwith different other class of medications and systemic risk factors were identified. Other class of medications includes 5-alpha reductase inhibitor, angiotensin receptor antagonist, benzodiazepines, antipsychotics and antidepressants. Other risk factors include increasing age, male gender, diabetes, hypertension and decreased preoperative pupil diameter. It is very important for surgeons to identify these risk factors preoperatively and take appropriate preoperative and intraoperative measures to tackle the dreaded complications of IFIS. Sometimes, it is important for an ophthalmologist to work in cooperation with physician and urologist to minimize the complications. In conclusion, awareness of the risk factors associated with IFIS, their detailed preoperative assessment and intraoperative measures and surgical intervention is crucial in addressing IFIS. Lack of awareness can turn a routine, uneventful surgery into one with significant visual morbidity.

Introduction: Perinatal asphyxia is a major cause of neurological morbidity and mortality among survivors and is a complication that occurs between 5-10% of deliveries. The term asphyxia should be exclusively used to indicate those babies who have metabolic acidosis and hypoxia at birth. Aim: To analyse whether the increase in Nucleated Red Blood Cell Count (NRBC) in asphyxia is significant or not as compared to the non asphyxiated group. Material and Methods: This was a prospective study in Department of Obstetrics and Gynaecology in tertiary care health centre. Cord blood samples were collected from 100 newborns with asphyxia at birth and equal number of normal appropriately matched control to study NRBC per 100 WBC in Cord blood sample. The study was done during the period of December 2013 to November 2015 over 200 newborns. The statistical analysis was done using SPSS software version 16 and Chi-square test. Results: The mean count of NRBC/100 WBC in the study was 25.59±7.19 (SD). Mean count in the control group was 12.69±5.29 (SD). The difference was statistically significant (p<0.001). Conclusion: NRBC count can be useful for the evaluation of perinatal asphyxia, where facilities for pH sampling are not available and can serve as a liable, inexpensive and easily available marker of perinatal asphyxia.

Megalocornea and megalophthalmos are bilateral developmental anomaly of the anterior segment of the eye. Either of these conditions has a high risk of developing glaucoma. We report the rare case in a 9-year-old child with simple megalocornea in one eye and megalophthalmos in other eye. He has increased corneal diameter in both the eyes and iris stromal hypotrophy exposing the radial vessels, raised intraocular pressure (IOP), and optic nerve head cupping in the left eye (LE). LE trabeculectomy with Ologen was performed. Postoperative IOP was well controlled at 1-year follow-up with favorable bleb morphology.

Purpose: To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods: It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results: Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion: Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.

Congenital infiltrating lipomatosis of the face (CIL-F) is characterized by unilateral diffuse infiltration of facial soft tissue by mature adipose cells with associated skeletal hypertrophy. The disease is also considered a subtype of partial hemifacial hyperplasia. We present a case of right hemifacial swelling with severely restricted mouth opening diagnosed with CIL-F associated with temporomandibular joint ankylosis which is very rare, and very few case reports of the same have been published. Computed tomography findings have been discussed in detail with review of literature.

Purpose: To evaluate the safety and efficacy of surgical membranectomy with a vitrector via a limbal approach for posterior capsular opacification (PCO) in children. Methods: In this retrospective analytical interventional study, medical records of children younger than 17 years who underwent surgical membranectomy with anterior vitrectomy via a limbal approach were analyzed. Time lag for PCO formation after cataract surgery was assessed. Any adverse events during surgery, rate of successful completion of membranectomy, postoperative complications, improvement in visual acuity, and intraocular lens (IOL) centration were recorded. Results: A total of 60 eyes of 58 children were included: 26 had traumatic etiology and 34 had developmental cataract. Mean time duration for PCO formation was 27.83 ± 39.83 months for traumatic cases and 53.53 ± 52.20 months for developmental cataract ( P = .04). A satisfactory opening in the center of the membrane was achieved in 47 cases (n = 47, 78.3%). The complications encountered were uveitis (5 eyes), corneal edema (3 eyes), pigment deposition over IOL (2 eyes), raised intraocular pressure (1 eye), IOL drop (1 eye), and broken haptic (1 eye). Membranectomy with posterior optic buttonholing of the IOL in 9 aphakic eyes resulted in good IOL centration, no anterior chamber reaction, and no iris optic capture in the postoperative period. Mean visual acuity improved from 1.16 ± 0.52 to 0.73 ± 0.55 logMAR ( P < .001). Conclusions: Surgical membranectomy with a vitrector via a limbal approach is a safe and effective method for managing PCO in the pediatric population. Posterior optic buttonholing of the IOL during membranectomy or secondary IOL implantation results in good IOL centration and fewer complications. [ J Pediatr Ophthalmol Strabismus. 2020;57(1):33–38.]

Purpose: To assess the success rate of external dacryocystorhinostomy (DCR) with silicone intubation for recurrent lacrimal abscess in children younger than 6 years. Methods: A single-center retrospective analysis of 46 eyes of 40 children who underwent DCR with silicone tube intubation for recurrent lacrimal abscess was done. Probing done previously in these cases was unsuccessful. Only those children who underwent incision and drainage of the abscess at least once with antibiotic treatment were included in the study. In all cases, silicone tube removal was done after 3 months. A successful outcome was defined as the absence of subjective complaints of pain and swelling over the medial canthal area and watering and discharge at 6 months postoperatively. Objective assessment of patency of the lacrimal apparatus was done by sac syringing at 6 months postoperatively. Results: The mean age at surgery was 4.93 +/- 0.93 years (range: 3 to 6 years) and the mean follow-up duration was 11.80 +/- 11.87 months (range: 6 to 84 months). Intraoperative difficulties encountered were excessive perisac adhesion (n = 28) and severe bleeding/hemorrhage (n = 24). A total of 82.61% cases had a successful outcome after DCR with silicon tube intubation. One child had granuloma formation at the wound. Spontaneous tube extrusion occurred in three children. Conclusions: DCR with silicone tube intubation is a safe and effective surgical approach with satisfactory outcomes for treating recurrent lacrimal abscess with congenital nasolacrimal duct obstruction in children younger than 6 years.

The authors report a rare case of slipped medial rectus muscle with stretched scar in the left eye of a 45-year-old woman following pterygium surgery. There was total limitation of adduction in her left eye with complaints of diplopia in all gazes with maximum separation of images in dextroversion on diplopia charting. Hess charting showed underaction of the medial rectus muscle of the left eye and overaction of the lateral rectus muscle of the right eye. Based on the history and findings, a diagnosis of medial rectus muscle disinsertion of the left eye during pterygium surgery was made. Medial rectus muscle exploration was done and the slipped medial rectus muscle was found attached to its original insertion site via pseudotendon/stretched scar. The capsule was dissected, the scar tissue was excised, and the slipped medial rectus muscle was identified, hooked, and secured with sutures. The muscle was reattached with advancement. Postoperatively, the patient was orthotropic and there was no diplopia. Accidental medial rectus muscle disinsertion during pterygium surgery is a rare but serious complication. Proper care should be taken intraoperatively during pterygium surgery to avoid this complication. However, meticulous surgical exploration and reattachment of the muscle yields satisfactory results. [J Pediatr Ophthalmol Strabismus. 2019;56:e34-e37.].