INTRODUCTION:Frontalis sling surgery is indicated in severe ptosis with poor levator action. A number of new sling materials are available, including silicone sling. The efficacy of sling surgery with silicone sling was analyzed. METHOD:A retrospective study was conducted where records of patients who underwent frontalis sling surgery using silicone slings between July 2014 and June 2016 in a single center were analyzed. Patients had a follow-up of at least three years. The amount of correction achieved and complications, if any, were noted. Mean preoperative Marginal Reflex Distance 1 (MRD1) and mean postoperative MRD1 values were compared at six months, one year, and three years using a paired "t" test. Lid height asymmetry (LHA) was also measured preoperatively and compared with the postoperative values at six months, one year, and three years after surgery using the paired "t" test. RESULTS:About 27 patients underwent this procedure. Bilateral sling surgery was performed in all patients. Seventeen patients had severe simple congenital ptosis, three had monocular elevation deficit (MED), six had Marcus Gunn phenomenon (MGP) with ptosis, and one patient had blepharophimosis epicanthus syndrome (BPES). MRD1 was measured preoperatively to be 0.37 ± 1.72 mm. Follow-up MRD1 was measured at six months, one year, and three years postoperatively and was found to be 4.46 ± 1.28, 4.26 ± 1.46, and 3.79 ± 1.72 mm, respectively. Mean preoperative MRD1 and mean postoperative MRD1 values were compared at six months, one year, and three years using a paired "t" test and were found to be statistically significant (p < 0.001) at all follow-ups. Lid height asymmetry (LHA) was measured at 1.74 ± 3.96 mm preoperatively. Postoperatively, LHA was measured at six months, one year, and three years and was found to be 0.44 ± 1.18, 0.59 ± 1.3, and 0.89 ± 1.60 mm, respectively. On comparing mean preoperative LHA and mean postoperative LHA values at six months (p = 0.0006), one year (p = 0.0023), and three years (p = 0.0253) using a paired "t" test, the difference was found to be statistically significant at all follow-up visits. At the end of the three-year follow-up, good correction was seen in 48.15% (13/27) of the cases, fair correction was seen in 29.62% (8/27) of the cases, and poor in 22.22% (6/27) of the cases. A satisfactory correction was seen in 19 patients (70.37%). Complications seen were under-correction in one eye, lid notch in one eye, tube exposure in two eyes, suture granuloma in one eye, and late recurrence of ptosis in four eyes. CONCLUSION:Silicone sling surgery is an effective surgery with few complications and a stable outcome even after three years of follow-up.

Purpose: To study and evaluate the change in retinal nerve fiber layer (RNFL) and macular thickness and its clinical correlation with visual outcome following amblyopia therapy. Methods: In this prospective interventional study, children with moderate to severe amblyopia were given optical correction and part-time occlusion therapy. Visual assessment and optical coherence tomography (OCT) were performed at days 0 and 3, 6 months of follow-up. Results: A total of 30 children aged from 5 to 12 years with a mean age of 5.26 ± 1.65 years with moderate to severe amblyopia were included. About 19 patients (63.33%) were males and 11 patients (36.66%) were females. Anisometropia was the most common cause of amblyopia in our study population affecting 46.67% of patients. The mean global RNFL thickness in amblyopic eyes before and after patch therapy were 111.13 um and 104.96 um respectively (6.17 um thinner than better eyes). The macular thickness before and after patch therapy was 227.06 um and 226.80 um respectively (0.26 um thinner than better eyes). Conclusions: Part-time occlusion therapy results in visual gain in children with moderate to severe amblyopia. However, it causes thinning in both the RNFL and macular thickness at days 0 and 3, 6 months of follow-up.

Purpose: To evaluate the rotational stability of toric intraocular lens (IOL) when co-implanted with a capsular tension ring (CTR) as compared to that of a toric IOL without a CTR. Methods: This was a prospective randomized clinical trial performed in a tertiary care centre in India. Fifty adult human eyes with visually significant cataract and regular corneal astigmatism ≥1.5D divided into two groups of 25 eyes each, A and B by simple randomization. Eyes with corneal pathology, lens subluxation, and a specular endothelial cell count <2000/mm2 were excluded from the study. The eyes in both the groups underwent standard phacoemulsification and were implanted with a toric IOL. In Group A, a CTR was put in the bag before IOL implantation. The groups were called for follow-up on day 1, 1 week, 1 month, and 3 months, postoperatively. The axis of the toric IOL on each visit was measured by slit lamp imaging in retroillumination and analyzed digitally. Results: Mean rotation of toric IOL at 3 months postoperatively was 1.85 ± 1.72° in Group A and 4.02 ± 2.04° in Group B. The difference was statistically significant (P = 0.003). Conclusion: Coimplantation of a CTR is a safe and effective technique for ensuring better rotational stability of toric IOLs.

To evaluate whether retropupillary fixation of the iris-claw intraocular lens (IOL) is a safe and effective treatment option in children with large lens subluxations.

To compare 25- and 20-gauge pars plana vitrectomy (PPV) for the management of pediatric cataract.

To assess the efficacy of vertical muscle surgery for management of hypotropia in monocular elevation deficiency (MED) type II. Knapp’s is described as standard procedure for management of MED type II. However, it is not graded and has unpredictable amount of correction. Besides this, there is drift towards overcorrection with time and limitation of movements in extreme adduction and abduction. MED is a vertical misalignment for which vertical muscle surgery is also described but limited literature is available.

Purpose: This study aimed to propose the role of amniotic membrane transplantation (AMT) as an additional modulator in primary Mitomycin C (MMC)-augmented trabeculectomy. Methods: This was a randomized prospective interventional study. Forty eyes of 39 adult patients with uncontrolled primary glaucoma were randomly divided into two equal groups. Control group underwent trabeculectomy augmented with MMC while the study group underwent additional AMT. Patients were followed up for 12 months and outcomes measured were intraocular pressure (IOP), need for additional intervention, and bleb morphology. Results: Complete success (defined as IOP <16 mmHg on no medication) could be achieved in 85% eyes in study group while it was 60% in control group (P = 0.04). IOP reduced by 71.1% in study group from 41.9 ± 10.6 to 12.1 ± 2.7 mmHg and from 40.5 ± 8.5 to 12.8 ± 4.5 mmHg in control group, a decline of 68.29%. Blebs in AMT group showed better bleb morphology in terms of significantly better extent (E3) on day 1 (P = 0.03) and better height (H2 and H3) (P = 0.04), according to the Indiana Bleb Appearance Grading Scale, at all follow-up visits along with normal vascularity. The study group required significantly lesser (P = 0.03) bleb needlings as compared to control group. Conclusion: Amnion enhanced the efficacy of MMC-modulated trabeculectomy in terms of eyes with complete success and lesser interventions such as bleb needling. This reiterates the role of amnion as a safe and effective bleb modulator. A diffusely elevated bleb with healthier conjunctiva can go a long way in predicting better health and longevity of the bleb.

ATS have to be followed with a pinch of salt. The ethnicities, the compliance, the severity of amblyopia and age at presentation have to be considered before tailoring the occlusion schedule of any patient. neurotransmitters and modulators, including dopamine. The primary site of action of these drugs is thought to be the cortex, although there is also some evidence of an effect on the retina. 23,24 The medical treatment of levodopa or citicoline is inherently bilateral and slightly enhances the vision of the better eye in most. Use of patching along with either medication has been found to produce faster improvement as well as less regression.

Purpose: Role of amniotic membrane transplantation as an additional modulator in primary Mitomycin C augmented trabeculectomy. Design: Randomised prospective interventional study. Methods: 40 eyes of 39 adult patients with uncontrolled primary glaucoma were randomly divided into 2 equal groups. Control group underwent trabeculectomy augmented with Mitomycin C while the study group underwent additional amniotic membrane transplantation. Patients were followed up for 12 months and outcomes measured were Intraocular Pressure, need for additional intervention and bleb morphology. Results: Complete success (defined as intraocular pressure <16 mmHg on no medication) could be achieved in 85% eyes in study group while it was 60% in control group (p=0.04). Intraocular pressure reduced by 71.1% in study group from 41.9 ± 10.6 mmHg to 12.1±2.7 mm Hg and from 40.5 ± 8.5 mmHg to 12.8 ± 4.5 mmHg in control group, a decline of 68.29%. Blebs in amniotic membrane transplantation group showed better bleb morphology in terms of significantly better extent (E3) on day 1 (p=0.03) and better height (H2 and H3) (p=0.04), according to Indiana Bleb Appearance Grading Scale, at all follow up visits along with normal vascularity. The study group required significantly lesser (p=0.03) bleb needlings as compared to control group. Conclusion: Amnion enhanced the efficacy of Mitomycin C modulated trabeculectomy in terms of eyes with complete success and lesser interventions like bleb needling. This reiterates the role of amnion as a safe and effective bleb modulator. A diffusely elevated bleb with healthier conjunctiva can go a long way in predicting better health and longevity of the bleb.

Managing hypotropia is a challenge for strabismologists. Monocular Elevation Deficit (MED) is one of the causes of hypotropia seen frequently by a stabismologist. Co-existence of horizontal deviations, ptosis, amblyopia, Dissociated Vertical Deviation(DVD) make the management of MED difficult. Even for the correction of hypotropia, there are different surgical techniques, which reflect the variety of causative mechanisms. After reviewing available literature, we have attempted to simplify this complex entity in terms of its pathogenesis, presentation, differential diagnosis and finally, appropriate management.

PURPOSE:Despite recent advances in the management of epilepsy the efforts to assess knowledge, attitude and practice towards epilepsy are limited, particularly in the developing countries. To delineate the magnitude and scope of this problem, present study was conducted to assess the knowledge attitude and practice about epilepsy amongst schoolteachers in Northeast Uttar Pradesh, the most populous state of India. The basis of involving schoolteachers was their special role in Indian society with their larger interaction among the segment of population most affected by epilepsy.METHODS:Simple self-administered questionnaires were sent to the schoolteachers of primary and secondary levels. The questionnaires contained 15 questions related to awareness and attitudes towards epilepsy with details of first aid management of seizures.RESULTS:We found that 97% of schoolteachers were aware of epilepsy with majority including it as a brain disease. A substantial proportion (38.2%) was uncertain about relation of epilepsy and insanity and 31.7% felt epileptics to be of below average intelligence. Only about half of them (55.3%) preferred their children to play with an epileptic. An overwhelming no was obvious about marriage with an epileptic (86.8%). Only 27.8% of the respondents had given any first aid measure to a seizing patient with only 16.3% giving it properly.CONCLUSION:Despite a great degree of awareness about epilepsy amongst schoolteachers in India negative and wrong attitudes still exist. Stress on proper first aid measure to a seizing child needs greater emphasis to remove fright and fear amongst the public. Besides adequate management, public education to address existing biases and fear are equally important to improve the quality of life of epileptics.