BACKGROUND Treatment of fungal ulcers is one of the most challenging tasks. Various topical antifungal drugs have poor corneal stromal penetration. Voriconazole is a broad spectrum drug and is an effective agent for the treatment of fungal keratitis as a topical preparation. It is potent against a broad range of clinically significant fungal infections both in the eye as well systemically. In tropical climatic conditions filamentous fungi commonly cause eye infections and are associated with poor visual outcomes. The treatment options for mycotic ulcers are limited, therefore direct intrastromal injections are helpful in the management of these deep mycotic keratitis. We wanted to evaluate the role of intrastromal injection of voriconazole in the management of deep fungal keratitis not responding to conventional therapy. METHODS This an interventional case series study done at a tertiary care centre in south India from the year April 2019 to August 2020. Eight eyes of eight patients with microbiologically proven deep stromal recalcitrant mycotic keratitis not responding to topical antifungal medications were evaluated. Voriconazole 50 microgram / 0.1 ml was injected around the infiltrate in the corneal stroma as an adjunctive to the topical antifungal treatment. Main outcome measure was a reduction of the size of the infiltrate and ulcer and decrease in infection on regular follow ups. RESULTS Before injecting voriconazole, all the cases were of either gradually worsening of lesions on topical treatment, or not responding to topical treatment. After the injection a rapid decrease in the size of corneal ulcer, hypopyon, and infiltration was seen within 3 weeks. CONCLUSIONS Targeted delivery of intrastromal voriconazole may be a safe and effective way in the management of deep seated fungal ulcers which respond poorly to conventional treatment procedures, thus reducing the need for further surgical treatment. KEYWORDS Intrastromal Injection, Voriconazole, Fungal Keratitis, Deep Mycotic Keratitis

To study the incidence of angle recession and risk factors for development of traumatic glaucoma in closed globe injury.MATERIAL AND METHODS: In our study prospective analysis of 25 patients with closed globe injury visited to BGS Global Institute of medical science, department of Ophthalmology, were evaluated for angle recession and risk factor for development of traumatic glaucoma were noted, that is increase in Intra ocular pressure (IOP) >21mm of Hg for minimum 3 months were diagnosed as Traumatic glaucoma.RESULTS: The incidence of angle recession in our study conducted for 2 years from February 2013 to February 2015 was 68%. The risk factors of developing traumatic glaucoma was high in patients with hyphema, angle recession >180 degrees, traumatic cataract and elevated baseline Intra ocular pressure.CONCLUSION: Clinically not all patients with angle recession goes for traumatic glaucoma. Presence of hyphema, increase in baseline intra ocular pressure, angle recession >180 degrees and increased pigmentation at the angle were associated with traumatic glaucoma after closed globe injury.

Dirofilariasis is a zoonotic infection. In India dirofilarial cases are rare; few cases are reported from Kerala and Karnataka. We report a rare case of live dirofilarial worm removed from left eye sub conjunctival space of a 27 years old male.

BACKGROUNDThe aim was to study the surgical outcome in no suture, no glue conjunctival autograft pterygium surgery. MATERIALS AND METHODSThis was a prospective interventional study.30 eyes of 30 patients with primary pterygium that came to the outpatients department at BGS GIMS, Bangalore from June 2014 to June 2015 were included in the study.After excision of pterygium and corneal scraping the recipient bed was allowed to bleed to form a thin layer of blood to provide fibrin naturally.A thin conjunctivolimbal autograft taken from superotemporal area was placed on the scleral bed with no glue/suture and waited for fifteen minutes for natural haemostasis.Patients were followed for 6 months postoperatively for any complications. RESULTSIn our study from June 2014 to June 2015, 30 eyes subjected to pterygium excision with no glue/suture conjunctival autograft surgery were followed up for a period of 6 to 9 months.Cosmesis was excellent in 28 cases as graft was well taken and patients were happy, 2 patients had graft retraction at first post-operative week and regrafting was done.No recurrence was seen during this period. CONCLUSIONPterygium excision with no glue, no suture conjunctival autograft surgery is a simple surgery, cost effective with better cosmetic results with less complication.