Hydroxychloroquine (HCQ) in recent times has been used in treatment for a variety of autoimmune diseases and dermatological and rheumatological conditions. Retinal toxicity from HCQ and its analog chloroquine has been recognized for many years. Retinal toxicity secondary to HCQ is irreversible and can continue to progress even after cessation of therapy. Prompt screening and serial monitoring, with the utilization of imaging modalities, is of paramount importance to early detection.

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Aurolab aqueous drainage implant is a nonvalved tube implant used to treat refractory glaucoma. Although implanting the device could be surgically more demanding than certain other drainage devices, the author aims to describe the techniques which enable him to perform the surgery safely and efficiently.

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Purpose: The purpose of the study was to analyze the optical coherence tomographic (OCT) features of adult-onset foveal vitelliform dystrophy (AOFVD) using high-resolution spectral-domain (SD) OCT and to correlate each variable with visual acuity. Design: This was a retrospective, observational case series. Materials and Methods: Patients with a diagnosis of AOFVD based on clinical presentation, autofluorescence, and OCT were included in the study. SD-OCT images were analyzed. The vertical and horizontal basal dimensions of vitelliform material, the thickness of neurosensory retina (NSR) above the lesion, and the integrity of inner segment-outer segment (IS-OS) junction and external limiting membrane (ELM) were assessed, and each was correlated with best-corrected visual acuity. Results: Thirty-six eyes of 25 patients were included in the study. Mean age of patients was 65.39 ± 11.3 years. A weak positive correlation was noted between lesion dimensions and LogMAR visual acuity, but this was not statistically significant. A significant negative correlation was seen between thickness of NSR above the lesion and LogMAR visual acuity, indicating that as the overlying NSR became thinner, vision worsened. Although a worse visual acuity was noted in eyes with disrupted IS-OS junction and ELM, the result was not statistically significant. Conclusion: As the size of the vitelliform material increased, there was progressive thinning of overlying NSR which could lead to worsening of visual acuity.

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Cystoid macular edema is a complication of uveitis which can lead to severe visual impairment if left untreated. Uveitic macular edema occurs when the balance between the water entering the eye and pumped out of the eye is altered thus losing equilibrium in the physiologic function of the retina. Edema has a negative impact on visual recovery in patients with uveitis and may continue to exist despite control of uveitis. This delayed resolution of edema observed clinically and by imaging is most frequent following intermediate uveitis, birdshot retinochoroidopathy, sarcoid uveitis, panuveitis, and iridocyclitis associated with human leukocyte antigen B27. Literature about management of uveitic macular edema is limited, and no consensus has been reached with regard to management protocol. Several treatment options exist including corticosteroids, nonsteroidal anti-inflammatory drugs, immunomodulatory agents, implants, and surgery. These therapies can be administered through various routes such as oral, topical, periocular, or intravitreal injections. A response to treatment is seen as decrease in macular thickness and improvement in visual acuity.

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Aim: The aim of this study is to compare the ocular biometric parameters between intraocular lens (IOL) master and applanation A-scan in eyes with different axial lengths (ALs). Materials and Methods: A cross-sectional observational study was conducted 211 patients scheduled for cataract surgery at a tertiary care eye hospital. AL and anterior chamber depth (ACD) measurements were obtained both by IOL master and applanation A-scan under standard operating conditions and analyzed. Results: The study sample comprised 211 eyes of 211 patients. Mean age of patients was 60.04 ± 7.90 years (range 40–84 years), 81% were male and 19% were female. Eyes were divided into four groups depending on their AL measurements as extremely long >27.0 mm, long 25.0–27.0 mm, medium 22.0–25.0 mm, short <22.0 mm. The ALs measured by IOL master was significantly higher than those measured by A-scan (P < 0.001). Mean ACD with both methods was 3.23 ± 0.45 and 3.20 ± 0.46, respectively. In the subgroup analysis, there was good agreement between AL and ACD between IOL master and ultrasound A-scan in extremely long, long, medium, and short eyes. Conclusion: AL and ACD showed good agreement between IOL master and applanation A-scan measurements at all range of ALs.

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The bullous variant is a rare manifestation of central serous retinopathy (CSR). Multiple therapeutic approaches have been described to treat these bullous detachments which mainly involve laser photocoagulation or surgical drainage. Here, we demonstrate the efficacy of oral eplerenone in the treatment of the bullous variant of CSR. A 44-year-old female presented to us with diminution of vision in the left eye (OS) for 1 month. On clinical examination, she was diagnosed to have a chronic CSR in both eyes along with a bullous retinal detachment in the OS which was confirmed on multimodal imaging. She underwent focal laser, which failed to resolve the bullous variant in the OS, then the patient was started on oral eplerenone for 3 months. At 3-month follow-up, the ultrasound scan of the OS confirmed resolution of the bullous detachment, and some residual subretinal fluid could be noted at the posterior pole. This was maintained till 6-month follow-up. Oral eplerenone can be an effective, cheap, and safer alternative in treating patients with nonresolving bullous detachments secondary to chronic CSR.

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Aim: The aim of this study is to assess the effectiveness of botulinum toxin in patients presenting with isolated lateral rectus palsy. Materials and Methods: This prospective interventional controlled trial from March 2012 to March 2015. Inclusion criteria were acquired lateral rectus palsy, no other neurological defects, normal magnetic resonance imaging scan, and age >30 years. The cases were treated with 15–25 units of botulinum toxin depending on the angle of squint. The surgical field is prepared, the medial rectus insertion grasped firmly with forceps, and the eye rotated to the primary position. Botulinum toxin is injected 5 mm from the medial rectus insertion, inside the bulk of muscle through a 27-gauge needle (without electromyographic guide) under topical anesthesia. No peritomy is done. Controls were treated with intravenous steroids for 3 days changed to oral steroids on tapering doses. Cases and controls were followed up 10, 30, 60, 120, and 180 days after initiating treatment. Wilcoxon signed-rank test is used for paired samples; Mann–Whitney U-test is for independent samples; P< 0.05 was considered statistically significant. Results: Ten cases (six female) were enrolled into the study. Ten age-matched controls (six female) were also enrolled. The baseline characteristics of cases and controls were comparable in terms of duration of symptoms, head posture, primary deviation in the primary position, and limitation of abduction. After 10 days of injection, 100% of cases attained primary deviation <10 prism diopters and subsidence of diplopia in the primary position. Nearly 80% of cases showed partial recovery of abduction after 30 days. Controls attained primary deviation <10 prism diopters and subsidence of diplopia in the primary position after 150 days (range: 120–180 days). Conclusion: Botulinum toxin is effective in achieving early subsidence of diplopia in the primary position and early recovery of abduction in patients presenting with isolated lateral rectus palsy.

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Objective: The objective was to study the incidence and risk factors predisposing to retinopathy of prematurity (ROP) and to assess the outcome after laser photocoagulation. Design: This was a retrospective cohort observational study. Materials and Methods: Infants admitted to a Neonatal Intensive Care Unit of 12 referral hospitals in Kerala between May 2015 and June 2016 were followed up till retinal vascularization completes. Preterm infants with birth weight <1700 g and gestation >34 weeks were screened for ROP at 4 weeks after birth or 31–33 postconceptional age, whichever was later. Infants with birth weight >1700 g and gestation >35 weeks were screened only on neonatologist's discretion. All infants were screened according to the Indian guidelines of type 1 and 2 ROP. We treated both eyes of all infants showing threshold ROP. Statistical analysis was done using SPSS version 16 (SPSS Inc., Chicago, IL, USA). Results: The incidence of ROP in 622 infants screened was 158 (25.4%), of which threshold ROP was seen in 61 (9.80%). No ROP was found in infants weighing >2000 g or with a gestational age >36 weeks. Risk factors predisposing to ROP were hours on ventilator, hemoglobin%, oxygen therapy, and number of blood transfusions, which were more significant in infants with type 1 or threshold ROP than type 2 ROP. Out of 97 infants with type 2 ROP, we saw stage 1 in 31 (30.92%), stage 2 in 59 (60.82%), and stage 3 in 7 (7.21%) infants. 61 (9.80%) infants with threshold ROP were treated with laser photocoagulation. Aggressive posterior ROP or rush disease was seen in 29 (47.54%) of 61 infants with type 1 ROP. Only 2 (3.27%) infants showed falciform fold over macula and 1 (1.63%) infant was blind due to retinal detachment. Conclusion: One-fourth of the infants showed ROP, of which one-tenth needed laser photocoagulation, the outcome of which was good. Risk factors predisposing to ROP were low hemoglobin, high oxygen therapy, increased number of blood transfusions, and hours of ventilator.

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We present a case of a heavily pigmented ocular surface squamous neoplasia (OSSN) in a healthy 58-year-old male with a history of chronic sun exposure. The lesion was 4 mm × 3 mm in size and located in the nasal limbus. Its surface was irregular and pigmented with feeder vessels. Excision biopsy with cryotherapy was done and 0.04% mitomycin was also applied using sponges for 2 min. Topical mitomycin C 0.05% was given in four cycles over the course of 2 months. Histopathology revealed stage 3 conjunctival intraepithelial neoplasia with tumor-free margins. Three months postoperatively, the patient was asymptomatic with an acceptable cosmetic outcome. We report this uncommon case of OSSN which was heavily pigmented, its treatment, and follow-up.

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Purpose: The aim of this study is to review the pattern of visual disability and the type of low vision rehabilitation done in patients who attended the low vision clinic at a tertiary eye care referral center in Kerala between May 2015 and April 2016. Materials and Methods: This is a retrospective, hospital-based review of 200 medical records of patients who attended a tertiary eye care center in Kerala between May 2015 and April 2016. Criteria for low vision were defined as best-corrected visual acuity binocularly (BCVA) for distance by logarithm of minimum angle of resolution chart was >0.4 and for near was N8 with + 4.00 DS addition with near vision test types. The data collected included age, gender, diagnosis, BCVA for distance and near, improvement of near vision after low vision aid (LVA), and the type of LVA preferred by the patient. Results: Two hundred patients were reviewed. Of these, 64% were males and 36% were females. The age group was between 5 and 90 years. Fifty-one percent low vision was because of proliferative diabetic retinopathy (PDR) with or without maculopathy, 5% central serous retinopathy, 1% venous occlusions, 12% age-related macular degenerations, 6% retinal detachment, 3% macular hole, 19% other retinal diseases, 1% glaucoma, and 2% others. BCVA binocularly for distance was between 0.4 and 0.7 in 46%, 0.8–1 in 44%, and >1 in 10% and near vision with +4.00 add was between N8–N12 in 56% and N18–N36 in 44%. With LVA, 62% improved to N6, 35% N8–N10, and 3% N12–N18. Nearly 61% of patients preferred prismatic spectacles. Conclusion: Patients with PDR with or without diabetic maculopathy who had low vision in spite of maximum treatment formed the largest group in our study. The BCVA for near improved to N6 in 62% of the patients. Prismatic spectacles were the LVA most commonly preferred for near vision.

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Aim of the Study: To study the efficacy of medical management in orbital parasitic lesions. Patients and Methods: A retrospective chart review of 25 consecutive patients with orbital parasitic mass between May 2015 and June 2016. Data were collected and analyzed. Standard medical management of oral albendazole in the dose of 15 mg/kg weight twice a day for 2 weeks and then once a day for another 2 weeks along with oral corticosteroids 1 mg/kg body weight tapered over 4 weeks. Surgical excision planned only in patients with unresolved/residual masses. All the patients were followed up periodically. Main outcome measures were clinical resolution. Observations and Results: The mean age at presentation was 40 years, and 15 (60%) were female. All patients had unilateral involvement. The left eye was involved in 15 (60%) patients. All patients presented with lid edema. Some patients presented as itching, periorbital edema, and redness, chemosis, or proptosis. Among 25 patients, 18 (72%) patients, presented with preseptal mass,5 (20%) with postseptal mass and 2 (8%) with Subconjunctival mass. 12 (48%) patients had diabetes. Absolute eosinophil counts were within normal limits. Eighteen (72%) patients treated with combination therapy responded well with no residual mass. Surgical excision was done for seven patients (persisting 3 [12%], residual mass 2 [8%], and primary excision 2 [8%]) followed by combination therapy. First week of follow-up mass showed a mild reduction in size, along with surrounding edema, itching, and chemosis; in 2^nd week, all patients reported significant improvement in signs and symptoms; in 4^th week, no mass was palpable, soft tissue thickening of skin was noted which disappeared gradually over weeks. Conclusion: Various parasitic infections are important causes of ophthalmic disease worldwide. Kerala is considered as endemic for dirofilariasis due to the climatic conditions and the presence of suitable vectors species.^[4] Parasitic orbital mass, should be included as a differential diagnosis for orbital mass. A trial of medical management with oral albendazole and corticosteroids merits consideration as first line of therapy over primary excision in all clinically diagnosed orbital parasitic mass.

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The management of total eyelid avulsion is an arduous task with unpredictable functional and cosmetic result. We present a case of total lower eyelid avulsion in a 6 year old child following injury with bicycle. The reconstruction was done within 6 hours of injury. Retrieval of tissue from the incident site and its preservation permitted us to use it as a composite autograft. The child has recovered well with minor sequelae.

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