Amrita Mukherjee

A new surgical technique of intra-scleral tube fixation in Ahmed Glaucoma Valve implantation: ‘Scleral Sleeve Method’

Purpose To present a new surgical technique ‘Scleral Sleeve Method’ which would reduce the risk of Ahmed Glaucoma Valve (AGV) tube related complications in patients undergoing AGV FP7 (New World Medical Inc., Rancho Cucamonga, CA) for refractory glaucoma. Design Prospective, Non-Randomized, hospital based interventional case series. Subjects A total of 16 eyes of adult patients (10 males and 6 females) with refractory glaucoma. Methods Instead of using sutures to fix the AGV tube to sclera, we devised a novel method of intra-scleral tube fixation by creating a scleral tunnel fashioned in form of sleeve. Main outcome measure Post-operative tube related complications. Result There were no tube related complications such as exposure, extrusion or retraction in any of the cases. Conclusion Use of scleral sleeve method for tube fixation, along with graft to cover the tube, will provide additional safety measure and reduce the risks of tube related complications.

A Rare Case of Orbital Apex Syndrome in Herpes Zoster Ophthalmicus.

Orbital Apex Syndrome (OAS) is a rare complication of Herpes Zoster Ophthalmicus (HZO). We are reporting a case of 65-year-old male who developed OAS following HZO. Patient presented with vesicular rash in the typical dermatomal distribution, severe periocular congestion and limited ocular motility in all gazes along with loss of vision. Soft tissue inflammation improved within 4 weeks of initiation of treatment while ocular motility slowly improved over 3 months. Patient did not gain vision despite receiving systemic steroids and systemic anti-viral medication. Variable improvement in ocular motility and visual function in our patient points towards multiple mechanisms involved in pathogenesis of this disease, some of which are yet to be understood.

Topical Mitomycin-C Chemotherapy in Ocular Surface Squamous Neoplasia.

A 60-year-old male patient presented with slowly growing mass lesion in both eyes. Best Corrected Visual Acuity (BCVA) was 6/60, N18 in Right eye Oculus Dexter (OD) and finger counting 1 meter, <N36 in left eye Oculus Sinister (OS). Examination revealed localized gelatinous mass lesion at temporal limbus in OD [Table/Fig-1a] and diffuse mass lesion involving more than 9 clock hours of cornea in OS [Table/Fig-2a]. Biopsy of the lesion was done and diagnosis of localized Ocular Surface Squamous Neoplasia (OSSN) in OD and diffuse OSSN in OS was made.

Treatment of Recalcitrant Cyclitic Neovascular Pupillary Membrane

levels between 12 and 15mmHg 2 to 6 months after surgery. All patients had undergone multiple glaucoma surgeries before and suffered from rapid conjunctival scarring. In none of them IOP control could be achieved previously. Combined XEN and Baerveldt implants were indicated to control IOP levels instantly after surgery, while still having the advantage of less scarring over the Baerveldt plate as compared with the Ahmed implant. From our personal limited experience, the following observations can be made: (1) The hypotony disappeared in all 4 childhood glaucoma cases within 2 days without any secondary signs of hypotony. This may be due to the swelling of the XEN implant which will make both the scleral canal through the thinned sclera watertight as well as compensate the difference between the outer diameter of the XEN and the inner diameter of the Baerveldt tube. Therefore, harmful hypotony was not an issue in any of our 4 childhood glaucoma cases. In 1 adult case IOP remained at levels of 5 to 7mmHg during the first 2 weeks, possibly due to cyclophotocoagulation 2 years before. One other adult case developed an IOP elevation to 26mmHg 2 weeks after surgery, which is presently under care. (2) When reopening the surgical site in 1 childhood glaucoma case, the XEN-Baerveldt connection was in place without any sign of displacement or kinking. Therefore, at least in the order of some weeks, the technique is stable and stable position of the tubes can be expected by encapsulation. It is, however, helpful or even mandatory to create a scleral tunnel as suggested by D’Alessandro and colleagues, and not use a patch only. In 2 cases F.G. created an additional loop of the Baerveldt tube (Fig. 1) to maintain the option for a later conventional tube implant if needed. Although the loop would be more prone to movement, there was no displacement when the 1 case was reopened. (3) There was no sign of erosion, kinking, or tendency to dislocate at the junction of the 2 tubes. With sufficient sutures and a stable coverage of sclera as shown by the D’Alessandro Mermoud technique, dislocation or disintegration of the XEN should not occur. So far, we could not see any postoperative movement of the XEN implant in the anterior chamber. (4) The cost for a rare disease as childhood glaucoma (in particular the aphakic secondary glaucomas) may be acceptable when considering the cost per year over the long life expectancy of these children. Cost is —as calculated per year—lower than in adulthood tube implant surgery with 1 of the current tube systems. Although the XEN-Baerveldt combination in adults might be too expensive as a standard procedure, it could be helpful in selected patients with risk of corneal decompensation, repeated scar formation, or risk of wipe-out. In summary, we consider this approach a valuable attempt to minimize corneal complications in children after tube implantation and treat severe refractory glaucoma in adults. However, the IOP control is still an issue and may need longer experience or modification of this technique.

Intravitreal Ziv-Aflibercept in Treatment of Naïve Chronic Central Serous Chorioretinopathy Related Choroidal Neovascular Membrane

Purpose. To study the effect and outcome of intravitreal Ziv-Aflibercept (IVZ) in treatment of Chronic Central Serous Chorioretinopathy (CSCR) related Choroidal Neovascular Membrane (CNVM). Methods. A case report of 48-year-old male patient treated with 1.25 mg/0.05 ml IVZ (total 3 doses at monthly intervals) in CSCR related CNVM. Pre- and posttreatment fundus fluorescein angiography (FFA) and Optical Coherence Tomography (OCT) were done to document response along with improvement in visual acuity. Patients. Single eye of a 48-year-old male patient. Results. Regression of CNVM was noted with improvement of macular contour and thickness on OCT and cessation of leakage on FFA. Visual acuity improved from 3/60, <N36 to 6/12, N12. Discussion. Anti-VEGF injections have shown benefit in treatment of CNVM. There is very little information about benefit of IVZ in CSCR related CNVM. Conclusion. IVZ is effective in regression of CSCR related CNVM and is associated with better macular anatomy and improved visual function.

Primary Corneoscleral Cyst in a Pediatric Patient

Purpose: Primary corneoscleral cyst is a rare disease occurring in the pediatric age group. We report a case of corneoscleral cyst with visual diminution. Methods: We conducted a case report. Results: A 7-year-old girl presented with corneal opacity in the left eye. Examination revealed a corneoscleral cyst. The corneal part of the cyst involved visual axis. Surgical excision with a scleral graft was performed, leading to an improvement in visual acuity. No recurrences were observed until the last follow-up at 18 months. Conclusions: Corneoscleral cyst should be considered in the differential diagnosis of cystic ocular surface disorders in the pediatric age group.

Comment on: A rare case of eyelid sarcoidosis presenting as an orbital mass.

Cite this article as: Mohan A. Bilateral congenital infantile hemangioma of upper eyelids. Indian J Ophthalmol 2016;64:542-3. This is an open access article distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Xeroderma pigmentosum with bilateral ocular surface squamous neoplasia and review of the literature

Xeroderma pigmentosum is a rare genetic disorder associated with various ocular malignancies. Here we report a single paediatric case of xeroderma pigmentosum with bilateral ocular surface squamous neoplasia (OSSN) presenting with diffuse lesion in one eye and a large mass in the other eye. Diffuse OSSN in one eye was treated with topical chemotherapy using mitomycin-C (0.04%) and the large OSSN in the other eye was treated with a combination of surgery and topical chemotherapy. Long-term follow-up and a multimodality treatment approach are necessary to identify and manage recurrences of OSSN in XP.

Orbital myiasis in eviscerated socket and review of literature.

Orbital myiasis is a potentially destructive infestation of the orbital tissues. It is uncommon in clinical practice and is seen in patients with poor hygiene with debilitated or immunocompromised state. We report a case of orbital myiasis in an empty socket of an immunocompetent individual. A 65-year-old immunocompetent patient was found to have orbital myiasis in an empty socket status postevisceration, for which he underwent treatment by manual removal of the larvae after application of a suffocating agent, turpentine oil. A total of 12 larvae were removed over the ensuing week. The tissues healed with secondary intention leaving an irregular healthy scar. It was noteworthy that once eviscerated the eye was neglected by the patient. Empty orbital sockets are potential sites for infestations.

Rare case of iridofundal coloboma with buried optic nerve head drusen in a paediatric patient

### Case An 8 year-old boy presented with typical iridofundal coloboma (IFC) in the left eye (OS) with buried optic nerve head drusen (ONHD). Right eye (OD) had iris coloboma associated with total cataract and retinal detachment. He did not have any neurological symptoms. Best-corrected visual acuity in OD was light perception (PL+), OS was 6/6, N6. Posterior segment in OS revealed the presence of a retinochoroidal coloboma. The disc looked elevated with irregular margins with hyperaemic appearance. Venous pulsations were present with normal looking calibre of vessels with a normal peripapillary retina. These features …