Manthan Hasmukhbhai Chaniyara

Rescuing the host Descemet’s membrane in full-thickness traumatic wound dehiscence in deep anterior lamellar keratoplasty: intraoperative optical coherence tomography (iOCT)-guided technique

Optimal visual recovery following full-thickness traumatic wound dehiscence in a case of operated deep anterior lamellar keratoplasty (DALK) is rarely seen. Here we report a case of 22-year-old male patient presented to our casualty department with complaint of sudden-onset diminution of vision in his right eye following blunt trauma of 1 day duration. DALK had been performed 11 months ago for advanced keratoconus in the same eye. Best-corrected visual acuity (BCVA) in the right eye was hand movement close to face with accurate projection of rays and in the left eye was 20/20. Slit-lamp examination showed the presence of inferior 180° graft dehiscence with broken sutures and shallow anterior chamber with corneal oedema. Repair of the dehiscence with descemetopexy was done under the guidance of intraoperative optical coherence tomography with the successful rescuing of the host Descemet’s membrane. BCVA at 6 months follow-up was 20/40.

Intraoperative Descemet’s membrane detachment in a case of phacomorphic glaucoma

A 60-year-old female patient with phacomorphic glaucoma underwent initial medical management to control the intraocular pressure (IOP). After 48 hours, a stable IOP was achieved and subsequently the patient was planned for phacoemulsification followed by intraocular lens implantation. There was initial difficulty while reconstructing the corneal wounds; however, phacoemulsification and IOL implantation were uneventful but during viscoelastic removal, an inadvertent Descemet’s membrane detachment involving the central cornea was noted. Postoperatively corneal oedema persisted till 1 week, following which there was a gradual improvement with topical antibiotics, steroids and hyperosmotic agents. At the end of 6 months, the best corrected visual acuity was 20/25 with a central corneal thickness of 580 µm without any need for additional endothelial replacement surgery.

Discerning the optic nerve and retinochoroidal pathology using B-scan ultrasound in cases with anterior segment opacity

Case 1: A posterior segment B-scan ultrasonography in a patient with typical iris coloboma and total cataract, showed well-defined excavated area in the inferior part just below the optic disc (red arrow) with the absence of retinochoroidal layer, suggestive of fundal coloboma (yellow arrow) (figure 1A). Involvement of macula and types of fundal coloboma can be ascertained quite fairly based on ultrasonography which might provide a clue or prediction about postoperative visual gain or visual prognosis.1 Figure 1 (A) Axial scan depicting a well-defined posterior ocular coat excavation below the optic nerve head (red arrow) is suggestive of fundal coloboma (yellow arrow). (B) Axial scan showing a well-defined excavated area over the optic nerve head (red arrow) suggests an optic disc coloboma (yellow arrow) along with thinned out inferior neuroretinal rim (purple arrow)

Surgical removal of a giant iris stromal cyst: an intraoperative optical coherence tomography-guided approach

An 11-year-old girl was brought with the chief complaint of progressive diminution of vision in her right eye for the past 3 months. There was no history of ocular trauma or any ocular surgery. Systemic and family history was insignificant. Visual acuity was 20/20 in her left eye and counting finger close to face with projection of rays being accurate in her right eye. Slit lamp examination of her right eye showed large cystic lesion filling almost entire anterior chamber. With the help of various imaging modalities like anterior segment optical coherence tomography (OCT) and ultrasound biomicroscopy diagnosis of iris stromal cyst was confirmed. Right eye surgical removal of the iris stromal cyst was done under real-time imaging of intraoperative OCT (iOCT). Best-corrected visual acuity at 6 months follow-up was 20/20 without any recurrence. iOCT-guided approach for complete removal of the iris cyst seems more promising.

Optimising the surgical outcome in a case of post-traumatic cataract using ultrasound biomicroscopy

A 12-year-old boy was brought with the chief complaint of diminution of vision in his left eye for the past 1 month. History revealed a blunt trauma to his left eye with a wooden stick 6 weeks ago.Visual acuity was 20/20 and hand movement close to face in right and left eye, respectively, without any relative afferent pupillarydefect. Slit-lamp examination showed a total cataractous lens with signs suggestive of suspected posterior capsular (PC) defect. The PC defect was screened initially using B-scan ultrasound of the posterior segment, followed by confirmation of the same using ultrasound biomicroscopy. Left eye lens aspiration along with limited anterior vitrectomy followed by placement of multipiece intraocular lens in the sulcus was performed. Best-corrected visual acuity at 6 months of follow-up was 20/20.

Bilateral fungal keratitis with ring infiltrates: a rare scenario

A 12-year-old boy presented to the emergency department with chief complaints of pain, redness, discharge and diminution of vision in both eyes over the previous 20 days. There was no history of preceding trauma, contact lens use, any eye drop usage or ocular surgery. Systemic history was not significant. Presenting uncorrected visual acuity in his right eye was counting fingers at 1 m and 20/200 in the left eye, with accurate projection of rays in both eyes. Slit lamp biomicroscopy showed the presence of bilateral diffuse conjunctival congestion, corneal ring infiltrates and epithelial defect with corneal oedema. Potassium hydroxide wet mount showed the presence of septate fungal hyphae. The patient was treated with topical 5% natamycin and 1% voriconazole over a period of 6 weeks. Best-corrected visual acuity was 20/600 in the right eye and 20/20 in the left eye at 6-month follow-up.