Sujith Vengayil

Anterior segment OCT-based diagnosis and management of retained Descemet's membrane following penetrating keratoplasty.

PURPOSE To report a case of retained Descemets membrane after penetrating keratoplasty for congenital hereditary endothelial dystrophy (CHED) documented by anterior segment optical coherence tomography and review of literature. METHODS Case report and review of literature. RESULTS A 14-year-old boy underwent penetrating keratoplasty for CHED. A retained host Descemets membrane was detected with a supernumerary anterior chamber on the first postoperative day. The retained Descemets membrane was documented using slit lamp adapted anterior segment optical coherence tomography (SLOCT). Surgical intervention for the Descemets membrane removal was done in the third postoperative week. The complete removal of the membrane was confirmed on SLOCT. CONCLUSION Inadvertent retention of the host Descemets membrane is a rare but possible complication in penetrating keratoplasty for CHED. Proper anticipation, early detection and removal will help in preventing any undue risk of graft failure.

Intracameral SF6 injection and anterior segment OCT-based documentation for acute hydrops management in pellucid marginal corneal degeneration.

PURPOSE To report a case of acute hydrops in pellucid marginal corneal degeneration (PMCD) documented with anterior segment optical segment tomography and successfully treated with sulphur hexafluoride (SF6) intracameral injection. METHODS A 47-year-old female patient presented with spontaneous onset of pain, redness and decreased vision in her left eye. Clinical evaluation revealed bilateral PMCD with evidence of acute hydrops in the left eye. Anterior segment Slit lamp Adapted Optical Coherence Tomography (SL-OCT) examination revealed intrastromal clefts with Descemets membrane detachment in the left eye. She was managed with descemetopexy with 0.2ml injection of iso-expansile SF6 (18%) intracameral. RESULTS The patient showed excellent early resolution of the stromal edema with reattachment of the Descemets membrane. CONCLUSION Prompt intervention in acute hydrops in PMCD cases helps in achieving early good visual results and prevents potentially serious complications such as perforation. Newer imaging modalities like SL-OCT helps in better visualisation and also in monitoring the response to treatment.

Viscoexpression of large free floating cysticercus cyst from the anterior chamber of the eye by double incision technique

We describe a case of 16-year-old girl who reported with diminution of vision in left eye for past seven months with appearance of white reflex. Slit lamp biomicroscopy revealed the presence of a live grayish white cyst in the anterior chamber. The ultrabiomicroscopic evaluation revealed a large live Cysticercus cellulosae cyst in anterior chamber. The CT-scan of the brain revealed multiple non-contrast enhanced lesions with calcification in brain parenchyma. The patient was started on oral prednisolone and oral albendazole. The cyst was removed in toto from the eye by double incision technique. The patient achieved visual acuity of 6/12 post-operatively.

Challenges of eye banking in a developing world

Eye donation is an act of supreme kindness to humanity and the society is obliged to bring honor to the memory of all eye donors for this truly philanthropic gift. Understanding the functioning of eye banks, donor criteria and the process of eye donation is the basis for facing challenges within eye banking in the developing world. The number of banks and their organizational level, methods of explantation, processing and preservation, quality standards, and new developments will have to be reviewed and regulated regularly. Efforts towards improvement in eye banking will ensure higher standards of both the quality and quantity of corneal tissue for rehabilitation of corneal blind patients. Effective state legislation is required to meet a society’s ophthalmic surgical needs in transplantation programs. Incorporating advanced tissue-engineering services into the scope of the functions of an eye bank will make such higher end facilities available to routine corneal surgeons, thereby raising the standard of eye banking to greater heights.