Monika Dahiya

Kissing nevus or divided nevus is a rare form of congenital nevus that usually occurs on adjacent parts of the upper and lower eyelids of one eye. Most often, the formation is present since birth, but it may also appear later during the course of life. We are reporting a case of kissing nevus of eyelids in 27 year old female present since birth and treated by microdissection radiofrequency ablation (MRA) over a period of 4 months in 2 sittings and patient was followed up regularly on OPD basis. It showed good cosmetic results without any structural and functional impairment. With the advantage of simplicity, precision and effectiveness, radiofrequency ablation can be used to treat kissing nevus with good cosmetic results and skin grafting can be avoided.   Keywords: Divided nevus, Kissing nevus, Radiofrequency ablation

Background: Phacoemulsification is a variant of extracapsular cataract extraction surgery which is the gold standard treatment modality for cataract surgery nowadays. The common nucleotomy techniques of phacoemulsification are divide and conquer, stop and chop and phaco chop. Aim of this studyto compare different techniques of nucleotomy during phacoemulsification with respect to corneal endothelial cell loss, central corneal thickness (CCT) and comment on their merits and demerits. Materials and Methods: 60 patients undergoing cataract surgery by phacoemulsification were randomly divided into three groups of 20 each (Group A, B and C) who underwent nucleotomy by divide and conquer, stop and chop and phaco chop technique respectively. The preoperative endothelial cell density and central corneal thickness were recorded using Topcon SP3000P non-contrast specular microscope. All patients were followed up at 1, 4 and 12week after surgery and evaluated for vision, slit lamp examination, endothelial cell count and central corneal thickness. Results: The age group of patients studied was 50-80 years, where maximum number of patients were in 51-60 years age group. Out of 60 patients, most common morphological type of cataract was nuclear (40%) cataract followed by cortico-nuclear (36.67%) cataract. After 1 week of surgery, drop in endothelial cell density was 7.06% in Group A, 6.49% in Group B and 6.84% in Group C patients. A further slight decrease in endothelial cell count was recorded during 4week and on final follow up visit at 12 weeks after cataract surgery, there was an endothelial cell loss of 9.51%, 10.9% and 11% in Group A, B and C respectively. The central corneal thickness at 1postoperative week increased by 2.75%, 2.35% and 2.20% in group A, B and C respectively. Further evaluation of CCT at 4and 12 week after surgery showed the values to be almost same as preoperative values. The rate of complications, which mainly included postoperative keratitis, mild anterior uveitis and cystoid macular edema, were found to be almost the same in all the three study groups. Conclusion: All the three nucleotomy techniques of phacoemulsification i.e divide and conquer, stop and chop and phaco chop are equally efficacious in terms of CCT changes, endothelial cell loss and complications rate in the hands of an experienced surgeon.   Keywords: Endothelial cell loss, Nucleotomy, Phacoemulsification.

Aim: To study the etiology of vitreous haemorrhage in a tertiary eye care hospital of North India. Materials and Methods: A hospital based cross-sectional study was done in RIO, PGIMS Rohtak over a period of over 2 years which included 200 patients presenting with vitreous haemorrhage. All patients were evaluated in detail to establish the etiology of vitreous haemorrhage. The data was analyzed using microsoft excel and SPSS 17.0 software. Result: A total of 200 patient presenting with vitreous haemorrhage involving one or both eyes were evaluated. The mean age of patients was found to be 47.40+19.6 years with a range of 6 months to 85 years. Only 24% cases had bilateral involvement. Male were found to be affected more commonly than females with M:F ratio of 2:1. In more than 85% cases, proliferative diabetic retinopathy, retinal vasculitis, branch retinal vein occlusion, central retinal vein occlusion, retinal tear, rhegmatogenous retinal detachment and ocular trauma was the underlying etiology. Conclusion: Proliferative diabetic retinopathy, branch retinal vein occlusion, posterior vitreous detachment with retinal tear are most common causes of vitreous haemorrhage in elderly patients while in young adults, retinal vasculitis is most common cause. While in children, trauma is found to be the most common etiology of vitreous haemorrhage. Keywords: Diabetic retinopathy, Ocular trauma, Vasculitis, Vitreous haemorrhage.

Aim: To study role of intrastromal and intracameral voriconazole combination in recalcitrant fungal Keratitis. Materials and Methods: 20 cases of recalcitrant fungal keratitis involving >50% stromal thickness and not showing good response to oral fluconazole, topical natamycin (5%) and topical voriconazole (1%) eye drops after 4 weeks of treatment were included in the study after taking informed written consent. Patients with impending or frank perforation, scleral involvement and endophthalmitis were excluded from the study. 30 min before the procedure, patient was given Tab acetazolamide 250mg stat to lower the intraocular pressure (IOP). Then under all aseptic conditions, 50 microgram/0.1 ml dose of intrastromal and intracameral voriconazole was given with 30G needle. Cases were examined daily for 1 week and then every week for 4 weeks for monitoring progression of fungal keratitis. Results: Out of 20 cases, 18 (90%) patients showed significant improvement after 4 weeks. Depending on the response after 1 week, patients were planned for repeat injection and only 1 patient required >3 injections in whom Lasiodiplodia theobromae was the causative organism. Only 1 patient got worsened and was ultimately managed with therapeutic keratoplasty. Conclusion: Intrastromal and intracameral voriconazole combination is an easy procedure with short learning curve which is highly efficacious and cost effective in recalcitrant fungal keratitis.   Keywords: Fungal keratitis, Intractable infection, Voriconazole.

Aim: To compare the efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision. Materials and Methods: A prospective observational study was conducted in thirty consecutive patients of primary progressive pterygium after taking their informed written consent and ethical clearance in a tertiary eye care centre of Northern India. Patients were randomly divided equally into group “A” and “B” each constituting fifteen patients. Group A patients underwent suture technique and group “B” patients underwent sutureless technique for conjunctivolimbal graft placement. Comparison of both groups was done in terms of intraoperative time, postoperative symptoms and recurrence over a period of one year. Data was compiled and entered into Microsoft Excel software and SPSS version 21.0 was used for data analysis. Results: The mean duration of surgery was 42 min and 30 min in group A and B respectively and this difference was found to be statistically significant (p=0.0001). On 1 postoperative day, pain and foreign?body sensation was present in 12 patients in group A, while only 1 patient of group B had these symptoms and this difference was statistically significant (p = 0.00014). Postoperative hyperaemia was seen in 8 patients of group A and 6 patients of group B which was statistically insignificant (p = 0.564). Only two patients in group A had conjunctival chemosis while no patients in group B developed chemosis, and the difference was statistically insignificant (p = 0.964). Subconjunctival haemorrhage was seen in 2 patients of Group A and 1 patient of Group B which resolved over a period of 2-3 weeks. Conjunctivolimbal graft was found to be more stable in group A while it was misplaced in 1 patient of group B and the difference was statistically insignificant (p = 1.000). Only 1 patient of group A developed suture related complication i.e suture granuloma. Over a period of 1 year follow up, only 1 patient of group A had recurrence of pterygium. Conclusion: Sutureless glue-free technique is a time saving, cost effective and better surgical modality in comparison to conventional suture technique for autogenous conjunctivolimbal grafting in primary pterygium resection.   Keywords: Conjunctivolimbal autograft, Pterygium, Suture technique, Sutureless technique.