Purpose:IgG4-related disease is a multisystem disorder involving the orbit and adnexa. The purpose of the present study is to report the varied clinical presentations of IgG4-related ophthalmic disease (IgG4 ROD) and their management outcomes.Methods:This was a retrospective study carried out between January 2013 and December 2020. All patients fulfilling the criteria for diagnosis after histopathological and hematological examinations were included in the study. Demographic data, ophthalmic and radiological findings, surgical details, and management outcomes were analyzed.Results:A total of 21 patients (25 eyes) were included in this study. Twelve were females (57.1%), and nine (42.9%) were males. Four patients (19%) had bilateral involvement. Extraocular muscles (EOMs) and orbital soft tissue were the most common sites involved (n = 13, 52% and n = 12, 48%, respectively). Lacrimal gland was involved in eight cases (n = 8, 32%). Eleven eyes (44%) had multiple periocular and adnexal site involvement. Serum IgG4 titer was found to be elevated in 14 cases (66.7%). All the cases were treated with the oral steroid. Adjuvant immunosuppressant was recommended in seven cases (33%). Recurrence was observed in seven cases (33.3%) at a mean interval of 21.1 ± 16.1 months, and it was found to be three times more common in patients with raised serum IgG4 levels and those with EOM involvement.Conclusion:IgG4 ROD is a rare orbital and adnexal disorder. It can be associated with raised serum Ig G4 levels and systemic evaluation is mandatory. Steroids remain the main stay of management with immunosuppressants being added in refractory cases.

Intumescent cataracts complicate cataract surgery due to high intra-lenticular pressure, often causing radial tears, such as the Argentinian flag sign. The micro-Rhex-pression technique offers a precise solution for achieving safe continuous curvilinear capsulorhexis in these cases. By creating a small central puncture in the anterior capsule and using controlled decompression with capsule massage to release liquified cortex, this method effectively reduces intra-lenticular pressure and minimizes tear risks. Applied in over 1,600 cases, it achieved a 99.6% success rate with minimal complications. Compared to costly femtosecond laser capsulotomy, micro-rhex-pression is affordable, efficient, and easy to learn, making it highly accessible. This technique advances intumescent cataract management by providing a reliable, safe, and accessible approach for optimal surgical outcomes. Its straightforward approach and short learning curve make it accessible, providing surgeons with a reliable method to improve outcomes in managing challenging intumescent cataracts. This technique enhances surgical safety and accessibility, transforming the approach to such complex cataracts.

Macrophage-like cells (MLCs) in the vitreoretinal interface are involved in angiogenesis and retinal homeostasis. This study investigated the changes in the MLCs at the vitreoretinal interface using optical coherence tomography angiography (OCTA) with progression of diabetic retinopathy (DR) and treatment response. This cross-sectional, retrospective, observational study involved 86 eyes, categorized into four groups: Diabetes Mellitus without DR (n = 17), DME without treatment (n = 22), DME with anti-VEGF (n = 23), and DME with Dexamethasone (n = 24). The MLCs were imaged in the vitreoretinal interface slab 3 micron from the internal limiting membrane in OCTA. The images were processed with Image J and overlaid on the angiography en face image. Significant differences in MLC count ( P = 0.038), MLC density ( P = 0.007), and central subfield thickness (CST) ( P = 0.000) were observed with increasing severity and progression from no DR to DME. Both anti-VEGF and DEX treatment were associated with significant reduction in MLC count ( P = 0.000, 0.002), MLC density ( P = 0.000, 0.002), and CST ( P = 0.008, 0.030) A positive significant correlation was noted between MLC density and change in BCVA and CST. No significant difference was noted between anti-VEGF and DEX groups. MLCs increase with worsening DR and show reduction with treatment response with direct correlation with BCVA and CST. MLCs can act as a surrogate marker for treatment response in DME.

Purpose:To assess the retinal thickness in patients with type 1 diabetes mellitus (T1DM) and type 2 DM (T2DM) of equal disease duration, comparing them with age- and sex-matched healthy controls.Methods:This cross-sectional, comparative, and observational study included 96 participants, categorized into four groups: A1 (patients with T1DM, n = 24), A2 (age- and sex-matched nondiabetic controls for A1, n = 24), B1 (patients with T2DM, n = 24), and B2 (age- and sex-matched nondiabetic controls for B1, n = 24). Evaluations included retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC) thickness, central macular thickness (CMT), visual acuity, color vision, and contrast sensitivity. The primary objective was to compare RNFL, GCC, and CMT between T1DM and T2DM patients with equivalent disease duration and their respective controls. Secondary analyses assessed differences in visual acuity, color vision, and contrast sensitivity between T1DM and T2DM patients.Results:The mean age of T2DM patients was 50.96 years, and for T1DM patients it was 28.96 years. T2DM patients exhibited significant GCC reduction in the superonasal (P = 0.046) and inferonasal quadrants (P = 0.048) compared to T1DM. T2DM also showed significant RNFL thinning in the superior (P = 0.037), inferior (P = 0.012), and temporal quadrants (P = 0.025) compared to T1DM after adjustment for age and DM duration. No significant difference in CMT was observed between T1DM and T2DM. In T1DM patients, mean best-corrected visual acuity was significantly worse than that of controls (P = 0.019). Contrast sensitivity and color vision did not differ significantly between T1DM and T2DM.Conclusion:This study reveals earlier RNFL and GCC thinning in T2DM compared to T1DM.

Objectives:To correlate corneal concentration and minimum inhibitory concentration (MIC) of antifungal drugs in patients undergoing therapeutic penetrating keratoplasty (TPK) for fungal keratitis.Methods:The study included 43 cases of culture- and smear-proven fungal keratitis that underwent TPK due to inadequate responses to topical natamycin (NTM) 5% and/or topical voriconazole (VCZ) 1%. Liquid chromatography mass spectrometry (LCMS) was used to analyze the host corneal tissue of the patients to measure the intracorneal concentrations of NTM and VCZ. Antifungal susceptibility testing was performed using the E-test method with standard-dose antifungal E-strips on the same corneal tissue.Results:The mean age of study participants was 48.11 ± 15.22 years. Aspergillus sp. was the most commonly identified fungus. The study found that the mean intracorneal concentration of NTM was 80.76 ± 107.59 µg/gm (n = 30/43), while that of VCZ was 0.0962 ± 0.25 µg/gm (n = 32/43). Twenty-one cases had MIC-90 values for both antifungal drugs. Over 85% of cases had an intracorneal concentration lower than VCZ MIC-90, and 61.9% of cases showed NTM intracorneal concentration higher than its MIC-90.Conclusion:Despite achieving corneal concentration higher than the MIC-90, cases with recalcitrant fungal keratitis had a poor clinical response to NTM, suggesting other possible reasons, such as poor drug penetration and drug resistance.

Purpose:To determine the risk factors and clinical characteristics of shallow anterior chamber (AC) following choroidal detachment.Methods:A retrospective case-control study. The data of glaucoma patients undergoing intraocular surgery were collected. Based on clinical documentation, patients were categorized based on the presence or absence of a shallow AC after choroidal detachment. Clinical characteristics of eyes that developed a shallow AC were compared to those of controls that had a large AC depth (ACD) after choroidal detachment.Results:Among 3,492 eyes undergoing intraocular surgery, 99 eyes (2.84%, 95% confidence interval [CI]: 2.28%–3.39%) developed a documented choroidal detachment; 77 eyes met the inclusion criteria, with 52 exhibiting shallow AC and 25 maintaining deep AC. The preoperative ACD was notably deeper in the deep AC group (2.96 ± 0.28 mm) compared to the shallow AC group (2.55 ± 0.59 mm) (P = 0.002). Additionally, the deep AC group had a wider preoperative AC width (ACW) (11.95 ± 0.42 mm) than the shallow AC group (10.92 ± 0.35 mm) (P < 0.001). The shallow AC group was more likely to be phakic (94.2% vs. 76.0%, P = 0.02), more likely to have angle-closure glaucoma (51.9% vs. 28%, P = 0.048), and more likely to have undergone external filtration surgery (96.2% vs. 80%, P = 0.033). Multivariate analysis identified only ACW (odds ratio = 0.56 per 0.1 mm increase, 95% CI: 0.41%–0.75%, P < 0.001) as significantly associated with a shallow AC.Conclusion:The incidence of choroidal detachment post-intraocular surgery was 2.84%. Smaller ACW was the primary risk factor for shallow AC after choroidal detachment, warranting preoperative measurement and tailored surgical planning for high-risk eyes.

Purpose:We aimed to estimate prevalence of vision impairment (VI) due to cataract and its associated factors and barriers for accessing cataract surgical services in India in persons aged ≥50 years.Methods:Analysis of data collected in National Blindness and Visual Impairment Survey, India (2015–2018), was performed (n = 85135). Prevalence of cataract-associated VI was defined as cataract in at least one eye, pinhole visual acuity (PinVA) worse than threshold (6/12, 3/60) in the cataract-affected eye, and not having a more avoidable cause of VI (presenting visual acuity PVA < 6/12 in better eye) in the person.Results:The prevalence of cataract-associated VI at PinVA < 6/12 was 12.9% (95% CI: 11.8, 14.0) and 3.0% (95% CI: 2.6, 3.5) at PinVA < 3/60. The highest prevalences at PinVA < 6/12 were noted in Janjgir-Champa (19.0%), Nalbari (17.9%), and Warangal (17.9%). Females had higher prevalence at PinVA < 6/12 (univariate odds ratio [OR] 1.2) and PinVA <3/60 (univariate OR 1.5). Statistically significant gender differences (females worse off) were noted in Sikar, Ambedkar Nagar, Guna, Banda, and Thrissur at PinVA < 6/12. Prevalence increased with increasing age and decreasing literacy and varied across administrative zones on multivariate analysis. Need not felt was the major reason for not availing cataract surgical services in persons with visual impairment at PinVA < 6/12 (48.1%) and PinVA < 3/60 (27.8%) thresholds.Conclusions:The burden of cataract-associated VI at PinVA < 6/12 in India is significant. Interventions to overcome social determinants and enhance awareness about surgery are required.

Intraocular gnathostomiasis is an exceptionally rare manifestation of Gnathostoma spinigerum infection. Ingested larvae from undercooked meat[1] can migrate to various body parts, causing significant morbidity. Intralenticular localization-where the larva is embedded within the crystalline lens-is extremely unique, with this video documenting the first reported global case. To present the clinical, diagnostic, and surgical aspects of a unique case of intralenticular gnathostomiasis, providing educational value to ophthalmologists, parasitologists, and primary care physicians. This case emphasizes the importance of considering parasitic infections in differential diagnoses, particularly in patients with relevant dietary or travel histories. A foreign national presented with ocular irritation and gastrointestinal symptoms following the consumption of undercooked meat. Clinical findings included anterior chamber reaction, mild vitritis, optic disc edema, retinal hemorrhages, and curvilinear retinal scars. Endogenous endophthalmitis was initially suspected. On Day 18, a live worm was visualized within the lens on slit-lamp examination and anterior segment-optical coherence tomography (AS-OCT). The video illustrates the diagnostic journey and meticulous surgical extraction of the worm in toto. An animated segment demonstrates the presumed migratory path of the larva. Histopathology confirmed the species as Gnathostoma spinigerum. • Diagnosis: Emphasizes the importance of detailed history-taking, including dietary habits and travel exposure. • Documentation: High-quality images of the motile worm within the lens aid future recognition and diagnosis. • Surgery: Demonstrates the technique to safely extract the worm, providing insights into managing such rare and delicate cases. • Postoperative Care: Discusses the importance of postoperative monitoring and care for full visual and systemic recovery. https://youtu.be/VAdj17UZVA0.

Purpose:In the current study, we have screened the OPTN gene in a cohort of unrelated juvenile open-angle glaucoma (JOAG) patients negative for possible pathogenic variants in CYP1B1 and MYOC genes.Methods:Polymerase chain reaction (PCR) amplification and sequencing were employed to identify nucleotide variants within the coding sequence and intron-exon boundaries of the OPTN gene in 85 JOAG patients and 100 controls. A pathogenicity prediction of identified variants was performed by six distinct online algorithms. Possible structural alterations caused by pathogenic variants were investigated using GOR IV, PyMol, ChimeraX, and molecular dynamics simulations using Gromacs software.Results and Discussion:PCR amplification and sequencing revealed a total of 27 variations, encompassing eight missense, six synonymous, and 13 intronic changes. Out of the 85 patients, three JOAG individuals exhibited possible pathogenic variants. A novel missense variant p.(Q518L) was also observed and registered at NCBI with accession number PP898303. Computational algorithms identified three potential pathogenic variants. These variants induce disruptions and structural alterations which in turn compromise their functionality. This ultimately leads to retinal ganglion cells death and the eventual manifestation of glaucomatous damage resulting in vision loss.Conclusion:This is the first report showing the involvement of pathogenic OPTN gene variants in JOAG cases from North Indian population which was unknown till now. This study provides population-specific data on genetic contribution of OPTN genes in JOAG pathogenesis. Genetic investigations like this may help in the understanding of disease pathogenesis and development of therapy for glaucoma management/treatment in the near future.