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Sutureless scleral fixation of intraocular lens (sSFIOL) is a commonly employed method of optical rehabilitation of aphakic patients with deficient capsular support, and corneal transplant surgeries can be simultaneously combined with sSFIOL to handle aphakic corneal opacities. A single-stage procedure circumvents the need for repeat intraocular procedures and carries lower risk of graft endothelial damage, endophthalmitis, and macular edema associated with sequential surgeries. However, it mandates surgical expertise and increases the chances of postoperative inflammation. A basket of options is available with the corneal surgeons regarding the manner of host and donor preparation as well as the approaches to scleral fixation and certain intraoperative modifications along with postoperative vigilance may enhance the surgical outcomes. Most of the studies pertaining to keratoplasty with sSFIOL categorize to case reports/series, surgical techniques, and retrospective studies with very limited prospective data available currently. The purpose of the present review is to consolidate all available literature on concomitant sSFIOLs and keratoplasty procedures.

Purpose: To evaluate the role of intraoperative optical coherence tomography (i-OCT) in donor grading, selection, and preparation during different types of keratoplasty. Methods: Seventy-one consecutive donor corneas collected over 6 months, after clinical grading, were observed by an experienced corneal surgeon under an i-OCT equipped microscope. The donor preparation (manual/automated) for different types of keratoplasty procedures was also undertaken under i-OCT. Results: The mean central corneal thickness of optical and nonoptical grade tissues was 533 ± 19 and 662 ± 52 mm, respectively. The i-OCT-based grading matched with clinical grading in 98.5% cases. Irregular thickness, anterior stromal hyperreflectivity, and previous scars were appreciated in 1.4, 1.4, and 7.04% donors, respectively. During Descemet stripping automated endothelial keratoplasty, i-OCT facilitated selection of appropriate microkeratome head for automated donor preparation in all cases, besides allowing manual dissection of partially dissected lenticule, identification of site of inadvertent perforation, and eccentric trephination in one case each. During Descemet membrane endothelial keratoplasty, i-OCT-based assessment of preexisting scar (five cases) guided careful tissue selection (2/5) and preparation. During predescemetic endothelial keratoplasty, precise needle advancement allowed successful type-1 bubble formation in all cases. All manually punched donors demonstrated an extra endothelial ledge, while those with automated preparation showed tapering donor margins. Conclusion: i-OCT might serve as a useful imaging tool for objective assessment of donor characteristics. The modality may complement clinical evaluation for donor grading, selection, and preparation.

Obstetrical forceps-induced Descemet membrane tears (FIDMT) are usually encountered during complicated forceps-assisted deliveries. The condition may lead to significant visual debilitation in young children and is frequently ignored due to its low incidence. Undue stretch on the Descemet's membrane during the process of forceps-assisted delivery results in their vertical/oblique tear (s), which usually leads to corneal edema in early neonatal life. On its resolution, these residual tears result in visually disabling astigmatism that can lead to dense and recalcitrant amblyopia. Slit-lamp examination, anterior segment optical coherence tomography, specular microscopy, confocal microscopy, and corneal topography and tomography can be employed for its accurate diagnosis. While these can be prevented by improved perinatal care, once diagnosed, they mandate prompt refractive correction and amblyopia therapy to prevent disabling visual deterioration in affected children. In adulthood, medical and surgical management may be planned for symptomatic patients based on coexistent amblyopia as this is the major factor guiding visual prognosis. There is limited comprehensive literature in this regard, and the present review discusses the pathogenesis, clinical features, and recent developments in investigations, management, and outcomes of FIDMT during the last three decades.

Lyophilization is another reasonable alternative of conserving donor cornea but requires special lyophilization machine and dry ice for its execution alongside a rehydration process before surgery for maintaining corneal architecture. Considering the limitations of afore-mentioned preservation techniques, ophthalmologists can consider exploring non-donor dependent approaches such as autologous partial thickness scleral flaps, tenon's patch grafts, conjunctival flaps, and autokeratoplasty for restoring ocular integrity in emergency corneal disorders. [...]as rightly suggested by authors, we need to revise our present storage methods for effective and timely utilization of precious human tissues.

Purpose: To formulate a treatment algorithm for the management of descemetocele. Methods: This was a prospective interventional study that was conducted at a tertiary eye-care center. All consecutive cases of descemetocele during the study period (April 1, 2017-March 31, 2018) were evaluated for the following parameters: age, sex, previous medical or surgical therapy, risk factors, preexisting ocular diseases, location, site and size of descemetocele, interventions undertaken, visual acuity, and the fellow eye status. The surgical modalities and fellow eye status were correlated individually with therapeutic and functional outcomes, based on which a treatment algorithm was formulated. Results: The study included 24 eyes of 24 patients (19M, 5F) with a median age of presentation of 45 years. The mean follow-up duration was 6.79 ± 3.97 months (3-12 months). The most common cause of descemetocele was microbial keratitis (66.66%), and most cases were central (50%), small (58.33%), and non-perforated (79.16%). The surgical interventions undertaken were cyanoacrylate glue (CG, 37.5%), penetrating keratoplasty (PKP, 33.33%), patch graft (16.66%), and deep anterior lamellar keratoplasty (DALK, 12.5%). Therapeutic success was noted in 13/24 eyes (54.16%). Final visual acuity > 3/60 was seen in 25% cases. Suboptimal therapeutic (P = 0.07) and visual (P = 0.34) outcomes were noted in subjects with non-functional fellow eye. Conclusion: PKP was preferred for descemetoceles with active microbial keratitis and extensive infiltrates, while CG and DALK were undertaken for healed microbial keratitis, neurotrophic keratitis, and ocular surface disorders with partial limbal stem cell deficiency (LSCD). For total LSCD, amniotic membrane graft was preferred.

Purpose: To evaluate the impact of 2019 COVID-19 pandemic, national lockdown, and unlocking on ophthalmic care provided by the government-funded apex health institute of India. Methods: Retrospective review of electronic medical records of all patients presenting to the ophthalmology department from March 23, 2020, to July 15, 2020, was compared with that from March 23, 2019, to July 15, 2019. The data between March 23, 2020, to May 31, 2020 (lockdown) and June 06, 2020, to July 15, 2020 (unlock) was compared separately. Parameters evaluated were age, gender, presenting complaints, final diagnosis, treatment advised, and surgical interventions. Results: During the lockdown, routine outpatient flow reduced by 97.14% (P < 0.001), the median age of presentation decreased to 29 years (55 years last year) and males increased by 4.7% (from 61.51% to 66.21%) in 2020. Emergency services decreased by 35.25%, percentage of children decreased by 4.28% (from 34.28% to 30%) and males increased by 13.53% (from 59.97% to 73.5%). Mechanical trauma, microbial keratitis, and conjunctivitis were the most common reasons for presentation. The former lessened by 41.75% while the latter two amplified by 1.25 times and 2 times, respectively. While sanitizer-associated chemical injury increased in proportion, endophthalmitis, and postoperative complications declined. The number of donor corneas collected and emergency therapeutic keratoplasties performed decreased by 99.61% and 92.39%, respectively (P < 0.001). During the unlocking phase, routine patient consultations were 71 ± 19/day, significantly lower than 978 ± 109/day of last year (P < 0.001). No voluntary eye donation was reported during this period. Conclusion: COVID-19 pandemic and national lockdown severely hampered the delivery of ophthalmic care by the apex-ophthalmic institute. Unlike anticipated, lifting of pandemic-associated lockdown served only minimally in improving patient inflow in its initial phases.

Purpose: To describe the surgical results of concomitantly performed optical penetrating keratoplasty (PKP) with glued intrascleral haptic fixation (ISHF). Methods: Retrospective review of 18 patients (15-72 years) with best-corrected visual acuity (BCVA) of ≤1/60 subjected to unilateral concomitant optical PKP with ISHF and followed up for 13.11 ± 5.83 months (6-26 months) was undertaken. Results: The most common diagnoses were failed PKP (9/18, 50%) followed by aphakic bullous keratopathy (5/18, 27%). Preoperative glaucoma, peripheral anterior synechiae (PAS), and deep vascularization were present in 7/18 (38.88%), 12/18 (61.11%), and 5/18 (27.77%) patients, respectively. Intraoperatively, concomitant procedures such as pupilloplasty and intraocular lens explant were undertaken in 5/18 (27.277%) patients and 1/18 patients (5.55%) experienced suprachoroidal hemorrhage. At final follow-up, BCVA was ≥6/60 in 50% patients (mean astigmatism: 4.79 ± 1.68D), and 55.55% cases experienced graft failure (90% failed within one year of surgery). The most common causes of graft failure were glaucoma (50%), glaucoma with rejection (20%), rejection (10%), retinal detachment (10%), and suprachoroidal hemorrhage (10%). The ODDS ratio (OR) of having graft failure with the following factors was postoperative secondary interventions (OR: 6), postoperative complications (OR: 2.25), prior failed graft (OR: 1.8), preoperative PAS (OR: 1.75), intraoperative concomitant procedures (OR: 1.5), preoperative glaucoma (OR: 1.33), previous surgeries (OR: 1.24), and deep corneal vessels (OR: 0.66). Conclusion: All patients underlying PKP combined with glued ISHF must be counseled about suboptimal surgical outcomes. Emphasis is laid on appropriate case selection and stringent follow-up during the first year after surgery. Secondary interventions should be undertaken cautiously and judiciously in these patients.

Purpose: The aim of this study was to evaluate long-term intraocular pressures that provide stabilization/reversal of glaucomatous neuropathy after surgery in primary congenital glaucoma (PCG). Methods: Prospective evaluation of consecutive PCG patients who underwent trabeculectomy-trabeculotomy and followed up for ≥2 years. Records of regularly performed examination under anesthesia were maintained to ascertain intraocular pressure, (IOP), fundus, refraction and corneal diameter. Outcomes - Primary: cup: disc ratio and intraocular pressure, Secondary: corneal changes and refractive error Results: A total of 174 eyes of 108 children with PCG had a preoperative IOP of 22.44 ± 9.5 mm Hg. Postoperative review IOP was 11.8 ± 4.5 mm Hg, cup-disc-ratio was 0.52 ± 0.23 and corneal diameter was 12.75 ± 0.9 mm. Primary outcomes: Linear regression analysis showed a significant positive correlation of review IOP with cup disc ratio, P = 0.004. 67.9%, of eyes at a review IOP range of 6-12 mm Hg showed reversal, 14.1%, were stable, at 6-15 mm Hg, while 3.84% showed an increase in cup: disc ratio 16-22 mm Hg. Patients operated before 6 months of age had a significantly smaller final cup-disc ratio, P = 0.0013. Patients with a final cup: disc ratio of >0.9 were significantly older at surgery, P < 0.001. Secondary outcomes: There was a positive correlation of final myopia with review IOP on linear regression analysis, P = 0.012. The final spherical error in eyes having cup disc ratio of ≤ 0.5 was -0.96 ± 4.5 diopters, as against -3.45 ± 7.7 diopters in eyes having cup-disc ratio of 0.6-0.8 and -3.8 ± 6.9 diopters in eyes with cup disc ratio of ≥0.9, P = 0.015. There was no significant change in corneal diameter. Conclusion: Patients operated after 6 months of age had a larger final cup: disc ratio, while postoperative review intraocular pressures over 2 years of at least ≤15 mm Hg in primary congenital glaucoma eyes, commonly lead to reversal/stability of the neuropathy, and a lower incidence and degree of myopia.