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Purpose: Tessier classification is used to classify congenital facial cleft disorders utilizing the anatomical location of the cleft and its extension. The orbital and ocular morbidities associated with the birth disorder are numerous. The authors decided to perform a retrospective analysis of the clinical features of the patients who presented to a tertiary care hospital with orbito-cranial clefts. Methods: The authors retrospectively evaluated the records of patients with craniofacial clefts who had presented to a tertiary eye care hospital in northern India in the last 2 years (January 2019-December 2020). The clinical features were studied, entered in MS Excel, and the data were evaluated. Results: The data of 40 patients with Tessier cleft were found. The majority of the patients were male and presented in the pediatric age group. Unilateral involvement was more common, with maxillary hypoplasia being the most common facial anomaly associated. Eyelid coloboma and euryblepharon was the most common periocular finding; lateral epibulbar dermoid and corneal opacity were the most common ocular surface anomaly. The majority of patients had presented for cosmetic correction. The syndromic association was with Goldenhar syndrome (n = 13), Fraser (n = 2), and one each of Treacher Collins, blepharocheilodontic, organoid nevus, and oculo-dento-digital syndrome. Combined clefts were also seen. Conclusion: Tessier cleft classification is a useful tool to classify cranio-facial left anomalies. Multitudes of ocular and orbital anomalies can be associated with their different forms. Better knowledge and understanding of the classification will aid immensely in predicting the ocular defects and planning their management.

Oculoplastic surgeries encompass both emergency surgeries for traumatic conditions and infectious disorders as well as elective aesthetic procedures. The COVID-19 pandemic has brought about a drastic change in this practice. Given the highly infectious nature of the disease as well as the global scarcity of medical resources; it is only prudent to treat only emergent conditions during the pandemic as we incorporate evidence-based screening and protective measures into our practices. This manuscript is a compilation of evidence-based guidelines for surgical procedures that oculoplastic surgeons can employ during the COVID-19 pandemic. These guidelines also serve as the basic framework upon which further recommendations may be based on in the future, as elective surgeries start being performed on a regular basis.

Purpose: To describe the swept-source optical coherence tomography (SS-OCT) features of regressed macular retinoblastoma (RB). Methods: A cross-sectional observational study was carried out in 13 patients with regressed macular RB with good fixation in at least one eye. Fundus photography and SS-OCT were documented. High-resolution scans with good signal strength were selected. The types of clinical regression and SS-OCT characteristics of the regressed lesions (presence of vitreous detachment, intratumor schisis/cavitation, calcification, foveal dip, and OCT pattern) were noted. Results: Of the 13 eyes, 7 (53%) were group B, 4 (30%) were group C, and 2 (17%) were group D. Lesion involving fovea was seen in seven eyes (53%). On SS-OCT, the lesion was isodense to hyperdense in all cases. Three patterns of regressed RB were noted on OCT. Intralesion calcification was noted in eight cases. Subretinal fluid was not detected in any of the cases. Conclusion: SS-OCT is a useful technology to image and analyze cases of regressed macular RB including large lesions. SS-OCT system helps in successful imaging even in smaller children.

To improve the diagnostic as well as therapeutic utility in the cases of pathology related to the lacrimal drainage system, authors have made an effort by permanently engraving the numbers in millimeters scale on either side of the probe using cutting edge laser technology [Figure 1]a. The probe on one side has a measuring scale at every 2 mm (from 2 to 20 mm) [Figure 1]b and the other end has a measuring scale at every 5 mm (from 5 to 20 mm) [Figure 1]c.{Figure 1} With the help of routine probes, the procedures are time-consuming and may give a false reading about the site of obstruction. [...]using calibrated Bowman probe, the level of obstruction within the lacrimal system can be made out more accurately with minimal wastage of crucial time.

Purpose: A pilot randomized control trial to compare the efficacy and side effects of intralesional and oral propranolol in periorbital and eyelid capillary hemangiomas. Methods: Twenty patients were prospectively randomized to two groups of ten each. Group 1 was initiated on oral propranolol 1 mg/kg/day titrated to final dose of 3 mg/kg/day over 1 week which was continued for 6 months and then tapered over 1 week; Group 2 received 3 doses of direct intralesional propranolol hydrochloride 1 mg/ml; 0.2 ml/cm 4-6 weeks apart. Hemangioma area and corneal astigmatism were measured. Results: Within each group at 6 months there was a significant reduction in area (group 1: 83.48 ± 11.67%,P= 0.0019; group 2: 67.78 ± 21.71%,P= 0.0019) and improvement in astigmatism (pre, post: group 1: 2.98D @ 179.8°, 1.13D @ 179.8°,P= 0.0045; group 2: 1.62D @ 90.16°, 0.75D @ 179.9°,P= 0.0001). There was no difference in area reduction (P = 0.056), change in appearance (P = 0.085), ptosis (P = 0.23) and side effects (lethargy, poor feeding;P= 0.171) between the two groups. Conclusion: Efficacy and side effects with intralesional propranolol are comparable to oral propranolol for periorbital and eyelid lesions.

A 19-year-old male patient presented to the ocular emergency services with sudden onset of proptosis, pain, and bloody discharge. Further evaluation revealed bilateral visual acuity of finger counting close to face vision with an accurate projection of rays. Computed tomography scan of the head and orbit revealed diffuse orbital hemorrhage (mainly along the ocular coats) in the absence of any subperiosteal or intracranial hemorrhage. A complete hematological workup was done and it revealed decreased factor IX levels (9% of normal) consistent with hemophilia B (Christmas disease). The patient was managed medically with factor IX supplementation. At the end of 6 weeks, patient's visual acuity improved to 20/20 in both the eyes.

To study the clinical profile of children aged <10 years presenting with epiphora at a tertiary eye care center, to compare the clinical profile between the early onset (<3 years) and the late-onset (≥3 years) group, and to study the success of different treatment modalities. A prospective nonrandomized observational study was conducted in 209 eyes of 167 patients (42 bilateral cases). The main outcome measure was postoperative relief of presenting symptoms and signs at 3 months follow-up. Fifty-five percent cases (92 of 167) were early-onset cases, and 45% (75 of 167) were late onset. The male:female ratio was 1.9:1. Seventy-five percent cases were unilateral. The etiological profile was -76% cases of congenital nasolacrimal duct obstruction (NLDO), 18% traumatic/surgical, 4% acquired NLDO, and 2% punctal causes. The overall success rate of all the treatment modalities in our study was 80% (167/208) -82% for sac massage, 77% for probing, 79% for intubation dacryocystorhinostomy, and 100% for punctal surgery. A significant association was noted between the treatment outcome and laterality (P = 0.04), presence of infection (P = 0.032), symptom severity (P = 0.027), history of previous treatment (P = 0.024), and age. No significant association was found between the treatment outcome and gender (P = 0.73), socioeconomic status (P = 0.43), etiology (P = 0.45), and treatment modality (P = 0.33). This study describes the complete range of causes and treatment modalities for pediatric epiphora and highlights the etiology, signs and symptoms, treatment, and the comparative outcome between the early versus the late-onset group and analyses the factors predictive of the outcome.

BackgroundVimentin is an intermediate-sized filament which is highly expressed in mesenchymal cells and is associated with epithelial–mesenchymal transition (EMT). EMT markers ZEB2 and Slug lead to Vimentin overexpression and E-cadherin loss, resulting in invasion and metastasis. However, the status of Vimentin remains unexplored in eyelid sebaceous gland carcinoma (SGC). The study aims to determine status of Vimentin in SGC and its association with EMT markers E-cadherin, ZEB2 and Slug.MethodsVimentin protein expression was undertaken in 66 cases with SGC by immunohistochemistry (IHC). Messenger RNA (mRNA) expression was determined in 42 fresh tissues by quantitative real-time PCR. Association of Vimentin with E-cadherin, ZEB2 and Slug was also analysed. Patients were followed up for 17–69 months (mean 34.02 ± 14.73 months).ResultsIHC revealed Vimentin overexpression in 37/66 (56%) cases. This overexpression showed significant association with lymph node metastasis (p=0.004) and pagetoid spread (p=0.05). Patients with high Vimentin expression also had poor disease-free survival (p=0.033). Univariate Cox regression model indicated that high Vimentin expression (p=0.043) and advanced tumour stage (p=0.002) were independent adverse prognostic factors. High Vimentin mRNA expression was seen in 16/42 (38%) cases and correlated significantly with lymph node metastasis (p=0.027), advanced tumour stage (p=0.002) and large tumour size (p=0.023). Vimentin expression overall showed a significant inverse association with E-cadherin and direct association with ZEB2 expression.ConclusionsVimentin overexpression in SGC is associated with EMT and leads to poor clinical outcome. It also emerged as a novel predictor for lymph node metastasis and poor survival.

BackgroundMicroRNA (miRNA)-200c and miRNA-141 are tumour suppressors, which regulate epithelial-mesenchymal transition (EMT), leading to tumour invasion and metastasis in various malignancies. miRNA-200c and miRNA-141 maintain the epithelial phenotype by post-transcriptionally inhibiting the E-cadherin repressors, zinc finger E-box binding homeobox (ZEB)1 and ZEB2. The present study was performed to determine the prognostic significance of miRNA-200c and miRNA-141, and their association with EMT markers ZEB1, ZEB2 and E-cadherin in eyelid sebaceous gland carcinoma (SGC).MethodsExpression levels of miRNA-200c and miRNA-141 were determined in 42 eyelid SGC cases by quantitative real-time PCR (qPCR). Their association with ZEB1, ZEB2 and E-cadherin was determined by qPCR and immunohistochemistry. Kaplan-Meier plots and Spearman's rank correlation tests were applied to analyse the data. Patients were followed up for 7–44 months.ResultsLow expression levels of miRNA-200c and miRNA-141 were seen in 36/42 (86%) and 28/42 (67%) cases, respectively. Low miRNA-200c correlated significantly with large tumour size (p=0.03) and poor differentiation (p=0.03). Low miRNA-141 correlated significantly with large tumour size (p=0.02) and lymph node metastasis (p=0.04). Survival analysis revealed that patients with low miRNA-200c (p<0.05) and miRNA-141 expression (p=0.07) had shorter disease-free survival. There was a significant association of both miRNA-200c and miRNA-141 with E-cadherin and ZEB2 expression.ConclusionsLow levels of miRNA-200c and miRNA-141 in patients with eyelid SGC facilitates tumour progression by promoting EMT and miRNA-200c has emerged as a novel potential predictor of survival.