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Typical ocular coloboma is caused by defective closure of the embryonal fissure. The occurrence of coloboma can be sporadic, hereditary (known or unknown gene defects) or associated with chromosomal abnormalities. Ocular colobomata are more often associated with systemic abnormalities when caused by chromosomal abnormalities. The ocular manifestations vary widely. At one extreme, the eye is hardly recognisable and non-functional—having been compressed by an orbital cyst, while at the other, one finds minimalistic involvement that hardly affects the structure and function of the eye. In the fundus, the variability involves the size of the coloboma (anteroposterior and transverse extent) and the involvement of the optic disc and fovea. The visual acuity is affected when coloboma involves disc and fovea, or is complicated by occurrence of retinal detachment, choroidal neovascular membrane, cataract, amblyopia due to uncorrected refractive errors, etc. While the basic birth anomaly cannot be corrected, most of the complications listed above are correctable to a great extent. Current day surgical management of coloboma-related retinal detachments has evolved to yield consistently good results. Cataract surgery in these eyes can pose a challenge due to a combination of microphthalmos and relatively hard lenses, resulting in increased risk of intra-operative complications. Prophylactic laser retinopexy to the border of choroidal coloboma appears to be an attractive option for reducing risk of coloboma-related retinal detachment. However, a majority of the eyes have the optic disc within the choroidal coloboma, thus making it difficult to safely administer a complete treatment.

Retinal cavernous hemangiomas is a rare vascular tumor, isolated and non-progressive. This tumor is incidentally diagnosed on fundus examination and visual impairment can be rare presentation from vitreous hemorrhage, pre-retinal traction, hyphema, or macular scarring. The tumor has typical appearance of grape-like clusters of dilated vascular sacs with variable surface gliosis. Characteristic imaging findings aids in diagnosis. Newly emerged imaging tool is optical coherence tomography angiography (OCT A) which obtains high-resolution visualization of retinal vasculature in non-invasive fashion. In the present case report, we analyzed various diagnostic tool available for retinal cavernous hemangiomas; illustrating on the OCT A features.

We present a case of persistent macular hole (MH) having an apical diameter of 140 microns and a basal diameter of 530 microns following a combined phacoemulsification and MH surgery. Considering post-operative cystoid macular edema (CME) as the possible reason for the failure of the initial surgery, a trial of IVTA was given. The synergistic effect of mechanical plugging of the hole by TA, coupled with resolution of cystoid changes and falling back of the macular hole resulted in the successful closure of the persistent macular hole with improvement in vision from 20/250 to 20/63.

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA <3/60). Post treatment marginal improvement in CDVA was found (P = 0.46). However, statistically significantly improvement was noticed in IOP (P < 0.00001). Conclusion: Injudicious use of steroids leads to vision threatening complications like ocular hypertension and glaucoma in children of VKC. Weak steroids like loteprednol or fluorometholone should be used instead of higher potency drugs. Vision and IOP should be monitored fortnightly in children using topical steroids to detect steroid responders at the earliest.

Purpose: To report the outcomes of pars-plana approach for the management of brunescent cataract in eyes with severe microcornea and associated chorio-retinal coloboma. Methods: This was a retrospective, single center, interventional case series performed in a tertiary eyecare center in central Medical records of consecutive cases of microcornea with coloboma who underwent pars-plana vitrectomy with phacofragmentation (PF) between January 2015 and December 2017 were reviewed. Results: The study group comprised of 30 eyes of 30 patients, of which 18 (60%) were males and 12 (40%) were females. The mean age of the patients was 41.9 years (range of 17-70 years). The mean corneal diameter was 6.7 mm with a range of 4-8 mm and all the eyes had dense cataract with nuclear sclerosis of grade 4 or more. The mean preoperative visual acuity was 1.97 (+/-0.067) Log MAR and the mean postoperative vision at 1 month was 1.6 (+/-0.39) Log MAR. Postoperatively, 21 patients (70%) gained ambulatory vision. The visual gain in all the patients was maintained over a mean follow-up period of 15.5 months. Conclusion: Pars-plana vitrectomy with PF can be considered in eyes with severe microcornea and brunescent cataracts, where cataract surgery through the limbal (anterior) approach is not only difficult but at times impossible due to anatomical restraints.

Purpose: To assess clinical features, visual outcomes, and setting of mobile battery blast-induced eye injuries in children. Methods: Retrospective case sheets of children with mobile battery blast injuries were reviewed at a tertiary eye care center from January 2015 to March 2022. We noted the mode of injury, battery status, and clinical presentation and analyzed the treatment outcomes. Results: The study included 14 eyes of 11 patients. Three patients (27%) had bilateral ocular injuries. The most common reasons for the blast were wiring a bulb to the battery or charging the battery with a universal mobile charger, seen in four cases each. Three eyes had closed-globe injuries (CGIs), whereas 11 had open-globe injuries (OGIs). Of the 11 eyes with OGI, four also had a retained intraocular foreign body (IOFB). Only four (36%) eyes having OGI could achieve vision better than 6/60. All three eyes with CGIs developed secondary glaucoma, and two underwent trabeculectomy. However, the visual prognosis was better (>6/36) in eyes with CGI. Overall, mean visual acuity at the final follow-up was improved to 1.41 ± 1.14 logMAR from 2.32 ± 0.76 logMAR at presentation. This was also found to be statistically significant with a P value of 0.02. Conclusion: Battery blast-induced ocular injuries, although rare, often lead to poor outcomes. Apart from charging, playing with discarded or damaged batteries was a common reason for battery blasts in our series.

Purpose: To find the accuracy of Scheimpflug imaging for the evaluation of posterior lens capsule and to assess the incidence of pre-existing posterior capsular tear (PCT) in pediatric traumatic cataracts. Methods: It was a prospective, non-randomized, and interventional study. Scheimpflug imaging was done preoperatively to detect pre-existing PCT in pediatric traumatic cataracts after blunt trauma. All patients underwent cataract extraction with intraocular lens implantation. Intraoperatively, the posterior capsule status was noted and compared with the preoperative Scheimpflug images. Results: Forty-seven eyes of 47 children having traumatic cataracts following closed-globe injury were included. There were 32 males and 15 females with a mean age of 10.91 ± 2.75 years. The mean duration of performing the Scheimpflug imaging from injury was 41.7 ± 7.78 days. Preoperative Scheimpflug imaging showed intact posterior lens capsule in 36 eyes and PCT in 11 eyes. Intraoperative, 37 eyes had an intact posterior lens capsule and 10 eyes had PCT. The Scheimpflug imaging did not detect the PCT in three eyes (false-negative), and in four eyes, PCT was detected falsely on Scheimpflug imaging (false-positive). The sensitivity and specificity of the Scheimpflug imaging were 70 and 89.18%, respectively. The accuracy of the technique was 85.11%. Conclusion: Scheimpflug imaging is a useful modality for the detection of PCT preoperatively in cases with doubtful posterior lens capsule integrity.