Sahil Agrawal

This was a prospective, interventional, comparative study conducted on patients with congenital simple severe ptosis. A novel method of silicone rod fixation to the tarsus (tarsal tunnel technique, group 1) was done compared with a conventional technique of silicone rod fixation (suture fixation technique, group 2) in frontalis suspension surgery. A total of 30 patients were randomized into two groups of 15 patients each. Postoperatively, MRD1, vertical palpebral aperture, and eyelid fold height were comparable in both groups till the last follow-up with stability in eyelid position. Patient satisfaction scores showed similar results with good-fair satisfaction grading in 13 patients in group 1 and 11 patients in group 2 at 6 months follow-up. No significant complications occurred in either group. Tarsal tunnel fixation of silicone rods is a novel method in sling surgery with optimal cosmetic and function outcomes. Further long-term studies are needed to validate the results of the technique.

Waardenburg syndrome (WS) is a genetic disorder that may be discernible right at birth. The syndrome is well known to have heterogeneous expression; the range, and severity of which may vary greatly from case to case, even among the individuals of the same household. Here, we report a 19-year-old female who was initially diagnosed as a case of Blepharophimosis ptosis epicanthus inversus syndrome (BPES) and referred to our subspecialty clinic for undergoing surgery. On examination, she had medial canthal dystopia, telecanthus, synorphys, and similar facial features in a first-degree family member. These features were suggestive of WS. After that, the primary diagnosis was revised; systematic evaluation was performed, surgical correction for her telecanthus was ventured with a favourable outcome. Both WS and BPES may present with similar facial features and thereby pose a clinical dilemma. Such misdiagnosis may hinder proper evaluation and management of any underlying systemic associations.

Purpose: This study aimed to determine the clinical indications for orbital exenteration, demographic profile of these patients, and clinicopathologic correlations in the current times and to compare these results with previous published data. Methods: It was a retrospective study. All exenterations performed at a tertiary eye care center over a period of 20 years (from January 2001 to June 2020) were retrospectively evaluated. Patient records were reviewed to obtain demographic data, presenting symptoms and their duration, laterality, and clinical and histopathologic diagnosis. Results: A total of 352 cases (males:females = 222:130) who underwent exenteration were identified. Patients age ranged from 11 months to 87 years (mean: 43.86 years, median: 50 years). The most common indication for exenteration was found to be eyelid malignancy in 54.36%, followed by retinoblastoma in 18.75% and primary orbital tumors in 14.49%. Out of 156 cases of eyelid malignancies requiring exenteration, squamous cell carcinoma (SCC) was the most common histologic subtype ( n = 94, 60.26%), followed by sebaceous gland carcinoma ( n = 40, 25.64%) and basal cell carcinoma ( n = 20, 12.82%). The most common primary orbital tumors requiring exenteration were adenocystic carcinoma of the lacrimal gland in adults and rhabdomyosarcoma in the pediatric age group. Benign conditions requiring exenteration included fulminant fungal orbital infections and lymphangioma among others. Conclusion: The number of exenterations performed have significantly increased in terms of absolute numbers. However, the ratio of exenteration to other tumor-related surgeries, mainly excision biopsy, has reduced compared to that reported from a previous study. The most common indication in our study remains eyelid malignancy followed by intraocular malignancy. However, SCC has emerged as the most common tumor histologic subtype requiring exenterations.

Purpose: To evaluate the surgical outcome of porous polyethylene orbital implants in anophthalmic sockets with implant migration. Methods: A prospective interventional case series: Patients of anophthalmic sockets with implant migration were recruited, which were replaced with porous polyethylene implants. Patients were evaluated for recurrence of implant migration, ability to wear artificial eye, movement of prosthesis, complications, and satisfaction. Results: Fifteen patients with a mean age of 8.33 years were operated for implant migration. Postoperatively, recurrence of implant migration was seen in one patient. Fourteen patients were able to wear the artificial eye. The overall mean prosthetic motility at 6 months of follow-up was 26% of the contralateral eye. Enophthalmos (>2 mm) and pseudoptosis (>2 mm) were present in 2 patients each. Satisfaction was good in 10 patients and fair in 5 patients. Conclusion: The recurrence of implant migration was almost nil with the use of porous polyethylene orbital implant in a follow-up of 6 months. A majority (93%) of the patients could wear the artificial eye with good satisfaction.

Purpose: This study investigates an intravitreal dexamethasone implant and its efficacy and complications in patients with diabetic macular edema (DME). Materials and Methods: This was a prospective, interventional study involving 30 eyes of 20 patients with DME. Patients' eyes with DME which were pseudophakic with a visual acuity of 6/12 or less and a central macular thickness (CMT) of 300 microns or more on optical coherence tomography were included. Primary efficacy variables were best-corrected visual acuity (BCVA), CMT, and intraocular pressure (IOP), noted at baseline. The patients were followed up and parameters noted at 1 week, 1 month, and 3 months following the implant into the vitreous cavity. Results: Eyes receiving the implant had a significant improvement ( P < 0.001) in BCVA and gained a mean of 6.10 letters on the Snellen chart over the 3-month period. Furthermore, there was a significant reduction in CMT in the eyes receiving the implant. The mean increase in IOP over the 3-month follow-up, although statistically significant, was well within the normal physiological range. Conclusion: The study concluded that intravitreal dexamethasone implant is an effective treatment for DME, and it has a statistically significant and clinically meaningful effect on BCVA and CMT.

Marshall-Smith syndrome (MSS) is an extremely rare developmental disorder characterized by accelerated skeletal maturation, failure to thrive, dysmorphic facies, respiratory difficulties, and neurological abnormalities. Herein, the authors report bilateral proptosis in a 10-year-old child with MSS. At present, there are limited reports on ophthalmologic considerations in MSS; therefore, this article subserves to broaden the clinical spectrum seen in this syndrome.