Negative dysphotopsia (ND) was diagnosed when the mydriatic effect waned off by 4 h after intraocular lens implantation providing time for the institution of immediate rectification measures. ND was a peripheral temporal visual field defect (VFD) and manifested as a 100% black shadow having an inner arc with a sharp, smooth, and concave edge and outer border extending to the temporal periphery. ND disappeared when two fingers were kept blocking the ND over the affected side within ≤1” of the temple. The extent of VFD varied with eye movement. Clinically, intraocular lens is the cause of ND and not neuroadaptation.

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Pseudopterygia are the advancement of the conjunctiva onto the corneal surface in the setting of active or old ocular surface inflammation. Pterygia and pseudopterygia are exceptional conditions in children.^[1] We report a case of a 3-year-old child with a visually significant bilateral double-headed pseudopterygium, which developed following pediatric cataract surgery. The child was managed with pseudopterygium excision with conjunctival autograft and amniotic membrane grafting followed by visual rehabilitation.

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Ophthalmia nodosa is an inflammatory response of ocular tissue to caterpillar hair or any other insect hair that comes in contact with the eye. A young child with a painful red eye was found to have a dead caterpillar embedded in the upper tarsal conjunctiva. We describe the management and the need for creating awareness among doctors for timely suspicion of a foreign body.

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The mainstay management of progressive epithelial cysts spans from fine-needle aspiration of the cyst content to radical en bloc excision. Such a surgical approach may result in cyst rupture, recurrence, or collateral tissue damage. Based on previous experience, we aimed at evaluating the off-label use of topical brimonidine as a conservative measure for treating epithelial cysts of the iris and conjunctiva before commencing a surgical excision. We describe two different cases of epithelial cysts in which topical brimonidine was issued with successful outcome, making the more traditional surgical intervention redundant.

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Rhinosporidiosis is a rare ocular infection and a chronic granulomatous disease caused by Rhinosporidium seeberi. The disease is endemic in India and Sri Lanka but has been known to occur even in colder regions of North America and Eastern Europe. It is most commonly seen as a soft polypoidal pedunculated mass affecting mucus membranes of the nose, pharynx, and conjunctiva. We present a case of a 23 years male who presented with a flat, pedunculated, highly congested mass with a bumpy surface attached at the inferior border of the tarsal conjunctiva. It was initially suspected to be an epithelialized impacted foreign body but when completely excised and sent for histopathological examination revealed rhinosporidiosis. Diagnosis is based solely on microscopic features. Even though a rare clinical entity, it should be borne as a differential in case of any pedunculated conjunctival mass.

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In a prospective proof-of-concept study probing the role of para-inflammation in central serous chorioretinopathy (CSC) pathogenesis, eligible subjects with chronic CSC non-responsive to conventional treatment received a single dexamethasone (DEX) implant monotherapy. Six middle-aged males (mean age = 46.5 ± 10.8 years) with a mean disease duration of 4.5 ± 2.5 years, at the primary efficacy endpoint of six weeks, showed complete resolution of subretinal fluid (SRF) in four out of six eyes, significant reduction of SRF height (174 ± 86 μm to 22 ± 34 μm; P = 0.028) and central subfield thickness (347 ± 139 μm to 180 ± 47 μm; P = 0.003), indicating DEX as a promising treatment option for chronic CSC.

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Fetal valproate syndrome (FVS) results from valproate intake during pregnancy. Children with FVS may have various ocular abnormalities such as refractive error, amblyopia, and strabismus. Congenital pediatric cataract has been reported earlier in two cases. We describe a case of FVS, who presented to us with a bilateral total white cataract. The child underwent bilateral lens aspiration + posterior capsulorhexis + anterior vitrectomy + intraocular lens (IOL) implantation under general anesthesia followed by refraction.

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To report an unusual presentation of calcific band keratopathy and to hypothesize what causes this presentation, as well as its management with ethylenediaminetetraacetic acid (EDTA) chelation using dipotassium-ethylenediaminetetraacetic acid (K2-EDTA). We have conducted a review of the literature on the pathogenesis and treatment of calcific band keratopathy while focusing on the role of hypercalcemia, dry eyes, and corneal exposure. A 53-year-old patient developed an atypical calcific band keratopathy attributed to her ocular and medical history, which included end-stage renal disease (ESRD), hypercalcemia, glaucoma, dry eyes, and chronic use of eye drops. Within two months after starting the administration of oral vitamin D supplements, white/grey opacities appeared on the patient's cornea, as well as hypercalcemia. The patient was instructed to desist vitamin D supplements. Superficial epithelial keratectomy with EDTA chelation using K2-EDTA was performed while abstaining from the limbal opacities. After a 30-day period, the patient's cornea remained clear, and no recurrence of corneal opacities was observed. To the best of our knowledge, this is the first published case that reports this type of unique presentation of calcific band keratopathy. The hypothesis for the reason of the unique clinical presentation of our case will be discussed.

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Topical anti-glaucoma medications are the mainstay of therapy in Glaucoma. All anti-glaucoma medications are associated with adverse effects. As ripasudil hydrochloride hydrate 0.4% is a relatively new drug, we describe a series of patients who developed allergic contact dermatitis after the use of topical Ripasudil. Twelve eyes of seven patients treated with topical ripasudil that subsequently developed allergic contact dermatitis were included in the case series. All seven patients developed itchy, hyperpigmented lesions around periocular areas which got relieved after cessation of the drug.

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Choroidal effusion is a collection of fluid in the suprachoroidal space, which may be rarely seen after few surgical procedures or in unoperated eyes, especially in the settings of hypotony, inflammation, or both. Certain systemic medications such as sulfonamides have been identified to induce sudden myopic shift and acute angle closure glaucoma with ciliochoroidal effusion. We report a case of a 78-year-old man who developed bilateral choroidal effusion on the first postoperative day after an uncomplicated cataract surgery in one eye. The most probable cause was identified to be the consumption of carbonic anhydrase inhibitor in both pre- and postoperative periods, and there was a complete resolution of choroidal detachment after discontinuation of the drug.

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Implantable phakic contact lens (IPCL) exchange or removal is commonly done in case of wrong size implantation leading to either pupillary block glaucoma or cataract, residual refractive error, recurrent uveitis, and endothelial cell loss. Usual time for phakic lens exchange is within 3–6 months after the primary procedure. In this case report, we have shown that IPCL exchange can be considered as an option even after a long period of 7 years in young, high myopic patients, where clear lens extraction and corneal refractive procedure are not recommended.

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Heimann–Bielschowsky phenomenon (HBP) is an unusual condition with a low-frequency, coarse, vertical nystagmoid movement that develops after long-standing profound vision loss in an eye. We report a case of HBP in an eye with a mature senile cataract that resolved spontaneously after cataract surgery. A 50-year-old male presented with a mature senile cataract in his right eye, without any previous history of abnormal movements of either eye. The affected eye was only perceiving hand motions at 2 ft due to the mature cataract, along with an intermittent, slow, vertical nystagmoid movement. The evaluation was consistent with the diagnosis of HBP, and it was decided to proceed with cataract surgery and reassess postoperatively. The patient underwent uneventful cataract surgery with good visual outcome as well as spontaneous resolution of the HBP. To the best of our knowledge, this is the first case of HBP associated with senile cataract, which resolved after cataract surgery was performed.

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Keratoglobus is a rare noninflammatory corneal thinning disorder characterized by generalized thinning and globular protrusion of the cornea. Clinical presentation is characterized by progressive diminution resulting from irregular corneal topography with increased corneal fragility due to extreme thinning. Optical management usually involves in the form of spectacles or contact lenses. Contact lenses provide adequate vision for ectatic cornea without compromising the ocular health. Our case series discusses about the importance of the scleral lens modifications in improving vision as well as preventing corneal hydrops induced by scleral lenses.

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Miscommunication arises when interacting members connect, but one or more of its members in the communication chain does not fully understand what has been conveyed. This can happen for a variety of reasons, including the initiator's inappropriate word selection, existence of communication barrier between the initiator and receiver, the receiver's misperception, and less frequently, the receiver being “off-target” to the communication chain. This case involves a 54-year-old woman with no known comorbid conditions who experienced an acute panic attack just before the start of scheduled cataract surgery, which was managed with abandonment of surgery followed by monitoring and treatment in the intensive care, conducting the departmental root cause analysis, and subsequent performance of uneventful surgery with satisfactory outcome after addressing the root cause.

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Systemic lupus erythematosus (SLE) can have various ophthalmic manifestations, of which a rare but serious association is peripheral ulcerative keratitis (PUK), which can progress to corneal melt and perforation. Adequate immuno-suppression and close follow-up are required in these patients to prevent ocular and systemic progression of disease. We report a case of PUK in SLE which progressed rapidly despite immuno-suppression and required surgical intervention.

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Herein, we report a rare case of persistent corneal epithelial defect (PCED) in a 9-year-old child with floppy eyelid syndrome (FES) and abnormal sleeping position. The boy presented with a two-month history of foreign body sensation in the right eye, a 4 × 5 mm² corneal epithelial defect, irregular astigmatism, a long history of snoring, and intermittent nasal congestion. However, no improvement was observed after basic treatment for one month. The child slept in the prone position and was obese. After changing the sleeping position and undergoing nasal therapy in combination with artificial tear therapy, his corneal epithelial defects disappeared, and corneal astigmatism was reduced.

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Pterygium is a common conjunctival degeneration and surgical excision is the mainstay of treatment. HSV keratitis after ocular surgery has been attributed to various factors including reactivation of latent infection secondary to surgical trauma to the corneal subepithelial nerve plexus and the modulation of the ocular immune response in the postoperative period caused by steroids. In the current case, the patient had persistent epithelial defect which was non responsive to routine topical lubricant therapy and showed a classical dendritic ulcer pattern upon staining with fluorescein dye. Upon initiation of conventional anti-viral therapy, the patient improved and the epithelial defect was gradually healed. HSV keratitis can rarely present as a non-healing epithelial defect after pterygium surgery and a close follow-up in the post-operative period, timely diagnosis and prompt antiviral therapy plays an important role in achieving a favourable clinical outcome in such cases.

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Anterior capsular contraction syndrome can cause a remarkable loss of sight in the postoperative period, requiring early laser or surgical treatment for visual rehabilitation. Despite several studies comparing the outcomes of femtolaser cataract surgery and conventional phacoemulsification, the incidence of anterior capsular contraction after laser cataract surgery is not known. We present a case of severe anterior capsular contraction with total occlusion of capsular opening in a patient after 7 weeks of uneventful femtolaser-assisted cataract surgery, who was treated with neodymium: yttrium aluminum garnet laser anterior capsulotomy. There is no other published report of complete occlusion of femtolaser capsulotomy by capsular contraction and fibrosis.

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Urrets-Zavalia syndrome (UZS) is a rare post-operative condition characterized by a fixed and dilated pupil after ophthalmic surgery. UZS syndrome was first appreciated by Castroviejo and was later published in 1963 by Alberto Urrets-Zavalia in patients who underwent penetrating keratoplasty (PKP). Though there are many risk factors for UZS, the most widely accepted theories are ischemia of the iris and acute rise in intraocular pressure (IOP), with possible spontaneous partial recovery expected in some of them. Contrastingly, permanent UZS was also rarely reported in the literature by Mocan et al. among the pigment dispersion syndrome (PDS) population. In this manuscript, we have reported an unusual presentation of UZS after iStent implantation (Glaukos Corporation, United States) with the following two possible risk factors, namely, acute post-operative IOP spike and pre-existing pigmentary dispersion syndrome condition, which, accordingly to our knowledge, has never been reported in the literature before.

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A 39-year-old adult male presented to the outpatient department of a tertiary care eye hospital with keratouveitis and responded to treatment for viral keratouveitis. On a follow-up, the clinically ulcer suggested fungal keratitis, which was supported by in vivo confocal scan. The episode was managed with antifungal therapy. Tear film polymerase chain reaction (PCR) found cytomegalovirus DNA. Repeated episodes were likewise managed, but ultimately there was stromal scarring which required penetrating keratoplasty. Surprisingly, histopathology of specimen showed microsporidia. Till last follow-up, the graft was clear and the patient had 20/40 vision. Microsporidia should be a differential in refractory stromal keratitis.

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Intraocular cilium is a very rare intraocular foreign body. We report a 24-year-old male patient who presented with self-sealed corneal laceration with retained eyelash in the anterior chamber, following an injury with a plastic object. In view of the anterior chamber reaction, topical and oral steroids were started and surgical removal of the intraocular eyelash was performed.

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We report a case of macular corneal dystrophy with suspected keratoconus on clinical examination in a 20-year-old female. On Scheimpflug imaging, anterior sagittal and posterior sagittal maps were suggestive of keratoconus. Anterior segment optical coherence tomography showed focal areas of hyperreflectivity in the anterior stroma with diffuse thinning. We report this case to illustrate that high astigmatism and thinning, commonly present in macular dystrophy, may have features suggestive of keratoconus. Corneal haze precludes an accurate assessment of the posterior corneal curvature.

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Orbital emphysema (OE) is an uncommon, benign, and self-limiting condition that results from trapping of air in loose periorbital subcutaneous tissues. We report a series of five cases of OE, four post traumatic, and one after forceful nose blowing. They presented with acute periorbital swelling. The clinical diagnosis was confirmed on imaging promptly. They were counseled to keep a keen eye for any signs of deterioration and kept on close follow-up. Some key clinical and radiological clues which indicated a relatively low risk of deterioration were noted, so they were conservatively managed with cold compression, avoidance of nose blowing/sneezing, nasal decongestants, oral antibiotics, and anti-inflammatories. Complete resolution of symptoms occurred within 2–3 weeks. Timely diagnosis, thorough patient counseling, conservative management, close monitoring, and expedient surgical intervention on deterioration are keystones in OE management.

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Peli prisms are Fresnel prisms for visual field expansion in homonymous hemianopia. They can be dispensed as temporary (press-on) or permanent prisms. In this case series, we discuss the general fitting techniques and report fitting Peli prisms in four unusual scenarios. We show that children and one-eyed patients can be fit with Peli prism. Peli prism can be fit over safety goggles, but fitting in progressive addition lenses can be challenging. Careful counseling, setting realistic goals, giving a proper Peli prism trial, orienting for spatial mislocalization, and demonstrating the visual field expansion are all key ingredients to achieve success.

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The authors describe the first case report of management of central serous chorioretinopathy (CSCR) associated with subretinal fibrin deposition by intravitreal injection (IVI) of brolucizumab in a 45-year-old male. At 3 months, his best-corrected visual acuity (BCVA) improved from 20/200 to 20/80. On fundus evaluation, there was complete resolution of the subretinal fluid (SRF) and fibrin, which was confirmed on spectral-domain optical coherence tomography (SD-OCT). There were no reports of ocular or systemic adverse effects. Increased flux and permeability of the retinal pigment epithelium secondary to anti-vascular endothelial factor (anti-VEGF) injection agent can explain the migration of the fibrin toward the choroid and its resolution. Further molecular and clinical studies are warranted to better understand the role of brolucizumab in the management of fibrinous CSCR.

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We report the first case of cyanopsia following implantation of a non-diffractive extended depth-of-focus (EDOF) intraocular lens (IOL). A 79-year-old male artist underwent cataract extraction with a non-diffractive EDOF ultraviolet absorbing toric IOL (Alcon AcrySof IQ Vivity DAT315) and then experienced persistent cyanopsia in fluorescent lighting following surgery. His symptoms persisted and were visually debilitating. He underwent secondary IOL exchange with a yellow-tinted non-diffractive EDOF toric IOL (Alcon AcrySof IQ Vivity DFT315) and the recurrent cyanosis abated. Surgeons should be aware of cyanopsia following implantation of ultraviolet absorbing IOLs and be prepared to address these complaints should they arise.

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The authors describe the first case report of spontaneous closure of full-thickness macular hole (FTMH) in a 74-year-old female patient with macular neovascularization (MNV) secondary to age-related macular degeneration (AMD) after intravitreal injection (IVI) of brolucizumab. A significant improvement in the pigment epithelial detachment (PED) morphology seems to have facilitated the hole closure by relieving the centrifugal traction onto the overlying retina. Another proposed mechanism for hole closure is glial cell proliferation caused by the brolucizumab molecule acting on the underlying MNV. However, more histologic validation is needed to confirm the same.

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We report a rare case of keratoconus (KC) progressing to advanced stage in a pregnant female with previously stable KC managed with collagen cross-linking 7 years back. A 26-year-old female first visited during the second month of her pregnancy with stable KC managed with collagen cross-linking 7 years back. She was found to have corneal melt with haze and was advised to undergo keratoplasty surgery. However, the patient was not willing for that, and the surgery was deferred. After 4 months, the patient came with similar complaints. On examination, the corneal melt was advanced and the patient was suggested surgery again. However, she again deferred the surgery. At the eighth month of pregnancy, the patient came with advanced melt with well-epithelized descemetocele, which was then successfully operated on an emergency basis with full-thickness penetrating keratoplasty.

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We report a case of epithelial ingrowth (EI) after traumatic corneal lamellar laceration in a 57-year-old woman with a history of corneal trauma on her left eye (LE) 1 month before. On examination, best-corrected visual acuity (BCVA) was counting fingers at 1 m. Slit-lamp biomicroscopy showed a partial thickness corneal laceration with an undisplaced flap with EI within the flap–stroma interface. Since the EI affected the visual axis, we performed mechanical debridement. BCVA of the LE improved to 0.6 at 1 year postoperatively without recurrence of EI and with good flap apposition. We conclude that timely surgical debridement of posttraumatic EI can result in a favorable visual outcome.

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Ozurdex^® (Allergan, Inc., Irvine, CA, USA) is an intravitreal sustained-release drug delivery system containing dexamethasone, mainly used for the treatment of macular edema in diabetes, retinal vein occlusions or treatment of non-infectious posterior uveitis, as approved by the US FDA. It can be implanted into the vitreous cavity via the pars plana route. Migration of this implant into the anterior chamber may occur in cases of aphakia, pseudophakia with defective lens capsule, zonular dehiscence, iatrogenic, or as in pseudoexfoliation syndrome. We report a case of a pseudophakic patient with intact posterior capsule and no significant history suggesting a zonular weakness, who presented with diminution of vision due to anterior migration of the dexamethasone implant and its effects on the cornea. Measurements of specular microscopy provide useful information which may aid in management pre- and post-removal of migrated implant.

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A 43-year-old man presented with a painful left proptosis 6 years after he had had orchiectomy for a mixed germ cell tumor. He also previously developed pulmonary and brain metastases, which were treated with chemotherapy and radiotherapy. Magnetic resonance imaging studies revealed an irregular mass confined to the left superior orbit. The neoplastic cells stained positive for human placental lactogen and sal-like protein 4 but negative for Alpha fetoprotein (AFP), CD30, and octamer binding transcription factor 3/4, compatible with metastatic choriocarcinoma. A painful mass located in the superior orbit in a young man must arouse the suspicion for a metastatic testicular carcinoma.

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Christmas tree cataract has rarely been described. It is characterized by a polychromatic luster, the exact etiology of which is unclear. Postulated causes for this include the possible role of cholesterol or calcium deposition. We describe a case of a unilateral Christmas tree cataract in a patient who underwent cataract surgery and highlight the role of Scheimpflug and anterior segment optical coherence tomography (ASOCT) in complementing the clinical diagnosis. Further, biochemical analysis of the lens matter revealed an increase in calcium and cholesterol.

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The authors describe a case of an 82-year-old female with type 3 macular neovascularization (MNV) who underwent a single-dose of intravitreal injection (IVI) of brolucizumab at baseline. The patient demonstrated significant visual improvement from 20/400 at baseline to 20/32 at 3 months without any significant adverse events. Notably, there was complete resolution of the subretinal fluid (SRF), intraretinal fluid (IRF), and subretinal hyperreflective material (SHRM) at 1 month postinjection, which was maintained for up to 3 months. Further prospective studies with a larger sample size are warranted to better understand the morphological and visual responses of type 3 MNV to brolucizumab therapy.

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Keratoconus (KC) is a multifactorial disease with numerous associated systemic disorders. Hormonal dysfunction is commonly identified as a risk factor in the progression of KC. However, KC is very rarely known to be associated with congenital uterine anomalies. We present a case report of a 34-year-old female diagnosed with bilateral KC with hypoplastic uterus and septate vagina, albeit with normal sex hormonal parameters. Recognizing the existence of this rare association will encourage the diagnosis of such cases in futurity. Also, it is mandatory to do karyotyping in these cases to rule out the risk of developing gonadoblastoma.

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A 72-year-old lady complained sudden-onset loss of vison in the left eye after falling from bed. She was only able to perceive light from the left eye. Anterior segment examination showed a solid subconjunctival mass in the superonasal quadrant adjacent to limbus, suggestive of anterior phacocele. Ultrasound B-scan confirmed the diagnosis, and patient was taken for surgery which led to good visual recovery. Appropriate and timely diagnosis and management of such cases can improve prognosis of such cases.

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Penetrating ocular injuries following direct impact of fish are rare. A 26-year-old man presented to the emergency department with history of pain and blurring of vision following injury to the left eye due to the impact of glass perchlet fish. Ocular examination revealed best corrected visual acuity of log of minimum angle of resolution (logMAR) 0.18, eyelid edema, blepharospasm, and circumcorneal congestion. A full-thickness corneal laceration measuring 3 mm, confirmed by positive Seidel's test, and a partial-thickness corneal laceration measuring 1.5 mm were noted. Patient was managed by application of cyanoacrylate glue and bandage contact lens. We report the first case of corneal perforation by glass perchlet fish.

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We describe the long-term outcomes of two patients who underwent toric intra-ocular lens (IOL) implantation for cataract with post-keratoplasty astigmatism. At 6 years, the IOL was found to be stable with a rotation of less than 2°. Neither of our patients had graft rejection after IOL implantation. There was no significant increase in the corneal thickness, and graft clarity was maintained. The endothelial cell loss in our patients was 10.8% at 1 year, 13.2% at 2 years, and 7.8% at 6 years in case 1 and 9.3% at 1 year, 12.4% at 2 years, and 37.3% at 6 years in case 2.

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A 21-year-old healthy male presented with loss of vision associated with metamorphopsia in the right eye of 6 weeks duration. The patient was a known case of best vitelliform macular dystrophy in both eyes. Clinical and imaging studies lead to a diagnosis of the choroidal neovascular membrane (CNVM). The diseased eye was treated with a single dose of intravitreal brolucizumab. Significant gains in visual acuity and reduction in the subretinal fluid were noted over 2 months of follow-up. Intravitreal brolucizumab can be an effective option in treating CNVMs associated with macular dystrophy.

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Idiopathic intracranial hypertension (IIH) is commonly seen in females of reproductive age (15–45 years). Here, we report a unique case of a 22-year-old female presenting with complaints of headache and vomiting with a history of polycystic ovarian syndrome for which she was on treatment. The patient had bilateral optic disc edema on fundus examination. Hematological investigations showed severe iron deficiency anemia with hemoglobin 3.7 g/dl. Lumbar puncture showed raised cerebrospinal fluid opening pressure of 270 cm of H₂O. Magnetic resonance imaging brain showed partially empty sella and T2 hyperintensity in optic nerve canal, suggestive of IIH. The patient was treated subsequently with blood transfusion followed by iron therapy. After treatment, she showed drastic improvement with the resolution of papilledema and normalization of visual field analysis. Our findings emphasize the importance of hematological investigations and prompt treatment in IIH, which ensure a better prognosis by shortening the disease course.

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A 38-year-old male presented with complaints of gradual and painless diminution of vision in both the eyes for 1 month. He also had a history of on and off diarrhea for the past 4 months. He was a known case of latent auto-immune diabetes mellitus. Ophthalmic examination showed bilateral conjunctival xerosis and inferior corneal ulceration with stromal edema and Descemet's folds. With the suspicion of vitamin A deficiency-induced keratomalacia, a complete workup was performed. He turned out to be a case of chronic calcific pancreatitis, and stool test was also positive for steatorrhea. The patient was started on oral vitamin A supplementation. Topical lubricants and prophylactic antibiotics were also started in both the eyes with the application of bandage contact lens. Visual acuity improved within a period of 2–3 weeks of treatment and is now on regular follow-up.

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A 58-year-old male presented with a progressive decrease in vision after he received intravitreal ozurdex injection 6 months ago for diabetic macular edema. Visual acuity in the right eye and left eye was 20/630 and 20/125, respectively. The right eye lens showed intralenticular dexamethasone implant. Intraocular pressure was 40 mmHg in the right eye and 16 mmHg in the left eye. Fundus examination revealed nonproliferative diabetic retinopathy with macular edema in both eyes. As the patient's intraocular pressure was not controlled by maximum medical therapy, he was listed for phacoemulsification with intraocular lens implantation.

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A 68-year-old lady was referred for evaluation of bilateral hypopyon uveitis by her ophthalmologist. She had a history of bilateral cataract surgery 8 months ago and had received intravitreal dexamethasone implants for recurrent bouts of anterior uveitis with cystoid macular edema (CME) in both eyes 4 months ago. Systemic history was significant for diabetes mellitus and recurrent skin lesions. Aqueous tap was negative for infection on culture and polymerase chain reaction (PCR). Skin biopsy showed non-necrotizing granulomas, negative for Mycobacterium tuberculosis and fungi, suggestive of sarcoidosis. She received oral steroids and methotrexate, which resulted in resolution of ocular and skin lesions. This case highlights a rare presentation of hypopyon in ocular sarcoidosis.

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A child with bilateral advanced steroid-induced glaucoma and uncontrolled intraocular pressure (IOP) on maximum medical therapy underwent trabeculectomy surgery. The eye developed a dense anterior chamber inflammation with a high IOP in the postoperative period, which was managed medically. The IOP got controlled in the following visits, but the pupil remained mid-dilated, fixed, and nonreactive to pilocarpine, and a provisional diagnosis of Urrets-Zavalia syndrome was made. Urrets-Zavalia syndrome is a rare postsurgical complication characterized by a fixed dilated pupil with iris atrophy. This is the first such case reported in a pediatric patient following trabeculectomy.

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Familial exudative vitreoretinopathy (FEVR) is a rare inherited slowly progressive disorder characterized by failure of vascularization of the peripheral retina and poor vascular differentiation. Retinitis pigmentosa (RP) is a group of clinically and genetically heterogeneous inherited retinal disorders characterized by diffuse progressive dysfunction of predominantly rod photoreceptors with subsequent involvement of cone photoreceptors. A 13-year-old boy presented with nyctalopia and low vision for 10 years. Fundus evaluation showed retinal pigmentary changes in the mid-periphery. The fundus fluorescein angiogram showed straightening of retinal vessels, vascular leakage, and avascularity of the peripheral retina, suggestive of FEVR. Full-field electroretinogram (FFERG) showed grossly reduced scotopic and photopic responses in both eyes, pointing toward retinitis pigmentosa (RP). To the best of our knowledge, this case is the second one internationally, and the first in India to show the coexistence of FEVR and RP in the same patient.

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Evans syndrome (ES) is a rare disease characterized by simultaneous development of autoimmune hemolytic anemia and immune thrombocytopenia with or without immune neutropenia. We report the first case of ES presenting as retrobulbar neuritis. Purpose of this report is to create awareness about ES. A 25-year-old female presented with sudden painful loss of vision. Neuroimaging confirmed retrobulbar neuritis. She had menorrhagia and iron-deficiency anemia. She had pallor, hepatosplenomegaly, and hemolytic anemia. She was treated with intravenous steroids. ES is a disease of high morbidity.

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Vitreous prolapse and intraocular lens decentration following neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy is rare. We report a case of a patient who developed blurring of vision, due to vitreous prolapse and decentration of the intraocular lens, following Nd:YAG laser capsulotomy for posterior capsular opacification (PCO), which was restored to complete visual recovery with surgical management. The report aims to highlight the importance of precise focusing, usage of minimum optimal power required, and appropriate sizing of Nd:YAG laser posterior capsulotomy. Although Nd:YAG laser posterior capsulotomy is a safe procedure for treating PCO, it is not free from complications.

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Ocular dog bite injuries are reported mostly in children and are commonly associated with severe adnexal injuries. We studied six ocular dog bite injuries that presented in the emergency unit of a tertiary institute within six hours of injury between April 2021 and March 2022. All patients had lid laceration and one case had canalicular tear with severe tissue loss in the lower lid. Wound apposition was done with loose sutures on skin and minimal trauma to tissues. Wound healing was good in all cases. This approach of lid injury repair helps to reduce chances of infection while achieving good cosmesis.

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We report a case of a middle-aged woman who presented to us 8 months after a road traffic accident with the complaint of binocular diplopia. She had limitation of elevation and depression of OD with ptosis, which improved on OD adduction. She underwent (OD) lateral rectus (LR) transposition to superior rectus with Foster augmentation, (OS) LR recession under adjustable suturing technique – 9 mm (5 + 4), and medial rectus (MR) plication 6 mm under local anesthesia. LR was re-recessed by 1 mm the next day. Postoperatively, at 3 months, prism bar cover test showed orthophoria for distance and near in primary gaze with − 3 limitation of elevation in OD.

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A 19-year-old male presented with night blindness and gradual diminution of vision since 5 years. Clinical examination and investigations revealed bilateral atypical retinitis pigmentosa (punctata albescens) with foveal atrophy and optic disc drusen. On general examination, patient had central obesity, post-axial polydactyly and brachydactyly in upper and lower limbs, hypogonadism, cognitive deficit, and speech impairment, which were suggestive of Bardet–Biedl syndrome. This is a rare case of Bardet–Biedl syndrome with atypical retinitis pigmentosa (punctata albescens) and bilateral optic disc drusen.

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Medulloepithelioma is a rare nonhereditary tumor seen most often in children, usually in the first decade. In this paper, we present a case of extensive unresectable medulloepithelioma with neovascular glaucoma and anterior chamber seeding, which was confirmed histopathologically by performing biopsy and successfully managed using plaque brachytherapy along with a review of literature on brachytherapy in medulloepithelioma. The unique features in our case are extensive tumor, with anterior chamber seeding and neovascular glaucoma which have been successfully managed with brachytherapy. Also, the placement of brachytherapy plaque over the corneal surface has not been described previously for managing extensive medulloepithelioma. So far, brachytherapy has been tried in only three cases with concomitant neovascular glaucoma, of which two cases required subsequent enucleation.

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Orbital abscess secondary to dacryocystitis is rare.^[1] Morganella morganii is a gram-negative rod and a facultative anaerobic enteric bacterium causing opportunistic infection, often isolated as a cause of nosocomial infection, specifically in urinary tract or wound infections. Risk factors may be old age, presence of concomitant bacteremia, hospitalization, recent surgery, concurrent antibiotic use, and immunocompromised hosts.^[2] According to authors' knowledge, till date, only one case of orbital abscess due to M. morganii has been reported secondary to sinusitis. There are no reports of orbital abscess due to M. morganii following dacryocystitis till date.^[3] We report a rare case of orbital abscess secondary to dacrocystitis caused by M. morganii and Klebsiella pneumoniae in an immunocompetent patient.

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This report describes the changes in the higher-order aberrations (HOAs) and modulation transfer function (MTF) in anterior lenticonus in a case of Alport syndrome managed by using extended depth of focus (EDOF) IOL. The patient was a 23-year-old male complaining of diminution of vision in both eyes and had a best-corrected visual acuity (BCVA) of 6/24 and 6/18 in the right and left eye, respectively. Slit-lamp examination revealed anterior lenticonus in both eyes. Optical coherence tomography showed temporal retinal thinning, and aberrometry revealed increased HOA and a reduction of MTF. The patient underwent sequential, bilateral, clear corneal phacoemulsification with EDOF IOL implantation. Postsurgery, improvements in BCVA and MTF with a significant reduction in HOA were noted. To conclude, the EDOF lens is a viable option for implantation in cases of Alport syndrome with anterior lenticonus.

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A 73-year-old lady presented with complicated cataract, white tumor hypopyon, and an elevated, nonpigmented mass at the root of iris. Magnetic resonance imaging (MRI) revealed ciliary body involvement suspicious of atypical melanoma. Patient underwent enucleation. Histopathology with immunohistochemistry (IHC) markers clinched the diagnosis of diffuse large B-cell lymphoma (DLBCL) of ciliary body, with positive lymphoma markers CD20, CD3, BCL2, and PAX5 and negative melanoma markers HMB45 and S100. Primary lymphoma of ciliary body, especially the DLBCL type, is rare. Our report shows that primary lymphoma of ciliary body may be considered as a differential in cases with atypical features. Histopathology and immunohistochemistry are valuable tools in diagnosing challenging cases.

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Persistent fetal vasculature may present as anterior, posterior, or mixed type. Its typical features include microphthalmia, retrolental fibrovascular membrane, stretched ciliary processes, Mittendorf dot, total cataract, and Bergmeister papilla. Atypical features described in literature are axial myopia, platyphakia, lentiglobus, and a normal sized cornea. Platy-phakia (Flat-Lens) is a term commonly used for antero-posteriorly flattened crystalline lens. It is a described but extremely rare finding in Persistent Fetal Vasculature and may represent absorption of the lens with fusion of vestigial lens remnants with retrolental fibrovascular membrane.[1] The spectrum of unusual features may also include unregressed vascular vesicular cataractous lens. The visual prognosis in PFV is generally guarded owing to the developmental anomaly and associated amblyopia, strabismus, glaucoma, and retinal pathologies.

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Anterior segment dysgenesis (ASD) is a spectrum of disorders affecting the anterior chamber structures and is frequently associated with glaucoma and corneal opacity. It usually has bilateral presentation. We report a case of a 22-year-old male with unilateral Peters anomaly. However, on detailed examination, trabeculodysgenesis was noted in the fellow eye. This highlights the importance of a complete bilateral ocular examination with gonioscopy even in unilateral congenital ASD, which can aid in early diagnosis and management.

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Macular telangiectasia is characterized by bilateral alterations of the macular capillary network and neurosensory atrophy, but it is very rarely associated with macular edema. Presented here is a case with bilateral macular capillary telangiectasias with severe macular edema and subretinal fluid accumulation. Here, a proposed mechanism for the injury to the capillaries, causing telangiectasias and edema, is the toxicity of drug diethylcarbamazine, which the patient had been self-administering for lymphatic filariasis for 20 years. The drug at increased concentrations is known to accentuate free radical–mediated cellular injury by inhibiting the lipooxygenase pathway.

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Neodymium-ytrrium aluminium garnet capsulotomy is the gold standard for the treatment of posterior capsular opacification and is most commonly performed as an outpatient procedure. Here, the authors report a rare and probably the first encounter of a complication post laser capsulotomy seen in a 54 years old female who presented with defective vision and pain for 6 months after the procedure. Examination revealed one of the haptics of intraocular lens piercing through the iris into the anterior chamber, causing chronic inflammation leading to cystoid macular edema. The exact position of the intraocular lens and it's haptics were confirmed using anterior segment optical coherence tomography.

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Congenital toxoplasmosis is asymptomatic in 85% of the cases and can flee detection due to a lack of a standard screening protocol. Management of foveal-threatening Toxoplasma retinochoroiditis is critical and involves pyrimethamine and sulfadiazine as the first-line treatment, but safer drugs like clindamycin and azithromycin are also available. We report two cases of bilateral congenital Toxoplasma retinochoroiditis in infants who were screened in the newborn intensive care unit (NICU), to highlight the importance of timely treatment with a combination of steroids and antibiotics in order to prevent vision-threatening sequelae.

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Intravitreal clindamycin is one the modalities in managing ocular toxoplasmosis. Here we report clindamycin-induced macular infarct followed by full thickness macular hole with epiretinal membrane and macular atrophy. A 54-year-old male diagnosed with ocular toxoplasmosis in the right eye was treated with intravitreal injection of clindamycin and dexamethasone. Patient developed macular infarction with epiretinal membrane (ERM) and full thickness hole, with corresponding decrease in visual acuity and was managed with vitrectomy. Clindamycin injection has potential to cause retinal complications, and hence, one needs to be extremely cautious while preparing the proper concentration of clindamycin as it requires appropriate dilution.

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A 20-year-old woman with facial features of DiGeorge syndrome came for a regular ophthalmic examination. She had hypoparathyroidism with hypocalcemic tetany and severe anemia but no cardiac anomalies. On ophthalmic examination, the visual acuity was 6/6 OU. She had bilateral eyelid hooding, ptosis, esophoria, posterior embryotoxon, and dilated, tortuous vessels with disc edema in the fundus. Bilateral vascular tortuosity and disc edema could mimic established papilledema or plus disease, which has significant treatment implications. Hence knowledge of ocular and systemic features is essential in providing recommendations for DiGeorge syndrome.

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Idiopathic intracranial hypertension (IIH) is a rare but potentially severe condition causing visual loss. Use of many drugs has been associated with the occurrence of IIH. We report the case of a 47-year-old female treated with risperidone for schizophrenia who presented with features of IIH. Withdrawing the offending drug, in addition to acetazolamide, drastically improved her symptoms within a month. We report this rare case to emphasize that a commonly used atypical antipsychotic medication (risperidone) can rarely cause IIH.

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A seven-year-old boy with a known case of bilateral rubella retinopathy presented to us as part of his annual follow-up. Best-corrected visual acuity (BCVA) at presentation was 20/80 in the right eye and 20/600 in the left eye. On dilated fundoscopy, the right eye showed the presence of subretinal neovascular membrane (SRNVM), subretinal fluid, and classical salt-and-pepper retinopathy, all of which was documented by imaging. The left eye was poorly dilating and showed a pale disc. The right eye was treated with two doses of intravitreal ranibizumab at an interval of two months. Post-treatment examination showed resolution of SRNVM accompanied by scarring and significant improvement in BCVA.

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NA-AION is the most common ischemic optic neuropathy, with an incidence rate of 2.5–11.8 per 1,00,000 in the population older than 50 years. Patients at high risk of complications due to carotid atherosclerosis may only present with ophthalmic symptoms initially. We report here a case of a 52-year-old male with disk pallor, provisionally diagnosed as NAAION. On examination, his BP was raised, and had raised ESR and hypercholesterolemia on his blood work. CT Carotid angiogram revealed attenuated internal carotids on the side of involvement with a small eccentric hypodense plaque in the common carotid. This case report of frequently diagnosed NA-AION has been shared to lay emphasis on the importance of a thorough systemic workup in these patients, as their association with systemic illnesses like stroke and obstructive sleep apnea is well known. It will help in not only saving the other eye but also their lives from such life-altering diseases.

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We report a case of retinitis pigmentosa (RP) coexisting with acute central serous chorioretinopathy (CSCR) with pachychoroid phenotype. A 37-year-old male showed clinical features of RP in both eyes with acute CSCR in the right eye. Fundus fluorescein angiography showed ink blot hyperfluorescence with focal leakage, which was successfully treated with focal laser. Both eyes showed features of pachychoroid. RP and CSCR occurring simultaneously is very rare and there are only a few reports published in literature, but none with pachychoroid features. We report the first case of RP with acute CSR with pachychoroid phenotype and comment on its treatment outcome.

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Intraocular lens (IOL) opacification after cataract surgery has been widely reported, but opacification during pars-plana vitrectomy (PPV) has not been reported. In our case, a 59-year-old male patient underwent PPV. During the surgery, IOL was found to be cloudy, and the area accounted for half of IOL. The surgical field was not affected. At the end of surgery, the degree of opacification decreased significantly. On the first day after surgery, IOL was completely transparent. IOL opacification may be caused by condensation and does not affect retina observation during PPV. It is not necessary to remove and replace the IOL immediately.

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Traumatic macular holes (MHs) still have a guarded prognosis. Whether spontaneous closure or early surgical intervention leads to a more favorable outcome is unclear. Topical therapy with carbonic anhydrase inhibitors was reported to be a non-invasive but effective treatment for traumatic MHs. A 17-year-old boy, whose face was injured by a firework explosion, presented to our emergency department with decreased vision in his left eye (20/125). A bio-microscopic examination revealed a vitreous hemorrhage that partially obscured the fundus. Optical coherence tomography (OCT) revealed an MH in the fovea with mild intra-retinal edema and juxtafoveal outer retinal layer alterations. Dorzolamide (2%) was administered four times per day. Two weeks later, OCT revealed a closed MH, and the patient's visual acuity had improved to 20/30 at 2 months following the incident. Topical aqueous suppression therapy may potentiate the closure of traumatic MHs by reducing the amount of intra-retinal fluid. It can serve as a non-invasive therapy for small traumatic MHs, especially those with the intra-retinal fluid, or as a temporary therapy before a scheduled operation.

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Adenocarcinoma of Moll is an unusual but dangerous tumor that rarely affects apocrine palpebral glands. In this work, we report an atypical presentation of palpebral Moll adenocarcinoma and discuss the anatomopathological diagnostic criteria. As its prognosis is poor owing to its capacity to invade other tissues, we emphasize the importance of performing an extension study on this patient. Expanding the sample size of reported tumors will be useful in defining their clinical characteristics and establishing guidelines for follow-up and treatment. Additionally, we present a review of the cases reported in the literature.

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The effect of vitrectomy on the course of dry age-related macular degeneration (AMD) in eyes with full-thickness macular holes (FTMHs) is not well understood and has been variably reported in existing studies. The phenomenon of disappearance of confluent soft drusen (drusenoid pigment epithelial detachment [PED]) after macular hole surgery is, however, a rarely reported occurrence. We report a case of a 61-year-old female patient with a large full-thickness macular hole of minimum diameter 586 μm with an underlying drusenoid PED, who underwent a pars plana vitrectomy with inverted internal limiting membrane flap and 20% sulfur hexafluoride gas injection. The macular hole was successfully closed along with collapse of the underlying drusenoid PED during the postoperative follow-up period.

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A 50-year-old male presented to the emergency ophthalmological service with amaurosis fugax in his right eye. A patent foramen ovale (PFO) was confirmed using transthoracic echocardiography. The patient underwent a PFO closure surgery. Postoperative transesophageal echocardiography revealed no obvious residual shunts. There was no recurrence of amaurosis fugax in the right eye during the follow-up period of more than two years. A PFO with ophthalmic and visual sequelae is an important emerging association. Such cases benefit from early referral to a cardiology specialist. Prompt diagnosis and treatment will help avoid unnecessary ocular or nonocular embolic events.

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Retinal hemorrhages are rare in optic neuritis. We report a case of atypical optic neuritis with widespread retinal hemorrhages. A 30-year-old Indian woman presented with sudden painful and severe visual loss in the left eye for 3 days. Fundus examination showed minimal optic disk edema associated with intraretinal hemorrhages extending to the periphery in the left eye. On neuroimaging, long segment thickening of the intraorbital segment of the left optic nerve was appreciated with T2 hyperintensity. Serum myelin oligodendrocyte (MOG) antibodies and neuromyelitis optica (NMO) antibodies were negative. Visual acuity improved rapidly after the administration of intravenous high-dose steroids, and fundus abnormalities resolved rapidly. Retinal hemorrhages can also be present in atypical optic neuritis in the absence of severe optic disk edema. Clinicians should be mindful of the variable presentations of optic neuritis to initiate proper and timely treatment.

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A four-year-old female presented to the department of ophthalmology with history (given by the mother) of noticing drooping of the left upper lid and small eye since birth. On examination, the patient was found to have mild ptosis, miosis, and mild iris hypochromia of the left eye. A diagnosis of Horner's syndrome was made. Retrospective evaluation revealed that the patient was diagnosed as a case of tracheoesophageal fistula (TEF) and esophageal atresia on first day of life and underwent surgical intervention on the second day of life. We present this case as that of diagnostic challenge with respect to the etiology of Horner's syndrome.

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Choroidal tubercles in miliary tuberculosis have been rarely reported. A 65-year-old male diagnosed with miliary tuberculosis was started on antitubercular therapy (ATT) and referred for fundus screening, which revealed lesions suggestive of choroidal tubercles and pigment epithelial detachments (PEDs), confirmed by optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). Choroidal tubercles were identified in Enhanced Depth Imaging-Spectral Domain-Optical Coherence Tomography (EDI-SD-OCT) as nodular hyperreflective lesions with thickening of overlying choriocapillaris– Retinal Pigment Epithelium (RPE)–Bruch's complex, myoid–ellipsoid junction disruption, and increased choroidal thickness. Choroidal thickening and PED decreased following ATT. EDI-SD-OCT is the investigative tool of choice to identify choroidal tubercles and inflammation. EDI-SD-OCT can be utilized as a biomarker in choroidal studies. PED may result due to choroidal inflammation.

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After orbital trauma, medial rectus (MR) and inferior rectus (IR) muscles are the most frequently injured, while the oblique muscles are the least frequently injured. This can be probably because of the anatomical specifications of these muscles within the orbit. It is very unusual to find an isolated muscle injury or hematoma without any other orbital or ocular damage. We report here the case of a 7-year-old boy who presented with an isolated superior rectus muscle (SRM) hematoma after a blunt orbital trauma.

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Goltz syndrome or focal dermal hypoplasia is a rare meso-ectodermal, X-linked dominant genetic disorder with female preponderance. Though the involvement of multiple systems is present, the hallmark of this syndrome is typical cutaneous features. Here, we report a unique case of Goltz syndrome in a 21-year-old male who presented to us with multiple growths on the palpebral conjunctiva of the right eye along with abnormal ice pick–type lesions on the skin. No significant family history was present. The affected eye also had iris and choroidal coloboma. Mild mental retardation and gingival hyperplasia were noted on systemic examination. Being a multisystem disorder, an ophthalmologist should be aware of its extraocular manifestations that can be fatal.

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We report an unusual presentation of ocular cysticercosis in a 30 year old female who presented with diplopia and hypertropia of left eye for 1 month, wherein cysticercus cellulosae cyst was found within the mass of the left inferior rectus muscle. After 7 days of presentation, the diplopia and corresponding hypertropia recovered on its own as the cysticercus migrated spontaneously to the subcutaneous tissue of the lower eyelid. It becomes important to report this case because of the rarity of the migration of cysticerci from the muscle in orbit to the subcutaneous tissue in the eye, which in itself is an unusual presentation.

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Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome or reversible posterior cerebral edema syndrome, is a reversible neurological condition characterized by headache, altered mental status, visual disturbances, seizures, and unconsciousness. It is a clinic-radiological entity with characteristic features on neuroimaging. We present a case of a young antenatal term patient with pre-eclampsia who had no previous history of hypertension. She underwent a cesarean section and in the post-natal period developed sudden bilateral severe vision loss without seizure because of PRES. The visual loss was reversible and improved on systemic and supportive anti-hypertensive patient.

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Orbital fat prolapse (OFP) is the herniation of intraconal fat into the subconjunctival space, which occurs mostly in the superotemporal quadrant and is more common bilaterally. We report a rare case of unilateral inferotemporal OFP and its anterior segment optical coherence tomography (ASOCT) features. On ASOCT, the lesion appeared uniformly smooth with no definite capsule. Fat lobules appeared hyporeflective, while the interlobular septae appeared hyperreflective. A hyporeflective space was noted, separating the fat and the overlying conjunctival stroma. This space was, however, obliterated in the areas corresponding to the maximum convexity of the lobules. These ASOCT findings correlate with the described histopathologic features of the OFP described in literature. Inferotemporal OFP and corresponding ASOCT features, to the best of our knowledge, have not been reported previously. We also propose its role in documenting progression that can aid in surgical decision-making.

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A 57-year-old male presented with a fleshy mass encroaching on the limbus in the right eye. With a clinical diagnosis of invasive squamous neoplasia, topical interferon-alpha was started. Since the patient had unremitting pain, exenteration was done. Histopathology revealed conjunctival spindle cell neoplasia, and immunohistochemistry markers favored malignant peripheral nerve sheath tumor (MPNST). To the best of our knowledge, this is the first description of orbital MPNST presenting as a surface malignancy.

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Myopic changes in the fundus have been known to have a protective role in vasculopathy. The reduced metabolic demands prevent the progression of vascular disorders in myopic eyes. However, this theory might not be applicable for myopia in retinopathy of prematurity (ROP) babies. An increased retinal surface area in an eye with a longer axial length might aggravate the progression of ROP. We discuss two cases of unilateral progression of ROP in a longer axial length eye.

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Encysted lacrimal mucocele refers to diffuse, centrifugal enlargement of the lacrimal sac resulting from combined proximal and distal obstructions in lacrimal drainage system. Its presence in adults is an extremely rare event. The authors describe a case of giant lacrimal mucocele in an adult female presenting with only mild epiphora. The patient underwent aspiration of pus followed by external dacryocystorhinostomy (DCR). Patient's symptoms of epiphora resolved after surgery.

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A 51-year-old lady presented with a sudden, painless blurring of vision in the left eye. She was on oral antidepressant desvenlafaxine, a serotonin-norepinephrine reuptake inhibitor, for the past 3 years. Her visual acuity was 6/6 OU. Fundus examination of the left eye revealed opacification of the retina as a result of retinal arterial occlusion. Nasal as well as temporal retinal quadrants were involved. Inferior half of the macula was also affected. Fundus fluorescein angiography of the left eye was unremarkable while spectral domain optical coherence tomography of the macula showed microcystic changes. After excluding embolic and nonembolic causes, we hereby report a case of retinal arterial occlusion resulting from desvenlafaxine-associated transient retinal arterial vasospasm, for the first time.

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A 62-year-old lady presented with bilateral granulomatous uveitis and cystoid macular edema. A diagnosis of ocular sarcoidosis was made (revised International Workshop on Ocular Sarcoidosis [IWOS] criteria) on the basis of lymphopenia, negative Mantoux, and QuantiFERON TB gold tests. Enlarged mediastinal lymph nodes, subpleural nodules, and nodular interstitial thickening were seen on high-resolution computed tomography (HRCT) thorax. Non-necrotizing granulomato us inflammation, negative for mycobacteria on staining and GeneXpert, was noted on endobronchial ultrasound-guided transbronchial lymph node aspiration (EBUS-TBNA). However, culture grew Mycobacterium fortuitum after 3 weeks. This case highlights a rare presentation of latent M. fortuitum infection presenting as ocular sarcoidosis, speculating the coexistence of two diseases in an individual, one possibly triggering the other.

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Acute retinal necrosis (ARN) occurs due to secondary reactivation of previous herpes simplex or varicella zoster infection. In children, ARN is rare and challenging to manage due to late presentation caused by difficulty in the communication of symptoms to caregivers and lack of treatment guidelines.^[1] Acyclovir used for treatment can cause direct tubular injury or crystal deposit in the tubules, causing acute kidney injury (AKI). Prompt management of AKI is required to avoid lethal complications. In this case report, we describe the case of a 14-year-old boy with ARN secondary to primary varicella infection developing AKI following intravenous acyclovir.

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Ewing's sarcoma (ES) is a rare, aggressive, and fatal malignancy of bones and soft tissues that affect children and adolescents. It has a high potential of hematogenous metastasis, with lungs, bones, and bone marrow being the most common sites. Extraskeletal metastasis of Ewing's sarcoma in the sinonasal cavity is rare and usually presents with nasal complaints and periorbital swelling. Diplopia as the presenting complaint of sinonasal tract metastasis of Ewing sarcoma has not been reported in the literature. A high suspicion for metastasis should be kept in mind in patients presenting with atypical ophthalmic findings of Ewing sarcoma and appropriate radio imaging should be procured for early intervention.

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Sarcoidosis is a systemic multiorgan granulomatous disease of unknown etiology in middle age group women. Orbital sarcoidosis is uncommon and the most common orbital manifestation is dacryoadenitis (70%). Extraocular muscle involvement is rare; if present, the superior rectus/levator complex and lateral rectus are most commonly involved. We report a 57-year-old male, a known case of biopsy-proven sarcoidosis, with medial rectus myopathy and lacrimal dacryoadenitis in the left eye, and angle closure with raised intraocular pressure (IOP) in both eyes. Imaging by computed tomography (CT) also confirmed the above findings. The forced duction test was positive confirming restrictive myopathy of the left medial rectus muscle. Orbital sarcoidosis has a highly diverse presentation; medial rectus involvement is a rare occurrence.

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Periocular and orbital infections post-strabismus surgery are uncommon, with most of these cases reported in children. We report a rare case of sub-Tenon's abscess in a 27-year-old female following strabismus surgery, which was successfully managed with systemic and topical antibiotics without any requirement for surgical drainage of the abscess.

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Congenital cranial dysinnervation disorders (CCDDs) as a group of neurodevelopmental diseases could present with various combinations of the affected cranial nerves. Olfactory aplasia or hypoplasia has been reported with other cranial nerves affected. Herein, we present an unreported association of olfactory aplasia and limited elevation in two patients who did not have other ocular motor nerve aplasia or hypoplasia on magnetic resonance (MR) imaging. We present two patients—an 11-month-old boy and a 9-year-old boy who showed limited elevation and were found to have olfactory aplasia. In conclusion, aplasia of the olfactory bulb may be associated with strabismus with some degree of ophthalmoplegia, thus should be carefully examined with various clinical manifestations.

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A 45-year-old woman presented with a history of unilateral fixed, painless, gradually progressive swelling in the right frontal part of the zygomatic bone for 6 years. On examination, the best-corrected visual acuity (BCVA) of the right and left eye was 20/20. On palpation, the swelling was a solitary mass of hard consistency, painless, adhering to deep planes under normal-looking skin. Orbital computed tomography (CT) scanning showed monostotic fibrous dysplasia of the lateral wall of the right bony orbit of the zygoma. The right orbital mass was managed by excisional biopsy with bone grafting. The histopathological report revealed a cavernous hemangioma of the zygomatic bone.

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A 24-year-old female presented with proptosis and limitation of eye movements and was investigated radiologically with a tentative diagnosis of lymphangioma. Initial biopsy was considered to be in favor of optic glioma on histopathology, but immunohistochemistry was negative for Glial fibrillary acidic protein (GFAP). A year later, the patient reported back with worsening proptosis. She underwent exenteration of left eye for a posterior mass encasing the optic nerve. The final diagnosis of myxoid liposarcoma was rendered on excision biopsy. The difficulties experienced in establishing diagnosis are shared in this case report.

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Sub-retinal hyper-reflective material (SHRM) is an important spectral-domain optical coherence tomography biomarker in neo-vascular age-related macular degeneration (nAMD). The exact nature of SHRM is not known, but it may contain fluid, fibrin, blood, neo-vascular tissue, and so on. Although nAMD with avascular SHRM usually resolves with anti-vascular endothelial growth factor and is known to have better visual prognosis, those with vascular SHRM have significantly poor final vision. We present a unique case of nAMD with an avascular SHRM in the right eye and a vascular SHRM in the left eye and how the two eyes behaved with treatment over a period of 12 months.

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