BACKGROUND: To assess the corneal endothelium, central corneal thickness and the factors associated with endothelial cell damage after phacoemulsification in diabetics in comparison with non-diabetics METHODS: It was a case control study with 80 eyes each in the diabetic group and the control group. Intraoperative mydriasis, effective phaco time (EPT) and postoperative inflammation were measured. Preoperative, 1 st week, 6 th week and 3 rd month postoperative endothelial cell density (ECD), coefficient of variation (CV), hexagonality and central corneal thickness (CCT) were also measured using Konan noncon robo specular microscope (Model - NSP 9900). RESULTS: In the control group, patients in the age group of 60-69 years were 3.8 times more at risk of ECL compared to patients in the age group of 50-59 years. Patients in whom EPT was ≥0.50 min, were 8.8 times more at risk of ECL when compared to patients in whom EPT <0.25 min. In the diabetic group, patients who had an inflammatory score of 1+ in the first postoperative week; also had 5.7 times more risk of ECL when compared to patients in whom the inflammatory score was 0.5+ in the first postoperative week. There was a significant increase in CV ( p -0.03) and CCT ( p -0.03), significant decrease in the hexagonality ( p -0.01) and no statistically significant difference in the endothelial cell loss (ECL) ( p -0.34) in diabetics after phacoemulsification when compared to controls. CONCLUSION: The present study reveals postoperative inflammation as a risk factor for ECL in diabetics and not intraoperative mydriasis and EPT.

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Neuroblastoma is an undifferentiated malignancy of primitive neuroblasts. Neuroblastoma is among the most common solid tumors of childhood. Orbital neuroblastoma is typically a metastatic tumor. In this case report, we describe a 2-year-old child with a rapidly progressing orbital tumor. Computed tomography revealed an orbital mass lesion with extraocular and intraocular components. An incisional biopsy was done, and a histopathological examination showed features suggestive of neuroblastoma. Systemic workup including ultrasonography of the abdomen, chest roentgenogram, whole body computed tomography, and bone scintigraphy showed no evidence of systemic involvement. The diagnosis of primary orbital neuroblastoma was made, and the child was subjected to chemotherapy followed by rapid melting of the tumor. Neuroblastoma should be considered in the differential diagnosis of childhood orbital tumors.

Purpose: To describe the varied presentations of posterior keratoconus. Methods: This is a 3-year institute-based retrospective study report from June 2015 to June 2018 that describes 13 eyes of 12 patients with varied presentations of posterior keratoconus, evaluating tomographic changes using Scheimpflug corneal tomography and anterior segment optical coherence tomography. Slit-lamp examination revealed circumscribed nebular corneal opacity with posterior corneal depression. Results: Eleven patients had unilateral and one had a bilateral presentation. Five patients presented in the first and second decade with a nebular opacity and circumscribed excavation of the posterior cornea. One patient was a 12-year-old girl who presented with systemic manifestations. Seven others were middle-aged adults with superior, central, or peripheral excavation. Two patients had microcornea. Conclusions: This is the largest case series on posterior keratoconus, depicting its varied features. Diagnosis of this uncommon condition requires a high index of suspicion, meticulous slit-lamp examination, and systemic evaluation to rule out other associated anomalies. We report a patient of unilateral posterior keratoconus with systemic associations, second such case in the literature.

Rhino-orbital mucormycosis (ROM) is an uncommon opportunistic infection affecting immunocompromised individuals. Poorly controlled diabetes mellitus is the commonest predisposing factor. A 42-year-old female with well controlled diabetic status, presenting with orbital apex syndrome (OAS) and Central Retinal Artery Occlusion (CRAO) is discussed in this report. There was no evidence of cellulitis, necrotic eschar or facial palsy. There were no features suggesting immunosuppression. The biochemical parameters including blood sugar and electrolytes were normal. Serology for HIV was negative. MRI showed pan sinusitis with thickening and enhancement of extraocular muscles. Urgent debridement of paranasal sinuses was done. Histopathological examination disclosed broad based, filamentous, aseptate hyphae suggestive of mucormycosis. Prompt treatment with systemic Amphotericin B and debridement of sinuses resulted in a favourable outcome. Mucormycosis presents with a constellation of clinical features including ophthalmoplegia, proptosis, ptosis, visual loss, chemosis, nasal discharge, abducens nerve palsy, palatal necrosis, cerebral involvement, hemiparesis and eye lid gangrene. The coexistence of sinus disease with OAS in a diabetic patient should trigger a vigilant search for a fungal etiology, despite the absence of immunosuppression. Microbiological culture may yield negative results and histopathological examination is mandatory. This report emphasizes the rare occurrence of ROM in an immunocompetent diabetic patient with good metabolic control. Early diagnosis and a multidisciplinary approach with intravenous antifungals, adequate sinus drainage and surgical debridement can greatly reduce the morbidity and mortality.