A 21-year-old patient presents to us with complaints of blurred vision and photophobia in the left eye, with an uncorrected visual acuity of 20/100 improving to 20/30 with pinhole and diagnostic rigid gas permeable lens trial. He had a history of trauma with subsequent cataract extraction, with residual irregular astigmatism and traumatic mydriasis. XtraFocus Pinhole intraocular lens (Morcher) was implanted in the left eye. One week postoperatively, the left eye uncorrected visual acuity improved to 20/30, uncorrected intermediate visual acuity improved to 20/40, and uncorrected near visual acuity improved to J4. The glare and photophobia resolved completely. Surprisingly, the patient complained of severely poor vision in dim illumination. His vision was limited to bare perception of objects and hand movements close to the face. He started facing difficulties in major activities such as driving at night and in dark ambient surroundings such as movie theatres, which persisted to the extent of necessitating explantation of the implant.

Purpose: To show the surgical and visual outcomes of a resident-performed manual small incision cataract surgery. Study Type: Retrospective observational case series. Study Setting: Ruby Eye Hospital. Materials and Methods: Manual small incision cataract surgery was performed on 339 uncomplicated cataract cases by three in-house residents. Preoperative visual acuity and vision with a pinhole were meticulously noted in the record sheets. All patients underwent thorough preoperative evaluation with the help of a slit lamp. Eyes with corneal guttae, undilated pupils, pseudo-exfoliation, raised intraocular pressure and posterior segment abnormalities were excluded from the study. The mean patient age was 59 years (min: 47 years and max: 85 years). Forty-seven percent were males, and the rest were females. The mean uncorrected preoperative visual acuity recorded was 1.3 logMAR units (max: 1 and min: 1.6, Std dev: 0.4). Forty-two percent of the eyes had dense nuclear cataracts (≥ Nuclear Sclerosis grade III from LOCS II). Results: The mean postoperative visual acuity recorded was 0.4 logMAR units [standard deviation 0.3 logMAR units (max: 1 and min: 0.1 p-value <0.001)]. Forty-three cases (12.6%) had tunnel-related complications (premature entry/button hole). Thirty-six cases (10.6%) had iatrogenic prolapse of the iris tissue. Eight cases (2.3%) had a runaway capsulorhexis, while 18 cases (5.3%) had iatrogenic posterior capsular rupture. Two cases (0.58%) had a large zonular dialysis. Ten cases (2.9%) were retaken to the operating room again for repeat intervention. Conclusion:The ophthalmic resident learning curve for manual small incision cataract surgery is steep, unlike what is reported in the literature. A good training program with a special emphasis on wound construction is of paramount importance for future residents.

A 28-year-old man presented with a sudden onset of visual loss in both eyes (OU). He had a known history of acute pancreatitis and hepatitis following alcohol abuse. Examination of the anterior segment of the eye revealed non-sustained pupillary light reaction. The fundus showed typical Purtscher's flecken over the posterior pole with multiple cotton wool spots and retinal superficial haemorrhages in OU. Fundus fluorescein angiogram revealed abnormal hypofluorescence in both the posterior poles. Optical coherence tomography (OCT) for Purtscher's flecken showed abnormal retinal thickening with hyper-reflective areas in the inner neurosensory layers. The patient responded favourably to high-dose corticosteroid therapy (1.5 mg/kilogram per body weight) with a tapering dose. There was a mild reduction of the ischaemic areas with a corresponding improvement in visual acuity. This case has been presented owing to its rarity and under-reporting. Treatment with corticosteroids yielded favourable results.

Purpose: To demonstrate the visual outcomes of a foldable, hydroxy ethyl-methacrylate, single-piece, posterior chamber phakic intraocular lens (pIOL). Study Type: Retrospective study. Materials and Methods: Patients presenting with moderate to high myopia who underwent surgical correction with a posterior chamber phakic IOL (refractive intraocular lens, phakic intraocular lens, Appasamy Associates, Chennai, India) were retrospectively reviewed. Only patients with at least one-year follow-up were included. Manifest refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), endothelial cell density (ECD), and pIOL vault were analyzed 1, 3, 6, and 12 months after surgery. Intraoperative and postoperative events were recorded in all cases. Results: The study included 30 eyes from 15 patients. The mean patient age was 25.8 ± 3 years. The spherical equivalent of manifest refraction was −11.47 ± 4.38 D preoperatively and −0.44 ± 0.55 D postoperatively. The preoperative CDVA was 0.17 ± 0.12 logMAR. The postoperative UDVA was 0.053 ± 0.11 logMAR (min: −0.17 and max: 0.2) and 0.019 ± 0.091 logMAR (min: −0.17 and max: 0.2) at the end of 1 month and 6 months, respectively. At the end of the 12-month visit, the postoperative UDVA was 0.032 ± 0.094, and the safety index was 2.42. The mean ECD was 2639 cells/mm 2 (min: 2389 and max: 2993 with SD: 139.53) at the preoperative visit and 2445 cells/mm 2 (min: 2050 and max: 2701) at the 12-month visit (5.8% loss, p less than 0.001). ECD loss from 6 months to 12 months was not statistically significant. No significant cataract formation, significant endothelial cell loss, glaucoma, uveitis, or any other vision-threatening complication were observed. Conclusion:Based on postoperative experience, we found that RIL phakic IOLs are safe and effective for treating high myopia at short-term follow-up.

A 17-year-old boy presented with sudden loss of vision in the left eye (OS) for 3 days. He was diagnosed with acute hydrops following keratoconic progression in OS. The patient was initially started on topical medical therapy, including steroids and hypertonic eye drops; showing no signs of resolution. Hence, the patient was planned for full-thickness compressive corneal sutures. Four sutures were placed along the central oedematous area covering the area of ruptured Descemet's membrane. Signs of resolution were noticed by 1st week and there was complete resolution of oedema by 3rd post-op week. Sutures were removed by 7th postoperative week/45th day. The patient was doing fine with visual acuity of 6/60 in the last visit with no symptoms of discomfort and no signs of corneal vascularisation. Full-thickness corneal compressive sutures is an effective alternative in cases of acute hydrops if perfluoropropane gas is not available.