Purpose: To clinically validate a new automated glaucoma diagnosis software RIA-G . Methods: A double-blinded study was conducted where 229 valid random fundus images were evaluated independently by RIA-G and three expert ophthalmologists. Optic nerve head parameters [vertical and horizontal cup–disc ratio (CDR) and neuroretinal rim (NRR) changes] were quantified. Disc damage likelihood scale (DDLS) staging and presence of glaucoma were noted. The software output was compared with consensus values of ophthalmologists. Results: Mean difference between the vertical CDR output by RIA-G and the ophthalmologists was − 0.004 ± 0.1. Good agreement and strong correlation existed between the two [interclass correlation coefficient (ICC) 0.79; r = 0.77, P < 0.005]. Mean difference for horizontal CDR was − 0.07 ± 0.13 with a moderate to strong agreement and correlation (ICC 0.48; r = 0.61, P < 0.05). Experts and RIA-G found a violation of the inferior–superior NRR in 47 and 54 images, respectively (Cohen's kappa = 0.56 ± 0.07). RIA-G accurately detected DDLS in 66.2% cases, while in 93.8% cases, output was within ± 1 stage (ICC 0.51). Sensitivity and specificity of RIA-G to diagnose glaucomatous neuropathy were 82.3% and 91.8%, respectively. Overall agreement between RIA-G and experts for glaucoma diagnosis was good (Cohen's kappa = 0.62 ± 0.07). Overall accuracy of RIA-G to detect glaucomatous neuropathy was 90.3%. A detection error rate of 5% was noted. Conclusion: RIA-G showed good agreement with the experts and proved to be a reliable software for detecting glaucomatous optic neuropathy. The ability to quantify optic nerve head parameters from simple fundus photographs will prove particularly useful in glaucoma screening, where no direct patient–doctor contact is established.

A functional corneal graft 34 years after penetrating keratoplasty (PKP) is rare and even rarer is its survival after wound dehiscence. We present a case of a 69-year-old man who had presented to the emergency services in January 2012 with corneal wound dehiscence OS extending to 8 o’clock following blunt trauma. His vision was perception of light. The best corrected visual acuity (BCVA) of the patient prior to graft dehiscence was 20/30. The patient had undergone optical penetrating keratoplasty for healed keratitis in OS in 1978 followed by phacoemulsification with intraocular lens implantation in 2009. Suturing of the graft was performed under topical anaesthesia. At 18 months follow-up, the BCVA was 20/60 with clear graft centrally and specular count was 865 cells/mm2. This case highlights that early and appropriate management of corneal graft dehiscence can achieve good functional outcome even 34 years following PKP.

PURPOSE: The purpose of this study is to analyze the ocular surface microbial flora in patients with chronic limbal stem cell deficiency (LSCD) due to Stevens–Johnson Syndrome (SJS) and ocular chemical injury undergoing cultivated oral mucosal epithelial transplantation (COMET). METHODS: Patients of SJS and chemical injury who had bilateral total LSCD planned for COMET were studied. Conjunctival swab was taken before surgery. Parameters evaluated were organism cultured, sensitivity pattern, frequency of positive culture, and clinical impact on management strategy. RESULTS: Thirteen patients were included in which nine were males and four females. All patients had positive conjunctival swab culture. Most common organism isolated was Staphylococcus epidermidis , followed by Staphylococcus aureus and Pseudomonas aeruginosa . The staphylococcal species isolated were sensitive to all the conventional antibiotics while Pseudomonas cultured showed resistance to cefuroxime, ceftriaxone, and ceftazidime. Repeat conjunctival swab sent after a week of topical antibiotic therapy yielded positive culture of the same organism twice in 25% (3/12), thrice in 58.3% (7/12), and four times in 16.6% (2/12) of the patients. One patient had a polymicrobial flora with positive yield of S. aureus (thrice), S. epidermidis (twice), and P. aeruginosa (twice) in consecutive conjunctival swab culture in the absence of clinical infection. Two patients with persistent positive cultures had to undergo repeat oral mucosal harvesting as the transplantation of the cultivated explants had to be deferred. CONCLUSION: Ocular surface in LSCD patients yielded pathogenic organisms on culture. Poor ocular surface with absent tear film could be the contributing factors. It is important to perform the conjunctival swab culture before COMET surgery.

The importance of nitrogen fixing activity of Clostridium pasteurianum and Klebsiella pneumonia in flooded soils is known for decades. The anaerobic and facultative anaerobic nitrogen fixing microorganisms were isolated from the flooded paddy ecosystem. Their growth on carbon sources, CO, production, denitrification, volatile fatty acid production, nitrogenase activity and protein profile of the cultures were estimated and characterized as Clostridium and Klebsiella.