Inverted internal limiting membrane flap technique for very large macular hole

AIMTo assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique.METHODSThis retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 µm who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure.RESULTSMean age was 63.2±8.4y with all 5 subjects being females. Mean duration of symptoms was 11±14mo with a mean postoperative follow up of 13.2±13mo. The mean base diameter of the macular holes was 1420±84.8 µm (1280-1480 µm). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen’s equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen’s equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted.CONCLUSIONThe inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.

Traumatic Vitreous Hemorrhage in Children-Clinical Features and Outcomes

Purpose: To determine the clinical profile, causes, and outcomes of traumatic vitreous hemorrhage(TVH) in children(<18 years of age).Methods:.Retrospective computer assisted chart review..501 eyes of 464 children(103 females; 361 males) who presented with TVH between 2001 and 2012 were included. All children underwent a complete ocular and systemic examination and investigation. The etiology, visual, and anatomic results of pediatric TVH were the outcome measures.Results: Median age: 12.27±4.51 years. 37 patients had bilateral VH; 43.24% of these were firecracker injuries..Commonest complaint was diminished vision(96.45%)..Mean BCVA(logMAR) at presentation was 2.64±1.11 logMAR. Sticks(43.43%).and cricket balls.(13.24%).were the commonest causes..Treatment included medical therapy(topical and / or systemic; 56 eyes), laser photocoagulation(34 eyes), and /or surgery.(387 eyes)..Mean final BCVA was significantly better(1.01±0.58 logMAR;P=0.011,Z test). Mean follow up in the closed and open globe trauma was 47±12.47 and 36.24±9.72 months, respectively.Conclusion:.TVH has significant implications in children.Firecracker injuries are notorious for bilateral VH.

Response of L V Prasad Eye Institute to COVID-19 outbreak in India:experience at its tertiary eye care centre and adoption to its Eye Health Pyramid

AIM:To summarize the experience of response to COVID-19 outbreak at a tertiary eye care institute and its network of health facilities in India.METHODS:Our responses are based on the principles of social distancing,hand hygiene,respiratory etiquettes,surface disinfection protocol,and rational use of appropriate personal protective equipment(PPE).We describe our response in terms of administrative controls,clinical protocols,staff protection,environmental controls,and social distancing measures.We also discuss our communication strategies and monitoring systems,to ensure compliance to protocols.RESULTS:Administrative control is mainly related to formation of task force and its functions.Clinical protocols are related to patient triaging methods and clinical examination guidelines in Outpatient,Inpatient and Operating Room.Staff protection is focused on training staff on the protocols to be followed in hospital as well as at home,and use of PPE.Environmental protocol is focused on cleaning and disinfectant methods to be used in the hospital.In addition,there are systems for communication as well as monitoring compliance to protocols.CONCLUSION:We hope that these protocols and our experience would help the ophthalmic community globally and serve as a guide to protect ophthalmologists and ophthalmic care personnel,and their patients across the world.