Sterilization is the backbone of a health-care organization and ensures high-quality patient care. While the horizon of medical and surgical devices has undergone vast expansions, not many discoveries have been made as far as novel sterilization procedures are concerned. Steam sterilization remains the most widely used modality of sterilization of equipment to date in most health-care organizations. Its limitation lies in the fact that there are many medical and surgical devices in the market today which are heat and pressure sensitive and can be damaged by the high temperature and pressure levels of steam sterilization. Novel sterilization techniques which are helpful in the sterilization of such sensitive instruments that are being widely used today include ethylene oxide (ETO) gas sterilization and plasma sterilization. ETO sterilization requires the instruments to undergo aeration after the sterilization process, which takes a significant amount of time. Since the sterilized materials can be used only after the aeration period, stocking up of medical instruments is required which incurs extra cost and entails further investment in this regard. In the last few decades, there have also been concerns over the safety of ETO gas itself. Hence, attention has shifted to plasma sterilization which has spiked the interest of medical professionals due to both its safety and economic running costs. This article reviews the evolution of plasma sterilization along with its working principle, methods of inactivation of microorganisms, advantages, and disadvantages. A literature search using the keywords “plasma sterilization” was carried out in PubMed and Google Scholar platforms. Out of the suggestions available, the search was zeroed down to the most relevant articles and a few landmark articles, with focus on the origin of plasma sterilization as a procedure, methods of generation of gas plasma, phases of plasma sterilization, and antimicrobial properties of plasma. A review of articles comparing the efficacy of steam sterilization, ETO sterilization, and plasma sterilization was performed. Standard textbooks, as cited in the references, were referred to as required. The operation and maintenance instruction manual for low-temperature hydrogen peroxide sterilizer ACTIPLAZ^R model HP-3041, Hanshin Medical Co. Ltd, South Korea, 2019, was used as the primary reference when describing the working of the aforementioned model (HP-3041) of plasma sterilizer.

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This article aims to provide relevant clinical pearls to help in the diagnosis and treatment of Rhino-orbital-cerebral mucormycosis (ROCM). The main risk factors apart from SARS-CoV 19 infection for ROCM are uncontrolled diabetes mellitus, diabetic ketoacidosis, and steroid usage. The major clinical findings in the case of orbital involvement are loss or decrease of vision, ophthalmoplegia, proptosis, and panophthalmitis-like picture. Effective management of the disease lies in prompt diagnosis, adequate surgical debridement, and appropriate systemic antifungal therapy. With timely attention, we can save the vision, globe, and life of the patient.

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Featureless retina is usually seen in patients with type one diabetes mellitus and is frequently misdiagnosed as asymmetric diabetic retinopathy (DR). It is characterized by retinal neovascularization with the absence of retinal lesions such as retinal hemorrhages, cotton wool spots, and intraretinal microvascular abnormalities, features which are typical of proliferative DR. Fundus fluorescein angiography is particularly helpful in these cases as it reveals extensive areas of capillary dropout and neovascularization. It is of utmost importance to anticipate its presence and manage these patients appropriately to prevent blinding consequences. This article offers some clinical insights for better diagnosing and managing such patients.

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Aim of the Study: To determine the prevalence of ocular morbidity among government schoolchildren from Mohsin's Schoolchildren Eye Screening Program. Design: A school-based, observational study design. Participants: Schoolchildren between 1^st and 10^th standards across various government schools. Materials and Methods: Students of 429 government schools of Visakhapatnam were covered under this eye screening program. It was a three-staged program. In the first stage, 84,727 students were screened for visual impairment and the presence of any abnormality by trained teachers or optometrists. In the second stage, those who were identified were subjected to a detailed ocular examination and refraction in the school premises by trained optometrists. Glasses were dispensed for those who improved to normal visual acuity and treatment was given for minor ailments by optometrists, residents and ophthalmologists requiring further evaluation were referred to the base hospital for examination and appropriate management by an ophthalmologist in the third stage. Results: 84,727 children from 429 schools were screened. Ocular morbidity was 6.07%. Refractive error was the most common ocular disorder identified in 3.74% with a significantly high rate among secondary schoolchildren (P < 0.001). Other common abnormalities found were color blindness (1.25%), allergic conjunctivitis (0.12%), squint (0.08%), infective conjunctivitis (0.02%), amblyopia (0.02%), and lid and adnexal disorders (0.02%). Conclusion: Ocular morbidity is a significant problem among schoolchildren. Visual impairment due to refractive errors is common and can be corrected by prescribing glasses. School screening programs are effective and essential in identifying ocular morbidity in schoolchildren.

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Introduction: Pterygium is a common conjunctival disorder seen in tropical countries. Surgery is the permanent treatment. Various methods of graft fixation include sutures, fibrin clot, and glue techniques. Fibrin clot (autologous serum) technique involves the utilization of the patient's oozed blood from the episcleral vessels to serve as natural glue adhering the graft to the underlying sclera, whereas commercial glue involves the use of two components for firm adherence of the graft. Aim: The aim of this study is to observe and compare the complication rates, outcomes, and recurrence with fibrin clot and glue techniques for pterygium. Materials and Methods: One hundred and twenty-six eyes of 126 patients with primary pterygium were operated under peribulbar anesthesia by a single surgeon after doing the routine clinical examination. Group A included 63 eyes where the fibrin clot technique was used for graft adherence and Group B included 63 eyes where commercial glue was used for fixing the graft. Pterygium was excised, and a conjunctival-limbal autograft was taken from the superior bulbar conjunctiva of the same eye. In the fibrin clot (autologous serum) technique, natural hemostasis was encouraged, and the graft was placed over the oozed blood, left undisturbed for 10 min. In the glue technique, hemostasis was achieved and graft was transplanted over the glue and left undisturbed for 2 min. Eye patch was removed the next day of surgery. Preoperative and postoperative photographs were taken. Standard postoperative treatment was given. Follow-up was carried on day (postoperative day) 1, 15, 30, 90, 180, and 300. Results: The mean surgical time was 29.3 and 19.6 min in Group A and Group B, respectively. Graft retraction and graft edema were noted in four patients (6.3%) in fibrin clot technique, and graft edema was noted in five patients (7.9%) in Group B, which resolved on subsequent visits with conservative management. No recurrence was noted in either group. No other postoperative complications were noted in both groups. Conclusion: Fibrin clot (autologous serum) and glue techniques do not use sutures, thus avoid the cost of sutures and suture-related discomfort and complications. Fibrin clot (autologous serum) is more economical than the glue technique. Cosmetic outcome in the immediate postoperative period is better with glue than fibrin clot technique. Long-term outcome is the same in both groups. Autologous serum avoids the transmission of prion diseases possible with glue method. Both the techniques are equally safe and efficient.

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Corona virus (covid-19) pandemic has shaken the entire world, its wide spread transmission has restricted everybody's day to day life, ophthalmologists are no exception, but in greater danger, as most of ophthalmologic examinations include close contact between patient and doctor, increasing the risk of transmission of deadly covid-19 virus. Adopting certain measures in ophthalmic practice reduces the transmission risk. Various ophthalmic manifestations of covid 19 includes follicular conjunctivitis, viral keratoconjunctivitis, hemorrhagic and pseudomembranous conjunctivitis, Central retinal vein occlusion (CRVO), Central retinal artery occlusion (CRAO) Cerebrovascular accident (CVA) with vision loss, Mucormycosis etc. For this review, literature search was conducted in PubMed and Google Scholar databases by using terms coronavirus, SARS-CoV-2, COVID-19, ophthalmology, ophthalmologist, telemedicine in ophthalmology and their combinations to gather efficient information that can enhance the daily practice. Most important modifications include personal protective equipment, environmental measures (air ventilation, instrument handling), administrative measures (physical distancing, triage setup). Vaccination plays a crucial role in hampering the effect of covid crisis, it should be given significant importance and extensive awareness. Telemedicine can change the entire scenario in doctor-patient relationship and everyone should have thorough knowledge about its guidelines. All these measures need gigantic efforts in reducing the covid-19 effect, paving the path for the “NEW-NORMAL”.

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Bietti's crystalline dystrophy (BCD) is a relatively rare tapetoretinal degeneration with marginal corneal dystrophy characterized by subepithelial corneal crystals at the limbus and intraretinal crystals in the posterior pole with atrophy of the retinal pigment epithelium and choroidal sclerosis caused by a mutation in the CYP4V2 gene. In this article, we present a case of a middle-aged female with a history of gradual, progressive, painless diminution of vision in both eyes showing multiple diffuse yellowish crystalline structures in the fundus with atrophy of underlying structures. Spectral domain-ocular coherence tomography of macula revealed bilateral multiple hyperreflective dots with outer retinal tubulations. Electroretinogram showed subnormal scotopic and photopic responses. Although very few cases of BCD have been reported, a wide knowledge about the disease is necessary to diagnose early and hence to uplift the quality of life to the patient by providing low visual aids and visual rehabilitation.

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India has the highest burden of tuberculosis (TB) in the world. In the last few years, there has been a re-emergence of the disease. Ocular TB is a form of extrapulmonary TB. Conjunctival TB is a relatively rare presentation of ocular TB. This report describes two such cases of TB of conjunctiva. One case presented with redness and pain in the right eye of 1-month duration. Examination revealed a conjunctival nodule. The other case presented with a mass in the left eye which showed a pink nodule. The presence of a conjunctival nodule with unresponsiveness to topical steroids and antibiotics was the common feature in both cases. Histopathology showed tuberculous inflammation and antituberculous therapy helped in the resolution of the lesions. Thus, in cases of conjunctival nodules unresponsive to steroids, TB should be suspected and a timely biopsy should be done, especially in a country like ours, which is endemic for TB.

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Open globe injuries (OGIs) with intraocular foreign bodies are a common presentation in ophthalmic practice. Foreign bodies in the angle of the anterior chamber have been described earlier. In this report, two such cases of foreign bodies in the angle, identified on gonioscopy, are described. One case presented with pain and redness of 6-month duration with trauma 3 years ago. Examination revealed corneal edema and a foreign body in the angle. In the other case, early gonioscopy was performed and an angle foreign body was identified. In both cases, the foreign bodies were removed with good visual results. An OGI with a foreign body embedded in the angle was the common feature in both cases which presented as late corneal edema in the first one. Thus, in cases of any OGIs, gonioscopy should be performed as early as possible, so that complications leading to visual loss can be prevented.

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Conjunctival ophthalmomyiasis is an infestation of larvae on the conjunctiva. The larvae of sheep botfly (Oestrus ovis) can be the cause of ocular irritation in occupationally predisposed individuals like shepherds. External (conjunctival) ophthalmomyiasis can progress to severe form of internal ophthalmomyiasis. We report the presence of live motile larvae of sheep botfly on the conjunctiva of a patient, shepherd by occupation presenting with irritation in the eye. Diffuse ocular examination was normal until everted lid examination revealed two white larvae with black dots at their head end crawling fast on the tarsal conjunctiva. Removal of the larvae is the only treatment, and treatment of the cattle as well, is essential to prevent recurrence and also to increase the cattle yield.

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A condition with deficiency of various enzymes which plays a crucial role in the degradation of glycosaminoglycans (GAG) is termed to be mucopolysaccharidosis (MPS). The disease entity is due to abnormal breakdown and diffuse accumulation of GAG in the various system including brain, eye, muscle, lungs, heart, and gastrointestinal system. The disease spectrum is highly varied from slight phenotypic changes to severe life-threatening illness. Morbidity, especially low visual acuity is due to the involvement of cornea (clouding of the cornea), optic nerve abnormality, and also retinopathy. Marked impairment of physical and intellectual function is common. The diagnosis is mostly clinical and advanced testing including enzyme assay and gene testing is required for typing and pinpoint diagnosis. The treatment options are limited in most cases as enzyme replacement therapy is not widely available and expensive. Bone marrow transplantation has been found to be successful but still a cumbersome option. Visual morbidity can be reduced by performing keratoplasty if corneal clouding is significant and visual prognosis is often guarded.

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Pythium keratitis is one of the chief etiologies of atypical microbial keratitis. It has an extremely grave prognosis. A low index of suspicion, its resemblance to fungal keratitis, and inappropriate diagnosis and management all contribute to the poor outcomes. The absence of adequate literature recommending a standard regimen further worsens the picture. Although Pythium resembles a fungus, it lacks ergosterol. Hence, antifungals are ineffective. While its successful management using antibiotics has been described, some conclude that surgery is the mainstay and recommend techniques to minimize recurrences. This review article aims to bring together the various modalities of diagnosis and therapy of Pythium keratitis. It focuses on the clues to clinical suspicion which would facilitate a prompt diagnosis. It also highlights the importance of high index of suspicion in presumed fungal keratitis with a poor response to antifungals. A search was carried out using PubMed and Google Scholar for articles in English language using the keywords: Pythium insidiosum, Pythium keratitis, management of Pythium keratitis, investigations in Pythium keratitis, Polymerase Chain Reaction in Pythium keratitis, diagnosis of Pythium keratitis, and treatment of Pythium keratitis. Articles were included if they were of high significance for this article. Case reports also were taken into consideration if they conveyed data of importance.

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Introduction: Age-related macular degeneration (ARMD) is a highly prevalent progressive retinal disorder which has multiple genetic, environmental, and nutritional risk factors, but the exact etiology is not yet fully understood. To unravel the mysterious etiology of ARMD, more than 100 different compounds have been analyzed in the blood, serum, plasma, aqueous, and vitreous humor for their association with AMD. The present study aims to estimate the serum levels of zinc (Zn), manganese (Mn), and selenium (Se) in ARMD patients when compared to normal. Aim: The aim of this study is to estimate the serum levels of Zn, Mn, and Se in ARMD patients and age-matched controls and to find out if any homeostatic alterations of these minerals occur in ARMD patients when compared to controls. Study Design: An observational study (pilot study). Methodology: 50 ARMD patients and 60 age matched controls included in the study were subjected to a detailed ocular examination . Fundus photography and Ocular Coherence Tomography were done in all ARMD patients. 5 ml of blood sample was collected from all cases and controls and sent for the estimation of serum levels of Zn, Mn, and Se. The results obtained were subjected to statistical analysis. Results: There was no statistically significant difference in the mean serum levels of Zn and Se between cases and controls. However, serum Mn showed a higher level in controls when compared to cases, and the difference was statistically significant. Conclusion: The present study showed a causal relationship between serum Mn level and ARMD.

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Background: As the global prevalence of diabetes is on the rise, diabetic retinopathy (DR) is also projected to escalate. DR is one of the major causes of preventable blindness. Aims and Objectives: The rationale of this study is to ascertain and record knowledge, attitude, and practice (KAP) patterns among diabetics on diabetes and DR and to recognize the barriers to compliance to regular screening. Materials and Method: A cross-sectional study using a 43-point questionnaire was conducted in an urban population. Each response was assigned a score to attain aggregates and was further cataloged into “good,” “average/moderate,” and “poor” KAP categories using Microsoft Excel/SPSS (Statistical Package for the Social Sciences). Results: One hundred and ninety-six diabetics with a mean age of 59.89 ± 11.83 years were included in this study. “Good” knowledge scores seen in 28.6% showed a statistically significant association (P < 0.001) with “positive” attitude (28.6%) and “good” practice (33.7%) patterns. Women had better overall KAP scores. Good vision (65.6%) and unawareness (31.3%) were the major barriers to compliance. Conclusions: Awareness of DR is lagging even amid educated urban population. Establishing diabetic morbidity and retinopathy awareness with emphasis on necessity of timely screening and treatment might be the way forward in this pandemic period.

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Purpose: The purpose of this study was to evaluate the prediction accuracy of Barrett Total Keratometry (TK) Universal II formula using swept-source optical coherence tomography (SS-OCT)-based optical biometer. Materials and Methods: One hundred and thirty-five eyes of 135 patients from Visakha Eye Hospital, Visakhapatnam, India, were prospectively enrolled in this study. Ocular parameters were measured using IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). Emmetropic spherical equivalent intraocular lens (IOL) power was calculated with Barrett TK Universal II formula using TK and Sanders–Retzlaff–Kraff (SRK)/T formula using standard keratometry. Selected IOL power and predicted refractive errors were recorded. Postoperative manifest refraction was measured at 1 month. Absolute prediction errors (APEs), mean absolute error (MAE), median absolute error (MedAE), and percentage of eyes within ± 0.25, ±0.50, and ±1.00 D of predicted refraction were calculated for each formula. Results: Barrett TK Universal II formula using TK values showed low APEs, MAE, and MedAE. There were a higher percentage of eyes with APE within ±0.25, ±0.50, ±0.75, and ±1.00 D. This formula gave better results when compared to SRK/T formula using K value. However, it was not statistically significant. Conclusion: IOL power calculation using SS-OCT-based optical biometer and Barrett TK Universal II gives better results with the least APE and using TK provides superior refractive outcomes which would be beneficial for the patients undergoing phacoemulsification with toric or multifocal IOLs.

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Aim: The aim of the study was to evaluate the patterns of fundus autofluorescence (FAF) and analyze the association between FAF and swept-source optical coherence tomography (SS-OCT) in idiopathic central serous chorioretinopathy (CSCR). Materials and Methods: 65 eyes of 65 patients were prospectively included in this study. Patients underwent a complete ophthalmologic examination. We classified patterns on FAF imaging into five types as blocked FAF, mottled FAF, hyper-FAF, hyper/hypo-FAF, and descending tract pattern. Each FAF pattern was then analyzed based on the SS-OCT findings. Results: Blocked FAF pattern was seen in 47.69% of patients, mottled in 7.69%, hyper in 23.07%, hyper/hypo in 18.46%, and descending tract in 3.07%. There is a significant difference between FAF patterns in all subjects (P < 0.0001). The blocked FAF pattern (mean [M] = 0.20, standard deviation [SD] = 0.14) showed the best visual acuity among all others. The descending tract FAF pattern group (M = 0.54, SD = 0.08) and hyper/hypo-FAF pattern group (M = 0.38, SD = 0.28) showed the least favorable visual prognosis in our study. The intact ellipsoid zone on the SS-OCT was mostly found in the blocked FAF group, and the disrupted ellipsoid zone was commonly exhibited in the hyper/hypo and descending tract groups. Disrupted external limiting membrane line on the SS-OCT was seen in one patient of the descending tract group only. Conclusions: The association between FAF and SS-OCT findings was analyzed in patients with idiopathic CSCR in our study. Detailed investigation using FAF could help estimate the duration of CSCR.

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A 52-year-old woman presented to our outpatient department with chief complaints of progressive diminution of vision in the left eye for 1 year. She did receive antitubercular treatment for 1 year in view of presumed choroidal lesion of tubercular origin. However, the lesion continued to increase in size and hence the patient came for second opinion. Multimodal imaging such as ultrasonography (A and B scan) along with indocyanine green angiography was suspicious for malignant choroidal melanoma. A diagnostic fine-needle aspiration biopsy confirmed the clinical diagnosis of amelanotic variant of choroidal melanoma. The patient subsequently underwent treatment with plaque brachytherapy. At 3-month follow-up, the tumor regressed with reduction in height as well as surrounding retinal pigment epithelial atrophy.

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A 27-year-old male patient complained of dull aching pain in the right eye (RE) for 3 months. On examination, the patient had mild proptosis of RE with downward displacement and fullness in superotemporal quadrant. No palpable mass was felt, and finger insinuation was possible, the swelling did not change in size on bending, coughing, and not pulsatile, and no bruit was heard. Visual acuity, color vision, and confrontation were normal. Mild ptosis with minimal abduction and elevation restriction was noted. MRI orbits revealed well defined fusiform, lobulated, extraconal soft tissue lesion in the superotemporal aspect causing abaxial proptosis with scalloping and thinning of bony orbital roof. Histopathology reveals features suggestive of cavernous hemangioma. Even though the most common location of cavernous hemangioma is intra-conal, its extra- conal occurrence also possible and needs high suspicion.

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Concurrence of two different neuro-ophthalmic entities in a single patient is rare. The second disease entity may get incidentally detected when the patient is evaluated for one pathology. Such coincidences may be seen in patients having systemic diseases with microvascular complications, such as diabetes mellitus and hypertension. Herein, we report a case of a 62-year-old female patient who was detected to have bilateral inferior altitudinal hemianopia with right homonymous hemianopia as a result of bilateral anterior ischemic optic neuropathy with left occipital lobe infarct.

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