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Tumors of the conjunctiva and cornea comprise a large and varied spectrum of conditions. These tumors are grouped into two major categories of congenital and acquired lesions. The acquired lesions are further subdivided based on origin of the mass into surface epithelial, mucoepidermoid, melanocytic, vascular, fibrous, neural, histiocytic, myxoid, myogenic, lipomatous, lymphoid, leukemic, metastatic and secondary tumors. Ocular surface tumors include a variety of neoplasms originating from squamous epithelium, melanocytic tumors and lymphocytic resident cells of the conjunctival stroma. In this review, we highlight clinical features of these lesions, important diagnostic and investigative tools and standard care of management.

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Background : Current amblyopia screening methods are not cost effective. Aim : To evaluate the diagnostic capability of a modified Brückner test (MBT) for amblyopiogenic risk factors. Materials and Methods : We applied the MBT using the streak retinoscope to identify anisometropia and strabismus by noting an inter-ocular difference in movement and glow, from children who failed 6/9 Snellen on community vision screening, followed by comprehensive eye examination. Statisitics : Data were analyzed by 2 Χ 2 tables for diagnostic test parameters (95% CI). Results : From 7998 children vision-screened, 392 failed 6/9 VA and were referred. Since 34 failed to reach the centers, and 15 were excluded due to poor/ no glow, data from 343 was analyzed. The prevalence of anisometropia of 0.5D was 17%, of 1D was 11% and of strabismus 5%. For the MBT the accuracy was ≥ 90% (95%CI 89% to 97%) over the three outcomes. The sensitivity, specificity, NPV and +LR for anisometropia of 0.5D were: 0.57 (0.48, 0.64), 0.97 (0.95, 0.98), 0.92 (0.90, 0.93) and 18 (9.7, 35); for 1D: 0.74(0.60, 0.82), 0.95 (0.94, 0.97), 0.97 (0.95, 0.98) and 16 (9.3, 28); and for strabismus: 0.5 (0.32, 0.66), 0.98 (0.97, 0.98), 0.97 (0.96, 0.98) and 20 (9.1, 42). Conclusion : Our data suggests that the MBT is highly accurate and useful for ruling in anisometropia and strabismus in children who fail 6/9 Snellen. The MBT needs further validation, both by different care givers and on differing populations. It offers an affordable, portable, and clinically useful tool to detect anisometropia and strabismus. We suggest that performing an MBT prior to uniocular retinosocpy should be a routine practice.

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Purpose : To identify under-five-year-old children with vision or ocular defect in two provinces (Wilayats) of central Oman in 2006. Study Design : Public health intervention study. Materials and Methods : Ocular examination in Manah Wilayat was conducted by nursing staff of the primary health center (PHC) and in Mudhaiby Wilayat was conducted by a trainee Omani optometrist. Abnormal sized eyeball, strabismus, nystagmus and white pupil were recorded. Visual acuity was tested by LOGMAR chart with Lea's symbols in children >2 years of age and preferential viewing was assessed by Lea's grating paddle or 'Hiding Heidi' picture in children ≤2 years age. Data was analyzed using Statistical Package for Social Studies (SPSS 12). Result : Among 1,520 examined children, three children had absent eyeball bilaterally and three had unilaterally absent eyeball. Strabismus and nystagmus were detected in 44 (2.9%) and 18 (1.2%) children respectively. 'Hiding Heidi' test was normal in 530/537 (87%) of children. Distant vision reading was ≥0.32 in 386/448 (86.2%) eyes. Preferential looking test suggested that half of the children had defective vision (>2cpcm). Screening at '1-2 year' and '3-4 years' age group could significantly predict eye problems ( P≤0.001). Conclusion : Eye and vision screening of under-five kids helped in detection of eye problems in early stages. Instead of universal screening, high risk population or children of '3 to 4' years for vision and '1 to 2' years for ocular abnormalities is proposed The existing health services could not detect some children with eye problems and they were identified during such screening.

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This paper summarises the current status of the use of vascular endothelial growth factor (VEGF) blocking agents in retinal vein occlusion. There have been no randomised controlled trials comparing this treatment with the current standard treatment (largely laser) so the lower grade evidence of single treatment case series and anecdotal reports are discussed. VEGF blockers are good at reducing macular oedema in the short term, do improve visual acuity in many cases, and do not seem to adversely affect the long term revascularisation that is necessary to overcome the vein occlusion. VEGF blocking agents are not used in isolation in this condition - they will remain an adjunct to systemic and other local treatments. The literature was reviewed in online searches of Embase and Ovid and the papers quoted are a representative sample of a larger body of publications.

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Purpose : To compare two phakic intraocular lenses, Artiflex and STAAR^® implantable contact lens (ICL), in high myopia. Setting : Isfahan Ophthalmology Clinic, Iran. Materials and Methods : In a randomized, prospective clinical trial study, 40 eyes of 20 patients who came to Isfahan ophthalmology clinic to correct their refractive error were examined. Artiflex was inserted in 20 eyes and ICL in the other 20 eyes. After 1 year, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), contrast sensitivity, intraocular pressure (IOP), and specular microscopy of corneal endothelium were assessed in both the groups. Results : In this study, there was no statistical difference between UCVA, BCVA, IOP, cataract incidence, contrast sensitivity, and specular microscopy, 1 year after surgery. 40% of eyes in the Artiflex group developed anterior chamber cell and flare reaction 1 year postoperatively, but no patient in the ICL group developed the same. So, there is obvious difference in the rate of anterior chamber cell and flare reaction between these two groups. Conclusion : These two lenses have similar outcomes except in the incidence rate of anterior chamber cell and flare reaction that is greater in the Artiflex group. So, these two lenses are safe with predictable outcome in treating high myopia.

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Purpose : We present the level of Knowledge, Attitude and Practice (KAP) among diabetic patients regarding eye complications and their care. Materials and Methods : A cross sectional study was conducted in 2008 at seven regions of Oman. Arabic speaking nurses interviewed diabetics at clinics. They used a closed ended questionnaire with 15 questions. The responses were analyzed and the KAP were grouped into excellent (>80%), good (60 to 79%), average (40 to 59%), poor (20 to 39%) and very poor (<20%). They were also compared among epidemiologic variants. Result : Of the 750 participants, 'Excellent', grade of knowledge about diagnosis and eye care was present in 547 (72.9%) and 135 (18%) persons respectively. The 'excellent' grade of attitude about eye involvement and eye care was found in 135 (18%) and 224 (29.9%) participants. The practice for undergoing eye check up and accepting treatment was of 'excellent' grade in 390 (52%) and 594 (79.2%) respectively. Age (OR = 0.98), Sharqiya region (OR = 25) and '5 to 9' duration of DM (OR = 2.1) were associated with the knowledge. '<1 year' duration (OR = 0.3) and Dhakhiliya region (OR = 39) were associated with the attitude while '5 to 9 year' duration (OR = 3.4) was associated with better practices. Conclusions : Knowledge about eye complications and care is satisfactory among persons with diabetes. However, levels of attitude and practice were less than desired and should be improved. This could strengthen program approach for early detection and care of eye complications of diabetes in Oman.

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Glaucoma diagnosis, identification of people at risk, initiation of treatment and timing of surgical intervention remains a problem. Despite new and improving diagnostic and therapeutic options for glaucoma, blindness from glaucoma is increasing and glaucoma remains a major public health problem. The role of heredity in ocular disease is attracting greater attention as the knowledge and recent advances of Human Genome Project and the HapMap Project have made genetic analysis of many human disorders possible. Glaucoma offers a variety of potential targets for gene therapy. All risk factors for glaucoma and their underlying causes are potentially susceptible to modulation by gene transfer. The discovery of genes responsible for glaucoma has led to the development of new methods of Deoxyribonucleic acid (DNA)-based diagnosis and treatment. As genetic defects responsible for glaucoma are identified and the biochemical mechanisms underlying the disease are recognized, new methods of therapy can be developed. It is of utmost importance for the ophthalmologists and glaucoma specialists to be familiar with and understand the basic molecular mechanisms, genes responsible for glaucoma and the ways of genetic treatment. Method of Literature Search The literature was searched on the Medline database, using the PubMed interface.

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Background: The aim of this study is to evaluate the safety and effectiveness of riboflavin-ultraviolet type A (UV-A) light rays induced cross-linking of corneal collagen in improving visual acuity and in stabilizing the progression of keratoconic eyes. The method of corneal cross-linking using riboflavin and UV-A light is technically simple and less invasive than all other therapies proposed for keratoconus. It is the only treatment that treats not only the refractive effects of the condition but the underlying pathophysiology. Materials and Methods: In this prospective, nonrandomized clinical study, 20 eyes of 19 patients with keratoconus were treated by combined riboflavin UV-A collagen cross linking. The eyes were saturated with riboflavin solution and were subjected for 30 min under UV-A light with a dose parameter of 3 mW/cm ² . Safety and effectiveness of the treatment was assessed by measuring the uncorrected visual acuity, best corrected visual acuity, manifest cylinder/sphere, keratometry, pachymetry, posterior and anterior elevations from Pentacam and corneal aberrations at 6 months and 1 year post-treatment. Results: Comparative analysis of the pre-operative and 1 year post-operative evaluation showed a mean gain of 4.15 lines of UCVA ( P = 0.001) and 1.65 lines of BCVA ( P = 0.002). The reduction in the average keratometry reading was 1.36 D ( P = 0.0004) and 1.4 D ( P = 0.001) at the apex. Manifest refraction sphere showed a mean reduction of 1.26 D ( P = 0.033) and 1.25 D (0.0003) for manifest cylinder. Topo-aberrometric analysis showed improvement in corneal symmetry. Conclusion: Cross-linking was safe and an effective therapeutical option for progressive keratoconus.

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Glaucoma is the second most common cause of blindness in the world as determined by the World Health Organization (WHO). Glaucoma diagnosis, identification of people at risk, initiation of treatment and timing of surgical intervention remains a problem. Despite new and improving diagnostic and therapeutic options for glaucoma, blindness from glaucoma remains a major public health problem. The role of heredity in ocular disease is attracting greater attention as knowledge and recent advances of Human Genome Project and the HapMap Project have made genetic analysis of many human disorders possible. Glaucoma offers a variety of potential targets for gene therapy. All risk factors for glaucoma and their underlying causes are potentially susceptible to modulation by gene transfer. The discovery of genes responsible for glaucoma has led to the development of new methods of Deoxyribonucleic acid (DNA)-based diagnosis and treatment. As genetic defects responsible for glaucoma are identified and the biochemical mechanisms underlying the disease are recognized, new methods of therapy can be developed. It is of utmost importance for ophthalmologists and glaucoma specialists to be familiar with and understand the basic molecular mechanisms, genes responsible for glaucoma and the ways of genetic treatment. Method of Literature Search The literature was searched on the Medline database using the Pubmed interface.

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Background: There is no proven effective treatment for vision loss in central retinal vein occlusion (CRVO). Bevacizumab has been reported in small series with limited follow-up, to have a positive effect in reducing cystoid macular edema (CME) and improving vision in CRVO. Purpose: To report long-term results with the use of bevacizumab in CRVO. Materials and Methods: Prospective interventional case series included 15 patients, serially evaluated with best corrected visual acuity (BCVA), optical coherence tomography (OCT), fluorescein angiography, and tonometry. Results were statistically analyzed. Results: Mean follow-up was 12 ± 3.6 months (range, 6−18 months); mean number of injections was 2.2 (range, 1−4) per patient. Statistically significant reduction of macular thickness (P < 0.001) was seen at six weeks (mean, 346 µ); three months (mean, 353 µ); six months (mean, 348 µ); and final follow-up (mean, 342 µ). Significant BCVA improvement was seen at six weeks (mean, 0.27 logMAR), three months (mean, 0.3 logMAR), three months (0.15 logMAR), and final follow-up (mean, 0.21 logMAR) (P = 0.009). Also, 73.3% patients had BCVA improvement at the last follow-up. Conclusion: Intravitreal bevacizumab is an effective treatment option for CME in CRVO patients. Reinjections at appropriate timing, based on the OCT findings, are important for better visual outcome.

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It has been more than a year since ophthalmologists and scientists under Dr. Robin Ali's team at the Moorsfield Eye Hospital and the Institute of Ophthalmology, University College London, successfully treated patients with a severely blinding disease, Leber's congenital amaurosis (LCA) using gene therapy. This success does not look to be transient, and this achievement in gene replacement therapy clinical trial for LCA has instilled hope in numerous families with patients suffering from this and similar retinal degenerative diseases, for whom restoration of lost vision has remained a distant dream so far. The encouragement that this success has given is expected to also lead to start of clinical trials for other blinding ocular diseases for which gene therapy experiments at the laboratory and animal levels have been successful. This article reviews the various studies that have led to the understanding of gene therapy outcomes in human ocular diseases and attempts to provide a brief sketch of successful clinical trials.

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Aim : This study was designed to evaluate the effectiveness of total levator aponeurosis resection in patients with very poor levator function secondary to primary congenital ptosis. Design : A retrospective, noncomparative single-institutional study was designed. Participants : Seven patients with very poor levator function secondary to primary congenital ptosis operated between May 2008 and May 2010 by one surgeon (AM). Materials and Methods : A retrospective study of seven patients with congenital ptosis evaluating eyelid elevation following total levator aponeurosis resection. End result is improvement of the eyelid elevation. Conclusion : Total levator aponeurosis resection is easy and effective tool in elevating the eyelid in patients with very poor levator function secondary to primary congenital ptosis.

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A case of idiopathic choroidal neovascular membrane (CNVM) is described in a 17-year-old female patient. On initial examination her vision was counting fingers at one meter in the left eye (OS) and Fluorescein angiography showed a well-defined hyperfluorescent area corresponding to the CNVM. Intravitreal bevacizumab was injected into OS, and at a five-week follow-up visit, visual acuity improved to 20/100 OS. This case is unusual, in that the CNVM developed in a young lady with no significant past medical history and with the absence of a choroidal or retinal pigment epithelial disease process that may be associated with a CNVM.

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Advances in neuroimaging and interventional techniques have revolutionized the early diagnosis, prognosis, and treatment of neuro-ophthalmic disorders. These techniques include computed tomography (CT), magnetic resonance imaging (MRI), CT and MR angiographic techniques, catheter digital subtraction angiography, functional MRI, positron emission tomography, and single photon emission computed tomography. In this review, the value of current techniques in the diagnosis, localization, and treatment of various neuro-ophthalmic disorders is described.

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Purpose: The limbus and its stem cells are very important in the pathogenesis of pterygium. In this study, the efficacy of limbal stem cells and conjunctival autograft transplantation for the treatment of primary pterygium will be assessed. Design: Prospective noncomparative cohort study. Materials and Methods: Forty-two eyes of 42 patients with grade I-III primary pterygium were included in the study. Pterygium excision was performed followed by superotemporal limbal stem cells and conjunctival autograft transplantation in all cases. Recurrence of pterygium and complications within a mean follow-up period of 18.26 months (10-28 months) was studied. Results: Recurrence of pterygium occurred in two eyes (2/42; 4.75%). No significant complications were noted. Apart from re-operation in the two recurrent cases, no further surgical interventions were needed in any case. Conclusions: Limbal stem cells and conjunctival autograft transplantation is a safe and effective technique for the treatment of different grades of pterygium. It is very useful in preventing pterygium recurrence, which is a major problem in pterygium surgery.

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Keratoconjunctivitis sicca, more commonly known as dry eye, is an extremely common and often unrecognized disease. It is the condition in ophthalmology that in its mild grade of severity will affect most of the population at one time or other. Due to a wide variety of presentations and symptoms, it often frustrates the ophthalmologists as well as patients. Due to multifactorial and elusive etiology, it is often challenging to treat dry eye. Ocular surface disorders are also clinically important to treat especially in terms of visual acuity. Xero-dacryology is therefore becoming a very important branch of ophthalmology. Recent studies have given insight into the inflammatory etiology of dry eye. The conventional and main approach to the treatment of dry eye is providing lubricating eye drops or tear substitutes. However, the newer treatment approach is to target the underlying cause of dry eye instead of conventional symptomatic relief. In light of the above knowledge, the present article focuses on newer theories on pathogenesis of dry eye and their impact on dry eye management. Method of Literature Search: A systematic literature review was performed using PubMed databases in two steps. The first step was oriented to articles published for dry eye. The second step was focused on the role of inflammation and anti-inflammatory therapy for dry eye. The search strategy was not limited by year of publication. A manual literature search was also undertaken from authentic reference books on ocular surface disease.

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Background : Corneal diseases are one of the major causes of visual loss and blindness, second only to cataract. Amongst corneal diseases, microbial keratitis is a major blinding disease. In some countries, fungal keratitis accounts for almost 50% of patients with culture-proven microbial keratitis. Aim : This study was conducted to determine the epidemiological characteristics of fungal keratitis in an urban population of West Bengal and identify the specific pathogenic organisms. Methods : The charts of patients with microbial keratitis who attended the Cornea Services of Priyamvada Birla Aravind Eye Hospital from January to December 2008 were retrospectively reviewed. Records of patients with 10% KOH mount and culture positive fungal keratitis were analyzed for epidemiological features, laboratory findings and treatment outcomes. Results : Of the 289 patients of microbial keratitis included in the study, 110 patients (38.06%) were diagnosed with fungal keratitis (10% KOH mount positive). Of the 110 patients, 74 (67.27%) fitted the study inclusion criteria (10% KOH mount and culture positive). Forty five of 74 patients (60.81%) in the study group were in the older age group (>50 years). Ocular trauma in 35 cases (47.29%) was identified as a high risk factor and vegetative injuries in 17 cases (22.97%) were identified as a significant cause for fungal keratitis. Maximum organism source was from corneal scrapings in 41 cases (55%). The predominant fungal species isolated was Aspergillus sp (55.40%) followed by Candida albicans 14 cases (18.91%) and Fusarium sp. in 8 cases (10.81%). Agricultural activity related ocular trauma was the principal cause of mycotic keratitis and males were more commonly affected. Thirty of 74 cases (40.55%) of the culture positive patients healed with corneal scar formation with medical treatment whereas 44 cases (59.45%) required therapeutic keratoplasty. Conclusion : Fungal keratitis is an important cause of microbial keratitis with injury to the cornea being a leading predisposing factor. Although Aspergillus sp. was implicated in most of the patients in our study population, Candida sp. were found in higher numbers than previously reported. Keratitis caused by filamentous fungi responds adequately to medical management. Therapeutic keratoplasty continues to remain an important treatment modality in infections with Candida sp. Early diagnosis with prompt identification of the pathogenic organism is mandatory to initiate appropriate therapy and thereby reduce morbidity.

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Purpose : To evaluate whether changes in optic nerve head topography and visual field in patients with primary open-angle (POAG) are related to central corneal thickness (CCT). Materials and Methods : Eighty eyes of 50 patients with POAG underwent ophthalmic examination; optic nerve head imaging with the Heidelberg Retina Tomography II (HRT II), ultrasound corneal pachymetry, and visual field evaluation with the Humphrey visual field analyser (program 24-2). Correlation between CCT, age, gender, family history of glaucoma, visual acuity, intraocular pressure (IOP), optic disc surface area, vertical and horizontal cup: disc ratios, neuroretinal rim area, mean deviation of visual field, and number of glaucoma medications was analyzed. Patients were divided into a thin CCT group <540 μm or a thick CCT group >540 μm. Pearson correlation was used for correlation coefficient and a P value of <0.05 was considered statistically significant. Results : Thin CCT was significantly correlated with vertical and horizontal cup: disc ratios, neuroretinal rim area loss, and smaller optic disc surface area (r=0.043, r=0.021, r=0.036, and 0.031 respectively). Thin CCT was also significantly associated with worsened mean deviation of visual field, and increased number of glaucoma medications (r=0.065 and r=0.423). Patients with positive family history correlated with with greater vertical cup: disc ratio, and more glaucoma medications but this was not statistically significant. Conclusions : In patients with POAG those with thinner CCT are likely to develop greater glaucomatous optic nerve and visual field damages than those with a thicker CCT.

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Purpose : To study the accuracy of different recent intraocular lens (IOL) calculation formulas in predicting a target postoperative refraction ± 1.0D (Diopters) in patients with long eyes (axial length ≥ 26.0 mm) undergoing phacoemulsification. Materials and Methods : This study comprised 127 eyes of 87 patients who presented with cataract and axial eye length ≥ 26 mm. Before phacoemulsification and IOL implantation; axial length measurement using immersion ultrasound A-scan technique, and autokeratometry with or without computerized corneal topography for K readings were done. The IOL power was calculated using four formulas, namely the SRK-T, Hoffer-Q, Holladay-2, and Haigis formulas. Four months after surgery, refraction was done. Differences between actual postoperative refraction and assumed target refraction using the different formulas were analyzed. P < 0.05 was considered statistically significant. Results : In all 127 eyes, the mean axial length was 31.71 mm (range, 26.06-37.11 mm) and the mean K was 44.68 D (range, 40.05-55.14D). The mean preoperative spherical equivalent (SE) was -17.52D (range, -12.25 to -30.50D). After surgery, the mean spherical equivalent was -0.8 ± 0.83D (range, +1.25 to -3.75D). The mean postoperative refractive SE when implanting a plus power IOLs was -0.3 ± 0.51D (P < 0.001) while the mean postoperative refractive SE when implanting a minus power IOLs was +1.21 ± 0.11D denoting a highly significant tendency toward hyperopia (P < 0.001). Concerning the minus power group, most postoperative refractive error was within +1.0 to +2.0D in the actual implanted IOL and in all other formula calculated IOL power. However, Haigis formula showed the least deviation while SRK-T and other formulas showed a greater tendency toward hyperopia. Conclusions : In eyes with high axial myopia, the performance of SRK-T, Hoffer-Q, Holladay-2 and Haigis formulas are comparable in low plus-powered IOL implantation. Haigis formula is the best formula when minus power IOL is implanted.

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