Insights into career prospects after post-graduation in ophthalmology

Postgraduate ophthalmic education in India has taken considerable strides and improved tremendously over the last decade. Career options have improved manyfold and trainee residents and fellows are often required to make key trade-off decisions when choosing a particular option. This leads many toward anxiety, fear, and dissatisfaction toward the decision-making process, and eventually even toward their career in ophthalmology. Candidates often seek guidance from mentors to aid in driving clarity of thought. To help candidates with a solid foundational knowledge of key ophthalmic education and training programs in our country and abroad, we have documented many career opportunities available after post-graduation and fellowship in this article. We have also added insights on various international fellowship and job opportunities along with notes on various national/international ophthalmic exams a post-graduate can consider.

Avoiding predatory publishing for early-career ophthalmologists

This article aims at analyzing the impact of predatory publishing in ophthalmology, criteria to identify a legitimate journal, red flags of a predatory journal, sources, and checkpoints available before publishing scientific work in a standard ophthalmology journal. A retrospective review was performed and a list of suspected Ophthalmology predatory journals was extracted through four major so-called blacklists: Beall’s, Cabell’s, Manca’s, and Strinzel’s list. This list of journals was then cross-referenced with the UGC CARE and vetted whitelist of vision science journals to remove the legitimate journals. Moreover, as all the predatory journals are supposed to be open access, all possible types of open-access journals on the Scimago webpage were also searched. A gross estimate in terms of publication cost was searched for, and a list of authentic links to find out a legitimate journal was prepared. Additionally, the methodology by which these predatory journals penetrate legitimate indexes such as PubMed was also evaluated. A total of 51 ophthalmology predatory journals were enlisted. Thirty-eight out of 124 Ophthalmology journals listed on Scimago were open access, and the cost of publishing in predatory journals ranged from USD50–500, which is substantially lower than that in legitimate journals (USD 50–3000). A total of 13 open-access platforms exist, with 10 characteristic red flags to identify a predatory journal. These journals have penetrated legitimate indexes such as PubMed by similar-sounding names to the legitimate journals and have published articles with external funding, which needs indexing. Predatory publishing impacts the quality of research in every field, including Ophthalmology, and must be discouraged.

Sympathetic Ophthalmia: Where Do We Currently Stand on Treatment Strategies?

Sympathetic ophthalmia is a rare bilateral diffuse granulomatous panuveitis that usually results from surgical or penetrating trauma to one eye. The symptoms range from impaired near vision to pain, photophobia, and loss of visual acuity. Anterior segment manifestations include bilateral acute uveitis with mutton-fat keratic precipitates and posterior segment findings include vitritis, multifocal neurosensory retinal detachment, choroiditis, optic nerve edema, and Dalen-Fuchs nodules. The diagnosis is clinical. Ancillary investigations include fundus fluorescein angiography, indocyanine green angiography, optical coherence tomography (OCT), ultrasound B scan, and autofluorescence imaging. The management options include corticosteroids (topical and systemic) as the first line along with immunomodulatory therapy started at the presentation of the disease. Recent advances include imaging with OCT-angiography, enhanced depth imaging-OCT (EDI-OCT, choroidal vascular index/CVI), targeting IL-23/IL-17 pathway, and use of biologics for the management of this rare entity. Recent advances in early diagnosis and prompt treatment has led to improved final visual outcomes in both the sympathizing and exciting eye. This review is aimed at giving a comprehensive overview of sympathetic ophthalmia along with a special emphasis on current treatment strategies and recent advances.

Is there a genetic link between Keratoconus and Fuch's endothelial corneal dystrophy?

Keratoconus (KC) is a noninflammatory, bilateral, progressive corneal stromal thinning disorder that leads to corneal ectasia, central anterior corneal stromal scarring, irregular myopic astigmatism, and reduced visual acuity. Fuchs endothelial corneal dystrophy (FECD) is bilateral, sporadic, or autosomal dominant, non-inflammatory, dystrophy involving the corneal endothelium. As the dystrophy evolves, the major complaints include glare, halos, and reduced visual acuity. Very rarely, both the pathologies can co-exist in the same patient. After the initial report of KC with FECD, there have been nearly 70 cases of coexistence reported in the literature till now. The reported number of cases varies from region to region and the majority of cases have no documented family history, hence it is difficult to approximate the incidence and prevalence based on the available literature. Hence, we hypothesize that both pathologies have probably the same genetic link. Available literature supporting the hypothesis has been discussed. We have also discussed various probable mechanisms of coexistence and proposed a management algorithm while assessing and attempting surgery in these patients. We also propose that all these patients must undergo genetic screening and counselling to prevent the spread of these pathologies in future generations.

First case of coloboma, lens neovascularization, traumatic cataract, and retinal detachment in a young Asian female

Lens neovascularization is a very rare entity to be encountered in the clinical practice. It is possibly a result of chronic ocular inflammation due to injury and subsequent uveitis. Early diagnosis and meticulous management can salvage visual acuity in such cases.

A rare presentation of anterior dislocation of calcified capsular bag in a spontaneously absorbed cataractous eye

Spontaneous lens absorption and dislocation of empty capsular bag in anterior chamber is an extremely rare phenomenon. The common predisposing factors can be weak zonular structure as in pseudoexfoliative syndrome, historical trauma or spontaneous absorption of hypermature morgagnian cataract. Here we describe a unique and rare presentation of a 53 years old gentleman who presented with defective vision in right eye (RE) for past 7 months. Visual acuity in RE was finger counting close to face and 6/60 in the left eye (LE). Anterior segment examination revealed a translucent membrane with rolled up margins in the right anterior chamber, anterior lens capsule calcification and posterior capsular breach, iridodonesis, pseudoexfoliation, sluggish pupil, and aphakia along with few vitreous strands. B scan revealed cortical matter in the anterior vitreous face in RE. The patient was planned for membrane removal, pars plana vitrectomy along with scleral fixation of intraocular lens. This case highlights the extremely rare presentation of capsular bag in anterior chamber in a spontaneously absorbed cataractous eye.

Intricate scientometric analysis and citation trend of COVID-19-related publications in Indian Journal of Ophthalmology during COVID-19 pandemic

Purpose:

To analyze the trend of COVID-19-related publications in the Indian Journal of Ophthalmology (IJO) and assess the specialty wise correlation, distribution, and citation trend during the COVID-19 pandemic.

Methods:

A retrospective analysis of all COVID-19-related articles was performed from April 2020 to May 2021. The bibliographic records were obtained from the website of IJO, Editor IJO email, and PubMed. The data was then exported as XML into Microsoft access for scientometric analysis. The articles were segregated as Original, Review, Case Report/Series, Letter to the Editor/Commentary, Guest Editorial, PointCounterpoint, Consensus Criteria, Ophthalmic Images, Photo Essay, Surgical Techniques, and All India Ophthalmic Society Meeting Papers. The data was comprehensively analyzed for specialty-wise correlations, distribution, citation trend, and reasons for the same.

Results:

A total of 231 COVID-19-related articles were published during the study period. The maximum articles were [82 (35.49%)] letters to the editor, followed by [51 (22.08%)] original articles, [30 (12.99%)] commentaries, and [20 (8.66%)] editorials. The least were perspectives, consensus, images, and photo assay with [1 (0.43%)] each. The maximum publications were in July [44 (19.05%)] and least in April [1 (0.43%)]. Considering specialty, the maximum articles were related to general ophthalmology [124 (53.68%)] and least were in refractive surgery and community ophthalmology with [1 (0.43%)] each. The maximum citations were for original articles [352 (34.65%)], which was 2.3 times higher than review articles and letters to editor [150 (14.76%)]. General ophthalmology had 740 (72.83%) citations, which were nearly five times that of cornea [140 (13.78%)].

Conclusion:

The IJO showed a trough and crest pattern of COVID-19 publications month wise. Letter to editor and general ophthalmology COVID-19 articles had maximum publications with maximum citations for general ophthalmology owing to practice patterns and COVID-19 challenges.

A tale of orbital cellulitis and retinopathy of prematurity in an infant: First case report

PURPOSE

Orbital cellulitis is an infectious pathology affecting fat and muscles behind the orbital septum. Retinopathy of prematurity (ROP) is an abnormal retinal blood vessel proliferation affective preterm low birth weight infants. Here we report the first case report of a 4-month-old infant who presented to our outpatient setting with orbital cellulitis and bilateral ROP sequelae.

CASE REPORT

A 4-month-old female infant was brought by her mother to the OPD with sudden onset redness, discharge, and swelling in the right eye accompanied by fever for 1 day. The child was born preterm at 8 months gestational age with a birth weight of 1.3 kg. Ocular examination revealed orbital cellulitis. Bruckner's reflex revealed an altered red glow. Ultrasound B scan confirmed bilateral localized highly reflective peripheral anterior looping membranes suggestive of retinal detachment as sequelae of ROP. The child was treated with topical eyedrops 0.5% Moxifloxacin 2 hourly and was referred to a tertiary hospital for higher management in the form of intravenous injections of Cefixime 50 mg/kg in two divided cases with Vancomycin 60 mg/kg/day in two divided doses for 5 days in a critical care unit (CCU).

CONCLUSION AND IMPORTANCE

Orbital cellulitis is an emergency ocular condition that should be promptly treated with a multidisciplinary approach. There is a high probability of missing the posterior segment pathology in such cases. Meticulous history taking, detailed ocular examination along with Bruckner's reflex help in immediately clinching the correct diagnosis in such cases and safeguards the clinician from any medicolegal issues in the future.