Conjunctival Relaxing Incisions with a Bare Bed: An Overlooked Privilege in Contracted Sockets

Introduction: The aim of reconstruction of a contracted socket is to retain a satisfactory prosthesis. Simple procedures to modify the socket architecture as first line options could avoid multiple staged procedures, increased surgical time, harvesting tissues or use of allografts. The objective of this study was to evaluate the outcome of modifying the socket architecture by making conjunctival relaxing incisions leaving it bare to re-epithelialize and compare it to dermis-fat graft. Materials and methods: A retrospective review of all socket reconstruction surgeries in our hospital over a period of 10 years (July 2009 to June 2019) was done. The two procedures which were compared were dermis-fat graft (DFG) and conjunctival relaxing incisions (CRI) without a graft. In the latter, the split conjunctiva was left bare under a conformer and temporary tarsorrhaphy. The conjunctiva was allowed to re-epithelialize under cover of topical antibiotic and steroid. Results: The patients included had a mean age of 24 years (n=8) in the DFG group and 36 years (n=10) in the CRI group. The most common cause of anophthalmic socket was enucleation for tumour and evisceration for trauma in the two groups, respectively. Six patients (75%) in the DFG group and six (60%) in the CRI group achieved good prosthesis retention (P = 0.51). None had post-operative infection. Conclusion: Transverse conjunctival relaxing incisions with tissue stretching can be a safe first line option to rehabilitate a contracted socket.

Prescription of near addition and its relation to accommodative reserve in presbyopia - The dichotomy between theory and practice

Purpose:

To study the relationship between the amplitude of accommodation (AA) measured by the Royal Air Force (RAF) rule and near addition (NA) prescribed in presbyopic patients to assess how far practice is different from theoretical recommendations.

Methods:

Patients, aged 40 to 60 years with best corrected vision of 6/6 N5 were included in this cross sectional observational study. AA was measured using the RAF rule. Refined with near Duochrome chart, the NA was given with the chart at 40 cm. Accommodative reserve was calculated from the measured AA, NA required and the calculated additional accommodation expended by the patient for reading. The percentage of reserve was calculated with and without the correction for depth-of-field.

Results:

A total of 130 patients were studied. In the patients above 50 years of age, the negative correlation of AA with age was - 0.298 (P = 0.065) and AA and NA was - 0.365 (P = 0.002) was weak. Among the patients aged between 40 and 50 years, the negative correlation of AA with Age and NA were strong; - 0.853 (P < 0.0001) and - 0.823 (P < 0.0001) respectively. When prescribing glasses, 62.01% (CI 58.78 to 65.23) and 90.93% (CI 62.50 to 119.37) of the AA was found to be kept in reserve for patients below and above 50 years of age respectively.

Conclusion:

Accommodative reserve kept in our study patients when prescribing NA was two to three times the theoretical recommendation. High percentage of accommodation kept in reserve suggest that the measured AA is not activated normally and require higher NA and one should not rely on patient’s ability to generate accommodative power especially in patients over 50 years.

Ocular myiasis in a glioma: a case report

Background: Ocular myiasis though rare, is usually found in association with basal cell carcinoma. It is rarer still in tumors other than basal cell carcinoma. We report a case of ocular myiasis in a glioma which is hitherto unreported to the best of our knowledge. Case: A 50 year old male presented with bleeding and maggots emanating from a tumourous outgrowth which had replaced his right eye. He complained of swelling and pain in his right eye for the last 2 years. Manual removal of maggots was carried out following which he underwent total excision of the mass and local debridement. Biopsy of the mass was consistent with astrocytoma. Conclusion: Myiasis though rare should be suspected in long standing neglected lesions with suggestive history. Infection, ischemic necrosis and malignancy coupled with overcrowding, poor living conditions, presence of excessive arthropods in the locality and low levels of hygiene drastically increase the risk of myiasis.