Schuklenk writes of the fetishization of lean operations and efficiency in hospitals, and how the emphasis on profits exposes the healthcare worker to disease.^[1] It is indeed true for health-care systems that have refused to learn from Ebola, Nipah, MERS-CoV, and even MDR tuberculosis.^[2-5]

How to cite this article: Bhartiya S. The COVID-19 Black Swan. Cli Exp Vis Eye Res J 2020;3(1):1.

Even though ophthalmology has several distinguishing characteristics that set it apart from other industries, there are many opportunities for us to learn from them. This crosspollination of ideas is critical for innovations in processes for greater efficiency, leveraging of technology, and drafting roadmaps for better patient safety and satisfaction. It is critical to evaluate the contextual and practical differences between industries as we select what can be learnt from elsewhere when we retool for the post COVID-19 world.

Key words: Covid 19, industry learnings, practice management skills

How to cite this article: Bhartiya S. Lessons from other industries: Ophthalmology and the COVID-19 crisis. Cli Exp Vis Eye Res J 2020; 3(1):2-5.

Received: 12-06-2020;

Accepted: 18-06-2020

Severe acute respiratory syndrome coronavirus 2 causes a highly contagious coronavirus disease named COVID-19 by the World Health Organization (WHO). It has emerged as a pandemic; number of affected individuals is only increasing and so is the spectrum of its clinical presentations. To control morbidity and mortality caused by COVID-19, all physicians including ophthalmologists, need to know its established as well as probable clinical presentations. Conjunctivitis can be the first presenting symptom of the disease. Ophthalmologists are at higher risk of contracting this infection due to close contact with the patient during different examinations and procedures. Examining such otherwise asymptomatic patients further increases the risk of infection. The present review updates about the current literature on COVID 19 in relation to ophthalmology. We need to control its spread at all levels, among patients and ophthalmologists, among staff as well as the community. Frequent disinfection and social distancing should be the new norm in clinics. Teleconsultation services need to be boosted and strengthened for future use along with efforts to end the pandemic.

Key words: Corona virus, ophthalmology, severe acute respiratory syndrome

How to cite this article: Kumari K, Kaur S, Sukhija J, Ram J. Coronavirus disease in ophthalmology practice: Current scenario; available evidence; and its implications. Cli Exp Vis Eye Res J 2020;3(1):6-12.

Received: 09-06-2020;

Accepted: 14-06-2020

Capillary hemangioma (CH) also known as strawberry nevi can present as a small red raised isolated lesion. Imaging techniques such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to differentiate CH from other vascular tumors, to identify the extent of tumor. Management should be customized according to the age of the child, extent and size of the tumor(s), growth rate, depth (superficial, deep or mixed).

Key words: Hamartoma, Hemangioma, Vascular tumors

How to cite this article: Wadhwani M, Singh R. Capillary hemangioma – A review. Cli Exp Vis Eye Res J 2020; 3(1):13-18.

Received: 05-05-2020;

Accepted: 18-05-2020

Secondary macular holes (MHs), most commonly caused by ocular trauma and high myopia, often pose a therapeutic challenge. The development of modern imaging modalities as well as advanced surgical techniques enables a better pre-operative evaluation, diverse treatments, and improved prognosis. This review presents and discusses the treatment options for each of these conditions, to provide the necessary up to date knowledge for decision-making in these cases.

Key words: Macular holes, Traumatic Macular Holes, Pars Plana Vitrectomy

How to cite this article: Sela TC, Hadayer A, Zahavi A. Secondary macular hole – A review of current management strategies. Cli Exp Vis Eye Res J 2020;3(1):19-25.

Received: 11-05-2020;

Accepted: 02-06-2020

Purpose: The purpose of the study was to compare the results of therapeutic keratoplasty (TK) with those of elective penetrating keratoplasty (PK).

Materials and Methods: A retrospective case-control institutional study design was used. The medical records of patients that underwent full thickness or lamellar keratoplasty between 1/2008 and 12/2015 in Rabin Medical Center (Petach Tikva, Israel) were evaluated. The study group included eyes which had TK. The control group included eyes which had PK during the study period. Outcome measures included demographic details, indication for TK, follow-up time, intraoperative and postoperative complications, the need for additional surgeries, best-corrected visual acuity (BCVA), and the presence of a clear graft at last documented visit.

Results: Out of 1094 keratoplasties performed in the study period, 17 (1.55%) were therapeutic penetrating keratoplasties. The control group consisted of 240 consecutive penetrating keratoplasties. Indications for TK were severe infections (14 eyes, 82.4%) and sterile perforations (3 eyes, 17.6%). In 9/17 (52.9%) TK eyes, there was a preexisting penetrating corneal graft. Twelve corneas were perforated at the time of surgery (12/17–70.6%). Eight infected corneas were perforated at the time of surgery (8/14–57.1%). No intraoperative complications were noted for any patient. There were no differences in age and follow-up period between the groups. Primary failure rates were higher in the study group (29.4% vs. 14.6%, P = 0.15) and fewer eyes in the study group had clear cornea at last documented visit (66.7% vs. 77.5%, P = 0.48). Persistent epithelial defects and glaucoma were more common in the study group (47.1% vs. 5.0%, P < 0.0001 and 47.1% vs. 17.1%, P = 0.006, respectively), as were the need for additional surgeries (64.7% vs. 18.7%, P = 0.0001). BCVA on last visit was worse in the study group with only 11.8% having 6/45 visual acuity or better versus 41.7% in the control group (P = 0.02).

Conclusions: Results of TK are inferior to those of elective PK. However, the primary purposes of TK, namely, saving the globe and maintaining useful visual acuity can be achieved in most cases. The increased complication rate and the probable need for additional procedures should be discussed with the patient.

Key words: Elective keratoplasty, hot graft, penetrating keratoplasty, therapeutic keratoplasty

How to cite this article: Sternfeld A, Dagan O, Bahar I, Nahum Y. Long-term outcomes of therapeutic penetrating keratoplasty versus elective penetrating keratoplasty in a tertiary care center in Israel. Cli Exp Vis Eye Res J 2020;3(1):26-30.

Received: 03-05-2020;

Accepted: 05-06-2020

Purpose: This study aims at examining patients across primary angle-closure disease (PACD) spectrum consisting of PAC suspect (PACS), PAC, and PAC glaucoma (PACG), their untreated first-degree relatives and studying their biometric parameters.

Materials and Methods: Sixty newly diagnosed patients of PACD (22 with PACS, 20 with PAC, and 18 with PACG) were enrolled as index cases. One hundred and eightytwo first-degree relatives of these 60 newly diagnosed patients were enrolled as study population of relatives. Biometric parameters of relatives were compared with index cases. Overall incidence and relative risk (RR) of getting angle-closure disease among first-degree relatives were analyzed.

Results: Axial length (AXL), anterior chamber depth (ACD), and aqueous depth (AQD) were highest in index cases of PACS followed by PAC and then PACG. In our study, mean AXL was found to be the shortest in the index cases of PACG (22.18±0.23 mm) as compared to PAC (22.85±0.24 mm) and PACS (22.56±0.15 mm). ACD and AQD followed the disease severity trend, being highest in PACS group followed by PAC and then PACG. In relatives, a significant difference was found in mean AQD of index cases and unaffected relatives (P = 0.001), AQD being higher in the latter. Nearly a third (31.1%; 19/61) siblings of PAC and PACG together had the angle-closure disease, while 38.46% (10/26) siblings of PACS had the angle-closure disease. The RR of having PAC was much higher in PACG relatives (1.83) than PAC relatives (0.74) as compared to the baseline population of PACS relatives. Thus, the RR of having any subtype of PACD was much more in first-degree relatives of PACG (1.44) than those of PAC (0.82).

Conclusion: Parameters, such as ACD, AQD, and AXL, follow a disease severity trend and can be used for population screening. First-degree relatives, especially siblings of patients with PACG, must undergo screening for timely detection of angle-closure disease.

Key words: Angle closure, biometry, glaucoma, primary angle-closure glaucoma, primary angle-closure suspect, primary angle closure, screening

How to cite this article: Kumar S, Ichhpujani P, Beke N, Thakur S. First-degree relatives of patients with angleclosure disease: A biometric evaluation. Cli Exp Vis Eye Res J 2020;3(1):31-35.

Received: 21-06-2020;

Accepted: 27-06-2020

Aim: The aim of the study was to understand the perspectives, experiences, and concerns of patients with wet macular degeneration (MD).

Background: There are limited tools available with real-world applications to assess patient-reported outcomes and experiences in those with wet MD.

Methods: A prospective analysis of 143 (M:F 46:97) patients with wet MD utilizing a wet MD patient-reported outcome and experience measure (POEM).

Results: The perceived understanding of their diagnosis, management plan, side effect acceptability, as well as their health practitioner satisfaction was favorable. There was much variability observed related to the perception of deterioration, concerns surrounding the loss of visual function, and the effect on everyday living with high interquartile ranges. Patients with worse visual acuity, those receiving treatment for a greater duration, and currently having active treatment in at least one eye indicated a perception of greater diagnosis understanding. Worse vision resulted in more interference with daily living.

Conclusions: The MD POEM can identify concerns pertinent to the patient. Qualitative analysis can be applied to interpret these findings to deliver health-care aligned to patient expectations.

Clinical Significance: The establishment of patient-centered care and delivery of holistic outcomes.

Key words: Age-related macular degeneration, intravitreal injections, patient-reported outcome measures

How to cite this article: Rowland CA, Lee GA, Vincent SJ, Rac KA, Lee LR, Shah P. Preliminary findings from the Implementation of a wet macular degeneration patientreported outcome and experience measure. Cli Exp Vis Eye Res J 2020;3(1):36-42.

Received: 24-06-2020;

Accepted: 29-06-2020

This study aims to describe intrastromal injection of antibiotics in the management of non-tuberculous mycobacterial (NTM) keratitis. NTM can be a devastating infectious keratitis which does not resolve with only topical treatment. A case report of a 48-yearold male with sight-threatening, culture-positive NTM after corneal trauma who had been treated unsuccessfully with topical antibiotics. The patient underwent injections of intrastromal antibiotics. Using a 30G needle, amikacin 5% and azithromycin 1% were injected to the corneal stroma from the corneal limbus and deposited around the corneal infiltrate in the deep stroma. This procedure was repeated a month later. Progression of the infiltrate was arrested while sparing the visual axis. The patient’s final corrected visual acuity was maintained at 0.7 and there was no need for therapeutic keratoplasty. Intrastromal bleeding occurred after the injections but resolved without sequelae.

Clinical Significance: Patients with confirmed NTM resistant to topical treatments can benefit from the early injection of intrastromal antibiotics. This may arrest progression and preserve vision while avoiding the need for a corneal transplantation.

Key words: Antibiotics, atypical mycobacteria, infectious keratitis, intrastromal injection, non-tuberculous mycobacteria

How to cite this article: Nche EN, Wajnsztajn D, Solomon A, Lavy I. Intrastromal injection of azithromycin and amikacin for recalcitrant non-tuberculous mycobacterial keratitis. Cli Exp Vis Eye Res J 2020;3(1):31-35.

Received: 01-03-2020;

Accepted: 09-05-2020

An incidental findings of multiple air bubbles at the right skull base and in the superior ophthalmic vein of an 87 year-old female is presented. Venous air bubble is usually a minor accident with no side effects, but it holds the risk of cardiopulmonary arrest or stroke if large amount of air is introduced. Every peripheral intravenous catheterization or injection might cause hazardous air emboli and should be performed while taking the standard precautions.

Key words: Air emboli, bubbles, intravenous infusion, computed tomography scan

How to cite this article: Goldenberg-Cohen N, Man-Peles I, Borissovsky N. Incidental findings of multiple air emboli in the brain and orbit. Cli Exp Vis Eye Res J 2020;3(1):48-49.

Received: 15-06-2020;

Accepted: 21-06-2020