Mycotic keratitis is common in warm, humid regions with a varying profile of pathogenic fungi according to geographical origin, socioeconomic status, and climatic condition. Clinical diagnosis can be challenging in difficult cases and those refractory to treatment. Fungal hyphae on microscopic examination and culture isolation have been the gold standard in the laboratory diagnosis of fungal keratitis. A culture isolate of the aetiological fungus is essential to perform antifungal susceptibility testing. As the culture isolation of fungi is time-consuming, causing delays in the initiation of treatment, newer investigative modalities such as in vivo confocal microscopy and molecular diagnostic methods have recently gained popularity. Molecular diagnostic techniques now help to obtain a rapid diagnosis of fungal keratitis. Genomic approaches are based on detecting amplicons of ribosomal RNA genes, with internal transcribed spacers being increasingly adopted. Metagenomic deep sequencing allows for rapid and accurate diagnosis without the need to wait for the fungus to grow. This is also helpful in identifying new emerging strains of fungi causing mycotic keratitis. A custom-tear proteomic approach will probably play an important diagnostic role in future in the management of mycotic keratitis. Positive repeat cultures are being suggested as an important gauge indicative of a poor prognosis. Positive repeat fungal cultures help to modify a treatment regimen by increasing its frequency, providing the addition of another topical and oral antifungal agent along with close follow-up for perforation and identifying need for early therapeutic keratoplasty. The role of collagen crosslinking in the treatment of fungal keratitis is not convincingly established. Rapid detection by multiplex PCR and antifungal susceptibility testing of the pathogenic fungi, adopted into a routine management protocol of fungal keratitis, will help to improve treatment outcome. Early therapy is essential in minimizing damage to the corneal tissue, thereby providing a better outcome. The role of conventional therapy with polyenes, systemic and targeted therapy of antifungal agents, newer azoles and echinocandins in fungal keratitis has been widely studied in recent times. Combination therapy can be more efficacious in comparison to monotherapy. Given the diversity of fungal aetiology, the emergence of new corneal pathogenic fungi with varying drug susceptibilities, increasing the drug resistance to antifungal agents in some genera and species, it is perhaps time to adopt recent molecular methods for precise identification and incorporate antifungal susceptibility testing as a routine.

Purpose: To find the clinical profile and prevalence of conjunctivitis and other ocular manifestations in mild COVID-19 positive patients in a nodal COVID-19 hospital. Methods: A retrospective cross-sectional, single-center study conducted in 127 mild cases of COVID-19 positive patients admitted between 27^th March and 19^th April 2020 in a tertiary care COVID-19 hospital in north India. From the hospital records, demographic data is collected. Ocular history and ocular examinations were done by face-to-face survey during ward rounds. Results: A total of 127 patients were included in the study with a median age of 38.8 years. Forty-eight (37.80%) patients had upper respiratory tract symptoms, 20 (15.75%) patients had systemic illness, 18 (14.17%) patients were using spectacles, and 50 (39.37%) patients had history of hand-eye contact. Out of 12 (9.45%) patients who had ocular complaints, 11 (8.66%) had ocular manifestation after admission. Among 11 patients, eight (6.29%) had conjunctival congestion. Three (3/8) patients had developed conjunctival congestion even before the manifestation of definite COVID-19 symptoms. Five patients (5/8) patients had no other associated ocular symptoms other than congestion. Six patients (6/8) had symptoms of upper respiratory tract infection. Conclusion: Mild conjunctivitis manifesting as conjunctival congestion is common and is one of the major ocular manifestations in COVID-19 positive patients even with milder disease.

We report a case of a man aged 35 years who presented with the chief complaint of painless diminution of vision in the right eye for 4 months. Examination revealed a large inferior retinochoroidal mass along with retinal detachment. An anterior choroidal mass with moderate internal reflectivity was seen on B-scan ocular ultrasonography and MRI and CT scan were indicative of a mitotic aetiology. Fluorodeoxyglucose-positron emission tomography scan ruled out any other systemic foci of involvement. Based on the above findings, a provisional diagnosis of amelanotic choroidal melanoma was made and he was taken up for choroidal aspiration biopsy, wherein the cytopathology report revealed hypercellularity with no identifiable pigments. In view of the above, a diagnosticandtherapeutic enucleation was performed; however, the histopathology report of the enucleated specimen revealed poorly differentiated retinoblastoma. This case highlights that the diagnosis of retinoblastoma should be kept in mind even in adult patients.

Background: Understanding the extent of the disease penetration and assessing its impact is critical during a pandemic. However, laboratory-based COVID-19 estimation can be resource-intensive and may not be feasible during an emergency, particularly in low-resource settings. Aim: To investigate whether self-reported symptoms can be used for COVID-19 screening to estimate the burden among individuals aged 18 years and above in a rural setting. Methods: A community-based cross-section study was conducted in a rural district of Haryana, a state in north India, using a self-reported semi-structured questionnaire developed on a digital platform. Information on COVID-19 manifestations as essential and non-essential, confirmed laboratory tests, and disability data using Washington Groups of Short Set were obtained. The sensitivity of the COVID-19 symptoms was estimated against laboratory-confirmed true positives. A chi-square or Fisher exact test for association and a multivariable regression to determine the predictors of the prevalence was carried out. Results: In total, 2954 respondents (79.8%), out of 3700 enumerated, were interviewed. The mean age of respondents was 42 years (SD 17.2), with 54.8% female respondents. The prevalence of COVID-19 based on self-reported symptoms was 6.2% (95%CI: 5.3–7.1). The age-adjusted prevalence was 6.04% (95%CI: 5.9–6.1). Of the total COVID-19 cases, 170 (5.7%, 95%CI: 4.9–6.5) revealed a laboratory-confirmed test. Given three essential symptoms to declare provisionally COVID-19 cases, the sensitivity was 82.9% (141/170), but considering two or more essential symptoms along with two or more non-essential, the sensitivity reached up to 91.8% (156/170). The multivariable analysis showed that increased age, higher education attainment, students, entrepreneurs, persons working in private sectors, and participants with poor hygiene were predictors. Conclusions: A symptoms-based identification of COVID-19 cases can give a reliable estimate and valuable insight into the extent of the penetration, especially in low-middle-income countries, and can be a supplement, not a replacement, to a laboratory test.