Indian Journal of Clinical and Experimental Ophthalmology

8-11

Authors: Rajasekar Mohan Metri,Ashwini K G*,Ganashree C P,Amrutha A M,Vijayalakshmi Mangasul

Introduction: Macular edema is the most frequent cause of visual impairment in patients with Nonproliferative Diabetic Retinopathy (NPDR). Clinically they are differentiated as focal and diffuse. Optical coherence tomography (OCT) can measure the retinal thickness and assess the response of surgery. This study was done to evaluate the efficacy of OCT as an investigative tool in diabetic macular edema. Materials and Methods: A prospective study was done among 30 consecutive eyes with Clinically Significant Macular Edema (CSME) over 8 months in our institution and divided into two groups with 15 each as focal and diffuse on the basis of fundus bio-microscopy and fluorescein angiography. Baseline measurements were done by OCT. Patients were followed up after surgery at 4 weeks and 12 weeks with repeat measurements. Data entered in excel sheet and analyzed using SPSS software. Data presented as tables and graphs with Spearman’s correlation and Paired t test. Results: Among 15 eyes with focal macular edema mean age of patients was 59.80 ± 5.13 years whereas among diffuse macular edema, it was 67.80 ± 3.76 years. There was negative correlation between BCVAb and FOVb among both the groups which was significant. (p=0.033, p<0> Conclusion: Optical coherence tomography is a useful modality of investigation in patients with diabetic macular edema. Thus OCT can be used for quantitative assessment in response to surgery.

16-19

Authors: Parag Apte,Rakesh Goud*

Purpose: To find out role of high serum homocysteine levels in retinal vein occlusion patients at Dr. D.Y. Patil medical College. Design: A matched case control type of study was conducted from 2016 to 2018. Materials and Methods: Total serum homocysteine (tHcy) was measured in patients coming at Dr. D.Y. Patil medical college, aged 20 years and above. We evaluated the presence of high homocysteine levels in patients with retinal vein occlusion. We evaluated serum homocysteine levels in 50 patients with retinal vein occlusion coming to our clinic. Control subjects consisted of age and sex matched patients that were referred to our clinic for retinal disease other than vascular occlusion. homocysteine levels between 4 µmol/L to 15 µmol/L were considered normal. High homocysteine level was defined as a total serum homocysteine level above 15 µmol/L. Results: The mean serum homocysteine level were 13.80+/-8.08 µmol/L (range, 4–33 µmol/L) for cases, and 6.43+/-1.38 µmol/L (range, 4–10 µmol/L) for controls. The mean serum homocysteine levels in cases were more than double that of controls. This difference was very highly statistically significant. Out of the 50 patients with retinal vein occlusion, 13 (26.00%) patients had serum homocysteine levels above normal levels as compared to the controls where none out of the 50 patients had homocysteine levels above normal. (Chi square = 14.94, d.f.=1, p<0> in both cases and control groups. Conclusion: High homocysteine levels is a statistically significant risk factor for retinal vein occlusion and it should be evaluated in every patient with retinal vein occlusion.

23-26

Authors: Mohammed Moizuddin*,Sulaiman Abdul Khadher

Aims: To compare the two modes of treatment in pterygium surgery in terms of postoperative outcomes and duration of surgery. Materials and Methods: Prospective study was conducted from September 2017 to June 2018 at the department of ophthalmology, Narayana medical college and hospital, Nellore. A total number of 40 cases with primary nasal pterygium were selected from outpatient department for surgical intervention. The patients were randomly divided into two groups for pterygium excision with autograft using either autologous blood (20 patients) or sutures (20 patients). After surgical intervention eyes were patched for 24 hours in both groups and two groups were compared for duration of surgery, recurrence, graft edema, graft stability and other complications. Results: In comparison to autologous blood technique granuloma was more in suture group whereas graft edema was more in autologous blood technique after pterygium excision with conjunctival autografting. Conclusion: Fixing of graft in pterygium surgery with autologous blood is a better and cost effective technique when compared with sutures without increasing complications.

30-34

Authors: Rohit Agrawal*,Pravin Tidake

Introduction: Papilledema is one of the true neuro ophthalmic emergencies. Most patients with elevated intra-cranial pressure (ICP) present to ophthalmologist with non-visual symptoms such as headache, nausea, vomiting and sometimes CSF rhinorrhoea. Patients may also note transient obscuration of visual (TOV) -episodes of unilateral or bilateral vision loss lasting 5-15 seconds. Papilledema serves as an important indicator and warning signal of intracranial pathology. Materials and Methods: It was a cross-sectional study. Patients with papilloedema were examined for clinical stage (Early. Established, Chronic and Atrophic), aetiology, visual acuity, colour vision, contrast and perimetry. Results: The most common aetiology for papilloedema was found to be ICSOL. Maximum number of patients were found to have early papilloedema. The correlation showed that visual acuity, colour vision and contrast were less affected in early stages of papilloedema as compared to late stages.

40-43

Authors: Syed Ali Nasar Waris,R S Naveen Balaji*,Rubina Huda

Introduction: One of the most important cause of dry eye is diabetes mellitus. Longer the duration of diabetes in a patients, higher is the chance of developing dry eye. Level of blood sugar in diabetic patients also has a role to play in causing dry eye disease. It is seen that dry eye disease is more common in patients with poor blood sugar control. In India, not much studies has been done on dry eyes in diabetic patients. This study was carried out in an attempt to find out prevalence of dry eye in diabetic patients. Materials and Methods: Hospital based prevalence study of hundred patients with type II diabetes was conducted in SRM medical college and hospital between august 2012 and July 2013.Detailed diabetic history, slit lamp bio microscopy, Schirmers test, tear break up time, fluorescein staining, Rose Bengal staining were done, along with a standard questionnaire. Results: Forty three (43%) type II diabetes patients had dry eye in our study. A significant association is found in dry eye with poor glycaemic control [p-0.001] and with longer duration of diabetes [p<0> Conclusion: Good glycaemic control is essential to reduce the prevalence of dry eye. Examination of dry eye should be considered as an integral part in the assessment of diabetic eye diseases.

48-51

Authors: Prasanna Jit Das,Abhisek Mondal*

Introduction: Infection in the orbit and the periorbital tissues are particularly important subsets of inflammatory diseases not only because of frequency of presentation but also because of life threatening conditions which demand prompt, specific and therapeutic management. Of the orbital inflammation with infections most common aetiological factors encountered, are due to bacteria. Materials and Methods: All patients with orbital signs and symptoms of inflammatory diseases of infectious origin were selected. Progression, symptoms, history of associated symptoms such as headache, fever, allergy etc. asked for. History of trauma, immunization and systemic illness, endocrinological disorders, infections of any systems and any dermatological disorders were taken into account. Local examination, ENT examination, laboratory and radiological investigations were done in all cases. Results: Incidence of orbital infection is 0.34%. Male preponderance and maximum number of patients were adult. The maximum aetiological factor of orbital infection being due to infections of the ocular adnexae, sinusitis, dacryocystitis, post-surgical, and trauma. Raised IOP in 24%, proptosis in 34%, restricted ocular motility in 42%, mechanical ptosis in 70%, NLD block in 18%, Corneal oedema or opacity in 14% and inflammation of ocular adnexae in almost all cases. In majority of the cases the organism responsible is Pseudomonas aeuroginosa, then staphylococcus aureus. Conclusion: Orbital infection is sight threatening and the pathognomic features and virulence of the causative organism is unpredictable. Early presentation appropriate diagnosis and judicious protocol if followed at an early stage would halt the morbidity and fatality.

58-60

Authors: Dinu Kumar Arthur,Ganapathy Kalaiselvi*

Aim: To assess the frequency of systemic and ocular co-morbidities among the patients seeking cataract surgery in a tertiary hospital, Puducherry, south India. Materials and Methods: This was a retrospective cross sectional study. All patients with senile cataract seeking cataract surgery in our hospital and research institute from July 2015 to June 2016 were included. Results: Out of 448 patient’s case records reviewed, there were 218(48.66%) males and 230(51.34%) females. 147 (32.81%) patients had systemic co-morbidity and 66 (14.73%) had concurrent ocular disease. Among the systemic co-morbidities, commonest was diabetes mellitus in 61(13.62%), followed by hypertension in 42(9.38%) and renal disease in 16(3.57%) patients. Among the ocular co-morbidities age related macular degeneration was the commonest seen in 19 (4.24%) cases, followed by diabetic retinopathy in 15 (3.35%) patients. Conclusion: Systemic and ocular co-morbidities are prevalent among the cataract surgery seeking population, which needs to be identified by the ophthalmic surgeons and systemic illness needs to be adequately controlled before surgery while ocular problems need prompt intervention with a close follow-up for a better quality of life.

66-70

Authors: Nida Khan*,Saroj Gupta,Prakash Agrawal

Purpose: To evaluate the angle of anterior chamber with SD-OCT in patients above 40 years of age presenting to tertiary health care center in central India. Materials and Methods: 120 Consecutive patients (240 eyes) above 40 years of age presenting to ophthalmology OPD of tertiary health care center were enrolled in a cross-sectional study. All patients underwent comprehensive ocular examination with included best corrected visual acuity, slit lamp, fundus, gonioscopy, intraocular pressure (IOP), evaluation of angle (i.e. AOD, TISA, TIA) of anterior chamber with SD-OCT. The duration of study was one year six months. Result: The mean age was 53.94 years. There were 61 males & 59 females. It was noted that mean nasal & temporal AOD was less in females (0.4175 µm, 0.4142 µm) as compared to males (0.4583 µm, 0.4613 µm). We found that older people have a narrower anterior chamber angle i.e. from 40-60 years of age mean TIA nasal & temporal was 29.13, 27.53 degree & above 60 years of age mean TIA nasal & temporal was-24.13, 22.63 degrees. Conclusion: We found that AOD is less in female as compared to male. It was also noted that older people have a narrower anterior chamber angle as compared to younger people. The gonioscopy has been considered as the gold standard for characterizing the ACA, but it is contact procedure, subjective and requires the expertise while the OCT is rapid, quantitative, reproducibility, non-contact procedure with less interobserver variability will help us to accurately assess anterior chamber angle.

78-81

Authors: D Nirupama*,B Hymavathi,L Prathima,T Sanjay Reddy,G Satyanarayana Reddy

Purpose: To evaluate the efficacy of Meibomian gland probing for obstructive Meibomian gland dysfunction (O-MGD) using intraductal Meibomian gland probe. Materials and Methods: 30 patients with Obstructive MGD based on 1. Presence of lid tenderness/ lid margin congestion/ telangiectasia /viscous meibomian gland secretion on slit lamp examination; 2. Tear Film Breakup Time less than 10 seconds; 3. OSDI (Ocular Surface Disease Index) score more than 12, were taken up to intraductal meibomian gland probing. Patients were reviewed after 1 month, 3 months and 6 months. In each visit slit lamp examination was done to see for the improvement of lid margin congestion. TBUT was done and improvement in symptoms were assessed with OSDI questionnaire. Results: At the end of 6 months 28 patients (93.3%) had improvement in TBUT and OSDI. Lid margin congestion decreased in all the patients. TBUT improved from 5.33 ±1.56 sec to 9.87±1.56 (p value 0.0001). OSDI score improved from 26±7.49 to 13.5±3.57 (p value 0.0001). 8 patients (26.6%) required retreatment after 3 months. Conclusion: Intraductal probing had a substantial improvement in lid tenderness, TBUT and provided symptomatic relief for patients with Obstructive-MGD.

87-90

Authors: Priti Singh*,Akhil Tanwar

Tobacco smoke contains a myriad of toxic chemicals. Smokers have been implicated to be at a higher risk of developing dry eye, cataracts, glaucoma, amblyopia, ARMD and diabetic retinopathy. In addition to this, many smokers are not aware of the adverse effects of smoking on the eye. A survey carried out in 2013 in the UK found that just 15% of smokers are concerned about the impact smoking has on their eye health. Aims: To find out the incidence, prevalence, status of ocular disease among heavy smokers and to know the awareness level among heavy smokers. Also to find out relation between ocular problems and systemic diseases in subjects. Setting: The study was carried out in patients attending eye OPD of a tertiary care centre during July and August 2015.This is a cross-sectional study. Materials and Methods: Clinical examination was conducted starting with the torch light examination and conjunctiva, cornea, lens, anterior segment were evaluated. This was followed by visual acuity assessment using snellens chart. Furthermore, Slit Lamp Biomicroscope was used in case of suspicious cases to add to our findings. Dry eye evaluation was done using Schirmer test strips. Lastly Direct Ophthalmoscopy was performed to look at the fundal changes. Appropriate statistical formulas were used. Results: The prevalence of Dry eye was 74.28%. The finding of dry eye in males and females was not significant at p value <0> Conclusion: We were able to quantify different ocular morbidities of which Dry eye was the most prevalent. Findings of cataract, ARMD and diabetic retinopathy were also present in some patients. We were also able to quantify findings of dry eye in males and females; however the difference was statistically insignificant. Our study also shed some light on various other associated systemic findings present in the patients in addition to the eye problems.

95-101

Authors: Manjunath D Patil,Jayaramulu H Sankaram*

Introduction: Various survey’s reveal that 1-2% of the population over the age of 40 years have glaucoma and its incidence increases with age. It is the third most common cause of blindness next to the cataract and refractive errors. The present study was undertaken to assess long term effects on controlling intraocular tension by trabeculectomy with and without intraoperative use of 5 – fluorouracil. Materials and Methods: The present study was undertaken in the Department of opthalmology, ARMCH & RC, Kumbhari. In the present study, 50 cases were operated for trabeculectomy by using following two methods – with and without use of 5 – Fluorouracil. Informed written consent under guarded visual prognosis was obtained from all patients. Results: Highest number of patients 17 (34%) were in the age group of 51-60 years, thus confirming that the glaucoma is more common in 6th decade. Intraoperative use of 5 – fluorouracil has resulted in stable control of intraocular tension over prolonged period of time while in trabeculectomy without 5 – Fluorouracil there was gradual loss of control of intraocular tension over prolonged period of time. Conclusion: Intraoperative use of 5 – fluorouracil in trabeculectomy is useful an alternative to maintain the intraocular tension in lower teens over prolonged period of time by modifying the conjunctival bleb morphology, without causing any serious corneal complications.

105-107

Authors: Tarannum Shakeel,Sushobhan Das Gupta*

Objective: To compare the rate of posterior capsular opacification and Nd:YAG laser capsulotomy in children and adults after cataract surgery and primary intraocular lens implantation. Materials and Methods: 38 eyes of 24 children and 53 eyes of 47 adults patients who had undergone phacoaspiration/phacoemulsification surgery with primary in the bag posterior chamber intraocular lens (PCIOL) implantation were included in the study. A retrospective analysis of data was performed. The rate of posterior capsular opacification (PCO) and Nd:YAG laser capsulotomy was compared between children and adults with different type of intraocular lenses (PMMA and acrylic). Results: Age of the children ranged from 2 to 12 years and that of the adults from 47 to 80 years. PCO developed in 27.28% eyes of children with Acrylic intraocular lens (IOL) and in 75% eyes with square edge PMMA lens. PCO did not develop in any of the adult patients with either PMMA or acrylic IOL. Conclusion: Rate of PCO in children is lower with acrylic IOL as compared to square edge PMMA lens. However in adults, PCO preventing effect of IOL material seems to be immaterial in the hands of an experienced phaco surgeon.

114-117

Authors: Akshay Rajeshwar Padgilwar,Sudhir Sudhakar Pendke*,Saud Gafur Deshmukh

Purpose: 1. To study the clinical and microbiological aspects of fungal keratitis; 2. To study the predisposing and prognostic factors. 3. To study the clinical course management and outcomes of fungal keratitis; 4. To study the morphological features of corneal ulcer; To study the complications and final visual outcome. Material and Methods: This study was carried out in Maharashtra in Marathwada region, over 31 patients, the patients who were showing signs and symptoms of fungal keratitis with special significance to predisposing and prognostic factors microbiological investigation management and follow up. The data was assessed on the basis of simple percentages and ratios. Results: Fungal corneal ulcer was predominantly found more in the age group of 51-60. Majority of fungal corneal ulcer were found in rural area. Majority of cases were more common in males as compared to female. Majority of fungal corneal ulcer patients had history of trauma as predisposing factor. Majority of trauma cases were because of vegetative material. Majority of fungal corneal ulcer were related to farming activities. Inferior quadrant of cornea was most frequently involved in fungal corneal ulcer. Majority of fungal corneal ulcer were having rolled out margins. Majority of cases had thick and fibrinous hypopyon. Hypopyon was present in majority of fungal corneal ulcer patients. Distribution of fungal corneal ulcer studied. Aspergillus niger-18(58.06%); Fusarium 8(25.80%); Cladosporium 3(9.67%); Penicillium 2(6.45%).

121-126

Authors: Kaiyoor Surya Divyalakshmi*,Rengappa Ramakrishna

Introduction: Glaucoma is a progressive optic neuropathy with characteristic optic disc and visual field changes. Major types include primary open angle and primary closed angle glaucoma. Cataract is a progressive degeneration of crystalline lens resulting in its opacification. Incidence of concurrent cataract and glaucoma is increasing. Combined cataract and glaucoma surgery i.e Phacotrabeculectomy can be considered in these cases. Intraoperative and postoperative complications are known in combined surgeries. Comparision of complications and its management in 3 different types of glaucoma undergoing phacotrabeculectomy will be done. Materials and Methods: In this study, 90 eyes with cataract were divided into three groups, group A with POAG, group B with PACG, and group C with PXFG. All patients underwent phacotrabeculectomy by a single surgeon. Intraoperative and post-operative complications at 1 day, 1 week, 1 month, 3 months and 6 months were documented. Management of the complications were also noted. Results: No significant difference was seen in the three groups with respect to complications except at 1 month when high IOP was noted in POAG and PACG, which was statistically significant (p <0> All these cases underwent Argon suturolysis. One case of bleb failure due to late fibrosis was noted each in angle closure and pseudo-exfoliation group at 6 months follow up, which was not statistically significant. Conclusion: No significant difference was noted in the rate of intraoperative and post-operative complications between 3 types of glaucoma following pahcotrabeculectomy. This study shows that phacotrabeculectomy might be used as safe surgery in patients having co-existent cataract and glaucoma.

131-133

Authors: Tanvi Poy Raiturcar*,Ugam Usgaonkar,Marushka Aguiar

Ocular tuberculosis is a very rare clinical presentation. The limited specimen size available for investigation makes it difficult to reach an accurate diagnosis. Here is a case of uveitis which did not show any improvement with topical steroids and progressively worsened to develop scleral abscesses. The only positive history was contact with a patient of pulmonary tuberculosis and the only positive investigation was a strongly positive Mantoux test. Based on these the patient was started on anti-tuberculosis therapy and showed a dramatic improvement. This is only the second such case reported in the literature.

439-442

Authors: Tanushree V*,Vinuta Mohan Kulkarni

Purpose: Study aims to correlate serum vitamin D level to disease severity in children with vernal keratoconjunctivitis. Materials and Methods: 50 patients in the age group between 5-15 years attending the out patient department of Ophthalmology from December 2017 to March 2018 were enrolled in the study. After detailed evaluation, vernal keratoconjunctivitis diagnosed based on signs and symptoms. Severity of the disease documented. Patients were started on treatment for vernal keratoconjunctivitis. Serum vitamin D level was obtained for all the patients. Patients with low level vitamin D were noted and treated for the same. Data collected and analysed using descriptive statistics. Results: Out of 50 patients, 36 were males and 14 were females. Mean age of presentation was 13 years. Serum vitamin D was less than 20ng/mL in 38 (76%) patients. In patients with mild to moderate disease it was between 10-20ng/mL and was significantly lower (<10ng> Conclusion: Children with vernal keratoconjunctivitis have low vitamin D level as a consequence of sun exposure avoidance due to intense photophobia and pruiritis. Evaluation of vitamin D level in vernal keratoconjunctivitis patients can help in early diagnosis and treatment.

447-449

Authors: Karma L. Bhutia*,Sonam C. Bhutia

Aim: To find the prevalence of glaucoma in diabetic patients attending tertiary care hospital, east Sikkim. Materials and Methods: A hospital based study of 75 diabetic patients attending the eye opd at Crh from March to August 2018 underwent complete ocular examination for glaucoma after taking a prior consent from the patient. Results: Out of 75 diabetic patients 15(20%) of them had glaucoma. Out of 15 diabetic patients with glaucoma 73.3% were males and 26.6% were females. The mean age of diabetics females having glaucoma is 53.75 ±16.39 and male is 60.36±12.14. As far as Ethnic distribution was concerned in our patients with glaucoma 60% were Nepali, 33.3% were Bhutia and 6.7% belonged to other communities. Conclusion: This study highlights the prevalence and the demographic characteristics of glaucoma among diabetes mellitus patients in a tertiary care hospital in east Sikkim. The northeast of India records the highest prevalence of diabetes mellitus hence the ocular manifestations of the disease are common. Since no such study has been done in Sikkim before this will play an integral role in raising awareness amongst the people about the ocular manifestations of the disease.

454-457

Authors: Shazia Qayum*,Vineet Gupta,Jyoti Chauhan

Introduction: Infectious keratitis is among the leading causes of preventable blindness in developing countries. The epidemiological profile of infectious keratitis vary significantly from country to country and even area to area within the same country. Aim: This study was conducted to know the epidemiological pattern, predisposing risk factors involved and microbiological profile of the patients with corneal ulcer. Materials and Methods: A retrospective analysis of all the patients presenting to MMIMSR eye opd with corneal ulcer between Jan 2016 to June 2018 was done. The demographic data as well as epidemiological profile including history of trauma, duration of symptoms, predisposing risk factors, time taken to present to hospital was collected. The diagnosis was made based on clinical findings on Slit lamp examination as corneal epithelial defect with stromal infiltrate and microbiological investigations. Results: There were a total of 234 patients documented to have corneal ulcer. The mean age of presentation was 46 ± 18 years. Only 20 (8.6%) presents within a week of symptoms and 122 patients (52.1%) presented within 2 to 4 week of symptoms. A history of ocular trauma was present in about 150 patients (64%) out of which trauma with vegetative matter in 88 (58.67%) patients and trauma with non vegetative matter in 51 (34%) patients. Corneal scrapping was positive in 185 patients (79.04%) with KOH mount being positive in 152 patients (64.95%). Gram stain was positive for bacteria in 21 patients (8.97%) and 12 (5.12%) patients reported both bacteria and fungus. In 47 patients (20.08%), no organism was reported. Among the gram positive isolates, Staphylococcus epidermidis was the most frequent species. The most common fungal isolate reported was fusarium in 49 patients (26.48%) followed by Aspergillus in 19 patients (10.27%). Conclusion: Infective keratitis is a common cause of ocular morbidity with fungal corneal ulcer being the most frequent ulcer. Fusarium species in fungal corneal ulcer and staphylococcal epidermidis in bacterial corneal ulcer were the common isolates. A lack of knowledge about the magnitude of the problem, financial limitations and topographical constrains were implicated in delayed presentation to a health center.

465-468

Authors: Kundan Malhotra,Gunjan Tank*,Kunjan Patel,Mansi Patel,Devyani Vaghela

Aims: To evaluate donor cornea by using eye bank specular microscope and evaluate outcome of keratolplasty according to the graft condition. Materials and Methods: This was a prospective study of 30 patients who undergone keratoplasty. Donor cornea was evaluated by slit lamp biomicroscopy and after preservation in MK media, evaluated using eye bank specular microscope. Final decision of transplantation was made on grading of specular microscopy. All patients undergone penetrating keratoplasty and post-operative outcome was measured. Results: In our study majority of donors were in age group of 21-40 years. Endothelial cell count of >3000 cells/mm2 was observed in 60% cases, while 2500-3000 cells/mm2 in 26.67% cases. The reason for penetrating keratoplasty were corneal opacity or scarring (40%), PBK (23.33%), acute infective keratitis (13.33%), regraft due to graft failure (10%), ABK (10%) and corneal dystrophy (3.33%). Postoperative clear graft was seen in 60% cases while cloudy in 20% and opaque in 20% cases. It was observed that large number of recipients (46.66%) had post-operative visual acuity more than 6/60. Conclusions: Though tissue utilization can be optimized with the use of eye bank specular analyzer, final outcome depends on multiple factors. Few tissues of older age can be utilized if having good endothelial count.

473-477

Authors: Dipak B. Patel,Anjasi M. Patel*,Mohak A. Shah,Aneesha K Vyas,Shail Shah

Aims: The purpose of the study was to evaluate the functional gain, visual outcome and patient satisfaction after LASIK. Materials and Methods: The study included 150 patients (85 males and 65 females) that underwent LASIK procedure for correction of refractive error and were followed up on first week, first and third month postoperatively. Visual acuity, Schirmer’s test and contrast sensitivity were evaluated on each follow up. The patients were asked to fill a questionnaire consisting of 14 questions scored as 0, 1 and 2 for an unsatisfied, satisfied and very satisfied patient respectively prior to surgery and on the last visit. The patients were divided into three groups on the basis of the score obtained as: (<10> Results: In this study, the UCVA in 98.6% of our patients was ?20/30 postoperatively. The mean Schirmer’s I value was 13.99 ± 1.530 in the right eye and 14.01 ± 1.544 in the left eye, while Schirmer’s II values were 13.44 ± 2.128 and 13.51 ± 2.351 in the right and left eye respectively at the end of 3 months. Contrast sensitivity improved to a mean of 1.79 ± 0.15 at three months. Night driving complications reduced from a mean score of 1.59 ± 0.29 to 0.58 ± 0.05 postoperatively. Conclusions: High level of patient satisfaction can be attained with LASIK procedure. Night vision problems and dry eye are imperative causes of dissatisfaction.

483-486

Authors: Salil Gupta*,Ishaan Gupta,Sanjay Kalra

Aims and Objective: To evaluate awareness of DR among a sample of T2DM in Karnal. Materials and Methods: Two hundred and forty seven diabetic patients were studied at Bharti Hospital and from Jan 2017 to July 2017. Details on awareness about DR, screening for DR, last ophthalmological evaluation, report of screening by fundus photography, quality of fundus photo and reason for poor quality were recorded. Results: Mean age of study cohort was 53.95±10.42 years. Most common age group was 51-60 (33.20%). Most of the diabetes patients knew that diabetes causes eye problem (80.16%), of them only 55.56% knew specifically diabetes causes retinopathy, diabetes causes Glaucoma (57.07%) and diabetes predisposes to cataract (68.69%). Further evaluation regarding awareness of symptoms revealed that most of them were aware regarding the blurred vision (72.22%) and blindness (68.18%), whereas most of the patients were not aware about the floating black dots/lines (78.79%), fluctuation of vision (85.86%), dark or empty spaces in the visual field (86.87%), difficulty in perception of image (86.36%), double vision (84.85%) and eye pain (79.89%). Duration of DM is related to eye disease (69.70%), dietary control and life style modifications are important for control of diabetes (76.77%), whereas 67.68% were unaware that the eye problem can be controlled/avoided with regular medication and diabetic control. Conclusion: Awareness of DR and associated factors especially symptoms of DR are less among the T2DM patients of study place. It is very important to spread the awareness regarding DR though various means of communication in order to decrease the prevalence of DR.

492-498

Authors: Aditi Sharma*,Aditya Vikram Sharma

Aims and Objectives: To compare the accuracy of ultrasound A scan biometry and IOL master (PCI) biometry in intraocular power calculation, by doing a comparative study of difference in biometry by conventional methods and optical biometry (IOL master). Materials and Methods: Place of study: Aravind Eye Hospital, India. Design of Study: Prospective, non randomised, clinical study. Study Group and Duration: The study involves patients who underwent cataract surgeries at Aravind Eye Hospital, Tirunelveli during the specified time period. The IOL power and predicted refractive outcome were calculated for every patient by both the methods, A scan ultrasound Biometry IOL master (Partial Coherence interferometry) Inclusion Criteria: Only those patients in whom it was possible to secure a reliable IOL master reading (on the basis of good SNR), were included. Results: In a 12 month period, 337 eyes were consecutively enrolled in the study. Both ultrasound A scan and partial coherence interferometry was performed and IOL power implanted as per the IOL master. Inclusion criterion and exclusion criterion used as mentioned. The difference in between the final and predicted refraction is compared for both the groups. The overall Mean absolute error was 0.402 ± 0.407 with the ultrasound A scan & 0.388 ± 0.406 for the IOL master, with the probability value (p-value) 0.3802. The mean numerical error (the difference between the refractive outcome and the predicted spherical equivalent) is -0.226 ± 0.526 (min -2.66 & max 2.06) for the ultrasound scan group and -0.217 ± 0.518 (min -2.41 & max 2.10) for the IOL master group, with the probability value (p-value) being 0.514. We got a comparative result in our study, though not significant, but it is more in favour of IOL master (PCI) as per the mean absolute error and mean numerical error calculations. When analysing the Mean Axial Length readings, the findings were almost similar, with an insignificant p-value.

503-506

Authors: Sooraj Singh Kubrey,Jyotsna Jareda*

Objectives: To determine institution based incidence of childhood blindness and to study its clinical profile. Type of Study: An observational retrospective, institution based study. Materials and Methods: This study was conducted in a tertiary centre in central India from July 2014 to September 2016. Children who met the inclusion criteria were enrolled in the study. They were thoroughly examined in each of details. Data was entered in a prescribed format and was analyzed to know the clinical profile of childhood blindness. Results: A total of 44064 patients were examined in the study. 47 cases met the inclusion criteria. Institutional prevalence was 1.06 /1000 population and incidence was 0.34/1000 population. Maximum cases of blindness belong to 0-5 year’s age and was more in females as compared to males. Corneal pathologies were leading cause of childhood blindness followed by trauma and congenital globe anomalies. Keratomalacia was a major cause of preventable childhood blindness. Conclusion: Childhood blindness is an important problem in the community. It should be dealt with proper planning. High percentage of childhood blindness is either preventable or treatable, so early detection and treatment is necessary.

511-514

Authors: Sangeetha Jayakumar,Kanthamani Krishnappa*,Darshan SM,Chirra Reddy Gari Meghana,Borra Harish Laxman

Purpose: To assess the clinical profile of lens-induced glaucoma (LIG), reasons for late presentation, and outcome of medical and surgical management. Materials and Methods: Retrospective analysis of 48 eyes with LIG over a 5-year period between 2014 and 2018 at a tertiary care centre in rural Southern India. Type of LIG, symptoms, preoperative and postoperative corrected distant visual acuity (CDVA), intraocular pressure (IOP), intraoperative and postoperative complications were assessed. Results: Forty-eight eyes of 23(47.9%) males and 25(52.1%) female aged between 50 to 80 years were included in this study. 32(66.7%) cases had presented with phacomorphic glaucoma and 13 (27.1%) with Phacolytic glaucoma who underwent medical and surgical treatment of the same. Mean pre-operative and postoperative IOP was 35.60 ± 5.81 mmHg and 20.417 ± 2.33 respectively. Similarly, the mean preoperative and postoperative CDVA was 1.44 ± 0.76 and 0.34 ± 0.20 respectively which was statistically significant. (P <0> Conclusion: LIG is an important vision-threatening disease occurring in the elderly due delayed treatment of mature cataract. This study shows that it is important to conduct periodic screening of the elderly to identify cataracts and manage it accordingly to prevent irreversible blindness.

518-520

Authors: Pragati Garg*,Laxmi Singh,Mohd Raza,Swati Yadav

Introduction: Refractive errors are apparently more prevalent among the high educational group and have become a huge economic and social burden.1 Materials and Methods: The study was conducted at Era’s Lucknow Medical College and Hospital and included 420 medical students of consecutive 4ys (2013-2016). Refractive error was assessed under cycloplegia using Snellen’s visual acquity drum and streak retinoscope. The students were categorized according to their refractive error and the prevalence was calculated. Results: Of 420 students 54% had refractive error. Of these 77.7% had myopia, 8.4% had hypermetropia and 1.7% had astigmatism. Myopes were further divided into mild moderate & severe. It was found that 62.8% had mild, 35.4% had moderate and 13.7% had severe myopia. Conclusion: The commonest refractive error among medical students is myopia of varying grades.

526-529

Authors: Dipak B. Patel,Palvee Menon*,Anshi Rathod,Aneesha Vyas,Poonam Rana

Aim: To compare the efficacy of 2% rebamipide and 0.5% Carboxy methylcellulose (CMC) eye drops in dry eye patients. Materials and Methods: A 100 dry eye patients were enlisted and screened. Patients were allotted randomly into 2 groups-(Group-A) 2% rebamipide or (Group-B) 0.5% Carboxy methylcellulose (CMC) ophthalmic solution, after screening and instilled as 1 drop in each eye four times a day, for about two months. The signs and symptoms were assessed -at baseline, 2, 4, and at 8-week visits. The objective signs were –“Schirmer test and Tear film break-up time” (TBUT) while subjective symptoms were dry eye related ocular symptoms (foreign body sensation, dryness, photophobia, eye pain, and blurred vision. Results: A compelling improvement was noticed in the Schirmer test and TBUT values after the treatment in the 2% rebamipide group. The patients on 2% rebamipide eye drop showed considerable improvement in dry eye related ocular symptoms, than the patients on 0.5% CMC eye drop (51% and 29% respectively) at 2 months. Conclusions: 2% rebamipide ophthalmic solution was more efficient in improving both the subjective symptoms and objective signs of dry eye in comparison to the CMC group in this 8-week study. These findings showed that 2% rebamipide is the more effective drug for dry eye.

535-540

Authors: Punit Singh,Anshi Rathod*,Zeel Patel,Nidhi Vithlani,Bhoomi Thakkar

Purpose: To find out correlation of swap and OCT in preperimetric glaucoma patient coming to Dhiraj general hospital. Materials and Methods: A complete ophthalmological examination will be done including uncorrected and best corrected visual acuity, slit lamp examination, central corneal thickness measurement by pachymetry, applanation tonometry, gonioscopy and dilated fundus examination and Humphrey perimetry followed by SWAP and FDT. Result: In the present study a total of 50 patients were screened. Out of this 22 patients had a CDR of 0.5 with healthy neuro-retinal rim (HNRR) in both the eyes. One patient had 0.5 CDR with inferior thinning in both the eyes. 8 patients had a CDR of 0.6 with HNRR and 1 had 0.6 CDR with inferior thinning. 2 patients had a large cup to disc ratio of 0.7 CDR but the neuro retinal rim on clinical examination appeared to be healthy. 14 patients had a large cup to disc ratio of 0.7 in both the eyes. Out of this 8 had inferior thinning of the neuro-retinal rim and 6 had superior thinning of the neuro retinal rim. 2 patients included in this study had 0.8 CDR with one having superior thinning and one having inferior thinning of the neuro retinal rim. The accuracy of OCT in detecting even the smallest nerve fiber layer defect was much higher than seen on SWAP. About 52% showed normal OCT as compared to perimetry group which was 60% and about 48% of patients showed affected nerve fiber layer thinning as compared to perimetry where visual field changes were 40%. Conclusion: In this study it was concluded that SD-OCT is better in detection very early stages of glaucoma where SAP or SWAP modality of perimetry does not detect. The sensitivity of OCT is much higher than perimetry and can help in detecting the suspects of glaucoma. Patients at with high risk (family history, smokers, large cup to disc ratio etc) should be screen for both OCT and SWAP. This will help us for manage patients better as they will be detected at a very early stage.

548-550

Authors: Kumar Amruth C,Ramya Deepthi P.*

Aim: Current study focuses to analyse the advantage of the technique which uses the autologous blood for sutureless securing the conjunctival autograft post pterygium excision. Materials and Methods: This is non-invasive study consists forty patients underwent primary pterygium surgery. After excision of pterygium, the patient’s conjunctival autograft from supero-temporal quadrant and patient’s autologous blood to attach the graft without sutures. 6 months of follow up data collected. Results: In total 40 patients, male to female number observed as 11: 29. In those, grade I, II and III were observed in 7, 25, and 8 patients respectively. During surgery, there were no complications observed. Two patients with subconjunctival hemorrhage, two patients with graft retraction, one patient with graft loss and one patient with pterygium recurrence were recorded. 34 (85%) patients had good recovery and cosmesis was also observed excellent. Conclusion: Non-invasive conjunctival autograft with patient’s autologous blood using technique without sutures observed to be safe and the best outcome, and also consumes less time and cost effective.

554-555

Authors: Madhusmita Behera*,Samir Patra

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive disorder with wide spectrum of clinical features. BBs is distinguished from the much rarer Laurence-moon syndrome, in which retinal pigmentary degeneration, mental retardation, and hypogonadism occur in association with progressive spastic paraparesis and distal muscle weakness, but without polydactyly. Most common feature of BBS is retinal dystrophy. The visual prognosis for children with Bardet-Biedl syndrome is poor.

168-174

Authors: Minu Sasikumar, C. V. Anthrayose (Andrews) Kakknatt, Monsy T Mathai

Purpose: To study RNFL thickness in gestational diabetes mellitus based on OCT measurements. Methods: Case-control study with Inclusion criteria: 2groups of age 18-40yrs at 32-34weeks gestation Group 1: Healthy pregnant women Group 2: Pregnant women with GDM Exclusion Criteria: Preexisting hypertension/retinal diseases/renal disease/vascular disease/glaucoma/IOP>21mmHg/cataract/ refractive error correction more than or equal to +/-5D (spherical) or +/-3D (cylinder). Grouping-Study Design: more than 2 unrelated group study. Sample Size: n=182 Procedure: After detailed history taking &.written consent detailed ophthalmic examination is done Patients are classified into group1&2. Using CIRRUS HD OCT peripapillary RNFL is measured in superior, inferior, nasal and temporal fields. Results: Peripapillary RNFL showed significant thinning in GDM patients when compared to healthy pregnant female. Conclusion: Peripapillary RNFL thinning in GDM patients measured in their third trimester suggest a neurodegenerative process preceding microvascular changes in gestational diabetes mellitus. The degree of retinal thinning at the level of macula correlated with the glycemic status of the patients. Thereby making it mandatory to carry out routine evaluation of retina with the help of OCT in all GDM patients to detect early neurodegenerative changes and to keep the blood glucose levels in normal range to prevent the occurrence of diabetic retinopathy

178-181

Authors: Shankar C, Premnath G, Balaji A, Lakshmi Ananya Aila, Sruthi G

Aim: The purpose of the study is to find the impact of diabetes mellitus on central thickness and endothelial parameters of cornea when compared with non diabetic patients and in relation to duration of disease and glycaemic control. Study Design: Prospective, Observational and quantitative study. Materials and Methods: Study included 125 patients (125 eyes) with diabetes mellitus and 143 controls (143 eyes). Tomey specular non-contact microscope (EM 3000) was used to measure central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation of cell size (CV) and percentage of hexagonal endothelial cells (6A). Results: Comparison of age matched controls with diabetics did not show any statistical significance with respect to CCT, ECD and CV. 6A showed some significant change (p value= 0.02) between controls and diabetics. There was no significant correlation with respect to the duration of diabetes and glycaemic control. Conclusion: Corneal endothelial parameters and thickness did not show any statistical significance between diabetics and controls except hexagonality of endothelial cells which was significant. Moreover there was statistically no difference based on duration of the disease, glycaemic control and presence or absence of retinopathy

189-192

Authors: Mairembam Ranjana, Kamson Anthony, Rajkumar Vidyarani

Aims: To quantify and compare the retinal nerve fiber thickness in normal, ocular hypertensive and glaucomatous eyes using Optical coherence tomography (OCT). Materials and Methods: Patients were divided in to three groups of 30 each for normal, ocular hypertensive and primary open angle glaucoma. Inclusion criteria were of patients between 30-70 years of age, visual acuity of 6/36 or better, Refractive error not exceeding 5D and no prior surgery. Complete eye evaluation and was done followed by OCT Scan using the protocol “Fast RNFL thickness”. RNFL thickness was assessed in 4 quadrants and statistical analysis was done using student t test and analysis of variance (ANOVA). Results: RNFL was significantly thinner in OHT eyes than in normal eyes specifically in the inferior and nasal quadrants. 12.6% decrease in RNFL thickness was seen in OHT eyes as compared to normal eyes and about 22.29% decrease in RNFL thickness in POAG eyes as compared to OHT. Conclusions: Incorporation of OCT in glaucoma practice can helped us in evaluation of optic disc, quantifying of RNFL, identifying the structural changes in RNFL and the progression of disease. The magnitude of focal RNFL thinning in OCT was related to the magnitude of decreased global indices sensitivity in glaucomatous patient.

197-203

Authors: Sonali Pote, Rupali Maheshgauri, R. Magdum, Gira Raninga, Saurabh Ashtamkar

When a patient suffers from co-existing cataract and glaucoma, the choice of surgery may be a combined procedure of cataract extraction and trabeculectomy as a one-stage procedure, or trabeculectomy first to restore visual rehabilitation and to prevent progressive optic nerve damage. The main purpose of this study was to evaluate the endothelial cell loss in trabeculectomy with small incision cataract surgery (SICS) against trabeculectomy and SICS alone. Materials and Methods: This study was conducted on 90 eyes divided into 3 groups among whom 30 cases underwent trabeculectomy through a superior incision, 30 cases underwent SICS with PC-IOL implantation with trabeculectomy through a common superior incision and 30 patients underwent manual SICS with PCIOL. The corneal endothelial cell count and loss was assessed on first postoperative day, 1st week, 1st month and at 3 months. IOP was assessed on postoperative 1st week, 1st month and at 3 months. Results: The endothelial cell loss was more in combined SICS with trabeculectomy group than trabeculectomy group alone. Conclusion: Preoperative evaluation of endothelial cell count must be considered and adequate intra-operative and postoperative measures should be taken to avoid cell loss. However, to avoid further endothelial cell loss due to a two staged surgery, a combined procedure would be a better choice. Combined SICS with trabeculectomy would also reduce the economical burden, postoperative morbidity and the visits of patient to operation theatre.

209-212

Authors: Meenakshi Pathania, VS Gurunadh, MA Khan

Purpose: To assess the efficacy and safety of sub-conjunctival bevacizumab in the management of grade II and III pterygium. Materials and Methods: Cases of pterygium with no other ocular abnormality and with no systemic disorders were subjected to anterior segment photography and graded. Ten cases of grade III pterygium and eleven cases of grade II pterygium were administered subconjunctival intralesional injection of 2.5mg/0.1ml of bevacizumab. Anterior segment photographs were taken on day 7, day 28 and day 90 along with complete ocular examination and general physical examination. The pterygium vascularity, size and thickness were assessed keeping note of any adverse effects ophthalmic or otherwise. An evaluation of the symptoms before injection and at day 90 was also done. Results: There was statistically significant improvement in the grade, color, intensity, size of pterygium, and symptoms of patients. There was a decrease in symptoms of redness, itching, watering, and irritation. Of the 10 cases with Grade III on enrollment, 08 (80%) had shown a decrease in vascularity with half of them graded as II and the remaining half as grade I. Of the 11 cases of Grade II pterygium at baseline, 05 (45%) cases changed to grade I by day 90. Conclusion: This study revealed that the sub-conjunctival injection of bevacizumab was found to be useful in reduction of symptoms of patients with grade III & II pterygium with no local or systemic adverse effects.

217-220

Authors: Piyush Madan, Sachin Daigavane

Introduction: Congenital nasolacrimal duct has accounts for 6 % of newborn infants with various treatment. Microbiological studies to identify the type of species involved in Lacrimal Sac infection secondary to Congenital Nasolacrimal Duct Obstruction (CNLDO) have been extensively reposted. Aims and Objective: to assess microorganisms causing congenital nasolacrimal duct obstruction. To see efficacy of probing as compared to silastic intubation. Materials and Methods: A total 100 patients were enrolled in the study. The patients came with epiphora and mucous discharge. Inclusion criteria for the study was patients presenting with CNLDO (Presence of atleast one sign of NLDO: Epiphora, increased tear lake, and/or mucopurlent discharge), Age upto 9 years. Exclusion Criteria: Punctual or canalicular abnormality, H/o previous surgery, H/o faciomaxillary trauma, cleft lip/ cleft palate or any facial deformity, acute dacryocystitis, previous history of probing. Sample size was 100 patients. Results: Haemophilus influenzae and streptococcus pneumonia were the most common microorganisms (n= 56, 40.5%; n= 37, 26.8% respectively) followed by moraxella catarrhalis (n=19, 13.7%), staphylococcus aureus (n=17, 12.3%), pseudomonas aeruginosa (n=9, 0.65%). Discussion: Congenital nasolacrimal duct obstruction results in stagnation of fluid within the lacrimal sac area which causes secondary bacterial infection. The prevalence of CNLDO with no growth shows the sole effect of congenital anomaly on the degree of tightness. Conclusion: The mocobiological study of CNLDO may have a value in predicting the obstruction.

225-229

Authors: Bhagwati Wadwekar

Purpose: This study aims to analyze the impact of complete excision of posterior remnant tissue (ExPRT) on outcome of modified single anterior flap external dacryocystorhinostomy (mSAF-EDCR). Materials and Methods: We analyzed records of all patients who had undergone mSAF-EDCR with complete ExPRT between August 2014 and October 2016. We also noted operative time, complications and surgical outcome of these patients. Results: Forty-one patients had undergone mSAF-EDCR with complete ExPRT. Average surgical time was 36 minutes (range 28 to 50). The most common complications were intraoperative bleeding in four cases and torn sac flap in two cases, laceration of nasal mucosa in one case and extension of skin incision in one case. Follow-up was done at tenth day and one month post-operatively. There was complete absence of watering in 36 patients and occasional watering in five patients. Tear meniscus height was normal for all patients. Syringing was patent in all 41(100%) patients. Hence both subjective and objective success rates were 100%. Conclusions: Our series of cases mSAF-EDCR demonstrated 100% success rate which may be attributed to complete ExPRT. Our study also indicates that mSAF-EDCR is technically easier and time saving, and should be preferred over conventional EDCR. The complications related to flap damage are also more easily manageable in mSAF-EDCR than conventional EDCR. These results also prompt future research to assess complete ExPRT during mSAF-EDCR surgery.

236-240

Authors: Arathi Choudhary, Monalisha Pattnaik

Aim: To study the epidemiology of ocular trauma in a medical college hospital in North Karnataka region. Materials and Methods: Demographic data, detail history and ocular examination were done for all the patients who presented to our hospital between the periods of August 2016 to April 2017 with any ocular trauma. Data were collected and analyzed using Open- Epi software. Result: 104 patients presented to our hospital during the time period of 9months.The mean age of trauma was 32.78 with SD 16.97. Male ( 65.38%) were more affected than female(34.61%).57.69% were from rural and 42.3% were from urban. Ocular trauma mostly occurs between 30-50 years (41.3%). Home, road and field were the most common location of ocular injury. Foreign body, stick and lime were the most common offending agent. The association between age of ocular trauma and location of injury and occupation was clinically significant with p value 0.05 and 0.041 respectively. The association between gender and location of injury was clinically significant with p value 0.0013 but occupation and gender of ocular trauma was clinically not significant with p value 0.08. Conclusion: Considering the prevalence, middle aged men are more vulnerable to ocular trauma mostly while working at field or driving. Prognosis might be challenging. Appropriate education for eye protection and use of safety measures, would help in reducing ocular morbidity. Educating for timely treatment and intervention after injury is helpful for saving vision.

245-248

Authors: T. Vijhaya Priya Rathinakumar, P. Amudha, S. Venipriya, K. Renuga Devi

Introduction: A pterygium is a triangular fibrovascular subepithelial growth of bulbar conjunctival tissue that has invaded the superficial cornea, causing visual impairment. It is a degenerative condition. Objectives: To study the prevalence and types of pterygium in patients in a tertiary hospital in Puducherry. Materials and Methods: A descriptive cross sectional study was done for a period of 6 months, in the out patient department of ophthalmology. Out of the 6028 patients who had registered, the clinical records of 345 patients with pterygium were retrieved and analysed using MS office Excel sheet. Results: The results depict that females (59%) were more affected than the males (41%) and nasal pterygium was more common than the temporal pterygium. It was also found that unilateral pterygium (81%) is more common than bilateral pterygium (15%) and progressive pterygium (67%) is more common than atrophic or recurrent types. Analysis also revealed that type I pterygium (51%) is more common. Conclusion: The prevalence of pterygium increased with increasing age and long term exposure to sunlight. It can be decreased by using protective measures

254-257

Authors: Prateek Nishant, Sony Sinha, Ranjeet Kumar Sinha

With an objective to enquire about availability of primary or secondary level facilities for refraction and explore reasons for approaching a tertiary OPD despite awareness of the same, a prospective study was conducted over a two month period in the ophthalmology OPD of a medical college of Bihar among patients aged 10-24 years from Patna district diagnosed with refractive errors, using a predesigned interview schedule and subsequent statistical analysis. Of 1075 subjects, about 61% of rural young people recalled that refraction facilities (of primary or secondary level) were available in the vicinity of their residence (about 18% denied availability, and 21% were unaware) while all 961 urban young people were aware of the same. The prime reason for visit among urban patients was the need for certification from a government institution for admission to an educational institution or job. Hence, there is need to establish new and advertise existing vision centres, conduct community screening, establish government-subsidized optician services network, inculcate importance of counselling patients among all eye care professionals, define the role of a tertiary care institution in the minds of the public and support the tertiary hospital by a high-volume primary eye care facility in the neighbourhood

263-267

Authors: Manoj Tyagi, Praveen Khare, Amita Sharma

Purpose: To investigate the correlation between dry eye syndrome with Androgen profile and its relation with use of Oral Contraceptives in females within child bearing age. Materials and Methods: Study consists of 100 healthy women between 20-49 years, out of which 50 were on OCPs (Oral contraception pills) and rest 50 as control group were not taking any hormonal contraceptives. Androgen profile was carried out by Enzyme Immuno Assay on blood samples which were collected during 6th to 8th day (Early follicular phase) of menstrual cycle. The tear secretion was measured by Schirmer’s test. Qualitative parameter of tear film was measures by Tear Breakup time (TBUT). Statistical analysis was done to determine the correlation between tear film parameters and androgen profile and oral contraceptive use. Results: Our result demonstrate that androgen profile (serum testosterone and DHEA levels) were decreased significantly (P<0> Conclusion: Our findings shows that androgen levels decrease in women taking oral contraceptives. These results support that androgen deficiency and oral contraceptives may be an important etiological factor in pathogenesis of dry eye syndrome in premenopausal women.

273-275

Authors: Harish Kumar N, Sandhya .R, Sharath B.N.

Introduction: India is a developing country & the garment workers in these industries are exposed to various occupational health problems, leading to sickness absenteeism and compromise in quality of life, & the eye disorders were reported by 11.2% of workers. The prevalence of pterygium in India varies from 9-12% in general population. This study aims at determining the proportion of garment factory workers suffering from pinguecula and/or pterygium and their associated risk factors. Methods: It was a cross-sectional study. All the garment factory workers presenting to the ophthalmology department for routine eye examination were screened for pinguecula and pterygium. Standard protocol was followed to measure vision using Snellen’s chart. Data was analysed for percentage and proportions after obtaining approval from Institutional Ethics Committee. Results: A total of 848 subjects were screened out of which 102 (12.03 %) were found to have pinguecula or pterygium. Of these 91% were females and 9% were males & the mean age of the affected was 39 years. Pinguecula was present in 84 subjects (82%) & pterygium was present in 18 (17.7%) subjects. The nature of work in majority of the subjects (n=79, 77.5%) was tailoring. Sickness absenteeism was more profound in pterygium group (28%). Personnel’s with greater than twelve years of work experience had suffered by pinguecula (44%) and pterygium (39%). Conclusion: In our study 1 in 8 workers suffered from pinguecula or pterygium. The affected belonged to middle age (39 years) and had significant work experience (above 12 years). Thus pterygium and pinguecula may be considered as major occupational health problems among the garment factory workers. Immediate policy decisions like screening and providing better working conditions for the workers is the need of the hour for the garment industries.

280-283

Authors: Rajkumari Vidyarani Devi, Kamson Anthony, Meirenbam Ranjana

Aims: To evaluate postoperative vision-outcomes and demography of cataract from different outreach camp conducted in northeastern part of India. Materials and Methods: The cases were selected from 31 different outreach camps conducted in northeast India mainly in Manipur and adjoining states between 2013 and 2015. Total of 11240 patients was screened and cataract was detected in 2182 patient. 41% were Male while female constitute 59% and most of them were between 60-70 years and surgery was done at the Base hospital. Majority (60%) of the patients underwent SICS and in remaining 39% was phacoemulsification performed. Results: The final best corrected visual acuity of 6/6 was achieved in (63.9%) and visual acuity between 6/12 to 6/18 in 629 (28.8%) cases, 6/24 to 6/36 in 150 (6.8%) and <6> Conclusion: The overall visual outcome was excellent with a very low rate of complication. SICS remain the procedure of choice for cataract surgery for such remote areas with limited facilities. Multiple outreach camp is the need of the hour to reduce visual handicap and improve quality of life in this regions.

287-289

Authors: Kambam Gainathi, Elfride Farokh Sanjana, Hannah Ranjee Prasanth

We describe a case of neuromyelitis optica - a Masquerade of multiple sclerosis. Neuromyelitis optica should be differentiated from multiple sclerosis, as treatment of multiple sclerosis can worsen symptoms of neuromyelitis optica. Both visual and neurological prognosis in neuromyelitis optica are poorer than in multiple sclerosis. Episodes of visual loss in neuromyelitis optica are recurrent leading to severe visual impairment. Immunosuppressive agents such as corticosteroids remain the mainstay of therapy for acute episodes.

7-11

Authors: Suroma Joysmine Marndi, Ram Kumar, Ram Yash Singh Yadav.

Aim: To assess pre-existing astigmatism and to evaluate the effect of limbal relaxing incision on pre-existing astigmatism post-operatively in patients undergoing SICS cataract surgery. Materials and Methods: The study was conducted in the Department of Ophthalmology at Nehru Hospital attached to B.R.D. Medical College, Gorakhpur from period of July 2016 to June 2017. Study Design: This study is a comparative observational study. All the surgeries were performed by one surgeon. Study Group: patients meeting the inclusion criteria i.e. 1-3 D astigmatism as per keratometric readings. Results: A total of 90 patients were included in the study. Mean age 58.19 ± 7 years(range 30-70yrs). Mean pre-operative astigmatism of 1.44 ± 0.39D was found in these patients. Data analyzed demonstrated statistically significant reduction in the mean post-operative day 30 astigmatism in the LRI group to 0.54 ± 0.34 D (range: 0 to 2.5) from 1.31 ± 0.38 D (range: 1 to 3 D) preoperatively as compared to control group to 1.19 ± 0.56 D (range: 0 to 2.5) from 1.57 ± 0.37 D (range: 1 to 3 D) preoperatively, p-value 0.0001. There were no intraoperative complications or postoperative subjective complaints in our patients. Conclusion: Limbal relaxing incisions performed during SICS cataract surgery appear to be effective as well as safe procedure to reduce pre-existing corneal astigmatism.

16-20

Authors: Eknath Biroba Shelke, Harshal Namdeorao Yerkade, Mahesh Prakashrao Sonepethkar, Pradip Bhikshukrao C

Introduction: Phacoemulsification technique for cataract using either peribulbar anesthesia (PA) or topical anesthesia (TA) has evolved in last decade. Only few studies has compared between two anesthetic procedures for phacoemulsification. We compared patient and surgeon satisfaction, clinical outcome between two anesthetic procedures. Materials and Methods: The Study was conducted during February 2017 to July 2017. Patients after being randomly assigned to group PA and TA were underwent phacoemulsification. Corneal condition, postoperative complication at day 1, best corrected visual acuity at day 40 were compared. Both patients and surgeons were asked questions on degree of analgesia and level of comfort respectively. Data was analyzed using appropriate test of significance. Results: 50 patients were taken into study in each group. No significant difference was noted between two groups pre-operatively. Patients in PA group felt statistically significantly less pain compared to TA group (χ2 = 11.78, df = 2, P = 0.0027). Satisfaction of surgeons was more with PA than compared with TA. [Relative Risk=1.49, (95% CI: 1.02-2.17)]. On day 1 postoperative complications were greater in TA group (76%) than compared to PA group (64%).Complications associated with anesthetic procedure were more in PA group than compared with TA group. Conclusions: Patient’s satisfaction was statistically significantly greater in PA group compared to TA group. Surgeon’s satisfaction was also not different from patient’s satisfaction and found to be more with peribulbar block than compared to topical anesthesia. Clinical outcome remains unaffected by either of anesthetic technique.

28-31

Authors: Talluri Jeeva Ratnam, Vijetha P.

Purpose: To know whether cataract alters critical flicker fusion frequency. Design: A hospital based observational study. Materials and Methods: There were 113 patients with immature cataract fundus view are studied. Pre and post operatively critical flicker fusion frequency (CFFF) test conducted and frequency values noted. All patients were recorded of vision, relative afferent pupillary defect (RAPD), intraocular pressure and dilated fundus findings. Any abnormal fundus, glaucoma and RAPD were excluded. Results: CFFF values taken for analysis. There was no change in CFFF values post operatively. Those who had higher CFFF values remained higher postoperatively also. And similarly remained low those with lower CFFF values. There was no statistical significance (p-value=0.2182). Conclusion: Cataract did not alter the CFFF. High or low CFFF values can be concluded as dependant on optic nerve and retinal health status.

36-39

Authors: Kumaresh Chandra Sarkar, Piyali Sarkar, Jayanta Das.

Introduction: Lens Induced Glaucoma (LIG) is one of commonest cause of secondary glaucoma due to senile cataracts. The purpose of this study was to assess the outcome of LIG following cataract surgery. Objective: To determine the frequency, types, the clinical presentations, management and outcome of lens-induced glaucoma (LIG). Materials and Methods: It was a prospective observational study which was done at Calcutta National Medical College, Kolkata, from July 2012 to June 2013. Patients who attended out-patient department (OPD) of this hospital with LIG were admitted for conservative management followed by cataract surgery. Demographic data, clinical presentations, management and outcome were recorded and analysed. Results: The age of presentation of LIG was varied ranging from 31 years to 85 years. The study had female preponderance (53.7%). The major type of LIG was phacolytic glaucoma (53.8%). All the patients had pain and watering in the eyes and decreased vision during admission. Most patients (31 eyes) were presented with visual acuity of hand movements (57.4%) and intraocular pressure more than 40 mm Hg (61.1%). Most of the patients (75.9%) underwent manual small incision cataract surgery (M-SICS) with posterior chamber lens (PCIOL) implantation. Reduced Intraocular pressure (IOP) after complete follow up was 15.2 mm Hg and most of the patients (75.9%) had their post-operative best corrected visual acuity more than 6/36 after completed follow up. Conclusion: Cataract surgery was the most important effective mode of lowering IOP and visual recovery in patients with lens induced glaucoma. Public awareness and early detection by house physician is important for an early intervention which aids IOP control and visual recovery in LIG.

46-49

Authors: Sheldon Goudinho, Lisa Jerry, Jasmine Mary Jacob.

Threshold severity of diabetic macular edema (DME) at which initiation of laser treatment is justified, was defined as ‘clinically significant macular edema’ (CSME) by ETDRS (Early treatment of diabetic retinopathy study). ETDRS showed that macular photocoagulation decreased persistent macular edema and risk of moderate visual loss by 50% in CSME. Benefit of treatment generally observed in 3-4 months. Objectives: To estimate the improvement in visual acuity VA and contrast sensitivity CS at four months following macular photocoagulation, in a single arm of Type 2 diabetes patients diagnosed with CSME in a semi-urban population of South Kerala. Methodology: It was a prospective study (Descriptive). 250 eyes of Type 2 diabetics with CSME were included. Focal/grid pattern macular photocoagulation, using frequency doubled Nd: YAG laser was administered to all participants. Improvement in VA was defined as gain by one line/more and decrease by more than two lines was considered as worsening. Any drop/gain in CS was considered significant. Analysed using SPSS 16.0. Results: 148 eyes (59.2%) received focal and 102 eyes (40.8%) received grid pattern lasers. 242 eyes were included in final analysis. VA in 77 eyes (30.8%) was stable, improved by one line/more in 134 eyes (53.6%), decreased by <2 lines in 22 eyes (8.8%) and decreased by >2 lines in 9 eyes (3.6%). Paired sample t-test to compare VA and CS before and after therapy, showed significant improvement (p<0.001 and p<0.001 respectively). Conclusion: VA as well as CS showed statistically significant improvement at 4 months following focal/ grid pattern of macular photocoagulation in CSME.

56-59

Authors: M.K. Singh, V.P. Singh, P. Bhushan, R.P. Maurya, P.K. Chaturvedi.

Purpose: Aims of this study is to characterise the visual disability of patients of moderate to severe diabetic retinopathy in terms of logarithm of minimum angle of resolution (LogMAR) visual acuity and contrast sensitivity. Methods: A total of 30 eyes with moderate to severe diabetic retinopathy having low vision (WHO Criteria) with predefined inclusion and exclusion criteria were included as cases and 40 eyes with normal or near normal visual status correctable by refraction were included as control in the study. The visual acuity and contrast sensitivity were noted and analysed. Results: The best corrected visual acuity (BCVA) of all eyes in control group is less than 0.5 LogMAR units. Among cases, 29(96.7%) eyes have BCVA in the range of 0.5 to 1.0 LogMAR units and 1(3.3%) eye has BCVA in the range of 1.0 to 1.3 LogMAR units, satisfying the inclusion criteria significantly (p value < 0.001). In case group, direct correlation of association is observed between uncorrected visual acuity and best corrected visual acuity (r = 0.69), near visual acuity (r = 0.49), best corrected near visual acuity (r = 0.64) and inverse correlation of association with contrast sensitivity (r = -0.65) which are statistically significant (p value <0.05). Conclusions: In patients of diabetic retinopathy with visual impairment, irrespective of varying pathology of visual impairment, there is a negative correlation between contrast sensitivity and visual acuity in logMAR units. The logMAR visual acuity and contrast sensitivity is a better tool than vision assessment by snellen chart for evaluation, monitoring and prescription of low vision devices in subjects with visual impairment.

67-69

Authors: Subramanya Kota Giliyar, Abdul Rauf Abid, Pooja B. Wagganavar, Vinuta Mohan Kulkarni.

Aim: To assess vision in children with delayed development or cerebral palsy attending OPD at tertiary care hospital, for early assessment and accurate detection of visual disorder, which in turn helps their rehabilitation, locomotor and cognitive functions. Materials and Methods: Total of 24 (18 males and 6 females) children with delayed development and 12 (6 males and 6 females) with cerebral palsy were examined. Central steady maintenance method (CSM) was used for visual assessment as children were not co-operative for Teller’s acuity card. Thorough examination was done in children including dilated refraction & fundus examination. Clinical findings like nystagmus, squint, roving eye movements were noted and photographed. Selected children were given glasses and few were advised visual stimulation exercises. Results: Out of 36 children, about 24 were males and 12 were females. It was noted that about 16% in developmental delay children and about 17% in cerebral palsy children had abnormal birth history Among 24 children with developmental delay, 16% had squint,12.5% had horizontal nystagmus, among 12 children with cerebral palsy, 66% had fundus abnormalities, 50% had squint,16% had horizontal nystagmus, Central steady maintenance was good in 8% of developmental delayed children and 15% of cerebral palsy children. Conclusion: Above study showed that visual assessment in children with delayed development and cerebral Palsy provided relevant information for creating a rehabilitation program aimed at the individual as a whole. Visual impairment plays key role in locomotor and cognitive performance in CP and visual exploration seems to be crucial in rehabilitation of affected children, contributing to their motor improvement and to a better visual prognosis.

73-77

Authors: Subhashchandra Daga,, Prajakta Sambare, Sucheta Kulkarni, Pravin Narwadkar, Chirag Bhalerao.

Design: A prospective observational study. Setting: The study was conducted over a period of one year, from 01-07-2013 to 30-06-2014 at a hospital attached to a newly established rural medical college in India; located 45 km away from the regional eye centre. Subjects: All babies, without exclusions, were screened for retinopathy of prematurity (ROP) as per guidelines of National Neonatology Forum (NNF) of India, i.e. babies born < 34 weeks gestation and/or < 1750 g birth weight, and the babies 34-36 6/7 weeks gestation or 1750-2000 g birth weight, with risk factors for ROP. Interventions: 53 babies were screened for ROP as per NNF guidelines. Main Outcome Measures: 16 babies required laser therapy from the 53 babies that were screened over a period of one year. All weighed 1500 g or less at birth. Their GA was less than 33 weeks or less. Conclusion: BW 1500 g or less and/ or GA less than 34 weeks, appear to be appropriate ROP screening criteria. Applying NNF criteria, no ROP would have been missed. In 19 (35.8%) babies screening could have been avoided. It is desirable to determine appropriate ROP screening criteria for a particular centre; based on local evidence.

85-88

Authors: Yogish S. Kamath, Ashish Rander, Shailaja B S, Lavanya G. Rao, Sulatha V Bhandary.

Aim: To assess the changes in Intraocular pressure (IOP) after intravitreal bevacizumab therapy. Design: Prospective, Observational, Tertiary care hospital based study. Participants: 95 patients receiving intravitreal bevacizumab, for varying indications, were included. Materials and Methods: A study of the change in intraocular pressure of 95 patient eyes receiving intravitreal injection of bevacizumab for varying indications was performed at 4hours, 2 weeks and 6 weeks post injection. Results: There was a statistically significant increase in IOP 4 hours post injection [p value= .000; 95% confidence limits of -2.07 to -1.11; mean difference of -1.59]. There was no statistical significance in IOP rise at 2 weeks (p= 0.32; 95 % confidence limits of -1.13 and 0.18; mean difference of -0.47) or at 6 weeks (p= 1.00; 95% confidence limits of -0.86 to 0.44; mean difference of -0.21). The endpoint IOP in the single injection and multiple injection groups was statistically insignificant (t=-0.32, df = 92, significance value=0.749, 95% confidence interval -1.48 to 1.07). Conclusion: Although a statistically significant short-term rise in IOP was observed, this increase was clinically insignificant. The IOP reverted towards baseline values on subsequent visits at 2 weeks and 6 weeks post-injection. The number of injections did not have any effect on the IOP change. Clinical significance: Our study evaluated the effect of intravitreal injection of bevacizumab on intraocular pressure in an Indian population and found no clinically significant rise in the same.

96-99

Authors: Rajni Sethia, Aakash Patel, Harita Shah, Roshani Patel, Toral Rajput.

Introduction: The purpose of this study is to find out the association of duration of diabetes and increased HbA1c level with corneal thickness in patients of DM. Materials and Methods: After obtaining approval by ‘Sumandeep Vidyapeeth Institutional Ethical Committee’, a comprised study of 150 type-II DM patients were conducted (only left eye included). All the patients underwent complete ophthalmic examination and all study procedure was performed after obtaining informed consent from all patients and in accordance with declaration of Helsinki. Result: The mean CCT of patients with DM <7 years was 543.1 (SD - 23.51) and that of patients with duration of DM ≥ 7 years was 546.95 (SD – 25.23). The difference was statistically insignificant (p value = 0.335). The mean CCT of patients with HbA1c <7% was 545.3 (SD – 24.31) and that of patients with HbA1c ≥ 7% was 545.1 (SD – 24.63). The difference was statistically insignificant (p value = 0.96). Conclusion: In our study we conclude that corneal thickness is not affected by DM, its duration and HbA1c levels.

107-111

Authors: Archana Nikose, Aditya Rokade, Pradnya Laddha, Prateek Mohod.

Aims and objectives: To study the incidence of clinical forms of vitamin A deficiency and create awareness for importance of dietary vitamin A among parents. Materials and Methods: This cross sectional study was done in a rural based tertiary care centre which included 256 patients attending the paediatric OPD between the age group of 1 month to 10 years during July and August 2015. Questionnaires were prepared for socioeconomic status and nutritional status. An ophthalmic examination was carried out along with a trained paraopthalmic assistant in the paediatric OPD. The findings of torch light examination were confirmed on slit lamp examination. The positive findings of vitamin A deficiency were compared with the WHO classification. Statistical analysis was done by using the SPSS software V.11. Results: The total number of children examined were 256 which included 101 (39.5 %) from rural areas and 155 (60.5 %) from urban areas. Conjuctival xerosis was noted in 19 (7.4%) children out of which 9 children (3.5%) were from urban and 10 children (3.9%) from rural areas. 21 children (8%) suffered from night blindness which is another sign of Vitamin A deficiency (XN). Conclusion: Vitamin A deficiency affects most of the school going children in rural India and it occurs mainly due to dietary insufficiency hence can be prevented.

115-119

Authors: Kalpana. R., Kanmani Kothandaraman, Anuradha. P.

Introduction: Diabetes mellitus one of the major cause of avoidable blindness where patients with diabetic retinopathy are 25 times more likely to become blind than the non diabetic. Diabetic retinopathy and neuropathy being the major microvascular complications of diabetes, the aim of this study is to determine the association of retinopathy with peripheral neuropathy in diabetic patients in a tertiary care hospital. Materials and Methods: Study included diabetic patients with age more than 35years of age with a total number of 150 patients attending ophthalmology outpatient department of Saveetha medical college and Hospital. They underwent a detailed ocular examination and fundus examination to know the prevalence and severity of diabetic retinopathy. Peripheral neuropathy was assessed by doing a nerve conduction velocity of peripheral nerves in all patients. The results were evaluated to ascertain the prevalence of diabetic retinopathy and to establish an association with diabetic peripheral neuropathy. Results: Among the study population the mean age of the patients was 58+/-8.5 and males were affected more than females. The occurrence of complications increased with an increase in HbA 1c values. The prevalence of diabetic neruropathy was 72% and diabetic retinopathy was 44%. The prevalence of diabetic retinopathy in individuals with diabetic peripheral neuropathy was 51% which was 1.75 times more than without diabetic neuropathy (29%). This helps us to know the magnitude of problem of diabetic retinopathy and to timely treat it.

123-126

Authors: Sushil Ojha, Ashutosh Sayana, Neeraj Saraswat, Vaibhav Kumar Jain

Aim: The aim is to study the management of primary pterygium by surgical excision with sutureless conjunctival autograft with limbal stem cells. Materials and Methods: Patients with advanced pterygium were recruited from eye outpatient department (OPD) of rural tertiary care hospital of central India from January 2016 to October 2016. Informed written consent was taken before enrollment. The total 54 eyes (of 42 patients) were operated for pterygium with conjunctival autograft with limbal stem cells. Graft margins were buried around 0.25mm below the host conjunctiva. Results: The mean age of the patients was 48.71 ± 12.87 years. The male patient were 30 (38 eyes, 71.43%) and females were 12 (16 eyes, 28.57%). The most common age group of presentation was 40 to 60 years (28 patients, 66.67%), followed by 61 to 80 years (10 patients, 23.81 %) and lastly age less than 40 years (4patients, all female, 9.52%). At the follow up of 6 months 1 eyes showed recurrence and at 1 year 1 eyes showed recurrence. The recurrence was 3.70 percentage at 1 year of follow up. The recurrent pterygium were reoperated with pterygium excision with mitomycin C (0.02). The patients with recurrence have completed 2 months follow up without any signs of recurrence. In 28 patients (51.85%) showed improvement in visual acuity (2 or more lines) on Snellen chart. Conclusion: Management of primary pterygium by surgical excision with sutureless conjunctival autograft with limbal stem cells is a effective surgical technique in preventing recurrence of pterygium and good cosmetic appearance of eyes after pterygium surgery. The author recommends use of Mitomycin C (MMC) or 5 Fluorouracil (FU) only in selected cases pterygium like extensively infiltrating pterygium or recurrent pterygium.

131-135

Authors: Heena C. Radadia, Ashiwini A. Sapre, Priya P. Joshiyara, Dhaval M. Shah, Nittal A. Ninama.

Introduction: Study was conducted to analyse the average macular thickness globally from different age group from the healthy Indian population. Study will help to quantify any difference in thickness between gender and right and left eye too. Data can be compared with different ethnic groups. Materials and Methods: In total 147 patients have been enrolled in study attending daily ophthalmology out patient department. Age distribution of patients are 11 to 75 years. After patient fits inclusion criteria, single handed macular thickness measurement by spectral Domain OCT was carried out after consent. Measurement area is automatically identified by placing rim of 1mm, 3mm and 6mm diameter evenly around the centre of macula. Here we have encountered only central subfoveal values. Then macular thickness is calculated itself by algorithm. Protocol also displays binocular symmetry. To make sure for the accuracy of the results only the signal strength of 6 or higher and binocular symmetry more then 85% will be accepted in our study. Each patient was scanned single time with accuracy. Change in macular thickness was calculated by using paired sample t test, independent sample t test and T- test assuming equal variences. Result: Mean central subfoveal thickness for our population is 238.7278±14.2460 µ. However for different age group A,B,C and D the values for central subfoveal thickness are 241.9038±14.6972µ, 241.6428±8.2017µ, 235.5681±14.3381µ and 236.8428±18.1032µ respectively. There is weak negative corelation between left eye macular thickness and age which is statistically significant (r= -0.22)(p=0.005) (95% CI for r= -0.37 to 0.06). There is no correlation between right eye macular thickness and age (r= -0.07)(p=0.35) (95% CI for r= -0.23 to 0.08). The mean±SD values for Right and Left eye are 237.5986±13.7804 and 239.8571±14.6568µ respectively. In paired t test for right and left eye macular thickness difference is statistically significant (p=0.0043)(95% CI -3.7967 to- 0.7203). Mean values for different age group A,B,C and D for right eye are 239.1923±13.7579µ, 240.2380±7.9994µ, 233.4318±14.5496µ and 238.4857±17.2496µ respectively. While for the left eye 244.6153±15.3650µ, 243.0476±8.2549µ, 237.7045±13.9610µ and 235.2000±19.0259µ respectively. Normative values we found for male and female are 238.5735±13.4868µ and 238.9556±14.9075µ respectively. Difference in right and left macular thickness in male and female is not statistically significant as (p=0.5867,p=0.9221)(95%CI-5.6616 to 3.2148, -4.5699 to 5.0468). Mean±SD for different age group A, B, C and D for male are 242.8076±12.7059µ, 240.8157±8.0868µ, 236.6052±14.1240µ and 234.5882µ respectively. While for left eye central subfoveal thickness for different age group A,B,C and D are 241.00±16.6589µ, 242.3260±8.3214µ, 234.7800± 14.5914µ and 238.9722±19.1989µ respectively. Conclusion: Study has provided normative data of central subfoveal thickness for normal west Indian population. Normative values derived from this study can be used for different macular diseases in which macular thickness either increases or decreases. However studies from different ethnic group shows different mean values for macular thickness. This should be considered while diagnosing any macular pathology involving thickness. In our study difference between gender is not statistically significant while difference between right and left eye shows significant difference.

141-146

Authors: Rashmi Jain, Sithara Sara Oomman, Irfan Ahamed H.B., Anupama Bappal, Vidya Hegde.

Introduction: Aim of the study was to measure the visual function and quality of life amongst cataract patients attending camps. Methodology: A cross sectional study was conducted among patients attending Ophthalmology camp and having impaired vision due to cataract. This study was approved by the Institutional Ethics Committee. After obtaining informed consent, validated questionnaires developed by Aravind Eye Hospital, to measure the Visual functioning (VF) and Quality of Life (QOL) were administered to the patient. Results: A total of 324 patients (201 males and 123 females) with mean age 54.33 years (SD=8.99) were interviewed. Nearly half (46.9%) of the patients had severe or grade IV visual impairment as per WHO criteria of visual impairment. Two-thirds participants admitted that impaired vision adversely affected activities of daily living. The various sub scales studied in QOL questionnaire were: self care, mobility, social and mental problems due to impaired vision. All of these were almost equally affected due to cataract. Total VF score differs significantly (p<0.0005) for various visual impairment categories, except between category 2 and 3, where there is no significant difference (p=.695). In the QOL score there exists significant difference (p<0.0005) between group 1 with respect to other groups of visual impairment. VF & QOL score had no statistically significant association with age, gender and socioeconomic class. Conclusion: The visual function score and the quality of life score worsen as the visual acuity deteriorates due to cataract. Hence we need to strengthen our outreach programs so that we diagnose and treat cataract early leading to better quality of life.

152-156

Authors: Sandeep. K, Kunal Bhadbhade.

Register The incidence of subclinical macular edema after uneventful cataract surgery has become an issue of safety for this frequent operation. It was reported that the incidence of leakage sites was most prominent after 6 weeks. There are studies which show increased OCT–measured foveal thickness following cataract surgery due to subclinical changes of the macular blood retinal barrier (BRB) in the postoperative period. Spectral domain OCT has been used to measure macular thickness in the present study which was demonstrated to be superior to time domain OCT in the investigation of retinal response to cataract surgery. The present study is a prospective interventional study done to evaluate the incidence.

398-401

Authors: Sujithra H, Manoj Prathapan, Meenakshi Dhar, Vandhana Sundaram.

Introduction: Determining prevalence of glaucoma in patients with obstructive sleep apnea syndrome (OSAS) could be meaningful from public health point of view in Indian scenario, given that only few studies are reported so far. Aim: To study the prevalence of glaucoma in patients with OSAS. Materials and Methods: This was a prospective, observational study carried out between June 2014 and June 2016 in a tertiary care hospital. The study enrolled patients who were diagnosed with OSAS by the overnight polysomnography, depending upon inclusion and exclusion criteria. The included patients underwent complete ophthalmological evaluation including visual acuity, intra-ocular pressure, slit lamp examination with biomicroscopy, gonioscopy, indirect ophthalmoscopy, automated perimetry and optical coherence tomography. Results: A total of 34 patients diagnosed with OSAS (28 male; mean age 53.94±14.34 year) were included in the study. Among 34 patients, 16 patients had severe, 13 had moderate and 5 had mild OSAS, respectively. Of the 34 patients included in the study, 10 patients had glaucoma (n=5 primary open angle glaucoma and n= 5 preperimetric glaucoma) with prevalence of 29.4%. There is no correlation between severity of OSAS and mean deviation (r= -0.062; p=0.73), pattern standard deviation (r= -0.024; p=0.89) and retinal nerve fibre layer thickness (r= 0.057; p=0.751). Duration of OSAS negatively correlated with RNFL thickness (r= -0.736; p<0.001). Conclusions: Our study demonstrated high prevalence of glaucoma in patients diagnosed with OSAS in Indian scenario. However, further large scale studies are required.

405-411

Authors: Premnath G, Adnan Mohamed M, Manoj Vasudevan, Swathi.

Introduction: Glaucoma is a disease which is asymptomatic in early stages and invariably results in blindness. The inadequacy in awareness among common people which gives rise to non-diagnosis or late diagnosis has been highlighted by various studies worldwide. This study is conducted to evaluate and compare the level of awareness and knowledge among the employees of a medical college and tertiary care hospital. Methods: 750 employees of a tertiary health care institution were involved in this cross sectional study to evaluate and compare the level of awareness and knowledge about glaucoma. Data were entered in Excel work sheets and SPSS 9.2 was used for analysis. Results: Valid responses from 698 participants, including 308 males and 390 females were evaluated. 19.2% staff have not heard about glaucoma out of which 74.2 % were non-medical staff, 18.1% were allied medical staff, 3.1% were dental staff and 0.9% were medical staff. All four groups varied in their responses pertaining to the knowledge of glaucoma. All the results were statistically significant (p<0.009 to 0.001). Conclusion: All employees except medical staff are poor in glaucoma awareness and all staff have poor knowledge of glaucoma which is variable among the different categories. It is inevitable for medical college employees to be aware of glaucoma. Augmentation of awareness and the knowledge of glaucoma among these personnel is the need of the hour.

416-418

Authors: Jyothi P., Sandhya S., Bindu.

Aim: To assess the intrasubject variability of CCT,IOP and VCDR in patients with POAG compared to normal. Design: Cross sectional study. Materials and Methods: A total of 100 eyes of patients on treatment for POAG and 100 eyes of normal individuals were included in the study. All patients underwent a complete ophthalmological examination including CCT corrected IOP, visual field by HFA and disc evaluation using 90D assisted slit lamp biomicroscopy. CCT was measured using ultrasonic pachymetry in all of them. The difference in IOP, Vertical CD ratio and CCT were compared between the two eyes in POAG patients and in normal individuals. Results: The mean difference in IOP was 3.52±3.8 in POAG group compared to 1.06±0.9 in normal .The mean difference in CD ratio was 0.132±0.15 in POAG compared to 0.05±0.07 in normal. The mean difference in CCT was also significantly higher in POAG patients. [8.10±7.4] when compared to normal individuals [5.05±5.17].

422-427

Authors: Pallamreddy Sree Lakshmi, G. Chandrasekhar, C.S. Sandhya.

Background: Diabetic retinopathy was responsible for 11.1% of new cases of legal blindness in all the age group and 19.1% of those in 20-64 years age group. The detection of pre-proliferative and proliferative diabetic retinopathy can prevent the complications if these patients are appropriately treated by photocoagulation of the ischemic retina. This study is meant to determine the role of F.F.A. in detection of diabetic retinopathy changes in diabetic patients. Methods: The present study was conducted for a period of two years. A hospital based cross sectional study of 100 eyes of 50 patients with diabetic retinopathy consisted of detailed anterior segment, and fundus examination clinically with FFA. Each angiogram was studied for the number, size and location of aneurysms, size and shape of foveal avascular zone and type of leakage. Result: The mean age of the patients was 55.65 years, the youngest was 21 years old and the eldest was 80 years old. 30% of total eyes were found to have micro aneurysms only, 20% of eyes were found to have moderate NPDR changes, IRMAS were found in 6% of eyes, 4% of eyes with ischemic maculopathy which was identified only through FFA. 30% of eyes with very severe NPDR turned out to PDR changes by FFA. Conclusion: In this study, we were able to identify the role of FFA in differentiating the lesions and assessing severity of characteristics like capillary loss. The procedure was useful in identifying subtle changes, which are otherwise difficult to appreciate by ophthalmoscopy, like, the number of micro aneurysms and their localization in different areas of fundus, and their size.

436-439

Authors: Arun Kumar Ayoor, Ranjini Kotancheri, Aligar Babu C, Swathi K

Introduction: Diabetes mellitus is emerging as a multisystem disease culminating in various complications especially to the ocular system if not treated at the earliest. The role of various comorbidities in aggravating the severity of diabetic retinopathy is sparsely studied. This study was performed to throw light at this aspect of the need for early identification of comorbidities and its role in progression of diabetic retinopathy. Methods: Study was conducted among 257 diagnosed type 2 diabetic patients with various grades of retinopathy as classified based on ETDRS classification. Clinical history and comprehensive systemic and ocular examination was done and laboratory profile of serum lipids and blood sugar values were collected. The analysis was carried out using SPSS software and results presented in percentages and p value <0.05 taken as significant. Results: 257 patients were studied with a mean age of 58.8+/- 10 years. Male female distribution 129:128. There were 221 non proliferative diabetic retinopathy, 33 proliferative diabetic retinopathy and 3cases of advanced diabetic eye diseases. The study group had 48.6% smokers, 40.5% hypertensives,13.6% coronary artery disease and 45.5% with serum lipid >200mg/dl. Present study revealed a positive association of retinopathy with hypertension (p value 0.034) and smoking (p value 0.002). Conclusion: Comorbidities associated with Diabetes mellitus were contributing to worsening of diabetic retinopathy. Hence the need for prompt identification and control of these should form a part of the routine management of any stage of diabetic retinopathy to prevent sight threatening complications.

444-449

Authors: Rajni Sethia, R N Kothari, Vivan Desai, Aditya Desai, Anjasi Patel.

Introduction: Vernal keratoconjunctivitis is a seasonally recurring, chronic, allergic bilateral inflammatory disorder of the conjunctiva and cornea caused due to immune mediated hypersensitivity reaction. Tacrolimus is an immunomodulator which induces suppression of T lymphocytes activity and causes reduction of ocular inflammation. Hence, in our present study we aim to evaluate the efficacy of 0.1% tacrolimus eye ointment as first line therapy in the management of Vernal Keratoconjunctivitis. Materials and Methods: This was a clinical, prospective and interventional study including 100 eyes of 50 patients with VKC which were serially selected. 0.1% tacrolimus eye ointment was instilled twice daily over a period of 12 weeks. On every fortnightly follow up, patients were assessed for 5 symptoms and 4 signs and the severity was graded as 0 (normal), 1+ (mild), 2+ (moderate), or 3+ (severe)in order to evaluate the efficacy of the drug. Results: There were 50 patients with VKC comprising of 41 males and 09 females. After treatment with Tacrolimus 0.1% eye ointment, there was statistically significant improvement in symptoms of VKC including itching, redness, photosensitivity, foreign body sensation and mucus discharge (P<0.001). Significant improvement in clinical signs of VKC including conjunctival hyperaemia, papillary hypertrophy, giant papillary conjunctivitis and limbal involvement (P<0.001) was seen at the end of the study. No significant adverse effects of tacrolimus were seen in these patients. Conclusion: Topical 0.1% tacrolimus eye ointment is very effective in the treatment of Vernal Keratoconjunctivitis with minimal long term side effects.

454-457

Authors: Hitesh Vyas, Mitul Patel.

Introduction: Cornea is anterior transparent layer of eye and important for image formation. Keratitis (corneal inflammation) and resulting corneal ulcer is important clinical challenge in ophthalmology. Prompt treatment requires identification of organism involved. Insight regarding types of organisms involved, patient demography, antibiotic sensitivity greatly helps in better patient management. Materials and Methods: Patients with clinical diagnosis of ‘Corneal ulcer’, attending Department of Ophthalmology GMERS Medical College, Gandhinagar were selected for this observational study. Total 79 patients were studied. Detailed history and ocular examination were undertaken for each patient. Corneal scrapings from corneal ulcer were taken for pathological and laboratory study to identify type of organism and its antibiotic sensitivity. Data was arranged in tables for analysis. Diverse types of organisms and their frequency of occurrence was calculated. Patients were selected as per predefined criteria. Study recruitment was done after informed consent. Institutional ethics committee clearance was obtained. Discussion: Corneal ulcer is important and serious ophthalmic problem contributing to significant portion of total blindness burden in our country. Understanding types and varieties of organisms gives insight regarding local community conditions. Antibiotic sensitivity study gives accurate guideline regarding precise use of antibiotic thereby shortening treatment period and minimizing antibiotic resistance. Comparison about various similar studies were carried out to elucidate findings. Results: Patient demographics tables and graphs were prepared and analysis presented.

462-466

Authors: Sreelakshmi Kothapalli, Gopala Krishna Ogirala, Jithendra Kandati.

Aims: The purpose of the present study was to identify the common predisposing factors in the region and to identify the common bacterial agents associated with bacterial keratitis and outcome of the condition with regard to individual pathogen. Settings & Design: A prospective hospital based cross sectional study for a period of two years at a tertiary care hospital by the department of ophthalmology in association with department of Microbiology. Material & Methods: 350 patients above >5 years attending the OP of dept. of ophthalmology with clinical signs and symptoms of Bacterial keratitis were enrolled. Demographic data, duration of illness, clinical signs and symptoms were noted. Corneal smears and scrapings were collected by following standard protocol, and were transported to microbiology laboratory for processing and isolation of pathogens. The isolated pathogens were identified by standard biochemical tests and microbiological procedures by following CLSI guidelines. Results: 350 cases of bacterial keratitis with 200 males and 150 females were enrolled as cases, 26-45 years was the most common age group in the study. 31.1% were farmers, 52% belong to low socio economic status. 60.6% had a history of previous injury or surgery to the involved eye. History of corneal injury with paddy husk was noted in 60.57% of cases which was a major risk factor. 315 cases forming 90% of all cases were positive for growth. Staphylococcus aureus was the dominant isolate in the study. Aspergillus niger and Candida albicans were the fungal isolates in the study. Conclusion: Bacterial keratitis is one of the serious ocular conditions which require emergency care and management. Corneal injury remains as the major risk factor and associated ocular disorders, contact lens usage are other risk factors. Old age, anterior chamber infiltration, long duration of illness was associated with significant risk of poor visual outcome in the study. Any programmes directed against this condition should focus on the above factors in prevention of bacterial keratitis and to prevent complications.

470-475

Authors: Rohit Saxena, Poonam Kishore, Sandeep Saxena

Cataract is one of the most important curable causes of blindness in India. Nowadays although the ‘cataract surgery of choice’ is phacoemulsification; manual small incision cataract surgery (SICS) has emerged as an alternative technique owing to its being cost-effective and having all advantages of a self-sealing sutureless incision but with the disadvantage of having higher postoperative astigmatism. The aim of our study was to compare the surgical outcome using two different incision sites – “superior and temporal” in terms of surgically induced astigmatism. After taking Informed consent all the patients were divided randomly into two groups. Group S received Superior incision and group T Temporal incision. All surgeries were performed under peribulbar anesthesia using an incision size of 6 – 6.5 mm. The incision architecture was kept same in both the groups. Postopratively patients were examined on days 1, 7, 30, 45 and 90. Keratometry with Uncorrected and Best corrected visual acuity was recorded on subsequent visits. The surgically induced astigmatism (SIA) was calculated by Vector method. When SIA was compared between the two groups, both in magnitude as well as axis, the change was found to be lower in temporal group as compared to superior group S. It was statistically significant (p=0.004). We therefore conclude that though both the groups had good postoperative visual acuity patients of group S had more postoperative and surgically induced astigmatism and therefore greater dependence on spectacles as compared to group T and this was found to be statistically significant.

480-484

Authors: Soumya Ramani, Thanuja G P, Divya D Sundaresh.

Aim: To analyze the intraoperative complications and postoperative outcome during cataract extraction in traumatic cataract. Methods: A retrospective analysis of all the traumatic cataracts presenting at M.S. Ramaiah Medical College Hospital during the period between January 2011 and December 2015 was done. A total of 41 traumatic cataract cases were seen during the 5-year period. Age, Sex, traumatic sequelae, surgical strategies, intraoperative complications and post-operative outcome were reviewed in all eyes. Results: Records of forty-one patients with traumatic cataract were analyzed. Males accounted for 90.24%, while females, for 9.76%. Thirty-five patients (85.36%) underwent surgery for traumatic cataract. A history of blunt trauma was elicited in 23(56.09%) and 18(43.91%) had a penetrating trauma. It was noted that the presence of corneal changes or iris abnormalities, did not affect the visual outcome. Pupillary changes influenced the visual outcome, with100 % of the patients with a relative afferent pupillary defect and a fixed dilated pupil having a vision worse than CF3m. (p <0.005).Among the intraoperative complications, vitreous loss had a bearing on the post-operative vision. Twelve percent of the patients had a vitreous loss, all of whom had a vision of 6/60 or worse. (p=0.028). The presence of postoperative complications also affected the visual outcome-78.6 % of whom, had a vision 6/24 or worse.(p=0.05). Conclusion: Traumatic cataracts pose a challenge to ophthalmologists, as they have an increased incidence of associated ocular abnormalities and intraoperative complications. Hence, pre-operative counselling of the patient, astute surgical planning, careful surgical management and an intense post-operative follow up regime are imperative in the management of traumatic cataracts, to attain a reasonable visual outcome.

488-490

Authors: Surohi Shah, Hemaxi Desai, Sanjeev Prasad, Krupali Raol

Aim: To evaluate the relationship between the axial length and refractive error and peripapillary retinal nerve fiber layer (RNFL) thickness measured using Stratus optical coherence tomography (OCT) in subjects with high myopia. Materials and Methods: It was a prospective comparative observational study. Eighty eyes of 40 non glaucomatous subjects aged between 18 to 51 years with spherical equivalent ≥ -6 dioptres (D) were examined during a period of 3 years. All subjects underwent a full ophthalmic examination. OCT was performed with OCT model 3000 version 48 (Stratus OCT, Carl Zeiss Meditec Inc.) Total average, quadrantic & mean clock hour RNFL thickness was measured with the fast RNFL (3.4) (768 A-scans in 1.92 seconds) scanning protocol. The same procedure was performed for 80 emmetropic eyes of 40 age matched subjects of the control group. Statistical analysis was performed with SPSS (version 11.5, SPSS, Chicago). Results: Mean age of myopes was 28.4 years (SD +/-10.3). Mean spherical equivalent was -9.48125 (SD +/- 1.73), with mean axial length of 28.72 (SD +/-1.70). In the emmetropic control group, mean age was 26.9 years (SD 9.9) and mean axial length was 23.8 (SD +/-0.4). There was significant difference between axial length (P<0.0001) of the two groups. Mean average RNFL thickness in myopes was 73.27µm with standard deviation (SD) +/-19.33 µm. Mean average RNFL thickness in emmetropes was 98.5µm (SD +/- 12.9 µm). RNFL thickness decreased with higher axial length (overall r2=0.016, P> 0.05), but the correlation was not found to be statistically significant. No statistically significant associations were noted between mean RNFL thickness and age (r2 = 0.017, p > 0.05). Conclusion: High myopic subjects tend to have thin peripapillary RNFL as measured by Stratus OCT. This phenomenon should be considered when interpreting a glaucoma suspect's RNFL measurements compared with the normative database which may be misleading in such cases resulting in a substantial proportion of false positive errors. The variation in the normal population needs to be taken into account to distinguish a pathologically from a physiologically thin RNFL. Stratified normal databases are required for accurate diagnosis of conditions resulting in nerve fiber loss such as chronic glaucoma.

495-499

Authors: Shruti P Hegde, Machireddy R Shekarreddy, Mohan Ram Kumar, Vijay Kautilya D.

Introduction: Diabetic retinopathy is an important microvascular complication of diabetes mellitus & to prevent the vision loss resulting from it, regular screening & timely diagnosis are very important. This study attempts to measure the level of awareness about eye complications of diabetes among patients with type II diabetes mellitus & their knowledge about its effect on vision and the available treatment options. Methods: A cross-sectional hospital based study was carried over a period of 6 months at ophthalmology OPD of a medical college hospital. The data collected was tabulated and is presented here as descriptive statistics, frequencies and ratios. Results and Discussion: Among 100 patients included in this study only 36 patients were aware of eye involvement in Diabetes mellitus. Only 17 patients knew the need for eye checkup even when sugar levels are controlled. 68 patients were getting their eyes tested for the first time. The commonest cause for not getting regular eye checkups, other than lack of awareness, was difficulty in reaching the hospital & time constraints. Conclusion: In spite of increase in incidence of DM in India, the awareness about eye complications & retinopathy remains poor among the affected patients. There is a clear cut difference in perception, between the general diabetic care & eye care, among these patients. Physicians play an important role in referring the patients for eye checkup.

504-506

Authors: Vani Puri, Amit Sethi.

Purpose: Clinical relevance of ocular dominance [OD] lies in its role in success of monovision. This study aims to determine easy and reliable methods to test OD and association of OD with handedness. Methods: Prospective study of 300 patients, with best corrected visual acuity of 6/6, interocular difference of < 1Dioptre, and absence of any ocular, oculomotor or binocular abnormalities. Two subjective tests were done to determine OD - Miles [sighting dominance] and Fogging tests. Handedness was determined by history. Ambidextrous patients and those unable to understand or giving equivocal replies, were excluded. Kappa [k] statistics [inter test agreement], and Chi-Square test and Odds ratio [association between handedness and ocular dominance] were applied. Results: Mean age 35.28 years, spherical equivalent refractive error ranged +2 and -6 D. Both tests had perfect agreement [k=1]. 67.33% patients were Right Ocular Dominant (ROD) whereas 32.67% were Left Ocular Dominant. 65.67% had matched dominance of eye and hand. No significant association between handedness and ocular dominance. Conclusion: Mile’s and Fogging tests are reliable and easy to perform in clinical setting. Since no direct analogy could be established between patterns of eye – hand dominance, assumption of OD cannot be made on the basis of handedness. As 94.33% patients were Right Handed whereas 67.33% were ROD, the results could not be directly extrapolated in patients with dense cataracts where OD cannot be conclusively determined.

513-517

Authors: Charushila Gajapati, R.D. Kulkarni, Nishant N..

Aim: To identify the etiology, clinical profile, management and outcome of cases of orbital cellulitis admitted to a tertiary care hospital during a period of 2.5 years. Methods: A retrospective review of medical records of 24 patients with orbital cellulitis from January 2015 to July 2017 was conducted. The age, sex, duration of symptoms, predisposing factors, clinical findings, laboratory and radiological investigations, treatment provided and complications were recorded. Results were analysed with SPSS software. Results: Sinusitis was the source of infection in 41.7% patients, dacryocystitis, mucormycosis and unknown source in 12.5% each. Diabetes mellitus was the major comorbidity including 41.7% of patients. Cavernous sinus thrombosis developed in 25% of cases, 41.67% of patients recovered without any complications whereas 8.3% patients died. Conclusion: Orbital cellulitis is a potentially dangerous condition causing morbidity as well as mortality. Cavernous sinus thrombosis is a frequent complication. Early diagnosis and prompt treatment with proper antibiotics and / or timely surgical intervention can achieve good prognosis.