Indian Journal of Clinical and Experimental Ophthalmology

391-397

Authors: Udayaditya Mukhopadhyay, Nabanita Barua, Sangeeta Thakur

Purpose: To evaluate the change in retinal nerve fiber layer thickness (RNFL) using Optical Coherence Tomography after trabeculectomy in adult patients with primary open angle glaucoma (POAG). Methods: A total of 40 eyes (30 patients) with POAG, uncontrolled on medical management were enrolled. Average and quadrant wise RNFL thickness were measured pre and post operatively at 1 week, 1 and 3 months. Data was analysed using SPSS software. Results: Intraocular pressure (IOP) reduced from 28.55+ 8.47 mm Hg, 14.8+ 5.97 mm Hg at 1 week, 14.25 + 4.47 mm Hg at 1 month, 14.9 +4.8 mm Hg at 3 months (p<0.0001)). There was no statistically significant change in RNFL level noted at 1 or 3 months (p=0.1847). Visual function (MD and PSD) also remained unchanged. RNFL thickness had significant negative correlation with age, IOP and pattern standard deviation. We divided the patients in two groups < 50 years and >50 years and analyzed the data but no statistically significant changes were found. Conclusion: In this study, post glaucoma filtration surgery, there was significant lowering of IOP but no difference in RNFL thickness, visual field parameters in adult POAG patients.

402-404

Authors: Atul Modesara, Kavita Parekh.

Aim: To compare the prevalence, demographical profile and visual status of Primary Open-Angle Glaucoma (POAG) and Primary Angle-Closure Glaucoma (PACG) at first visit in a Gujarat Adani Institute of Medical Science, Bhuj, Kutch. Materials and Methods: Cross sectional observational study of 50 patients with primary glaucoma was done. Detailed history was taken and all patients underwent complete physical and ocular examination. Results: 48% were suffering from POAG and 52% were suffering from PACG. Mean age was 56.58 in POAG and 54.42 years in PACG with male predomniancy in POAG. From POAG patients 41.6% had VA<3/60 comparative to PACG patients 15.3%. Conclusion: Prevalence of POAG and PACG is almost equal with PACG on slightly higher side and mean age of presentation was slightly higher for POAG than PACG. Good Vision (≥ 6/18) was more common in PACG than POAG while POAG is more commonly associated with blindness (<3/60) at presentation.

412-415

Authors: Praveen K Chaturvedi, Prashant Bhushan, Rajendra Prakash Maurya, Mahendra Kumar Singh, Virendra Prat.

Purpose: Aims of this study is to characterise the visual disability of patients of glaucoma in terms of LogMAR visual acuity, contrast sensitivity, optic disc changes and intraocular pressure. Materials & Methods: A total of 30 eyes with the glaucomatous damage 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, 25(83.3%) eyes have BCVA in the range of 0.5 to 1.0 LogMAR units and 5(16.7%) eyes have 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 = 0.8), near visual acuity (r = 0.73), best corrected near visual acuity (r = 0.48) and cup to disc ratio (r = 0.65) and inverse correlation of association with contrast sensitivity (r = -0.39) and intra ocular pressure (r = -0.51) which are statistically significant (p value <0.05). Conclusions: In patients of glaucoma with visual impairment, there is a negative correlation between contrast sensitivity and visual acuity in logMAR units.

419-421

Authors: Monika Kharbanda, Ishwar Singh, Sachin Walia, Harsimran Singh.

Introduction: Aim of the study was to evaluate IOP changes and anterior chamber parameters (depth and volume), in primary angle closure (PAC) cases after laser peripheral irodotomy (LPI) using Pentacam system in OPD patients at Govt. Medical College, Patiala. Material and Methods: Total 12 eyes of 12 PAC patients were analysed in the study in the period of 3 months from March 2017 to May 2017. LPI was performed on the enrolled eyes, Pentacam system was used to calculate anterior chamber and IOP changes pre and post 14 days of LPI treatment. Results: There was statistically significant difference before LPI and after LPI for all measured variables. The mean ACD and ACV increased by p=0.04 and p = 0.001 respectively in 12 patients. The mean IOP decreased in all eyes with p=0.03 at month 3 and thereafter. Conclusion: In conclusion, LPI produces significant anterior chamber depth & volume along with decrease in IOP making LPI effective in treatment of primary angle closure cases.

428-435

Authors: Piyali Sarkar, Sripurna Ghosh.

Introduction: The World Health Organization (WHO) has estimated that the number of people diagnosed with Diabetes is 347 million worldwide. Diabetic macular edema (DME) and Diabetic Retinopathy are the main causes of vision loss in Diabetes mellitus. Objective: To compare altered ocular blood flow by Doppler evaluation in middle aged type 2 diabetic patients with and without diabetic macular edema. Materials and Methods: An analytical cross–sectional study was conducted in the out-patient and in-patient department of ophthalmology and the department of radiodiagnosis in a tertiary care hospital including 36 patients in each group (A-with DME & B-without DME). Color doppler was done to evaluate ocular blood flow velocities in internal carotid, ophthalmic and central retinal arteries and central retinal vein. Results: The majority of diabetes patients in developing countries are middle aged (45–64 years of age). Vascular changes and subsequent ocular hemodynamic changes are critical events in the pathogenesis of diabetic retinopathy. Mean Resistivity Index (RI) and Mean Pulsatility Index (PI) in the ophthalmic artery were found to be significantly high in the DME group. Mean end diastolic velocity (EDV) in the common carotid artery was found to be significantly high in the NO DME group than the DME group. In our study, the mean values of Low Density Lipoprotein (LDL) (mg/dl) , Total cholesterol (mg/dl) , Serum urea (mg/dl), Serum creatinine (mg/dl) was found to be higher (Statistically significant) in the DME group as compared to NO DME group. Conclusion: Our findings may indicate disturbances of retinal and choroidal circulation in patients with DME. Further studies with larger groups of patients are needed to understand better the role of retrobulbar hemodynamics in the pathogenesis of Diabetic macular edema.

440-443

Authors: Abha Sinha, Somya Dulani.

Introduction: Herpes simplex viral keratitis is a very common infective disease in western countries. Despite the availability of excellent topical antiviral agents, HSV remains a leading cause of unilateral corneal blindness in the United States and in all developed countries. Primary infection usually occurs in early life, & may be asymptomatic, but the real danger lies in the virus ability to establish latency in the neuronal ganglia & reactivation. This reactivation is an immune phenomenon which can lead to progressive corneal damage, as recurrences may be multiple & severe, ultimately causing corneal scarring, vascularisation, thinning & even perforation. Materials & Methods: The present prospective study was carried out on 100 eyes involving 80 patients of viral involvement of cornea, who presented to Department ophthalmology, Government Medical College, Rajnandgaon (C.G.), India, during the period from March 2016 to February 2017.To study for the precipitating factors, age& sex distribution, laterality, different types of lesions, complications & recurrences, detailed history of each case was taken & examined thoroughly. Ocular examination with slit lamp was carried out thoroughly. Fluorescein staining was also done in each case. All diagnosis was made clinically. Observations: Majority (62.5%) of patients belonged to 20 to 40 years followed by 18.75% of patients in 40 to 50 years age group. No cases were seen under 10 years age group in present study. Males were more commonly affected than females by 57.5%.In present study at first presentation onset of disease was spontaneous in 58.75%.In rest of the cases major precipitating factors were history of minor ocular trauma, fever, stress, exanthematous skin eruptions & UV light. Bilateral herpetic keratitis was found in 25% patients in present study. In present study epithelial keratitis was most common lesion (60% cases) found followed by stromal keratitis (23% cases). Among patients of epithelial keratitis, superficial punctuate keratitis (42% cases) was most common, followed by dendritic keratitis (11% cases) & geographic ulcer (7%cases). Conclusion: HSV keratitis is a major cause of unilateral blindness. Early diagnosis &management could restrict disease progression.

450-453

Authors: Gautam Paul, Debadatta Dhar, Ankita Narula, Abhisek Mandal, Tshering Wangchuk Bhutia

Purpose: To isolate the bacterial flora from the conjunctival sac in patients undergoing cataract surgery and to determine the antibiotic sensitivity pattern of these organisms. Methods: A total of 500 cases both men and women were included in this study. Specimen were taken 1 day prior to the surgery from the conjunctival sac of the patients and then cultured for isolation of the bacteria along-with antibiotic sensitivity testing if any culture came positive. The percentage of bacterial isolates and the drug resistant isolates were compared. The study was conducted for a period of 18 months after obtaining a written and informed consent from all the patients. All forms of cataract in all age groups with the absence of any associated ocular infection were included in this study. Patients with prior history of any ocular infectious diseases and traumatic cataracts were excluded from this study. Results: Out of the 500 cases, 61 (12.2%) had positive cultures. The most frequently isolated bacterium was the Staphylococcus aureus found in 44(72.13%) cases, followed by coagulase negative Staphylococcus (CoNS) from 11(18.03%) cases, both showing high sensitivity to cefpodoxime (65%), cefuroxime (67%), gentamicin (74%), ciprofloxacin (72%) and vancomycin (83%), amoxycillin and clavulanic acid (53.5%) and methicillin (59%). Methicillin resistant strains were noted in 19.36% eyes. Conclusion: The most frequent bacterium in the conjunctival flora is the Staphylococcus aureus with high susceptibility rates to cefpodoxime, cefuroxime, gentamicin, vancomycin, ciprofloxacin and augmentin.

458-461

Authors: Arun Kumar A, Irshad E, Jithu V P.

Introduction: Dry eye is a complex multifactorial disease which forms a major proportion of ophthalmology out patients. Most of the patients are on chronic medications including psychiatric drugs. So prevalence of dry eye was studied in psychiatric patients on antidepressants. Methods: A cross sectional comparative study was conducted among 22 patients / 21 controls in a tertiary eye care hospital in Northern Kerala for a period of 1 year by assessing Ocular surface disease index score/Tear film break up time/ Schirmer test .Association of age gender, smoking, alcoholism, with dry eye disease was also studied. Results: Study showed a statistically significant correlation between antidepressant medications and dry eye with a P value of 0.012. Tricyclic anti-depressants contributed the majority for dry eye followed by selective serotonin re-uptake inhibitors and serotonin norepinephrine reuptake inhibitors. Females, old age and smoking showed high prevalence. Schirmer test was found to be 100% sensitive and specific and TBUT; 35% sensitive and 100% specific. Conclusion: Prevalence of dry eye disease is 50 % in patients on antidepressants compared to 14.2 % in control group. Schirmer test can be effectively used in patients for early detection of dry eye disease. The drugs with least side effects can be selected and treatment modified accordingly.

467-469

Authors: Kavita Parekh, Atul Modesara.

Introduction: Throughout the area around the world very less research are performed on presbyopia with smoking habit. The present study was considered with an aim to decide the prevalence of presbyopia between smokers and non smoker’s patients in Bhuj district. Materials & Methods: Out of the total 400 patient included, they were divided into two groups, Group 1 consist of 200 sample patients having habit of smoking regularly and rest 200 were included in the control group. Ohthalmic examination that includes colour vision, Snellen Visual acuity and examination of fundus was done in all the patients. Standard projected eye charts with black letters were used to obtain Snellen visual activity. Subjective refraction was performed with and without spectacles, first on right side and then on left side of eye of all patients. Results: Significant correlation was found between addiction of smoking and that of presbyopia with P≤0.02. When the dissimilarity was measured between onset of age and earlier succession of presbyopia between smokers and non smokers Statistical significance was found between two groups. Discussion & Conclusion: In a society having psychosomatic disorder it’s common to have presbyopia at an early age. Occurrence of hypertension, head ache and gastritis are an early indication presbyopia. Along with the above described factors, others factors that can cause early onset of presbyopia are nutritional deficiencies, systemic diseases and other environmental factors.

476-479

Authors: Sangeeta Agarwal, Shika Singh

Objective: To study the variations, changes and rate of progression in the fundus findings of patients having diabetes and hypertension both, and to compare these findings from those having diabetes alone. Result: FFA was done on total 30 patients, which were divided into two groups A and B there was male dominance (17. 56.6%). Majority of patients are in 50-70yr. age group. In group A, only 2 patients had Type-1 diabetes, rest had Type-2. In group A., maximum patient had history of duration of 20-60yr. where as in group B it is 10-20yr. In both groups mostly patients were on irregular treatment. Main FFA findings in both groups are Micro aneurysms and hard exudates, Hypertension was significantly related to retinopathy and both systolic and diastolic blood pressures were deemed to have an association.

485-487

Authors: Sulatha V Bhandary, Lavanya G Rao, Krishna Rao A, Sindhura Devi Adsumilli, Rohit Simha.

Aim: To study the prevalence of refractive errors and amblyopia in school children of kindergarten to tenth class. Materials and Methods: Prospective observational study conducted in a single school in south India. 970 students from LKG to class 10 underwent evaluation by 3 ophthalmologists and 2 optometrists on 12 consecutive days. All students of kindergarten underwent atropine refraction and those with suboptimal vision from Class I-X underwent best glass correction and refraction with homatropine. Fundus photograph was taken in all the students using a portable non mydriatic fundus camera to detect any fundus abnormality. Significant refractive errors requiring correction and amblyopia requiring management were defined as per American Academy of Ophthalmology guidelines. Results: Out of 970 students screened, 160 were in kindergarten. Of the 970 students 19.1% had refractive error, of whom 56.7% were unaware of their ocular condition (p=0.0001 statistically significant). Out of the 19.1%, Out of the 19.1%, 46(24.8%) were myopes, 4 (2.1%) hypermetropes and 135 (73.5%) had astigmatism. 91.8 % had binocular refractive error and one child (0.5%) had amblyopia. 18 (11.25%) of the 160 KG students had refractive error. Conclusion: 56.7% of the students were unaware of their refractive error which would have gone undetected if the screening was not done. In addition methodical evaluation of KG students is of great importance in identifying refractive errors and prevention of amblyopia in preschool children.

491-494

Authors: Udayaditya Mukhopadhyay, Sreyangshi Biswas, Jayant Kumar.

Introduction: Glaucoma is a known cause of visual loss despite successful congenital cataract surgery. The reported prevalence of glaucoma after congenital cataract extraction varies from 1 to 32 %. Some authors have reported increased CCTs among children who underwent cataract extraction. Nevertheless, it is unclear whether the increased CCT was present before cataract surgery or developed post-operatively. Aims: To evaluate longitudinal changes in CCT following congenital cataract surgery with and without IOL implantation. Settings and Design: The study was a prospective, longitudinal, observational clinical study. Materials and Methods: A total 30 cataractous eyes of paediatric patients (0 to 16 yrs) were enrolled from the paediatric ophthalmology clinic of our institute. CCT was measured preoperatively in all 30 cataractous eyes, out of which 15 eyes were left aphakic and the rest were made pseudophakic. CCT was measured at 1 month and 3 month post-operative period in both the groups. Statistical analysis used: The data collected was tabulated and analysed following standard statistical protocol using Metlab software. Results: Preoperative CCT values in cataractous eyes were found to tally with the mean CCT of healthy eyes in that same age group. The post-op CCTs after 1 and 3 month were found to be greater than the pre-operative measurements in all the patients. However, it was only in the aphakic group that the increase in CCT was found to be statistically significant. [aphakic p=0.003(1 month),0.004(3 month)]; [pseudophakic p= 0.11(1month),0.06(3 month)]. Conclusions: In aphakic eyes, cornea was found to have significantly increased CCTs post-operatively which in turn may influence IOP measurements (false positive results), glaucoma diagnosis,follow-up and treatment. In pseudophakic eyes, cornea was not found to have significantly increased CCTs post-operatively.

500-503

Authors: Yogish S. Kamath.

Purpose: To assess the awareness of diabetic eye disease amongst patients visiting a tertiary care hospital with Diabetes mellitus. Methods: A cross section of patients presenting to a tertiary care hospital with a diagnosis of diabetes mellitus , in a specified time interval ,were interviewed on the basis of a questionnaire regarding their awareness of eye disease due to diabetes and their actual attitude and practice. Results: 423 patients were included in the study. Their responses were analyzed as per the questionnaire, on percentage basis. Conclusion: The study concluded that despite a reasonably good awareness regarding diabetes mellitus and ocular involvement, there was poor attitude and practice of utilization of available resources for screening and treatment of diabetic eye disease.

507-512

Authors: Nirati Srivastava.

Introduction: Recent evidence suggests that inflammation and abnormalities of innate immunity play a role in the pathogenesis of age-related macular degeneration. In light of the evidence linking inflammation and AMD, it is of interest to determine whether CRP levels and other markers of inflammation are predictive of AMD. Methodology: 50 patients of AMD who satisfy the inclusion and exclusion criteria were included by non-random purposive sampling method. Relevant investigations like FFA and OCT were done. Serum CRP levels were assessed by latex agglutination by SeroCHEK AGAPPE Kit having analytical sensitivity as 6mg/L. Results: Majority of study patients have early AMD changes (70%) as compared to late ARMD changes (30%).Wet AMD corresponds to 16% of all the study patients. Both the groups, early as well as late AMD patients have male preponderance. Majority of patients with early AMD have vision from 6/6 to 6/12 and those with late ARMD have vision 6/60 and less than 6/60. Patients with hypertension, diabetes mellitus, cardiovascular disorders and smokers found no relationship with AMD. In the present study, maximum number of AMD patients have pseudophakia. All the study patients with early as well as late AMD changes, have serum CRP levels below 6mg/L i.e; below the reference value taken in this study. Conclusion: The present study does not support the theory alleging non-specific systemic inflammation in the aetiology and natural history of age related macular degeneration. Though, this may be due the small study sample.

518-520

Authors: Shadakshari S.M.

Aim: A comparative study on pterygium excision and glue free limbal conjunctival autograft with and without suture. Materials and Methods: 50 patients of primary nasal pterygium attending ophthalmology OPD in Rotary Hospital, Sirsi, Karnataka were randomly selected. The study was conducted during the period from June 2015 to January 2016. All patients were divided randomly into two groups. Group 1 consisted of 25 patients who underwent suture less, glue free limbal conjunctival autograft and Group 2 consisted of 25 patients who underwent limbal conjunctival autograft with suturing. Clinical data of all patients which included age, sex, laterality of pterygium as well as a history of other diseases, were obtained by reviewing the medical records and direct patient interview. All patients were subjected to detail comprehensive ophthalmic examination which included visual acuity, refraction, slit lamp biomicroscopy, measurement of IOP, extra ocular movements and dilated funduscopy. Results: In this study 50 primary nasal pterygium who underwent Surgery were assessed. Of 50 patients, 35 were male and 15 were female patients. The age of patients ranged from 30 years to 65 years. In our study mean Surgical time in Group A (n=25) was 20+1.5 min. as compared to Group B (n=25) which was 30+2 min. Early post-operative signs and symptoms like pain, foreign body sensation, hyperemia and chemosis were significantly less in Group A as compared to Group B. There was no significant difference is complication rate seen among to group except for graft retraction which was seen in Group A. Both groups achieved good visual acuity after 4 weeks. Both groups had no recurrence of pterygium. Conclusion: Among the two techniques Suture less and glue free limbal conjunctival autograft is easy to perform and it is safe, effective and economical.

241-242

Authors: Anil Kumar.

Biomedical statistics is essential part of any scientific study; a review of the current scientific literature indicates that statistical analysis is an area that frequently needs improvement. To address this, we put forward some of the most common errors in statistical analysis of ophthalmic data. In ophthalmic data generally when statistical tests are performed, the correlation generally present between observations made for the right and left eyes of a subject, is ignored or is not taken account for. The error leads in a consequence of over statement of the precision of the study that is resulting incorrect P values indicating a greater measure of statistical significance than the data warrant.”

249-251

Authors: CN Madhusudhana, Apoorva N, Varna V Shet.

Introduction: To identify the cause of penetrating ocular trauma; demographic, clinical profile and visual outcome of the patients presenting with penetrating ocular trauma to a tertiary care hospital. Materials and Methods: It is a hospital based- prospective study that was conducted over a period of one year. 146 eyes of 146 patients attending outpatient in the department of ophthalmology with penetrating ocular trauma were included. Demographic data like age and gender, cause of penetrating injury, nature of work that was being carried out at the time of injury, time duration between injury and presentation to the hospital, visual acuity and diagnosis were recorded. Evaluation of anterior and posterior segment was done at time of presentation. Final visual outcome was recorded at the end of 6-8 week follow up after complete treatment. Results: Penetrating ocular trauma was found to be more common in adults in the age group of 35-45 years and in males (71.23%). Most of them were working in agricultural field (42.46%) at the time of injury. The most common mode of injury was wooden stick. 52% of patients presented in 24-48hrs after injury, which were highest among the groups studied. Visual acuity of 6/60 or worse recorded at the time of presentation was 56.80%. After complete treatment and follow up at the end of 6-8 weeks, the best-corrected visual acuity ranging between 6/18 to 6/60 in co-relation with the time of presentation is 59.20%. Conclusion: Most common cause of ocular morbidity in village set up are found to be in people working in agricultural field without adequate protective measures. Hence the need to explore workplace strategies to minimize ocular trauma becomes a priority. Educating the community regarding the protective measures to be undertaken at the workplace is of utmost importance. Visual outcome was found to be better in patients in whom only anterior segment was involved and who presented to the hospital within 24hrs of trauma.

260-262

Authors: Manmohan Bhanot, Preet Sood, Gagan Chalana.

Introduction: Cataract surgery has become one of the most common and successful procedures in ophthalmology. In addition to improving visual acuity (VA), one of the goals of modern cataract surgery is to reduce pre-existing astigmatism (PEA), a factor that may reduce VA and affect the quality of vision. Materials and Methods: It was a prospective, interventional study conducted at a tertiary care center. The study population consisted of 142 cataract patients admitted in hospital and underwent manual small incision cataract surgery. Patients were randomized and divided into two groups(group A –superiotemporal, Group B –temporal) Patients were examined on post-operative Day 1, 1week, 40days Uncorrected and best corrected visual acuity was recorded. Slit-lamp examination, auto refractometer and keratometry examination were done. Results: The mean SIA in Group1 was found to be 0.532±0.317 and in Group 2 it was 0.435±0.338. The p value accordingly was less than 0.05, which is statistically non significant. T-test was applied to compare the two groups. Conclusion: SICS with the temporal approach provides a better stabilization of the refraction with a significantly less SIA than superior approach.

267-269

Authors: Manmohan Bhanot, Preet Sood.

Purpose: The study was to compare the effectiveness and patient tolerability of two strengths of ketorolac tromethamine ophthalmic solution i.e. 0.4% vs 0.5% in post-operative small incision cataract surgery patients. The study was conducted in Sri Guru Ram Dass institute of medical Sciences and research Amritsar. Materials and Method: This is a randomized single blind investigator masked study. Total fifty patients (25 in each group) screened for cataract surgery were enrolled. The patients were randomized and either of study medication was used. Study medications were ketorolac 0.4% and ketorolac 0.5% eye drops. One drop of each drug was instilled in operative patient in each group thrice day. Thereafter, Slit-lamp examination was done for aqueous cell and flare. Intraocular pressure was checked. The patients were evaluated for subjective tolerance postoperatively at days 1, 3, 5 7, 15and 30. The results were compared between the groups, also with baseline. Results: Only difference between two strength ketorolac is less stinging, discomfort and better ocular tolerability of ketorolac 0.4%. The patient operative outcome is same in the both strength. Ketorolac 0.4% has proven to better tolerated on the visual analogue scale. Ocular comfort was also much better. Although this difference is not statistically significant. In other parameters, difference were not observed between the two groups for best-corrected visual acuity, IOP& slit-lamp assessment of cells and flare measured. Conclusions: 0.4% ketorolac tromethamine ophthalmic solution is equally effective as 0.5% ketorolac tromethamine ophthalmic solution in reducing post cataract inflammation. But Patients with 0.4% ketorolac reported less discomfort.

274-276

Authors: M Gitanjali, Mirza M M Baig, Mohammed Ather, G Kulashekara Rao.

Aim: To assess prognosis of Amblyopia by evaluating and interpreting visual evoked potential changes before and after treatment. Objective: To identity a relation between VEP changes in amblyopic patients before and after treatment. To identify the relation between VEP changes (latency and amplitude) and visual outcome. Materials and Methods: This is a prospective interventional study conducted at the department of paediatric ophthalmology, Sarojini Devi Eye Hospital, Regional Institute of Ophthalmology, Hyderabad. The study was conducted from June 2009-Dec 2011. 30 amblyopic patients of age group 4-12 years with different etiologies presenting at Sarojini Devi Eye Hospital, Hyderabad were selected for the study. The etiology was 8 Strabismic amblyopia, 11 Anisometropic amblyopia, 11 Isometropic amblyopia. Sex ratio was 21 female to 9 male. The patients who were not treated earlier for refractive error, amblyopia or ocular disease were considered for study. Clear media and normal fundus on ophthalmoscopic examination was a prerequisite for selection. Children below 3 years of age, Non Co-operative and children with toxic amblyopia were excluded from study. All cases were thoroughly evaluated by an experienced Ophthalmologist by using, Torch and Loupe, Slit lamp, Direct and indirect Ophthalmoscope, Prism bars. Visual acuity was recorded by using Snellen’s chart or Allen’s Pictorial chart. Cycloplegic refraction was done in all cases. Post mydriatic test was done to prescribe glasses. All subjects were subjected to VEP test using Nicolet Viking Select Neuro diagnostic system Version 10. Occlusive amblyopia therapy was given for six month taking care about normal eye by avoiding occlusion for 2 days in a week. Post patch VEP was done and visual acuity recorded and conclusions were drawn. Results: Mean age of the patients is 7.46 + 1.98 years. 44 amblyopic eye of 30 patients underwent occlusion amblyopia therapy for six months. All amblyopic patients had decreased visual acuity, increased VEP latency decreased VEP amplitude, and had improvement following patching indicates increased response of higher centres. All cases showed more than two Snellen’s lines visual acuity improvement Conclusion: Paired T-Test was done with sample collections comparing pre patch and post patch VEP P100 values and found statistically very significant (RE and LE P values 0.003 and 0.031 respectively). On curve fit analysis the pre and post patch VEP P100values of right eye showed F value 10.335 and P value 0.003 on curve fit analysis post and pre patch VEP P100values of left eye showed F value 5.692 and P value 0.024 both of which are highly significant.

282-286

Authors: Abha Sinha, Somya Dulani.

Introduction: India is home to 310 million children between the age of 5-16 years accounting for 25.6% of country’s population. Eye diseases in children are important cause of medical consultation. Children should receive prompt & proper eye care in order to avoid vision problems & eye morbidities, which could affect their learning ability, personality & adjustment in school. Data on the pattern of presentation of childhood eye diseases are needed for planning & evaluating preventive & curative services. Materials and Methods: The present prospective study was conducted in department of ophthalmology Government Medical college, Rajnandgaon (C.G.), India during the period 30 January 2016 to 29 January 2017. All the patients less than 15 years of age coming for consultation in OPD during the study period were included in our study. A complete history was taken from patients and their parents. Full ophthalmological evaluation was done by consultant ophthalmologist at first visit, refraction was done by optometrist. Data were collected from the past records taken at the time of patient’s visit & collected data were analyzed. Results: A total of 530 children were enrolled for the study including 52.45% males & 47.55% females. In the present study overall refractive error was the most common (29.25%) ocular morbidity followed by allergic conjunctivitis (17.92%) & infection of eye and adnexa (14.72%). Allergic conjunctivitis was the second most common cause of ocular morbidity in children. Infections of eye & adnexa, which was the third most common cause of ocular morbidity in present study. Conclusion: In conclusion the most common causes of ocular morbidity in children were refractive error, allergic conjunctivitis, infection of eye & adnexa, congenital eye diseases & ocular trauma which can be either prevented or treated.

291-295

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

Aim: The aim of this study is to measure keratometry and axial length to get normative data for different age group population. That will help us to see for variation in corneal power and axial length in different age group, gender and between right and left eye. That will also allow us to compare this data with different ethnic population. Materials and Methods: The study was conducted with measurement of keratometry with keratometer and axial length with contact A scan biometry of 294 eyes of 147 patients. Age distribution of patients are 11 to 75 years. Patients were selected randomly from daily OPD. Changes in keratometry and axial length were calculated by using paired sample t test, independent sample t test and T- test assuming equal variances. Results: As per different age population normative data for keratometry in diopter in our age group A, B, C and D is mean±SD is 44.7082±1.4179, 44.3073±0.8552, 45.3186±1.4984 and 44.4210±1.2683 respectively. The normative data for axial length distribution in mm for the age group A, B, C and D is 23.089±1.0395, 22.5378±0.9570, 22.5561±0.8118 and 22.9575±1.0535 respectively. In present study there is no correlation between right and left eye keratometry and age as r value is (r=0.08, r=0.04)(p=0.29, p=0.59) (95% CI for r= -0.1961 to 0.1273 and 0.2203 to 0.1024). There is no co relation between right and left eye axial length and age as r value(r=-0.06, r=-0.03) (p=0.46, p=0.67) (95% CI for r = -0.1961 to 0.1273 and -0.2203 to 0.1024) In our study mean keratometric value for a given age group A, B, C, and D for right eye is 44.8006±1.5401 D, 44.2802±0.8156 D, 45.3727±1.4987 D and 44.3822±1.2437 D respectively. While mean keratometric value for left eye for a given age group is 44.6165±1.3084 D, 44.3345±0.9021 D, 45.2645±1.5135 D and 44.4597±1.309 D respectively. In paired t test for right and left eye keratometry difference is not statistically significant (p=0.6849)(95% CI -0.1192- 0.1810). For axial length mean±SD value for age group A, B, C and D for right eye is 23.0880±1.0910 mm, 22.5302±0.9724 mm, 22.6156±0.7861 mm and 22.9705±1.0636 mm respectively. While for the left eye axial length for group A, B, C and D is 23.0857±1.0069 mm, 22.5454±0.9532 mm, 22.4965±0.8416 mm and 22.9445±1.0585 mm respectively. In paired t test for right and left eye axial length difference is not statistically significant (p=0.1509)(95% CI -0.013- 0.089). In our study mean value for keratometry for a given age group A,B,C and D for male is 44.2076±0.5691 D, 44.1892±0.6806 D, 45.5231±1.3972 D and 44.0661±0.9158 D and for female is 44.2088±1.8045 D, 44.4050±0.9729 D, 45.1632±1.5669 D and 44.7561±1.4638 D respectively. Difference in right and left keratometry in male and female is not statistically significant as (p=0.1551,p=0.1281)(95%CI-0.7437 to 0.1195, -0.7629 to 0.0970) While for mean values for axial length for a given age group A,B,C and D for male 23.0546±0.8297 mm, 22.5447±1.1112 mm, 22.4497±0.8446 mm and 23.0464±1.0868 mm respectively. While for female is 23.1192±1.2303 mm, 22.5321±0.8211 mm, 22.6370±0.7849 mm and 22.8736±1.0292 mm respectively. Difference in right and left axial length in male and female is not statistically significant as (p=0.9698,p=0.9829)(95%CI-0.3163 to 0.3287, -0.3246 to 0.3177). Conclusion: This study provides normative data for keratometry and axial length distribution for different age group for West Indian population. Study will help to improve current biometry practice. Study also shows no any significant difference in keratometry and axial length values in different age group included in our study and also no any statistical significant difference between right eye and left eye and in gender too.

300-302

Authors: Surohi Shah, Hemaxi Desai, Sanjeev Prasad, Kupali Raol.

Introduction: Ophthalmia neonatorum is one of the most common infections occurring in the first month of life. 1 Neonatal ocular infections have been largely associated with various poor perinatal outcomes. The purpose of this study is to describe the maternal and neonatal risk factors associated with the vertical transmission of neonatal conjunctivitis as well as examine treatment for neonates with this infection. Materials and Methods: It is a prospective as well as retrospective study of 215 neonates visiting Ophthalmology OPD of our hospital with complaint of discharge from eye, out of which 100 neonates were taken retrospectively and 115 were taken prospectively. Thorough history was taken to identify risk factors. Conjunctival swabs were taken for culture sensitivity testing. The frequencies were calculated of various risk factors in neonates with ophthalmia neonatorum and their mothers. Results: The commonest risk factor identified was had low birth weight (10%). The most commonly isolated organism was Staphylococcus aureus (46%). Conclusion: Improving prenatal care to reduce sepsis and early diagnosis of STI with appropriate treatment may potentially reduce vertical transmission of neonatal conjunctivitis in this understudied population.

306-309

Authors: Gopal S. Pillai, Manoj Prathapan.

Aim: Primary Objective: To evaluate the macular GC-IPL layer thickness in Type 2 DM patients with diabetic retinopathy(DR) and compare its thickness with normal eyes. Secondary Objective: To identify any possible relationship between the GC-IPL thickness and grade of DR, duration of detected DM, age and gender of the patient. Materials and Methods: Patients were recruited from the outpatient clinic of the Department of Ophthalmology at Amrita Institute of Medical Sciences, Kochi, Kerala, India Inclusion criteria 1. Type 2 Diabetes with Mild Non Proliferative Diabetic Retinopathy (Mild NPDR) and Early Proliferative Diabetic Retinopath (Early PDR) without traction or vitreous hemorrhage (ETDRS classification) 2. Early proliferative diabetic retinopathy(PDR) was defined as presence of either neovascularisation of disc /elsewhere or preretinal hemorrhages or both (ETDRS) 3. Controls: Age-gender matched subjects free of ocular disease, diabetes, hypertension or other systemic diseases were recruited as controls from those who accompanied patients visiting the out patient clinic Statistically significant reduction of thickness of GC-IPL layer thickness between patients mild DR when compared to age matched controls (p=0.006). Results 1. Statistically significant reduction of GC-IPL thickness was seen in early PDR compared to controls (p<0.001). 2. GC-IPL layer were thinner in patients with mild NPDR when compared to age matched controls. 3. Difference in thickness between GC-IPL thickness between mild NPDR and early PDR was not statistically significant. 4. There was no relationship between GC-IPL thickness and duration of detected DM, age and gender of the patient. Conclusion 1. There was a statistically significant reduction of thickness of GC-IPL layer thickness between mild NPDR and Early PDR when compared to age matched controls. There was no significant difference between GC- IPL thickness between mild NPDR and early PDR. 2. These results support the concept that diabetes has an early neurodegenerative effect on the retina which occurs even before the vascular component of DR occurs. This reduction of GC-IPL thickness changes do not cause vision loss, but only supports neurodegenerative theory.

315-318

Authors: Sandhya R., Remy Jose Stephy H.

Introduction: This study was conducted to analyse the colour vision abnormalities among medical students. Materials and Method: In this cross-sectional study, 225 undergraduate medical students in the age group of 19-25 years (21.54±1.40)were screened for colour vision deficiency using Ishihara‘s Pseudoisochromatic chart 24 plate edition. Students with defective colour vision were identified and further classified according to its types. The data collected was entered and analysed using SAS 9.2, SPSS 15, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1. Results: After careful screening it was noted that, out of the 225 students, colour blindness was seen in 7 students(3%) including 6 males and 1 female. Among them, Deuteranomaly was detected in 4 males and Protanomaly in 2 male students and 1 female student. Conclusion: Present study shows higher prevalence of colour blindness in males than females which is similar to the previous studies done. CVD commonly remains undetected and hence students of health sciences must be screened for colour vision deficiency and made aware of their defect, so that they can take special care in clinical practice.

325-328

Authors: Sandeep K., Swetha Kumari C.

Aims: To assess the 1. rise of IOP without use of pre procedure and post procedure anti glaucoma medication 2. and to note the improvement in visual acuity. 3. to observe other complications. Materials and Method: This study comprise of total 100 eyes of 98 patients who had Nd-YAG laser capsulotomy. Visual acuity and ocular pressure were recorded before procedure using Snellen’s chart and applanation tonometry respectively. Capsulotomies were done using Nidek YAG laser system. Post-operative vision was recorded after 24 hrs. Post operative IOP was recorded at 4th hr, and 24hr. None of the patients were treated with IOP lowering medication. Results: Total 100 eyes of 98 patients with mean age between 40-76 yrs (53 males & 45 females) were studied. The improvement of visual acuity was excellent with > 90% of patients with > 2 lines of Snellen’s chart after 24 hrs. Max rise of IOP occurred with in first 4 hrs of post op period mean IOP decreased steadily and reached based line by 24 hrs. Conclusion: Although the improvement in visual acuity is excellent after Nd-YAG laser capsulotomy certainly there is rise of IOP during early post op period max in 4 hrs. This deviation of IOP appears to be self limited.

333-336

Authors: T. Venkatesh Kumar, Prasanth Hannah Ranjee, Sanjana Elfride Farokh.

Introduction: Contact lens usage is associated with various complications, many of which are preventable if the user is aware of them and strictly follows their ophthalmologists instructions with regard to hygiene and regular replacement of the lenses. The purpose of this cross sectional study was to assess the knowledge, attitude and practice of medical students using contact lens. As the participants were medical students, we expected a high level of knowledge regarding contact lens usage. Materials and Methods: A cross sectional study was conducted among the medical students using contact lens. A sample size of 50 was chosen. This was a questionnaire based study and a pre tested questionnaire was given to the participants to assess their knowledge, attitude and practice of contact lens use. Questions about the use of contact lenses, how to maintain them and awareness of the complications they may encounter due to improper use of contact lenses were asked in the questionnaire. Data was collected and tabulated in MS Excel, and further analyzed using SPSS software version 22.00. Results: Consultation of ophthalmologist on finding deposits on the lens was significant (P<0.05), 33.33%(1st year), 70.58%(2nd year), 58.82%(3rd year), 16.66%(4th year), 25%(CRRI) continued to use the contact lens. Use of contact lens following conjunctivitis was significant (P<0.05), 83.33%(1st year), 82.35%(2nd year), 100%(3rd year), 33.33%(4th year), 100%(CRRI) continued to use their contact lens. Knowledge of over-wear syndrome was significant (P<0.05), 50%(1st year), 29.41%(2nd year), 17.64%(3rd year), 66.66%(4th year), 75%(CRRI) had knowledge of over-wear syndrome. Conclusion: The main aim of the study was to assess awareness among the users about the lens care practices, regular cleaning and replacement of lens cases. Many students were found to be unaware of these complications. In conclusion, though health care professionals have knowledge about contact lens, they did not show correct practice of using contact lens with compliance being the major factor. Education, improving communication, behavioral modifications are important to improve the compliance.

342-345

Authors: Dipak B. Patel, Jyotindra N. Brahmbhatta, Hemal V. Jasani, Aditya P. Desai, Parin K. Mehta.

Introduction: Dry eye disease is a multifactorial disorder of the tear film due to tear deficiency or excessive tear evaporation, which causes damage to the ocular surface leading to tear film instability and is associated with visual disturbances and symptoms of ocular discomfort. The prevalence of dry eye ranging from 5 to 35% Worldwide, while in India it is 29.25% based on OSDI data. Trachoma is the leading cause of infectious blindness worldwide. Destructive nature of trachoma causes dry eye in its chronic course. Materials and Methods: Total 100 patients were included in the cross-sectional study in the duration of one-year duration from February 2010 to February 2011 at Dhiraj General Hospital. They were subjected to slit-lamp biomicroscopy, Schirmer’s test I and TBUT. Prevalence of trachoma in diagnosed cases of dry eye was also studied. Results: Prevalence of dry eye during 2010-11 was 17.77%. Amongst them, the prevalence of trachoma was 5%. Mean age of patients was 44.7±14.09 years. Discussion: Dry eye is leading cause of ocular discomfort in OPD patients. Prevalence of dry eye increases with age. There is a definite correlation between dry eye and trachoma. Trachoma is associated with dry, dusty environment, low socio-economical condition, overcrowding and poor hygiene.

351-355

Authors: Avisha Mathur, Arvind Chauhan.

Childhood blindness are group of conditions that occurs in childhood or early adolescence (<16 years of age), and if left untreated, results in severe visual impairment or blindness that is likely to be not treatable later on. The prevalence ranges from 0.3 per 1000 children aged between 0 and 15 years in prosperous countries to 1.5 per 1000 children in extremely poor communities. Materials and Methods: This study was done at Department of Ophthalmology at Mathura Das Mathur Hospital, Jodhpur. It is non randomized, observational study conducted from January 2015 to June 2016 (18 months) and all blind or severely visually impaired children with less than 16 years age attending Ophthalmology OPD or children living in blind schools near and within Jodhpur city were enrolled after receiving informed written consent by their parents/guardian. Results: In this research study, we found that hereditary causes were accountable for blindness in 160(56.34%) patients but we were not able to specify any inheritance pattern in 153(53.87%) patients. Intrauterine factors such as rubella and toxoplasmosis were responsible in 6(2.11%) patients. Perinatal/Neonatal factors such as cerebral hypoxia/injury and ROP were responsible in 6(2.11%) patients. Postnatal factors such as trauma, measles, neoplasms and meningitis were responsible in 14(4.93%) patients. In 98(34.51%) cases factor/factors causing cataract and glaucoma could not be determined but probably genetic factors appear to be responsible. Conclusions: We concluded that the most important causes of preventable blindness were genetic in 160(56.34%) patients followed by TORCH infections in 6 (2.11%), trauma in 4(1.41%), measles in 4(1.41%) and meningitis in 3 patients i.e. 1.06%. The most significant cause of disease which can be treated was cataract in 76(26.76%) patients followed by glaucoma in 12(4.23%) and ROP in 2(0.70%) patients. Timely recognition and treatment is necessary to prevent advancement of dense amblyopia.

361-364

Authors: Rahul Deshpande, Varsha Mangiraj, Madan Deshpande, Khurshed Bharucha, Rajiv Khandekar.

Introduction: Low vision (L. Vn) rehabilitation for adults is a part of our service oriented eye hospital. We studied changes in visual function (VF) & vision related quality of life (VQL) of adults with low vision at least three months after providing them rehabilitative services. Materials and Methods: This was a prospective study conducted in H V Desai Eye Hospital, Pune during 2010-2011. L. Vin disabled aged 16 years and older attending clinic were Our study population. Their distance and near Visual acuity presented and best corrected (BCVA) were noted. Other VF included contrast sensitivity, colour perception, dark adaptation and glare effects. The L Vn rehabilitation services (both optical and non-optical) were provided. Six months after intervention, the participants were interviewed using close ended questionnaire to determine their VQL and HQL. VF were also reassessed to estimate the impact. Result: We assessed 67 L Vn disabled. The distance vision improved by using L Vn devices in 48 (72%) disabled. The near vision improved with help of LVn devices in 57(85%) disabled. VF of all 59 (88%) participants with contrast defect improved by using filters, illumination changes and environmental changes in their workplaces. The participant's perspective suggested that marked improvement in VQL were for the outdoor and indoor activities, reading and Writing. There was decline in emotional distress due to the Visual impairment. Conclusion: Low vision rehabilitation improved VF, VQL and HQL of adult six months after use of low vision services

369-372

Authors: Sangeeta Agarwal, Akash Srivastava.

Objective: To determine the prevalence of computer vision symptoms in professional computer users working under acceptable ergonomics condition. Materials and Methods: A spot survey was carried out on subjects using computer in institutes, colleges and banks. A questionnaire was used and all filled proformas were collected and checked for the response. Result: Ocular symptoms are very common among the computer users with a prevalence of 82.46%. There is no remarkable sex disparity in prevalence of symptoms. It may vary from being occasional to routine. The presbyopic persons are more symptomatic, the prevalence of symptoms in them is 88.96% in comparison to 81.48% of pre-presbyopic persons. Eyestrain is the most frequently reported symptom by the computer users and it affects 61.67% subjects. Occasional double vision is the least reported symptom and it affects 8.67% subjects. As the per day working hours at computer increase, the prevalence and frequency of symptoms felt everyday.

377-379

Authors: Sandeep K, Vekkatram.

Background: Psuedoexfoliation syndrome involves all ocular structures and poses greater risk of eventful surgeries. Materials and Method: 50 patients with both Cataract and PEX were studied about50 eyes are studied. Results: Mean age group of these patients were 66. 28 years and more in males with higher incidence of bilaterally. Major patients had PEX material with 100% patients having different grades of trabecular pigment deposition. Intraoperative complications like, PC rent, Vitreous prolaapse, ZD or all was present in 20% of cases. Conclusion: poor dilation of pupils is one of the major pre-op finding in eyes with psudoexfoliation. Adequate surgical modifications may reduce the intra op complications.

384-386

Authors: Manmohan Bhanot, Rajan Bhatia.

Introduction: Dry eye is a multifactorial disease of tears and ocular surface that results in symptoms of discomfort, visual disturbances and tear film instability with potential damage to the ocular surface. Typical symptoms of dry eye syndrome are dryness, burning and a sandy-gritty eye irritation that gets worse as the day goes on. Symptom assessment is a key component of dry eye diagnosis - to the extent that many believe dry eye syndrome to be a symptom-based disease. Materials and Method: This study was carried out at ophthalmology Outpatient department of Sri Guru Ramdass Institute of Medical Sciences Amritsar. All the patients visiting for any ocular disease were screened for the presence of the dry eye over the period of 6 months i.e. June –Nov 2016. The patients were examined by Tear Film Breakup time and Schrimer’s test. The patients found positive were then asked to answer a pre-validated questionnaire. Results: Intially, out of total 12144 patients 4572 patients presented with symptoms of dry eye. After screening with Tear film breakup time (TBUT) and schirmer’s test, 2418 patients (19.91%) were diagnosed to be having actually dry eyes. Prevalence was found to be 12.55%in males and 7.41%in females. The association of various dry eye signs with smoking, anti arthritis treatment and antipsychotic drugs were found. Total 43.05% of the patients were involved in outdoor work. 19.72% were actively computer users, only 3.97% were using with screen while15.75% were using computer without screen. Conclusion: In our study due to more number of working women has highly influenced the result. The incidence of dry eye found highly variable depending upon the geography, living style as well as with the work profile of the patient complaining of dry eyes.

117

Authors: Rajendra P Maurya.

Among the various retinal vascular disorders, diabetic retinopathy (DR) is the most common while retinal vein occlusion (RVO) is the second most common vascular disease. Diabetic retinopathy, most common microvascular complication of diabetes mellitus (DM), is a leading cause of legal blindness within the working age population in developed countries. (1) The reason behind loss of vision are diabetic maculopathy and complications of proliferative diabetic retinopathy (PDR) such as vitreous hemorrhage, tractional retinal detachment and neovascular glaucoma, Risk of PDR is high in Type- I DM while diabetic macular edema (DME) is more commonly seen in Type- II DM. The prevalence of DR has been reported to be ranging from 3-4% in European population. (2) Population based studies in western world have revealed the prevalence of DR to be 28.7% whereas PDR and DME account of 9% and 17%, respectively. (3) United Kingdom prospective diabetes study (UKPDS) estimated a prevalence rate of DR of 35-39% in NIDDM.(4) Although the exact metabolic pathway causing DR is still unknown. The disequilibrium between vaso-proliferative and vasoinhibitory factors in retina and vitreous may result in excess release of VEGF which leads to vascular proliferation. (5) The accumulation of bi-products of glucose metabolism like fructose & sorbitol, in retinal cells may lead to retinal/ macular edema. Several host related risk factors activate the above pathogenic mechanisms such as duration of diabetes, glycemic control, anemia and dyslipidemia etc. Literacy status, socioeconomic status and pregnancy status also play important role in pathogenesis of DR. Low level of diabetes awareness in our country results in late detection of DR. Hari Ramakrishnan et al. in this issue, has published a study related to awareness of DR among the South Indian diabetic population and Divya et al. has published study on relation of body mass index and severity of DR.

122-124

Authors: Manjunath B. H., Sunitha M. N. Gowda, Shruti P. Choudhari.

Introduction: Diabetic retinopathy is one of the leading causes of blindness according to vision 2020 protocol. There is evidence of structural changes prior to clinically detectable vascular complications. With newer technologies, like optical coherence tomography (OCT) it is possible to obtain optical section biopsies and it aids in quantifying the effects of diabetic retinopathy on the retinal nerve fibre layer thickness. Objectives: To establish the role of OCT in evaluating the RNFL thickness in diabetics without clinically evident diabetic retinopathy. Materials and Methods: This study presents a total of 60 eyes of 60 patients attending the OPD at Bapuji hospital and Chigateri general hospital attached to J.J.M medical college, Davangere from September 2014 to September 2016. All patients were subjected to RNFL analysis using OCT. Results: In our study, we found a tendency towards thinning in RNFL thickness globally and significant RNFL thinning in the superior quadrant with increasing duration of diabetes (<5 years-120.24±17.54 and > 5 years-112.88±19.63). No significant change was observed with other variables. Conclusion: OCT may be used to detect earlier signs and structural changes of DR, leading to earlier diagnosis and intervention. The RNFL loss in diabetics without retinopathy could be an indicator of likely neuronal loss in early DR. Further clarifications are required in this regard, we believe that OCT measurements may be one of the useful methods to elucidate the characterization of early structural changes of DR.

128-131

Authors: Sanjeev Kumar, Jyotirmay Biswas, Roopleen.

Purpose: To study the long term course and visual prognosis in Eales disease. Methods: Patients who had been examined between 1984 – 1989 were included in the study. Results: A total of 34 patients were followed up of a minimum period of 10 years. The retinal leisons found during the initial examination was vitreous haemorrhage (34.5%) NVE (32.7%) vascular sheathing (30.9%) FVP (29.1%) NVD (14.5%) NVD and NVE (10.9%) & RD (5.4%) of eyes. visual acuity improved in 23.6% maintained in 58.2% & decreased in 18.2% of eyes. The complications were cataract, Tractional RD, Rubeosis iridis, Neovascular glaucoma & Phthisis bulbi. Conclusion: The most important elements in dealing with Eales disease are early diagnosis, periodic follow up and adequate therapy depending upon the stage of the disease.

138-141

Authors: Gopal S. Pillai, Natasha Radhakrishnan, Sandhya A. Menon.

Aim: To analyze the causes and characteristics of posterior segment inflammation in the Vitreo-retinal department in a multispecialty hospital. Methods: This is a retrospective study on 97 patients who presented with manifestations of posterior segment inflammation in a multispecialty hospital in the last 2 years were included in the study. They were analysed with respect to aetiology, clinical manifestations, intervention done and response to treatment. Results: Posterior segment inflammation was most commonly seen as a manifestation toxoplasmosis (18.6%) followed by systemic vasculitic disorder like SLE (16.5%). Other common causes included infections like tuberculosis, (9.3%) endogenous (bacterial and fungal endophthalmitis (12.4%) and viral retinitis. Others were VKH, vasculitis with unknown etiology, Behcets disease and sarcoidosis. Conclusions: We found toxoplasmosis to the commonest single etiological agent. There was a significantly higher incidence of posterior segment involvement due to systemic vasculitis in our study population which is hitherto been unreported in other study populations.

147-149

Authors: Rishi Mehta, Sharda Punjabi, Rachana Jain, Nutan Bedi, Chandra Kant Nagar.

Introduction: Retinopathy of prematurity (ROP) is a proliferative retinopathy and a disease of premature infants. As the awareness about the risk factors increases amongst the neonatologist and ophthalmologist, adequate screening of preterm infants is being performed at tertiary care centers which can lead to a reduction in prevalence of ROP. Materials and Methods: 69 preterm infants born ≤ 34 week or birth weight ≤1700grams from January2015 to December 2016 were screened for ROP. Fundus was examined by indirect ophthalmoscopy with scleral indentation. Data was analyzed and the prevalence was calculated. Results: Out of total 69 infants, males were 43 (62.31%). Mean gestational age among males and females (in weeks) was 28.66 and 29.20 respectively. Mean birth weight among males and females (in grams) was 1346.90 and 1284.40 respectively. Prevalence of ROP was 1.44%. Conclusion: Prevalence of ROP is decreasing at tertiary care centers.

154-158

Authors: Nishat Sultana, Apoorva Mithranand, Vinuta Mohan Kulkarni.

Background: Aim of the study is to evaluate endothelial cell density and central corneal thickness in cases of pseudoexfoliation admitted for cataract surgery in tertiary care hospital using specular microscopy. Materials and Methods: Total of 30 cases were studied prospectively in a period of 10 months during march,2016 to jan,2017 to evaluate the endothelial cell density and CCT using specular microscopy with detailed history and ocular examination. Result: In our study of 30 cases, it was shown no gender predilection and bilaterality was seen in 83%.80% of cases had endothelial cell density less than 2500cells/µm on specular microscopy. 93% of cases had CCT less than 545µm which is grossly significant as seen in previous studies. Conclusion: Pseudo exfoliative syndrome presents challenges to the operating surgeon that require careful pre-operative evaluation. Our study showed that these cases have significantly lower endothelial cell density and increased risk of corneal decompensation after intra ocular surgeries. These pseudo exfoliative cases also have significantly low central corneal thickness which may under estimate the IOP reading and overlook an early glaucomatous damage. Thus evaluation of endothelial cell density and central corneal thickness becomes an imperative pre-operative step in cases of pseudo exfoliation.

163-165

Authors: Prakash Kumar, Virendra P. Singh, Sanjay Singh, Rajendra S. Garbyal, Sanjeev Kumar.

Aim: To evaluate the tear film changes in patients with psoriasis. Materials and Methods: In this case control study, Schirmer’1 test and Tear film break up time were evaluated in 29 psoriasis patients and 12 healthy controls. Results: McMonnies questionnaire showed no significant difference between patients and control. Total 89.7% patients showed Schirmer’s value of more than 10mm. While 69% patients had tear film break up time value less than 10 seconds, which is statistically significant(p value<0.001). Discussion: The results of our study and similar results from other studies confirm that the decrease of tear BUT was more significant than Schirmer’s test in psoriatic patients. Conclusion: Tear film dysfunction is common in psoriasis patients, the decrease of tear film break up time is more significant than Schirmer’s test

173-176

Authors: Raiza Paul, Suma Unnikrishnan.

Aim: To study the functional and cosmetic outcome in the management of Concomitant Esotropia in children. Settings & Design: Observational case series. Materials & Method: 70 children who presented with concomitant esotropia at the out-patient clinic of the Ophthalmology Department in a tertiary care centre in south India over a period of 1 year. Each patient underwent a comprehensive ophthalmological evaluation and their initial visual acuity, binocular fusion and ocular deviation were documented. Management options included occlusion, optical correction and surgery for esotropia. During follow up visits their visual outcome were analyzed in terms of visual acuity, binocular fusion, and ocular alignment. Result: 44.3 % were males and 55.7 % females.51.4% had improvement in visual acuity which was more in the surgical group. Improvement in BSV was also more marked among the surgical group 63% vs 17.5% in the non-surgical management group. The mean ocular deviation was 32.14 pd of esotropia at initial visit which became 14.46 pd at 6 months follow up. Among the surgical group 72% achieved the desirable goal of <10 pd deviation whereas only 17.5% of patients in the non-surgical group had deviation <10pd. Conclusion: The patients included under the surgical management group showed better outcome in terms of binocular single vision restoration, improvement in visual acuity as well as better cosmetic alignment.

180-184

Authors: Ram Kumar, Deepti Yadav, Akash Srivastava.

Aim: To determine the proportion of posterior segment abnormalities in patients with or without risk factors having dense cataract prior to surgery using B scan ultrasonography. Materials and Methods: A cross sectional study was performed on 240 eyes with dense cataract using B scan ultrasonography. Patients having history of blunt/penetrating trauma, previous ocular surgery or known case of posterior segment pathology were excluded from the study. Results: Out of 224 patients in our study 152 patients were without any systemic risk factor. 12 patients had diabetes mellitus, 6 patients had hypertension, 42 patients had age ˂ 50 years, 16 patients had bilateral dense cataract. 152 patients did not have any systemic risk factor and 2 of them present with detectable posterior segment abnormality on ultrasound. Out of 240 eyes examined 200 eyes did not have any ocular risk factor in which 2 eyes detected with posterior segment abnormality. Out of 22 eyes with posterior synechiae 6 eyes detected with posterior segment abnormality. Out of 8 eyes had iris coloboma 6 eyes detected with posterior segment abnormality, Out of 12 eyes with elevated IOP 4 eyes detected with abnormal ultrasound. Out of 6 eyes with small cornea all 6 eyes detected with abnormal ultrasound. Out of 240 eyes with dense cataract examined preoperatively with B-scan ultrasound 31 eyes had detected with posterior segment abnormality. Out of 240 eyes 10 eyes detected with retinal detachment, 5 eyes detected with PVD, 2 eyes detected with retinal detachment with choroidal coloboma, 2 eyes had vitreous haemorrhage, 4 eyes had choroidal coloboma with optic disc coloboma, 4 eyes had posterior staphyloma, 4 eyes had cupping of optic nerve head. Conclusion: In our study Patients with systemic and ocular risk factors showed high incidence of posterior segment pathology. Ideally all the patients with dense cataract should undergo with a B scan examination but most patients with dense cataract are currently encountered in developing countries, most hospitals in these area do not have an easy access to ultrasound So the patients with systemic and ocular risk factors should be referred to the centers where the facility is available in order to plan better management and to determine proper visual prognosis before surgery.

189-191

Authors: Mohammed Ather, Rahmathunissa, Saudhamini Siguru, Wajhia Sultana.

Aim: To study effect of 5%phenylephrine eye drops on Blood Pressure. Materials and Methods: This is prospective randomly controlled study conducted at the department of Ophthalmology of Gandhi Hospital during January 2015 to December 2015. 50 patients between 30-70 years of age who came for eye check up to Gandhi Hospital were included in study. Informed consent was obtained from all patients. The patients who had Secondary Hypertension because of systemic disease like chronic renal failure, Pregnancy induced hypertension and other diseases were excluded from the study. Off 50 patients 25 had Primary Hypertension and came for eye check up with various complaints. 25 patients with matching age group of 30-70 years who were non Hypertensives were included as controls in the study. Blood pressure was recorded in all 50 patients as base line. Then one drop of 1% Tropicamide and 5% Phenylephrine eye drop combination was instilled into lower fornix of all patients after recording BP and every 15 minutes up to 30 minutes. The BP was recorded after 30 minutes again. Results: Rise in both Systolic and Diastolic pressure was observed in Group 1 i.e.: Hypertensives. Whereas in group 2 non hypertensives only rise in Systolic pressure was observed. Conclusion: 5% Phenylephrine causes rise in both systolic and diastolic pressures in Hypertensive group. The rise was20-40 mmHg in systolic and 10-20mmHg in diastolic pressure. The rise was significant in patients who were aged between 60-70 years irrespective of their sex. So it has to used with caution in elderly hypertensives.

198-201

Authors: Jasmine Mary Jacob, Sheldon Goudinho.

Cerebral palsy a diagnostic term to describe a group of motor disorders of early brain development.(1,2) Children with cerebral palsy should be treated and rehabilitated so that they can live in an inclusive society where their potential life skills and scholastic performance can be far greater as compared to when isolated from society.(3,4) Objectives: (1). To assess the visual acuity in children with cerebral palsy and to estimate the degree of visual disability due to refractive errors. (2). To find association between refractive errors and type of cerebral palsy. 80 children were included in this cross sectional hospital based study. A detailed eye examination was done by an ophthalmologist. Refractive errors were present in 52 patients. Astigmatism was the most common refractive error accounting for 38.8 % of the cases. Degree of visual disability was assessed in these children.18.75% of the cases had 100% visual impairment; 41.5% of the cases had 20% visual impairment. There was no significant association for refractive error with type of cerebral palsy in our study (p=0.543). The most common defects causing disability in children with cerebral palsy are amenable to treatment. The identification of visual defects and their timely treatment may have a bearing on the child’s education.

207-209

Authors: Vijay Kumar Srivastava, Kunal Verma.

Introduction: Conjunctival inflammation due to allergy is known as allergic conjunctivitis. Common ocular symptoms may be itching, swelling of eyelids, watering, watery discharge, photophobia and foreign body sensation. Aims and Objectives: To Compare the efficacy of Olopatadine Hydrochloride 0.1% and Azelastine Hydrochloride 0.05% Eye drops for Treatment of Allergic Conjunctivitis in Rural South India. Methodology: A prospective clinical trial in 74 patients was carried out. Patients by random selection were given treatment by Olopatadine Hydrochloride 0.1% and Azelastine Hydrochloride 0.05% eye drops. Patients were assessed by ophthalmologist 0, 3rd, 7th and 14th day after starting treatment. During visits the symptom were graded from zero to three scale. Result: The mean age in Olopatadine group was 18± 3.6 years and in Azelastine group was 19± 4.4 years. There were 26 Males and 11 Females in Olopatadine group and 28 Males and 9 Females in Azelastine group. The mean values for the duration of disease in both the groups were 2.8± 2.2 months and 2.9± 2.4 months respectively in Olopatadine and Azelastine group. The symptoms were compared in the two groups on 3rd, 7th and 14th day after starting treatment. The score given by the Ophthalmologist were markedly lower in both groups after treatment during all visits. (P<0.05). Conclusion: Both Olopatadine and Azelastine reduced symptoms of allergic conjunctivitis very significantly however Olopatadine was more effective.

214-218

Authors: Summa Unnikrishnan, Abhaya Balakrishnan.

Background: Refractive error is a major cause of childhood blindness worldwide and more than 13 million children are visually impaired.(1) With the advent of modern technology, many low birth weight babies are surviving. To improve the quality of life it is mandatory to screen them to prevent the development of amblyopia. The present study aims to find out whether birth weight and gestational age have any correlation with the refractive status. Materials & Methods: Cross sectional study conducted in 100 eyes of 50 preterm & 50 term babies from the paediatric ophthalmology and paediatric neonatal unit of a tertiary centre in south India. Babies were grouped according to their birth weight to three groups. Very low birth weight (< 1.5 Kg), low birth weight (1.5- 2.5 kg) and normal (≥2.5Kg). Gestational age was also considered. After adequate cycloplegia(2,3) retinoscopy was done to detect the refractive status. Statistical analysis was done using spss version 16. Results: There was a significant correlation between birth weight and refractive status. Myopia was the commonest refractive error in preterm and hypermetropia in term babies. The incidence of myopia was found to be inversely proportional to birth weight. There was no significant relation between the degree of myopia and birth weight. Anisometropia was seen more in preterm with statistical significance. The incidence of anisometropia decreases with increase in birth weight.

224-226

Authors: K. Kalaivani.

Aim: To screen for people with corneal blindness, to identify the etiology and to assess the risk factors for corneal blindness in and around Karaikal. Materials and Methods: About 50 patients with corneal opacity and with the visual acuity less than 6/60 clinically aging between five years to eighty years were enrolled for this study. A detailed history regarding the etiology, nature of injury, pervious corneal disease or ocular surgery was recorded for each patient. A thorough ophthalmic examination was performed which includes external eye examination, slit lamp biomicroscopic examination for the size, site and depth of corneal opacity, presence of vascularization or ghost vessels and the anterior segment pathology. Visual acuity was recorded with illuminated Snellen’s chart and intra ocular pressure measured with applanation tonometer. Results: Mean age of this study group was forty two years; Twenty seven patients were male and remaining twenty three were female; Seventeen people had both eye involvement, nineteen only right eye and fourteen had only left eye involvement. Study population includes farmers, laborers, students, housewives, mason and others. Twenty one patients were found to have infective etiology; fourteen had injury, rest had postsurgical, nutritional and degenerative causes. Conclusion: Infective keratitis is the leading cause of corneal blindness in our study, trauma being next important. Occupation is an important risk factor. Health awareness and safety measures can minimize the incidence of corneal blindness.

231-233

Authors: Vijay Kumar Srivastava.

Aim: To Study the Pattern of corneal ulcers in patients in semirural south India. Methods and Materials: It was a hospital based descriptive cross-sectional study carried out from April to December 2016. Patients reporting with non-viral corneal ulcers were studied for finding microbiological etiology such as bacterial and fungal; and standard laboratory methods were used. Data was analyzed by Statistical Package for Social Sciences (SPSS) version 16.0 and Chi-square test was used to test significance of attributes. Results: Out of 58 cases of microbial keratitis, all were sent for culture - 39 (67.24%) were culture-proven. 19 (48.71%) showed fungus, 17 (43.58%) were positive for bacteria, 3(7.69%) showed mixed growth, whereas 19(32.75% showed no growth. Patients with agriculture-based work had more risk of development of microbial keratitis. Conclusion: These results highlight the current trend in the microbiological aetiology of corneal ulcers in semi-rural south India. In rural background the prevalence of fungal keratitis is more, despite there being advanced diagnostic tools and treatment methods, results are still suboptimal in fungal corneal ulcers.

Page No. 1

Authors: Rajendra P Maurya

It is my humble privilege to present the special issue of IJCEO after successful journey of two years. This issue of IJCEO has several interesting articles on vision threatening morbidity , Glaucoma particularly on diagnosis and awareness of primary glaucoma. Primary open angle glaucoma (POAG) is a chronic, progressive, multifactorial neuro-degenerative disorder characterized by loss of retinal ganglion cells and their axon leading to optic nerve cupping and visual field defect. It is the second most common cause of blindness worldwide. Approximately 45 million people have open angle glaucoma and morbidity is expected to be 59 million by 2020.

Page No. 3-10

Authors: Pankaj Soni, Ashwani Srivastava, Akash Srivastava, Deepti Yadav

Objective: To correlate the cup/disc ratio with visual field defect in primary open angle glaucoma patient using magnified photograph of optic disc and Humphrey field analyzer. Method: Cross sectional study includes 114 eyes of 60 patients suffering from primary open angle glaucoma. All patients were 40 years age having IOP 21 mmHg and gonioscopically open angle of anterior chamber. The things assessed includes IOP, angle of anterior chamber, optic disc and visual field. Results: Total 114 eyes of 60 patients with primary open angle glaucoma included in study. Mean age of patient in our study was 58.7±10.26 year. Out of 60 patients, 31 (51.66%) were male and 29 (48.33%) were female. 12 eyes (10.52%) had IOP in the range of 21-24 mmHg, 52 eyes (45.61%) had IOP in the range of 25-29 mmHg, 48 eyes (42.10%) had IOP in the range of 30-34 while only 2 eyes (1.75%) had IOP > 35 mmHg. Mean IOP of 114 eyes was 27.9±3.23 mmHg. 32 patient (28.07%) had C:D ratio of 0.6 whereas 30 patient (26.31s%) had C:D ratio 0.7. Mean C:D ratio of POAG was 0.64±0.07. Considering other parameter of the optic nerve head it was seen that Bayonetting sign was present in 60 eyes. Meanwhile baring of vessels was seen in 46 eyes. Laminar dot sign, on the other hand was seen in 72 eyes. Beta zone peripapillary atrophy was seen in 78 eyes. Another important parameter of the optic disc is notching. In 53 eyes notching was seen. Out of these, 35 eyes show superior notching, of which 33 eyes (94.3%) correlated with inferior field defects. 18 eyes show inferior notching, and all of them showed superior field defect. Inferior neuroretinal thinning is found in 55 eyes, out of which 50 eyes (90.9%) had correlating visual field defect while 32 eyes (86.5%) with superior neuroretinal thinning correlate visual field defect. Maximum number of eyes show superior zone defect i.e. 54 eyes (47.36%) followed by inferior zone defect in 25 eyes (22.0%). The least common visual field defect in our study is baring of blind spot in 3 eyes (3.0%). Finally, the patients were divided into 2 group depending on their cup disc ratio, and their association with the field defects was evaluated. Group 1- patients with c:d ratio < 0.7;Group 2- patients with c:d ratio 0.7. The pattern defects signifying the localized defects were then compared between the two group. The average pattern defect in group- 1 was found to be 6.16 db, while the average pattern deviation in group- 2 was 9.62 db. The association of c:d ratio 0.7 with PD was seen to be significant with a p <0.001. Conclusions: This was a cross sectional study done over a period of 1 year to correlate the optic disc changes with the visual field defects by using optic disc evaluation and Humphrey visual field analyzer done. The correlation between cup disc ratio and intra.

Page No. 15-19

Authors: Sundip Shenoy, Dinesh P, Pavan Kumar Reddy, Pranessh Ravi

Background: PACS (primary angle closure suspects) continue to pose a diagnostic and therapeutic dilemma. PACS being converted to PACG as the disease evolves in the long run leads to irreversible blindness; hence the importance of screening with gonioscope to see which patients will improve with laser peripheral iridotomy (LPI). Objective: To assess the effectiveness of routine manipulative gonioscopy as a tool in order to predict angle opening after NdYAG laser iridotomy in PACS patients. Methods: Fifty patients having PACS were enrolled in the prospective observational interventional study. Main outcome measure were effect on IOP, effectiveness of manipulative gonioscopy with regard to angle opening and Van Hericksin predicting angle changes. Manipulative gonioscopy and Peripheral laser iridotomy was done. Wilcoxon signed rank was used to find the significance of study parameters. Results: Seventy four percent were females with males forming 26% of the study. Mean age was 65 ± 5.16 years. Comparison of Shaffers grading pre and post intervention in superior quadrant showed P value 0.020(suggestive of significance), inferior quadrant showed p<0.001 which was significant. Van Herick’s grading pre and post intervention in the temporal quadrant showed P value 0.005 and in the nasal quadrant showed P value of 0.001 which is strongly significant and correlates with gonioscopic findings. Conclusion: Study confirms that laser peripheral iridotomy increases peripheral chamber angle as predicted by manipulative gonioscopy in majority of cases prior to the intervention which correlates with schaffer/Van Herick’s grading. Laser peripheral iridotomy to all patients with PACS requiresproper evaluation as some cases have no effect on peripheral anterior chamber depth post LPI.

Page No. 24-27

Authors: Anitha S. Maiya, Ravindra B., Manjunath BH, Meghana Patil

Purpose: To evaluate the characteristics of Lens Induced Glaucoma among the rural population and to determine if cataract surgery in one eye plays a role in causing Lens Induced Glaucoma in the other eye. Methods: This prospective study included 43 eye of 43 patients who were clinically detected to have lens induced glaucoma and operated by one surgeon. A comprehensive ophthalmic evaluation was done and medical management instituted. All patients underwent Manual Small Incision Cataract Surgery and were followed up for 6 weeks. Results: Majority of the patients were in the age group of more than 60 years. The incidence of lens induced glaucoma was more among females (65.12%). Phacomorphic glaucoma was more common (30 cases; 69.77%) than phacolytic glaucoma (13 cases; 30.23%). Following cataract surgery, 26 eyes (60.47%) had visual acuity 6/18 or better. Majority of our patients(69.77%) presented within 7 days of onset of symptoms; among the 13 patients who presented after 7 days of onset of symptoms, the postoperative visual acuity tended to be poorer than in those who presented early. A majority of them (34 patients; 79.07%) mentioned having good vision in the fellow eye as the reason for delaying cataract surgery in the affected eye. Conclusions: Since LIG is a preventable condition, Ophthalmologists should stress the importance of undergoing cataract surgery when the cataract is still immature and in bilateral cases advice early surgery for the fellow eye. With advances in surgical techniques, good preoperative control of IOP and postoperative treatment, it is possible to restore good vision in patients with LIG who present early.

Page No. 31-33

Authors: MB Dongre, Khaire BS, Bhalerao Ravindra

Introduction: Pseudoexfoliation syndrome (PEX) is a common and clinically important systemic condition characterized by the pathological production and accumulation of an abnormal fibrillar extracellular material in many intraocular and extraocular tissues. Patients with PEX syndrome have a significantly higher risk for a variety of complications during cataract surgery. Aim and Objective: To study the clinical profile of cataract patients with co-existent pseudoexfoliation syndrome. Methodology: 85 patients with Cataract patients diagnosed with pseudoexfoliation on the basis of slit lamp examination. Data includes demographic profile of patient, detailed ophthalmological history and ocular Examination. Visual acuity testing, Slit lamp examination, Gonioscopy, Indirect ophthalmoscopy and Intra Ocular Pressure (IOP) was taken with the help of Schiotz tonometer. Keratometry and A scan was done to calculate IOL power. Results: Males for.med a majority of cases. Majority of the cases were in their sixth decade. In this PEX material was most commonly deposited on Anterior lens capsule 84.7%. Poor pupillary dilatation (<5mm) was seen in as many as 63% cases. 86% eyes had intra-ocular pressure in the range of 14mmHg- 21 mm Hg. Discussion and Conclusion: PEX material most commonly deposited on anterior lens capsule. Mixed cataract were more common in pseudoexfoliation syndrome.

Page No. 38-41

Authors: K. Kalaivani

Purpose: To find out the spatial distribution and to assess the severity of visual field defects in Primary Open Angle Glaucoma (POAG) and Primary Angle Closure Glaucoma (PACG) patients and also to compare among the two groups. Materials and Methods: 45 eyes of 28 patients with Primary Open angle Glaucoma and 39 eyes of 28 patients with Primary Angle Closure Glaucoma who were clinically diagnosed and monitored in the Glaucoma Service of our hospital for a period of 16 months were recruited into the study. Main outcome measures were 1) distribution of visual field defects, 2) severity of visual field defects and 3) comparison among the two groups. Results: There was no significant statistical difference in Mean Deviation and Pattern Standard Deviation between the two groups. Superior Field was more depressed in both groups. Glaucoma Hemifield Test also shows that all the zones of superior field were depressed in both the groups but the severity is more in open angle group. Conclusion: My study shows that superior field is more severely affected than the inferior in both groups. However, trans meridional variation in field loss is less pronounced in subjects with angle closure glaucoma.

Page No. 45-49

Authors: Kavitha Chikkanayakanahalli Venugopal, Lakshmi Bomalapura Ramamurthy, Pavana Acharya, Sahana Raviraj

Aim: To evaluate the effect of 6mm sutureless clear corneal incision on pre-existing astigmatism of 1D-2D and to compare outcome of superior and temporal incisions, in manual small incision cataract surgery (SICS). Methods: A prospective interventional study was conducted from January 2015 to July 2015 on 80 patients who underwent manual SICS, with pre-existing astigmatism of 1D-2D on keratometry. A 6mm superior or temporal sutureless clear corneal incision was made along the steep axis. Postoperative follow up was done on 1 st , 3 rd and 6 th week and keratometry values noted in each visit. Final refraction and correction noted at the end of 6 weeks Results: Out of 80 patients, 71 had 1D-1.5 D and 9 had 1.5D-2D astigmatism. The mean pre-operative astigmatism was 1.228D±0.32D. Among 62 cases of with-the rule astigmatism, full correction after surgery was noted in 37 patients (59.67%), partial correction in 19 (30.64%), no change in 6(10%). Among 18 cases of against-the rule astigmatism, 11 had full correction (61.11%) and 6 had partial correction (33.33%) and remained unchanged in 1(5.5%). So the mean post-operative astigmatism was found to be 0.43D±0.35. The astigmatic difference between pre-operative and post-operative astigmatism was found to be statistically significant. (P-value 0.0001). Peaking of pupil was noted in 3 patients and iris prolapse in two patients, accounting for minor complications in 6.7%. No other complications were observed till 6 weeks. Conclusion: A 6mm sutureless clear corneal incision on steep axis is an economical and effective way of reducing pre-existing astigmatism of 1D-2D in manual SICS.

Page No. 53-56

Authors: Shweta Tripathi, Shakun Gupta, Varun Arora

Introduction: To investigate the level of compliance with glaucoma medications in a clinical setting of a tertiary north Indian hospital amongst both rural and urban patients and the factors associated with failed compliance. Thus to improve patient care and reducing visual deterioration and loss from glaucoma. Method: This was a Cross sectional study done at the Glaucoma Clinic, Indira Gandhi eye hospital and research centre Lucknow, between October 2014 and March 2015. 198 patients in the clinic were administered a questionnaire by the doctor. All patients were examined to make sure they met the inclusion and exclusion criteria and then a standard questionnaire was filled for each patient by direct questioning and also form case records Impact of age, gender, place of residence, religion, education, social status, knowledge about disease, systemic illness, other medical treatment, duration of treatment and number of anti-glaucoma medication on compliance was evaluated.. Data was analyzed using SPSS version 15.0. Data has been represented as numbers and percentages. Associations were evaluated in terms of odds ratio and tested using chi-square test. Results: Out of 198 patients enrolled - 30.8% were females, 30.8% were in the age group of 61-70 years age group, 60.1% had an urban background, 73.3% were aware that they had glaucoma and 66.7% were under treatment for more than 2 years. Although rate of compliance varied among different age groups ranging from 0 to 34.4% yet this difference was not significant statistically (p=0.072.) The odds of compliance were higher (OR>1) among females as compared to males, urban as compared to rural, Hindus as compared to Muslims, 12th Class/ Graduates as compared to Uneducated/Primary educated, Higher socioeconomic strata as compared to other socioeconomic strata, those having knowledge about disease as compared to those not having knowledge about disease, having shorter duration (<2 years) of disease and those taking single AGM as compared to those taking multiple, however, this difference was significant statistically only for place of residence, education, social status, duration of treatment and number of AGMs only (p<0.05). The commonest reason cited for non-compliance was side effects (26.3%) of anti-glaucoma medications. Other causes included cost factor (19.2%), forgetting schedule (17.7%), depletion of medication before next appointment (14.6%), inability to understand instructions (12.2%) and loss of prescription (4%). Conclusion: Compliance rates were quite poor and were mainly associated with demographic factors, duration and number of drugs.

Page No. 61-65

Authors: Bindu S, Jyothi PT, Padma B. Prabhu, Sandh S

Background: Age related maculopathy causes irreversible central visual loss in elderly population. Photo stress recovery time and Amsler grid evaluation are the tests used to assess the functional integrity of macula. Aim of Study: 1. To determine the Photo stress recovery time (PSRT) in patients with asymmetrical age-related macular maculopathy (ARM) 2. To find out the prevalence and the relation between risk factors, visual acuity, Amsler evaluation and photo stress recovery time. Settings and Design: Hospital based Case series study. Materials and Methods: Out of the 2104 participants above 50years, 37 patients presented with features of age related maculopathy. The systemic and ocular risk factors of ARM was observed. Relevant clinical examination, photo stress test and amsler grid monitoring was done in all patients. Statistical analysis was done using SPSS Version 18. Results: The overall prevalence of age related maculopathy in the study population was 1.76%, and it increases with age. Mean age was 62.84 years ± 7.97. Males were more affected by the disease. Smoking, dyslipidemia, cortical cataract and hyperopia were the most common risk factors. Photo stress recovery time was prolonged in all patients with reduced visual acuity. Even in eyes with good vision it was abnormal in the early stage of the disease before visible change occurred in the macula. Abnormal recovery time was also noted in patients with normal Amsler grid. Conclusion: PSRT helps in early detection of macular dysfunction in better eye, as well as progression in worse eye in patients with asymmetrical age related maculopathy.

Page No. 69-73

Authors: Jayashree S Shah, Satya Swapnika Y, MS Padma Jothi

Background: This study was conducted to isolate the common fungi from the corneal ulcer of the patients and to treat fungal keratitis with appropriate antifungal drugs. Methods: All the patients with corneal ulcer who visited the Ophthalmology OPD at SSMCH, Tumkur were evaluated. Further, all the cases of corneal ulcer were examined with slit lamp biomicroscopy and corneal scrapings taken are subjected to KOH preparation and those with fungal etiology were identified and taken up for the study. The patients were taken into the study irrespective of the previous disease and previous medication. Results: Out of 20 patients recognised as fungal corneal ulcer, most of the patients belong to the age of 11 to 50 years as they are the working population. The patients with fungal corneal ulcer showed minimal symptoms than signs we lead to delayed avail to treatment. The earliest time the patient visited the hospital after the onset of the disease, was 2 days and the longest duration was 2 months. Those patients with a history of agricultural trauma had either remained negligent in early stage or tried all possible remedies within their easy reach in their initial conditions and come only when the pain became intractable with loss of vision. Conclusion: A high index of suspicion should be raised in cases with history of trauma and clinical features highly suggestive of fungal corneal ulcer (dry elevated surface, stromal infiltration with hyphate margins). 10% KOH smear is a rapid and sensitive method of diagnosis which is confirmed by SDA cultures that is the most sensitive and specific test available. Aspergillus and Fusarium are the most common isolates. Fluconazole and Natamycin are the drugs of choice in most filamentous keratitis. Most of the cases heal with some grade of opacity, ultimately requiring a therapeutic Penetrating Keratoplasty to regain useful vision.

Page No. 80-84

Authors: Neha R. Chandak, Sachin V. Daigavane, Surabhi R. Sharma

Introduction: Colour vision in humans is trichromatic. Colour vision deficiency (CVD) occurs when one or more of cone types are absent, or present but defective. It is a common X-linked genetic disorder. However, most colour blind children remain undetected due to absence of proper screening. Therefore, this cross-sectional study was carried out to determine the prevalence of CVD, type of CVD and prevalence of each type among school children of Wardha District. Materials and Methods: 850 school children in the age of 10-15 years were screened for CVD using Ishihara’s pseudoisochromatic test 38 plate edition. Results: Of 850 school children, 18 children (2.1%) (95% confidence interval: 1.35-3.33) suffered from CVD. Prevalence rate for CVD was found to be higher in males (3.7%) than in females (0.4%). The overall trend of defects was: deuteranomaly > deuteranopia > protanomaly > protanopia. The prevalence of congenital dyschromatopsia in school children of Wardha District was comparable to prevalence rates across India. Conclusion: Early diagnosis of congenital dyschromatopsia would allow for minimization of these problems, improvement of adaptation of children to their dysfunction, and, most importantly, for better planning of their professional future.

Page No. 91-95

Authors: Shakeen Singh, Pawan Prasher, Mandeep Kaur, Arushi Kakkar, Manish Chhabra

Purpose: To study the indications for penetrating keratoplasty(PKP) in Punjab. Design: Retrospective study. Methods: Retrospective analysis of medical records of patients who underwent PKP at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar from January 1, 2015 to January 1, 2017 was conducted to study the indications of PKP. Results: A total of 102 eyes of 94 patients were included in the current study, of which 75 (79.78%) were males. The mean age of the patients was 53.1 ± 17.2 (range 15 to 85) years. The most common indication for PKP was corneal opacity in 43 (42.15%) cases, followed by active infectious keratitis in 16 (15.69%), adherent leucoma in 12 (11.76%), bullous keratopathy in 10 (9.8%), failed graft in 9 (8.82%), staphyloma in 6 (5.88%), keratoconus in 1 (0.98%), and miscellaneous causes in 5 (4.9%) cases. Post infectious cause was the most common subcategory in the corneal opacity group, followed by post-trauma and post chemical burns. Conclusions: Corneal opacity, most commonly as a result of post-infectious scarring, is the most common indication for PKP in Punjab. Patient education, preventive measures, and improvement in primary eye health care services are required to reduce the burden of corneal blindness in this region.

Page No. 107-111

Authors: R N Kothari, Dipak B. Patel, Nirali Patel, Anjashi Patel, Toral Rajput

Introduction: “Meibomian gland dysfunction (MGD) is thought to be the leading cause of dry eye disease”. (1) The pathophysiology of MGD is complex and bacterial infection is a cause of MGD remains controversial. “Doxycycline is a long acting analogue of tetracycline which has been used to treat MGD through its antimicrobial, anti-inflammatory and anti metalloproteinase properties, with fewer side effects than tetracycline”. (2,3) This comparative and clinical study is being done to evaluate efficacy and compliance of oral doxycycline and oral azithromycin in meibomian gland dysfunction who were not responding to conservative management. Methods: The study was carried out from April 2016 to September 2016 in our institute. 100 patients were enrolled in the study. Thorough ophthalmic examination was done. Schirmer tests 1 and 2 and TBUT (tear film break up time) were performed to check for dry eye. Patients were called for 3 follow-up and whole ophthalmic examinations were repeated each time. Results: Total 100 patients were included in the study. Of these 59 males and 41 were females. In both group signs and symptoms improvement from pretreatment to last follow up was statistically significant (p=0.000). Improvement of symptoms and signs in both group was almost equal, so p-value is insignificant, when comparing between both groups (p=0.714). The side effects in doxycycline group was more as compared to azithromycin group at all follow up (p=0.012). Conclusion: This study demonstrated that both oral doxycycline and azithromycin are effective in patients with MGD. The side effects observed in doxycycline group were significantly higher in all follow up visits as compared to azithromycin group. Therefore, a five day course of oral azithromycin is suggested based on better clinical improvement, shorter treatment duration, less side effects and low cost.

Page No. 115-116

Authors: Ashok Madan, Mona Deshmukh, Bhushan A. Chaukhe

Electrical insults to the human body range from death to damage to various parts of the body. It can result in a wide range of ocular injuries with resultant ocular complications. Of these, electrical cataract can occur after a latent period and then can progress with starting rapidly. The clinical picture of electrical injury is influenced by numerous factors including voltage, tissue sensitivity, type of current (direct or alternating), length of contact, place and area of contact, and route traveled in the body. The majority of cases respond well to surgery, but final visual acuity will depend on the other ocular damage due to electrical current. However proper surgical management can result in good and stable visual acuity as is seen in this case. The need for awareness of the possibility of this complication and screening of all cases of electrical injuries is stressed. The majority of cases respond well to surgery. We report a rare case of a 15 years young boy having bilateral anterior sub-capsular cataracts caused by high-voltage electrocution in a young man who regained normal vision after surgery in both eyes. Bilateral Phacoemulsifiation with foldable hydrophobic lens [PCIOL] in capsular bag was done.