Indian Journal of Clinical and Experimental Ophthalmology

164-167

Authors: Veshal Madan, Renu Magdum, Somnath Ghosh

Purpose: Significance of clinical DME in an up becoming capital nation of diabetes mellitus in world has socio-economic effect due to VTDR is identified as the major cause of irreversible blindness in DR subjects in all age groups. Therefore, the need for reliable, safe and immediate detection of DME is a need for prevention of the disease & related socio economic burden. The study was to compare the diagnostic potential of two commonly established diagnostic instruments i.e.-SD-OCT & FFA for the detection of DME. Materials and Methods: A prospective study with purposively sampling technique was carried on 308 eyes of 154 type II DM patients to compare the detection potential between two popular retinal diagnostic techniques, SD-OCT a non-invasive technique versus FFA invasive method for DME. The standard parameters such as focal macular edema, diffuse macular edema and mixed edema with cystoid type were evaluated with FFA. Subsequently DME classification with presence of intraretinal edema, sub retinal fluid and mixed edema were diagnosed with SD-OCT for the same pool of patients. Clinical features in DME using reference ‘EDTRS’ scale of measurement. Results: Noninvasively 305 (99.1%) eyes were detected positive for various type of DME by SD-OCT while 282 (91.6%) eyes were detected positive by FFA. The prevalence of different types of DME such as cystoids, diffuse, focal and mixed was 7.8%, 13%, 7.1% and 63.7% respectively as diagnosed with FFA. Whereas, SRF, IR edema and mixed type was 4.9%, 3.6% and 90.6% respectively as diagnosed with SD-OCT. DME was not detected by FFA in 8.4% of eyes in overall study population. Whereas, SD-OCT was unable to detect DME in 0.9% of eyes. In our study overall performance of SD-OCT was better in detection of DME when compared to FFA. Conclusion: The present study showed the diagnostic potential and efficacy of SD-OCT over FFA in reliable and safe detection of DME in Type II Diabetic Mellitus patients was more and was easy and comparable to diagnostic findings of FFA specifically in cases of sub retinal macular as well choroidal edema due DME by SD-OCT.

175-177

Authors: Anubha Bhatti, Subina Narang

Purpose: To evaluate the effect of Atorvastatin on hard exudates in diabetic retinopathy in type 2 diabetic patients with normal lipid profile. Materials and Methods: Prospective study of 50 patients with clinically significant macular edema involving centre was done over 2 years (2015-16). We excluded patients with type 1 diabetes mellitus, patients with nephropathy/ heart disease, dyslipidemic patients, patients with laser treatment within 3 months of enrollment, patients with proliferative diabetic retinopathy requiring laser treatment. Detailed history was taken and thorough examination was done with +90 D lens for size and extent of clinically significant macular edema and grading of hard exudates. OCT was done for maximum retinal thickness. The outcome measures were visual acuity, change in grade of hard exudates and maximum retinal thickness. Change in maximum retinal thickness by 30% was considered as significant reduction of macular edema. Patient had minimum follow up of 6 months. Results: Of 50 patients 34 were male and 16 female. Mean follow up period was 10.5±4.0 months. Baseline mean visual acuity was 0.73±0.4 log MAR and baseline mean MRT was 360.03± 30.94 µ. Patients with grade 3 hard exudates were 6, with grade 4 hard exudates were 28 and with grade 5 hard exudates were 16 at baseline. Final mean visual acuity was 0.76±0.4 log MAR. Mean MRT at final visit was 284.6± 48.3 µ. 34 patients (68%) showed improvement by one grade and 2 patients showed improvement by two grade. The grade of hard exudates remained unchanged in 12 patients (24%) and deteriorated in 2 patients. Conclusion: Atorvastatin leads to significant improvement in grade of hard exudates in clinically significant macular edema and decrease in maximum retinal thickness on OCT. However visual acuity status was not significant over short term follow up

182-188

Authors: Praveen Kumar K V, Sharad Nivrutti Gomase, Chiranjeevi P

Introduction: Cognitive impairment may be present at birth or can occur later in adulthood. Few studies have shown correlation of cognition with retinal nerve fiber layer thickness (RNFL). The present study was planned to analyse RNFL thickness in disorders of cognition. Materials and Methods: 60 eyes of cognitive impairment were included. All patients underwent RNFL thickness measurement by OCT at initial visit and after 3 months. Statistical analysis was done with a p value less than 0.05 to be significant. Results: 60 eyes of cases of cognitive impairment were included. 16 (53%) cases had cognitive impairment following traumatic brain injury and 14 (47%) cases were secondary to Alzheimer’s disease. The mean RNFL thickness in the superior quadrant was 105.92 µm ±28.343µm at initial visit and at 3 months follow up was 105.72 µm±27.916 µm, in the nasal quadrant was 69.17 µm ± 13.199µm at initial visit and at 3 months follow up was 68.97 µm± 13.119 µm, in the inferior quadrant RNFL thickness was 111.03 µm±22.558 µmat initial visit and at 3 months follow up was 110.92 µm±22.372 µm, in the temporal quadrant was 59.35 µm ±11.333 µm at initial visit and at 3 months follow up was 59.18 µm ±11.247 µm but the difference was not statistically significant. Subgroup analysis of cases also did not show any statistically significant difference in RNFL thickness. Conclusion: RNFL thickness remains unaffected in cognitive disorders. However studies on a large sample of patients with a longer follow up are needed

193-196

Authors: Khushnood M. Sheikh*, Manisha Shashtri, Ombir Singh

Introduction: Retinal vein occlusion is second most common retinal vascular disorder after diabetic retinopathy. BRVO caused due to occlusion of branch vein of retina with involvement of particular quadrant. On ophthalmoscopic examination patient will have retinal edema and or macular edema with superficial and deep retinal haemorrhages and venous dilatation within the affected sector. The most recognized risk factor for BRVO are age and systemic vascular disorders. Materials and Methods: Prospective observational study was done for the period of one year. Patients more than 30 years of age attending ophthalmology OPD found to have BRVO were evaluated for various risk factors after taking consent. History and thorough eye examination were carried out including fundus photography and fluorescein angiography. Results: In this study 38 patients of more than 30 years (32-75 years) found to have BRVO out of which 21 were male and 17 were female. 25 cases (65.78%) (p-value 0.0384) having hypertension, 8 case (21.05%) (p-value 0.135) having diabetes, 7 (18.42%) (p-value 0.04) were smokers, 13 (34.21%) (p-value 0.0008) were having altered lipid profile, 15 (65.22%) (p value < 0> Conclusion: With the help of modern instrument and technology branch retinal vein occlusion can be easily diagnosed and treated. It is a multi-factorial disease affect the eyes of an individual having hypertension with other risk factors like ageing, hyperlipidaemia, homocysteinemia etc. so beware of four H, higher age, hypertension, hyperlipidaemia, homocysteinemia.

204-208

Authors: Jasmine Mary Jacob, Susan Kurian, Sheldon J Goudinho

Alterations in corneal astigmatism and tear stability in patients undergoing surgical excision of pterygium: a prospective study undertaken in a tertiary centre in south Kerala. Objective: To analyse the effect of surgical intervention on corneal astigmatism & tear stability in patients with ptreygium. Methodology: In this prospective observational study conducted in ophthalmology department, Dr. SMCSI Medical College, Karakonam, 39 eyes with primary pterygium enrolled between January 2016 to May 2017 for pterygium excision with conjunctival autograft, were analysed. Preoperatively and one month post operative. Uncorrected & best corrected visual acuity, keratometry readings (K1, K2) was recorded. Pterygia were graded as grade I, II, III & IV.TBUT and Schirmer’s test used to measure tear function. Descriptive measures were calculated using percentage or mean (SD). Pre-operative and post-operative difference in values of astigmatism and tear function tests were assessed using test of significance, paired t-test. Results: Of the patients enrolled with primary pterygium, 56.4% (22) were females and 43.6% (17) males. 42% had right eye ptreygium and 58 % in the left. 84.3 %( 33) were nasal, 12.8% (5) temporal and 2.6 %( 1) double pterygium. 76.9 %( 30) were grade II, 10.3% (4) grade III, 12.8% (5) grade IV. There was a reduction in astigmatism from 2.29 +/- 1.4D to 1.02 +/- 0.74D (p<0> Conclusion: Surgical intervention proved beneficial for patients with pterygium in terms of reduction of refractive astigmatism. A statistically significant change was not observed in tear function.

213-216

Authors: Abhinav Khadke, Mansur Ali Khan, P S Moulick, Sandeep Gupta, Sandeep Shankar

Introduction: Post cataract surgery dry eye in the susceptible population can adversely impact visual outcome and overall patient comfort. There are varying reports on the incidence of post cataract surgery dry eye depending on patient population and surgical technique. This study has evaluated the incidence and factors causing dry eye following phacoemulsification, small incisional cataract surgery (SICS) and conventional extracapsular cataract surgery (ECCE). Materials and Methods: Patients with cataract in the age group of 40 to 80 years with normal ocular surface and schirmers test at baseline were followed up after cataract surgery with schirmers recording at 1 month and 3 months. Pre and post- surgery schirmers values were compared for estimation of dry eyes. Results: A total 390 patients underwent cataract surgery with an overall post surgery residual dry eye incidence of 22.1% (95% CI 17.94 to 26.17) at the end of 3 months follow up. Of these 31% had mild, 67% had moderate and 2% had severe dry eye. A higher incidence was seen in SICS as compared to phacoemulsification. A statistically significant association was noted between dry eye and diminution of vision (p = 0.001).

221-224

Authors: Siddharam Janti, Ananya Aila, Kiruthika .S, Stephen Sudhakar

Introduction: Visual rehabilitation by corneal transplantation remains the only treatment modality for treatable corneal blindness. Unfortunately the demand of the donated cornea remains high in comparison to its procurement. As these target groups will be future health care providers thus it is important that they know the intricacies of corneal donation. These groups will create awareness among the general public, thereby significantly increasing the corneal donation rate. Objectives: To study the awareness and knowledge among medical, dental and nursing students towards eye donation in a medical college/Tertiary hospital. Materials and Methods: A cross-sectional study was conducted among 100 medical, 100 nursing and 100 dental students studying final year of their respective courses in Chettinad Health and Research Institute, Chennai. Results: There was statistically significance in knowledge between the medical and all other groups showing that medical students are more aware about the practice of corneal donation.(p value: 0.0000001). Overall the awareness about the existence of practice of eye donation was only 57% among the study groups. Only 33.3% of study populations were willing to donate their eyes and 36% of study populations were willing to donate their relative’s eyes. 67.3% of the students required their family‘s consent and approval for corneal donation. 58.6% of the students knew that eyes cannot be donated by a living person and also fact that a living person can only pledge for eye donation. 54 % knew that eyeball should be removed within six hours after death. Only 49% of the study population knew the name of nearest eye bank and only 24.6% of study population knew how long the donated eyes can be stored before transplantation. Overall, the awareness and knowledge of medical students was better than nursing and dental students in all the above aspects (p value: 0.0000001) but the levels of motivation were low in all the study groups (p value: 0.006). Conclusion: The result of this study concluded that medical students were more knowledgeable about various intricacies associated with corneal donation than other two study groups (p value: 0.0000001) which was statistically significant. There was no statistical significance seen in motivation levels of all study groups (p value: 0.06). This study was undertaken to assess the depth of awareness and knowledge among the study groups. These groups are targeted as they are future care providers giving us an idea about targeting motivation and awareness programmes among these groups

230-235

Authors: Smaranjit Biswas, Shashwat Bhattacharyya, Kanchan Kumar Mandal, Biswarup Ray

Background: Rhinoconjunctivitis is a common health problem that plagues the lives of children and adolescents alike with a significant impairment of the quality of life. Purpose: Aim of this study was to investigate the effect of intranasal corticosteroid, fluticasone furoate, on the change of IOP in allergic rhinitis patients. Materials and Methods: This was a prospective observational study carried at the Ophthalmology outpatient department of a Government Medical College in West Bengal involving all consecutive patients attending ENT OPD for allergic rhinitis of age group 12 years and above and prescribed fluticasone furoate nasal spray. The IOP of patients were measured before and after start of steroid nasal spray and follow up was done at regular interval. One and half year and follow up was done on 1st, 2nd, 4th, 8th and 12th week respectively. Results: A total of 108 patients were selected for the study, out of which 100 remained till the end of all follow ups. The IOP for each eye was compared with baseline IOP values (RE: 16.02±2.29, LE: 16.04±2.20) and at the end of the study the P value for each follow up was calculated. The t test revealed that there was no significant change (increase/decrease) in IOP in any eye over the course of time. r values shows that there was a strong positive linear correlation of IOP between and within the eyes at different levels of assessment after the starting of the treatment. Even after age group adjustment, there was no statistical difference in IOP between the eyes among the various age groups. Conclusion: The study demonstrates no statistically significant increase in IOP after the administration of fluticasone furoate nasal spray. We believe, therefore, that fluticasone furoate administered for a short time for the treatment of nasal allergy, is safe in terms of its effect on IOP in the Indian population.

241-244

Authors: Balakrishnan Madhavan, Sowmiya K.R, Rekha, Rajarathinam

Purpose: Study to find out relationship between visual acuity and retinal visual line disruption in ocular coherence tomogram (OCT) due to (1) changes in the inner segment and outer segment retinal junction (IS/OS), (2) external limiting membrane (ELM) in the foveal region in ocular blunt injuries and to find out it’s prognostic value. Materials and Methods: Prospective, observational study conducted on 100 eyes of 100 patients who visited the department of ophthalmology with blunt ocular injuries. Patients with associated pre-existing ocular and systemic diseases were excluded. Refraction was done to know the best corrected visual acuity in logarithm of minimum angle of resolution (log MAR) after regression of anterior segment signs. OCT was done to scan and study macular pathology and visual lines. Integrity of IS/OS junction and ELM were studied and analyzed the relationship with visual acuity to consider for prognostic value. Result: Statistically significant relation was noted between the visual acuity and disruption of lines at retinal IS/OS junction and ELM (P<0> Conclusion: The retinal visual line disruption can be used as prognostic indication for future vision.].

249-253

Authors: Sheldon Goudinho, Renjini. R.I, Jasmine Mary Jacob

Aim: to compare the degree of sensorineural hearing loss in patients with and without pseudo exfoliation. Materials and Methods: A comparative study design enrolling 44 patients each with and without pseudoexfoliation was employed. Pure tone audiometry was done to detect sensorineural hearing loss and to quantify the same according to WHO classification. Results: 52.3% of patients in the group with pseudo exfoliation had mild sensorineural hearing loss, i.e., difficulty with faint speech.6.8% had moderate sensorineural hearing loss.40.9% had no significant hearing loss. In the group without pseudo exfoliation, 56.8% had no significant hearing loss while 29.5% had mild sensorineural hearing loss.13.6% had moderate to moderately severe sensorineural hearing loss. Conclusion: There is an increased incidence of hearing impairment in pseudo exfoliation syndrome though not statistically significant.

258-262

Authors: Srimathy A Jain, Sutapa Das, M. Subashini, Kaviraj Mahadevan

Introduction: Headache attributed to refractive errors (HARE) is a common condition caused by myopia, hypermetropia, and astigmatisms. Headache is not necessarily experienced by all individuals with REs. HARE is mainly caused by the strain produced in the ciliary muscles to focus objects more often during near works like reading. This study is an attempt to estimate REs with headache and symptoms relief after correction respectively. Materials and Methods: 103 cases of both sexes with mean age 19.04±7.27 years referred to the ophthalmology out patient department with complain of haedache were included in the study. Objective refraction was measured with 0.5% cyclopentolate drops and retinoscopy was done with suitable lenses. All cases were followed up for a period of one month. Results: The frequency of REs in headache patients was found to be (29) 28.15% with hypermetropia 9(31.03%), myopia 6(20.69%), mixed astigmatism 5(17.24%), compound myopic astigmatism 4(13.79%), compound hypermetropic astigmatism 3(10.34%), simple myopic astigmatism 2(6.90%). Asthenopia was found in 62% of cases diagnosed with RE. Symptoms relief was seen in 69% of cases after spectacles prescription. 16 out of 19 patients with asthenopia experienced symptoms relief after one month. Conclusion: Among the many causes of headache, HARE is a subgroup to be resolved with ophthalmological consultation. The results of this study indicates a positive association of Res in causing headache and the importance of lens correction in symptoms relief. So, all headache cases should have ophthalmological examination since maximum amount of success is possible in HARE management.

268-272

Authors: Pragati Garg, Astha Agrawal

Aim: To study the prevalence of uncorrected low grade astigmatism as the sole cause of headache. Materials and Methods: It is a prospective cross sectional study, conducted in the Department of Ophthalmology for 18 months. A total of 400 patients presenting with headache as the single complaint were enrolled in the study. All the patients were evaluated for presence of astigmatism with the help of visual acuity, retinoscopy, keratometry and post mydriatic test and then the follow up was done at 4, 8 and 12 week to see the status of headache. Results: The prevalence of uncorrected astigmatism among cases presenting with headache as the single complaint was 49.3%. Age of patients ranged from 14 to 35 years with a mean age of 22.85+6.43 years, however, proportion of patients with age <20 years was significantly higher among astigmatism cases (50.8%) as compared to that of patients without astigmatism (40.9%). Mean age of astigmatic patients was also lower (21.72+5.53 years) as compared to that of those not having astigmatism (23.94+7.03 years). Majority of patients were females (69.8%). Statistically no significant association between gender and astigmatism was seen. Conclusion: The findings of the study thus suggested that among cases presenting with headache as the sole cause, prevalence of astigmatism is quite high and treatment of uncorrected astigmatism brought about a phenomenal improvement in symptoms of headache.

276-279

Authors: Shimna C P, Jasmine Mary Jacob, Pramod Thomas

Aims: To determine the hospital prevalence as well as the low vision causes among patients coming to a tertiary care centre. Settings and Design: Retrospective study was conducted by review of files of patients who presented to the Ophthalmology OPD from September 2013 to February 2014. Material and Methods: Records of 4989 patients in the 20-60 years age group who presented to the Ophthalmology OPD were collected and data obtained. Patients with a visual acuity of < 6>3 Results: There were 102 patients with low vision who attended the OPD during the study period. There were 36 (35%) male and 66 (65%) female patients among the low vision patients. The low vision causes were retinal diseases (72%), amblyopia (15%), corneal opacity (9%) and glaucoma (4%). Conclusion: Hospital prevalence of low vision was estimated to be 2.19% (SE-1.43). Among these patients, the causes of low vision were detected to be Retinal diseases like Diabetic Retinopathy, Hypertensive Retinopathy and pathological myopia, amblyopia, corneal opacity and glaucoma.

284-286

Authors: Priyadarshani Patil Cholera, Kshitij S. Tamboli, Nupur Chakravarty

Purpose: To study the refractive errors and its implication on the quality of life; among the children in the semi urban population. Materials and Methods: This prospective, cross-sectional study was conducted among the 500 children (5-15 years), over a period of 6 months. Observations: All patients examined for unaided visual acuity using snellens chart. After visual acuity, subjected to dilated retinoscopy and fundoscopy. Conclusions: It was concluded that clear need to have regular and simple vision testing of children of school going age, so as to detect visual abnormalities at an earlier stage thereby preventing long term visual disabilities. Regular school health programs regarding visual acuity improves scholastic performance of children.