Indian Journal of Clinical and Experimental Ophthalmology

435-448

Authors: Sandeep K,Phanindhara Reddy Yerramreddy*

Purpose: To detect dry eye and to associate it with rheumatoid factor and severity of disease in rheumatoid arthritis. Materials and Methods: Cross-sectional explorative study & study period December 2013 to October 2015. Fifty nine eyes of 30 patients diagnosed as rheumatoid arthritis age > 18 years were included. Status of rheumatoid factor, severity of disease calculated with DAS28-ESR were noted and TBUT, Fluorescein staining and Schirmer’s Test were done. Results: Out of 59 eyes 42.4% had TBUT <10> 5mm (mean 18.7 ± 6.8 mm). 42.4% were diagnosed with dry eye. Out of 51 eyes with positive rheumatoid factor 24 had dry eye but 1 out of 8 eyes with negative rheumatoid factor had dry eye (p=0.066). Mean severity score of disease based on DAS28-ESR was 2.9 in dry eye and 4.1 in patients without dry eye. Conclusion: Dry eye in rheumatoid Arthritis can be detected by simple tests and there is no statistically significant association between rheumatoid factor and dry eye. Dry eye is independent of severity of disease.

443-446

Authors: Satyam Kumar Jha,Ashwini K. V*

Aims: To assess the contrast sensitivity (CS) in different stages of primary open angle glaucoma and to correlate it with the severity (mild, moderate & severe) of glaucoma. Materials and Methods: This prospective randomized study was conducted at Sapthagiri institute of medical sciences and research centre, Bangalore between June 2017 & December 2017. A total of 100 eyes of 55 individuals aged 25-80 years diagnosed with POAG were enrolled in this prospective study. Selected subjects underwent detailed ophthalmic examination including ocular history, slit lamp examination, objective & subjective refraction (if required) to obtain best corrected visual acuity (BCVA) on Snellen visual acuity chart and dilated fundus evaluation using indirect ophthalmoscopy. Eyes with clear media and ?BCVA 6/60 were included and contrast sensitivity was measured using Pelli Robson chart at 1 meter distance. HFA report of included subjects were collected from Glaucoma department to classify them in to mild, moderate and severe groups according to their visual field findings (pattern deviation of HFA report). Classification was done according to International statistical classification of disease and related health problem (ICD 10). One way ANOVA and t-test was used to analyze the data. Results: There was 36% mild, 26% moderate and 38% severe cases of POAG classified according to ICD 10. The mean value of contrast in mild, moderate and severe POAG was 1.4341, 1.3267 and 1.1326 respectively. An analysis of variance tested whether there were significant difference in contrast sensitivity among mild, moderate and severe POAG. Results indicated that these means differed significantly p < 0> Conclusion: There was decrease in contrast sensitivity with the severity of POAG. Thus the contrast sensitivity testing should be made mandatory in evaluating POAG patients which could help in screening/diagnosis (early detection) and to assess the progression of the disease as well as response to the treatment

450-453

Authors: Sonam Verma,Nitin Nema*,Abha Verma,Shachi Dwivedi,Mayank Gupta

Objective: To study the risk factors and visual outcome in patients of presenile cataract. Materials and Methods: A cross sectional observational study was conducted between January 2016 and January 2017 at a tertiary health care centre. Patients with cataract between age 35 and 55 years were selected. Risk factors like diabetes mellitus, high myopia, dermatological diseases and tobacco consumption were noted. Visual acuity was recorded and a detailed examination of anterior and posterior segments was done. Patients underwent cataract surgery with intraocular lens implantation. Postoperative best-corrected visual acuity was noted. Result: Out of 120 patients there were 47 males (mean age 45.43 ± 6.79 years) and 73 females (mean age 47.33 ± 6.08 years), mostly with bilateral eye involvement (n= 103). Most of the cases were idiopathic (65.9%) whereas association of other risk factors in order of frequency was: tobacco consumption (10.8%), high myopia and diabetes mellitus (7.5% each), prolonged period of outdoor work and long-term steroid use (3.3% each), and dermatological diseases (1.7%). Using Annova test, a significant difference preoperative and postoperative vision was found amongst all age groups (p= 0.032). Conclusion: Tobacco consumption is a strong risk factor for cataractogenesis above diabetes mellitus and high myopia in presenile age group. A significant visual improvement results after cataract surgery and lens implantation.

458-464

Authors: Indra Dandaliya*,Dinesh Kumar Bedi,Sanjeev K Nainiwal

Aim: The study was conducted to evaluate and compare the changes in corneal endothelial cell count density (ECD) and Central corneal thickness (CCT) between diabetic and non diabetic population before and after phacoemulsification surgery. Settings and Design: This prospective, comparative, interventional study was carried out at government medical college and attached group of hospitals, a tertiary eye care centre in Rajasthan, India. Materials and Methods: A total of 50 patients with type II diabetes mellitus (age group 30-80 years) and 50 age matched healthy patients of senile cataract with clear cornea without any other ocular pathology were non-randomly selected for Phacoemulsification surgery (phaco) after detailed preoperative assessment. All patients were operated by the same surgeon with phaco chop technique to exclude any surgeon’s related bias. Endothelial cell count, CCT and Coefficient of Variance (CV) was measured with specular microscope pre-operatively and postoperatively at day 1st, 7th, 15th, 1 month, and 3 months serially. Result: Postoperatively, the mean ECD was decreased in both the groups but loss of endothelial cell count was significantly more in diabetic population as compare to non diabetic groups at day 1, day 7, day 15, 1 month and 3 months. CCT was increased on first post-operative day in both the groups, subsequently decreased and then returned back to about same as pre-operative state after 1 month. But postoperatively, the change in mean CCT was not significant between both groups. The difference in % CV was significantly higher in diabetic group as compared to non diabetic group postoperatively. Conclusion: The corneal endothelial cell changes were significantly high in diabetic population as compared to nondiabetic patients. The ECD loss, increase in mean CCT and % CV were more in diabetic population as compared to non diabetic. And patients with diabetes showed slower recovery in endothelial healing as compared to non diabetic group.

469-472

Authors: Nivedha S. Raman,Amod Hansdak*,Elfride Farokh Sanjana

Introduction: This study was undertaken to find out the ocular manifestations of diabetes mellitus among diabetics reporting to a tertiary health care facility in Pondicherry. Materials and Methods: Seventy diabetic patients reporting to Ophthalmology outpatient department were studied during the months of August and September 2017. A predesigned questionnaire was used to interview the diabetics, anterior segment examination was carried out using torchlight and slit lamp, and +90D lens was used for fundus examination. The findings were recorded and analyzed using Microsoft Excel and Epidata respectively. Result: Most of the study subjects belonged to the age group 41-70 years, literate, employed, and middle income group. Cataract and retinopathy were found to be higher in those with more than 10 years’ duration of diabetes. Conclusion: Healthcare providers need to focus their efforts on preventive measures to delay the onset of complications of diabetes. The importance of screening for diabetes and diabetic retinopathy and regular follow-up cannot be overemphasized in order to reduce the burden of disease and its devastating consequences

478-482

Authors: Thasni Mohammed,Padma B. Prabhu*,Jyoth P T

Purpose: To explore the factors influencing the severity of diabetic retinopathy among early onset type 2 diabetes mellitus. Materials and Methods: A descriptive cross sectional study was undertaken among subjects with early onset type 2 diabetes mellitus diagnosed with retinopathy. Demographic profiles like age, gender, duration of diabetes, co-morbidities and presence of macrovascular or microvascular complications were noted. Retina was evaluated using slit lamp biomicroscopy using 78D lens and Spectral Optical Coherence Tomography (OCT). Results: The study group included 135 subjects. There were 78 NPDR and 57 PDR cases. Those with PDR had higher age, longer duration of diabetes, lower Hb values, higher HbA1C and higher urine micro-albumin. They had a higher triglyceride values and lower HDL values. Conclusion: Higher age, longer duration, anemia, poor glycemic control and subclinical nephropathy were predictive of development of PDR among early onset type 2 DM subjects.

487-491

Authors: Nelly Nazareth,Sarita Gonsalves*,Vivekand U,F E. A Rodrigues

The goals of safe, effective anaesthesia is to achieve good surface anaesthesia, akinesia, hypotony, analgesia. Peribulbar anesthesia is a safer to minimize complications of retrobulbar anesthesia. Hyaluronidase is used to aid in the better diffusion of anaesthetic solution. The cost, limited shelf life, risk of anaphlylaxsis are its limiting factors. Hence the need for studying the efficacy of sodium bicarbonate as an alternative to hyaluronidase. Materials and Methods: Prospective randomized study on 100 patients who underwent cataract surgery. Group A was injected with an anaesthetic mixture containing 0.5% bupivacaine, lignocaine with adrenaline with 1ml hyaluronidase. Group B was injected with an anaesthetic mixture of 0.5% bupivacaine and lignocaine 2% to which 7.5% sodium bicarbonate was added. Results: Group A onset of anaesthesia 5 minutes 46(92%), 50(100%) of group B five minutes. Akinetic action of agent 1 better than agent 2., chemosis 16 (32%) in group A,18 (34%) group B. Lid edema nil group A, 17 (34%) of group B. Subconjunctival hemorrhage 3(6%) group A, 4(8%) group B. Peribulbar hemorrhage nil group A, 2(4%) group B. Globe perforation none. Raised IOP 1(2%) group A, 12(24%) group B Overall effective anaesthesia, akinesia achieved in 49 patients (98%) of group A, 43 (86%) of group B. Systemic complication in 1(2%) of group B. Conclusion: The present study showed that sodium bicarbonate is a effective alternative to hyaluronidase in peribulbar anaesthesia.

499-502

Authors: Sangeetha*,Kanthamani ,Borra Harish Laxman,Chirra eddy Gari Meghana

Purpose: To analyze and determine the postoperative visual acuity and complications after intraocular implantation of an iris-claw lens in aphakic patients. Setting: Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Design: Retrospective study. Materials and Methods: Medical records of cataract and aphakic patients who underwent posterior fixation of iris claw lens over a five-year period were reviewed for collection and analysis of data. Results: The study comprised 138 eyes of 57.25% female and 42.75% male with mean age of 62.84 ± 8.649 years. The follow up period was 6 to 24 months. The mean preoperative CDVA was 0.44 + 0.23 logMAR. After 1 year of follow up period the mean postoperative CDVA was 0.3+ 0.15 logMAR which was statistically significant (p <0 P=0.01).> Conclusions: This study showed the merits of retrofixated iris claw lens over AC IOL and SF IOL in terms of simple technique, short learning curve, satisfying overall visual outcome, less risk of complications and good safety profile.

507-510

Authors: J A Cacodcar,Tanvi Poy Raiturcar*,Ugam Usgaonkar,Marushka Aguiar

Context: Strabismus is one of the most common ocular morbidities affecting children, with a prevalence of 3 to 5% among children. Early diagnosis and treatment is very essential for successful treatment, which is only possible if the parents notice the signs and symptoms of strabismus early and seek timely treatment from qualified Ophthalmologists. Aims: To assess the level of knowledge, attitude & practices among parents towards children suffering from strabismus in Goa. Settings and Design: Cross-sectional study. Materials and Methods: 75 parents of children with strabismus and aged between 6 months to 14 years were administered a pretested proforma containing 12 questions, which included questions to assess their knowledge about strabismus and their attitudes and practices towards the condition, as well as their educational qualifications. Statistical Analysis Used: Percentages and proportions. Results: 90.66% had noticed the deviation of the eyes on their own. 81.33% were bothered by their child’s strabismus. 74.66% reported that other people notice their child’s strabismus. 76% felt uncomfortable when asked about their child’s strabismus. 53.33% were aware that strabismus may come in the way of their child’s scholastic performance and 44% feared fewer opportunities at school. 44% felt that their child has difficulty in socialising. 65.33% were aware about its effects on their child’s vision. 48% attributed psychological effects in their child due to strabismus. 56% were aware that strabismus is treatable. Conclusion: Hence health education is very important to increase the awareness and change myths about strabismus; thus making early diagnosis and successful treatment possible.

515-517

Authors: Kshama Dwivedi*,S P Singh

Introduction: To study the effect of excision of double headed monocular pterygium on astigmatism. Materials and Methods: 8 Patients of DMP presenting from January 2016 to December 2017 were treated with excision of pterygium followed by conjunctival autograft. Preoperative and postoperative astigmatism was measured by keratometry. Observation: The change between preoperative and postoperative day 45 astigmatism was found to be extremely significant (p=0.0003). Conclusion: DMP must be dealt with utmost care, owing to it’s higher impact in change of astigmatism.

521-525

Authors: N Lakshmi Chowdary*,B Pradhan

Introduction: Taking into consideration the wide spectrum of complications that follow MSICS and their influence on visual outcome, a sincere effort has been made in this study to critically analyze the incidence and the nature of various intraoperative, early and late post-operative complications among the total number of cataract extraction carried out. Materials and Methods: A Prospective observational study of 500 cases that had undergone MSICS after a thorough preoperative ocular evaluation including detailed history and clinical examination and these cases were studied for a period of 2 years and all the intraoperative, early and late post-operative complications were noted. Results: The commonest intraoperative complications were premature entry with iris prolapse (5%) followed by zonular dialysis (3%), commonest early post operative complications were SK (20%) and corneal edema (17%) and the commonest late post operative complications were PCO(18%) followed by astigmatism in 9% of the cases. Conclusion: SICS gives best corrected postoperative visual acuity of 6/6 or 6/9 in a greater proportion of patients and it has all the inherent advantages of the sutureless cataract surgery in terms of universal applicability, greater wound stability, lesser complications and early visual rehabilitation.

530-534

Authors: Shubhratha S. Hegde*,Mahima S.R,Sandhya Dharwadkar,Mohammad Abdul Kayoom N,Shashidhar H. B

Introduction: MPV and PDW are indicators of subclinical platelet hyperactivity and can be used as predictive factors for development and progression of diabetic retinopathy. Materials and Methods: This prospective case control study enrolled 150 patients with diabetic retinopathy (DR group) and 150 diabetic patients without retinopathy (control group). Detailed history and ophthalmic examination was done. The DR group was divided into 5 subgroups according to the ETDRS classification of diabetic retinopathy. MPV, PDW, FBS and PPBS values were obtained. Result: The mean value of MPV in DR group was higher compared to control group (p=0.016). PDW also followed the similar trend with DR group having mean value of 13.71± 1.36 fl and control group having 12.13 ± 1.29 fl (p=0.023). The study also found a trend of increase in severity of diabetic retinopathy with increasing level of MPV and PDW. However a statistically significant association was found only between MPV and stage of diabetic retinopathy (r= 0.214, p= 0.046). A marked increase in MPV and PDW values were found in those with Proliferative diabetic retinopathy (p<0> Conclusion: Platelet indices like MPV can be a cheap and easy to measure tool for monitoring diabetic retinopathy.

541-547

Authors: Aditya Vikram Sharma*,Aditi Sharma

We did an analysis of risk factors, clinical features and visual outcome in cases of non-arteritic anterior ischemic optic neuropathy (NA-AION) at a tertiary eye care centre in India. This is a prospective, observational, clinical study. A total of 60 eyes of 60 consecutive adult patients with disc oedema, due to non-arteritic AION, presenting in the Neuro-ophthalmology clinic of a tertiary care eye hospital, were enrolled over a period of 18 months (in specified period) according to the inclusion criteria. The study, including patient recruitment and data collection, was approved by the Institutional Review Board. All patients provided written informed consent after they received information about the disease and its relevant investigations along with the risks associated. Sample collection was done by application of inclusion and exclusion criteria on the patients presenting to the clinic. The study was carried out for a period of 6 months for each subject. The major outcomes of the study were: Metabolic Syndromes are the most significantly associated risk factors for the occurrence of NA AION. Clinical investigations mainly show the characteristic findings as mentioned in literature, with very little variation. However the importance of clinical examination, mainly pupillary reaction and fundus evaluation by slit lamp biomicroscopy, cannot be overlooked. Visual acuity is highly variable at presentation with cases even presenting with normal or near normal visual acuity. Visual outcome showed significantly improvement within 6 months of presentation. Non arteritic anterior ischemic optic neuropathy (NAION) was the most common form of ischemic optic neuropathy in our study. It is an idiopathic, ischemic insult of the optic nerve head characterized by acute, monocular, painless visual loss with optic disc swelling. The systemic risk factor which we found to be most strongly associated with was diabetes mellitus followed by systemic hypertension. Also an ocular risk factor of small cup size. We have few inherent limitations in the study mainly with the occurrence of symptoms and time of presentation of the patient, which may have a bearing on the final outcome of the disease. Also a short follow up limited us regarding study of the stabilization of visual acuity over a longer duration. However our study gives an overview of prevalent risk factors and clinical characteristics. It also shows a significant visual outcome after 6 months in NA-AION.

551-553

Authors: Punit Singh*,Deepak Patel

Aim: Study of incidence, clinical staging and risk factors of ROP in rural area. Materials and Methods: All premature new born infants at R.L.J. H Kolar were screened between July 2008 and June 2009.The incidence, clinical staging and associated risk factors were studied. We compared our statistics with urban area statistics from literature. Results: 210 children were screened. (43%) of them were diagnosed as ROP amongst which (50%) of them were having stage 1 ROP, (33%) stage 2, (15%) of them were having APROP. 22.5% of them had risk factors among them PIH (40%), anaemia (30%) were common. Conclusions: Incidence and risk factors are high in rural area compared to urban, so all premature infants should be screened thoroughly