Indian Journal of Clinical and Experimental Ophthalmology

189-190

Authors: Rajendra P Maurya

Indian Journal of Clinical and Experimental Ophthalmology (IJCEO) is a refereed, peer-reviewed, indexed journal with academics and experts of repute as members of its Editorial Board. IJCEO publishes articles in the field of Ophthalmology and Vision science for a worldwide readership. It publishes original research papers, unusual case reportsand critical reviews dealing with all sub specialties of Ophthalmology like Pediatric ophthalmology, Neuro-ophthalmology, Ocular Oncology &Oculoplasty, CommunityOphthalmology, Oculartraumatology, Vitreo-retina and Cornea & refractive surgery etc. Special emphasis is given to issues that include new clinical trials, technical & surgical innovations and current ophthalmic updates, research activities and continuedmedical education in ophthalmic teaching.

197-201

Authors: Digvijay Singh, Sneha Aggarwal, Murli Manohar Sachdeva, Rohit Saxena

Background and purpose: Anisometropia and surgical monovision is likely to have a detrimental impact on binocular visual functions. This study evaluates the effect of induced monocular blur in the form of a refractive defocus on visual functions and binocularity. Methods: An experimental study was conducted on 30 young emmetropic adults. Monocular myopia and hypermetropia was induced using 6 plus and minus spherical lenses in steps of 0.5 Dioptre ranging from +/-0.5DS to +/-3.00DS. Visual Acuity (LogMAR), contrast sensitivity (Pelli Robson), binocularity (Bagolini striated glasses) and stereoacuity (near Randot, distance Randot and Frisby davis Distance) were evaluated at baseline and each level of refractive defocus. Results: Induced monocular myopic shift resulted in reduction of visual acuity to 0.94 log MAR while hyperopic shift reduced visual acuity to 0.1 log MAR. Contrast sensitivity did not show a significant reduction with optical blur. Hyperopic shift did not hamper gross binocular visiona unlike myopic shift where distance binocular vision was elicited only till a +2D defocus and near binocular vision till a +3D defocus. Near stereopsis deteriorated with both a hyperopic and myopic blur but was not completely lost and could be elicited even with the maximal blur. Distance randot stereopsis was lost on inducing a +2.5D blur while Frisby Davis distance stereopsis was lost at +3D blur. Induced hyperopic shift did not lead to an absolute loss of distance stereopsis. Conclusion: Binocular visual functions were significantly affected by induced monocular blur through a spherical refractive defocus. Induced myopic shift caused significantly more stereo acuity loss than induced hyperopia. Optical blur impacts distance stereoacuity to a greater extent than near.

218-222

Authors: Kamal Mohan Verma, M.P.Tondon

Background: A the most recent (1997) project estimates world blindness to some 45 million blind, and an additional 135 million visually disabled (those with low vision). About 90% of the world’s blinds live in the developing world. It is estimated that there are 9-12 million blind people in India which amounts for one- fourth of all the blind people worldwide. Objective: To evaluate the low vision patient, to improve the quality of life with low vision aids of visually impaired patient and rehabilitation of low vision aids as per the need of the patient. Material and Method: Total 110 patients were taken for the evaluation of low vision and its rehabilitation in various disorders. The patient underwent a comprehensive clinical low vision examination, functional evaluation, assessment of patients need and demonstration of low vision devices. Result and interpretation: Majority of the patient were between the age group of 10-29 years, that is, about 45.46% of the total patients in study and males were slightly more 60(54.54%) as compared to females 50 (45.46%).The most patients have BCVA for distance before giving low vision is 5/60 – 3/60 in 60(54.54%) followed by 6/18-6/60 in 25 (22.72%) and 2/60-PL positive in 25 (22.72%) which is improved up to 5/60-3/60 in 50 (45.45%) followed by 6/18-6/60 in 40 (36.36%) and 2/60-PL positive in 20(18.18%) after prescribing low vision aids. The BCVA for near before giving low vision aids is ≤ N/36 in 60 (54.54%) followed by N/12-N/18 in 40 (36.36%) and N/10 in 10 (9.09%) patients, which is improved up to N/10 in 55 (50%) patients followed by N/12-N/18 in 35 (31.81%) and ≤N/36 in 20 (18.18%) after prescribing low vision aids. Conclusion: The incidence of low vision is mostly underestimated due to lack of knowledge about this condition. By proper diagnosis and evaluation, low vision patients can be rehabilitated to perform their day to day activities thus improving their quality of life.

228-233

Authors: Ojha Sushil, Tandon Anupama, Sharma Reena, Sami Ifsa, Singh Sonali, Saraswat Neeraj, Shukla Dipendra

Objective: To study the profile of the VKC patients in central India. Method: Prospective cross sectional study includes 186 cases of paediatric age group (age less than 16 years) suffering from Vernal Keratoconjunctivitis. Both male and female children were included. The things assessed includes clinical features and course of disease like recurrence or increase in severity even after starting treatment. Results: The total number of 186 cases of vernal keratoconjunctivitis were studied. Mean age of the patients was 10.40 ± 5.78 years. Out of these 123 (66.13%) were male and 63 were female, with a male: female ratio of around 2. Male children presented at earlier age than female may be because of more care of male child in rural India than female child. All patients in the present study had bilateral involvement. Most of the children were from age of 11-15 years ( 120 patients, 64.52%), followed by 6-10 years (54 patients, 29.03%) and only 12 patients (6.45%) of age less than 5 years. The most common presenting complain was itching (160 patients, 86.02%), followed by redness (128 patients, 68.81%), watering (120 patients, 64.52%), ropy discharge (67 patients, 36.02%) and photophobia 963 patients, 33.87%). On clinical examination most common sign was papillae (140 patients, 75.27%), followed by muddy sclera(83 patients,44.62%), gelatinous limbal opacification with thickening( 60 patients, 32.25%), shield ulcer( 11 patients, 5.91%), and advanced glaucomatous optic atrophy (4 patients, 2.15%). The systematic comparison of present study with the study done by Stafeno Bonini et al in 2000. Conclusions: Vernal Keratoconjunctivitis (VKC) is chronic ocular surface inflammatory condition mediated by type I Hypersensitivity reaction. The inflammation is mediated by Eosinophils, Ig E antibody, non- Ig E mechanisms, mixed mechanisms, genetic mechanisms and age-sex related effects. The VKC has a good prognosis in early stages but in chronic recurrent disease blinding complications can occur due to corneal scarring and advanced steroid induced glaucoma. So, by knowing the regional natural history of the disease will help in early intervention and will help in preventing blinding complications. It is necessary to create awareness for proper management of VKC patients of central India.

238-244

Authors: Ojha Sushil, Jain Vaibhav, Sharma Reena, Singh Brijesh, Shukla Dipendra

Purpose: Macular thickness parameters in normal paediatric population of central India. Materials and Methods: This observational cross sectional study was conducted at UPRIMS AND R (Uttar Pradesh Rural Institute of Medical Sciences and Research) Saifai, Etawah to detect normative optical coherence tomography database for paediatric population in central Indian region. The total 70 of normal Indian children (eyes) after thorough ocular examination were enrolled from eye out patient department (OPD). The macular thickness was measured using cirrus high definition optical coherence tomography (OCT) Inclusion criteria · Children with normal 6/6 visual acuity, · Any child of any age 5- 17 years but cooperative for doing OCT Exclusion criteria · Children with strabismus or amblyopia · family history of glaucoma · any hereditary eye disease · history of intraocular surgery or any kind of laser therapy, · mentally challenged children with neurological, metabolic, vascular disorders, · other systemic disease possibly affecting the eye, presence of a media opacity, · best corrected visual acuity of less than 6/9, · hypermetropia more than + 3D, myopia more than –5D, or astigmatism more than 2D were also excluded. In most of the cases both eyes were examined, using OCT and selected for normative database calculation. We also further tried to analyse whether sex and different age subgroups had any significant difference or not. The subjects enrolled had no ocular problems. The children came for routine eye examination in Ophthalmology OPD or paediatrics OPD or brother of patient or cousin of patient were enrolled when they met the inclusion and exclusion criteria. The complete Ophthalmological examination was done in all children including BCVA (best corrected visual acuity), IOP (intraocular pressure by tonopen), anterior segment examination by slit lamp , assessment of squint by cover test, cover-uncover test and posterior segment examination under mydriasis with slit lamp using 90D or Indirect ophthalmoscopy. Dilatations of pupil were done with tropicamide 1% for posterior segment examination. If required cycloplegia was done using homatropine or cyclopentolate (1% or 2%).The macular thickness was then measured with OCT. The OCT machine used was Stratus OCT, software version 4.0.4, Carl Zeiss, Dublin, CA. Results: Demographics: 70 subjects consented for the study. Out of these 5 (7.1%) were uncooperative and scan could not be done in them. One(1) subject had leucomatous corneal opacity in the left eye. 12 (9.3%) scans out of 129 were excluded because of poor scan quality. So a total of 59 children (117 eyes) were included in statistical analysis there were 36 male and 23 females. Among the total children 28 children were between 5-10years age group and 31 were between 11-16 years age group.There was no statistically significant difference between male and female average macular thickness, despite having higher male in the study. (36 male and 23 female) Macular thickness: The mean central macular thickness was 243.26± 22.136 μm(range was from 183µm-290µm. The mean macular thickness in males was 241.97 ± 22.773μm (range 219-264μm) and that in females was 239.70± 23.092 μm(range 216-262 μm). There was no statistical difference in the CMT in between males and females. This data has been shown in fig:4 (histogram). In regression analysis, it was found that in between 5-10 years age group mean CMT was 238.96± 20.723 μm (range was from260 μm -218μm) and between 11-16 years age group mean CMT was 243.00± 24.576 μm ( range was from 267μm -218μm) but this had no statistically significant (P =0.0702) effect on macular thickness. The macular thickness was found to be greatest in nasal quadrant followed by superior, inferior and then temporal (table 1). Furthermore thickness was found to be more in the inner macular area (3 mm area). Conclusion: In conclusion we analysed the normative database on OCT for for macular thickness in paediatric age in rural population of central India. The macular thickness noted in our study is comparable to that than reported in literature. The data obtained from the study would help in OCT evaluation for macular disorders. The Study would further help in characterising OCT scan to be normal or pathological if it lies outside the 2 standard deviation obtained in our study in children of central India.

252-259

Authors: Malathi V.K, Ramya Chelliah, KR.Sowmiya

Introduction: Retinopathy of prematurity (ROP), is a vaso-proliferative disorder of premature infants, especially in those exposed to high concentration of oxygen. Aim: To analyse the outcomes of laser photocoagulation in ROP. Materials and Methods: This is a Prospective interventional study of infants admitted in neonatal intensive care unit (NICU), who were less than 1.5 kilograms weight, less than 32 weeks of gestation, and high risk preterm infants outside this criteria were also included. The infants examined were grouped according to whether they required follow up observation or 532 nm Nd:YAG laser therapy using indirect ophthalmoscopy. Results: 73(36.14%) babies had ROP. 17 (23.28%) required laser treatment. 14 (82.35%) babies treated with laser recovered whereas 3(17.64%) progressed. Conclusion: Pre threshold and threshold ROP, have responded very well to laser treatment, reinforcing the need for timely screening and intervention. The use of 532nm laser with good outcome in our study shows its efficacy which is comparable to diode laser.

264-272

Authors: Reena Gupta, Chekitaan Singh, Bella Mahajan, AK Khurana

Purpose: To determine epidemiological characteristics, specific pathogenic organisms, risk factors for infective keratitis. Methods: Patients with signs and symptoms of infective keratitis were included. History, examination including visual acuity, slit-lamp bio-microscopy, microbiological examination including Gram staining, KOH mount, culture, sensitivity of corneal scrapings were done. Results: Forty cases were evaluated, thirty (75%) were males, ten (25%) were females. Age ranged from 5 - 70 years, 35% in age group up to 30 years, 50% between 31-60 years, 15% were > 60 years of age. Right eye was involved in 55%, left in 45%. Highest incidence of ulcers occurred in farmers and labourers (65%). History of trauma was present in 80% patients, ocular surface disease in 7.5%. Diabetes was present in 12.5%. 57.5% patients had hypopyon on presentation. Based on culture reports 62.5% had bacterial keratitis, 25% fungal keratitis and 12.5% sterile. 80% bacterial isolates were gram positive and 20% gram negative. Staphylococcus aureus(40%) was the commonest organism cultured followed by Staphylococcus epidermidis(32%), Pseudomonas(12%), Pneumococcus(8%) and Acinetobacter(8%). Aspergillus was isolated in 60% of cases and Fusarium in 40%. Gram positive isolates were maximally sensitive to Cefazoline, gram negative isolates to Gentamicin. Conclusion: Males in rural agricultural population in economically productive age group are most vulnerable to infective keratitis. Culture on blood and chocolate agar detects more number of organisms compared to Gram stain alone. Staphylococcus aureus was the most common bacterium and Aspergillus most common fungus isolated. Cefazoline and Gentamicin combined cover most bacterial isolates.