Indian Journal of Clinical and Experimental Ophthalmology

118-121

Authors: Divya N., Kanmani K..

Background: Increased body mass index has been found to be associated with microvascular as well as macrovascular complications of diabetes. Factors like insulin resistance, hypertension and dyslipidemia, are found to be strongly associated with elevated BMI and obesity; which in turn contribute to microvascular changes leading to the development of retinopathy. The objective is to study the association between Body mass index and the severity of retinopathy in patients with type 2 diabetes mellitus. Methods: This study will be conducted in the Department of ophthalmology at Saveetha Medical College and Hospital, Thandalam. All diabetic patients above 30 years of age whose fundus can be visualized will be taken for the study after taking informed consent. A total of 100 patients will be included in the study. Results: With increasing severity of retinopathy the proportion of patients contributing to highest tertile of BMI rises. Non-Diabetic (22.75±3.82), No Retinopathy (23.21±4.86), Mild Retinopathy (23.79±4.87), Moderate Retinopathy (27.9±6.77), Severe Retinopathy (28.21±7.12). Conclusion: This study observed a positive association of BMI with increasing severity of retinopathy. Larger studies keeping in mind the role of genetic predisposition and race might help in determining the role of body mass index in diabetic retinopathy.

125-127

Authors: Hari Ramakrishnan, Suseela B. Nair.

The present study is undertaken to assess the awareness of diabetic patients regarding the effects of diabetes on the eye, particularly diabetic retinopathy, among diabetic patients. The study was conducted among diabetic patients attending the Medical Outpatient Department. 100 patients were given a questionnaire which contained a sequence of questions related to their hospital visits, financial status, educational status, profession and current knowledge on diabetic retinopathy. 85 patients responded that they underwent ocular examination only if they had specific ocular complaints. 66 patients were aware that diabetes can affect eyes. 60 patients were aware that diabetes can be a cause for blindness. Only 56 patients knew that the risk of retinopathy increased with the duration of diabetes. 53 patients were unaware that retinopathy in its advanced stages was irreversible and that the resulting blindness is permanent. There is lack of awareness regarding diabetic retinopathy among diabetic patients. The health education programs organized to spread awareness regarding the complications of diabetes in the eye and need for periodic eye examination have not been optimal and more effective awareness programs are required.

132-137

Authors: Dongre Manoj B..

Aim and Objective: To study relationship between ARMD and risk factors. Methodology: A total sample size of 4000 patients above 60 years attending ophthalmology OPD of center were enrolled in the study. The data collection was done by using predesigned pretested questionnaire. A detailed history of selected subjects was recorded in relation to demographic information, family history, dietary habits, details of smoking and systemic problems, focused mainly on DM, hypertension and cardiac problems. All the patients selected for the study according to criteria for AMD subjected to detailed ocular examination with visual acuity; IOP measurement, slit Lamp biomicroscopy, direct and indirect ophthalmoscopic examination, Amsler grid test and fundus photography as needed. Results and Conclusion: Age, occupation, smoking and co-morbidity with hypertension, diabetes mellitus, family history of AMD and cardiovascular disease showed statistical association with AMD. In the study; sex, place of living, education, socioeconomic status, diet, BMI, cataract surgery, lens opacity, iris colour and refractive error showed no statistically association with AMD.

142-146

Authors: Dhaval Patel, Harsha Bhattacharjee, Shriya Dhar, Divakant Misra, Eknath Pawar.

Aim: To study the association of serum uric acid level with age related macular degeneration, if any. Materials and Method: In this hospital based, observational, case control study, 100 patients presenting to our out patient department over a period of one year were included. The selected participants were grouped into the ARMD group which included 50 eyes with non neovascular ARMD and neovascular ARMD) and 50 eyes in control group. All participants were undergone complete ophthalmic evaluation along with serum uric acid level determination. Results: 50 eyes of 50 patients diagnosed as having AMD and 50 eyes of 50 patients do not having AMD who served as a control were included in this study. The mean age was 66 years (49-85years). On an average higher serum uric acid were observed amongst males as compared to females (median: male vs female kruskal Wallace test H=22.5, DF=1, p<0.001).The average serum uric acid level were higher in patients with neovascular AMD (mean=505.00 ± std dev =13.57 mmol/l, n=19), than in the non-neovascular AMD (mean=322.93 ± std dev =26.26mmol/l, n=31),as compared to control group =318.42 ± std dev =76.23 mmol/l,n=50). On comparing the standardized serum uric acid level between neovascular AMD and control group, there was a statistically significant difference was observed. (H=40.734, DF=1, p<0.001). Conclusion: A statistically significant correlation exists between serum uric acid level and severity of age related macular degeneration. Patients with neovascular age related macular degeneration present with a higher serum uric acid level as compared to patients with non neovascular age related maculae degeneration. Also, males had a significantly higher serum uric acid level as compared to females.

150-153

Authors: Minu Ramakrishnan, Saba Kausar, Mayur Agarwal.

Objectives: To compare endothelial cell characteristics & corneal thickness between diabetic and non-diabetic population. Materials and Methods: This was a prospective, non-interventional, cross sectional study where 200 consecutive patients with diabetes mellitus and 100 controls were examined. Complete medical history was taken and ophthalmologic examination was done, including best corrected visual acuity tested by Snellen’s chart, intraocular pressure using applanation tonometer, slit-lamp examination, endothelial cell count and morphology (using non-contact specular microscopy) and central corneal thickness and binocular indirect ophthalmoscopic fundus examination. Patients with diabetic retinopathy were graded according to Early Treatment Diabetic Retinopathy Study (ETDRS) study. Data obtained was grouped and analysed. Results: The mean endothelial cell count in diabetic group was significantly lesser than that in the control group. (p=0.000). Also a reduction in the mean percentage of hexagonal cells was seen in diabetic group. (p=0.000) Whereas the mean corneal thickness in diabetic group was found to be more than that in the control group. (p=0.000). And we also found that there was a significant increase in the mean coefficient of variation in diabetic group as compared to control group.(p=0.000) Conclusion: The mean endothelial cell count is significantly lower in diabetics as compared to non-diabetics. The mean corneal thickness and also the mean coefficient of variation in diabetics is higher than the non-diabetics, but the mean percentage of hexagonal cells in diabetics is reduced.

159-162

Authors: Harsha Bhattacharjee, Hemlata Deka, Ronel Soibam, Kasturi Bhattacharjee, Dinakumar Yambem, Diva Kant.

Context: Endogenous cortisol profile in patients with central serous chorioretinopathy (CSC) is controversial. Hence this control study was conducted to evaluate endogenous cortisol levels in CSC patients. Aim: To evaluate endogenous cortisol levels in patients with CSC and to correlate it in different stages of the disease. Settings and Design: Prospective, interventional case control study. Materials and Methods: 40 cases of CSC were included in the study and 30 cases with acute, unilateral, sudden, painless loss of vision of recent onset were taken as controls. Serum cortisol estimation was done between 8am to 9am by chemiluminiscence method. Resolution of CSC was assessed based on clinical findings, Fundus fluorescence angiography (FFA), indocyanine green angiography (ICG) and optical coherence tomography (OCT). Statistical analysis: ‘Z’ test was used to test the significance of the means of serum cortisol level between the control group and the CSC group on the first visit and Paired ‘t’ test was used to test the significance for the difference of means of serum cortisol level on the 1st, 2nd and 3rd visits of the CSC group only. Regression analysis was done to test the population correlation coefficient of cortisol in the CSC group. Results: Mean age of the cases was 35.9 + 3.77 years and all were male. Mean 8 am serum cortisol level was 12.33 + 3.87 µg/dl in cases during the first visit and 13.33 + 4.28 µg/dl in the control group. It was within normal biological range in both the groups. Difference between mean serum cortisol in each group was statistically insignificant (P = 0.83). Difference of mean of serum cortisol levels estimated during 3rd and 6th months’ follow-up in cases was also not statistically significant. But population correlation coefficient detected a strong positive correlation (+0.655) between serum cortisol levels and CSC cases at each examination visits during the 3rd and 6th months’ follow-up. Healing of CSC was independent of cortisol levels. Conclusions: CSC was found to be associated with normal endogenous cortisol level. Serum Cortisol level at 8am was within the normal limit, both in the test and control groups. But a strong positive (+0.655) correlation between serum cortisol levels and CSC at each follow-up visits during the time the disease was active indicates the relationship between serum cortisol and CSC aetiopathogenesis at the biological level.

166-172

Authors: Kalpana Kumari, G. S. Titiyal.

Aims & Objectives: To study the ocular manifestations in HIV/AIDS patients in terms of percentage of ocular involvement, pattern, relationship of ocular conditions with CD4 counts and visual deterioration by the same presenting to a tertiary care center of Kumaon region, Uttarakhand, India. Materials & Methods: Hospital based observational prospective, clinical study in which 400 HIV positive patients were examined at a Tertiary care centre, Uttarakhand (Sushila Tiwari Memorial Hospital) in terms of clinical examinations, relevant investigations, treatment and were documented. Results: 400 HIV positive cases were examined. The commonest systemic disease was pulmonary Tuberculosis (18%). In the study group, 28.5% of the cases had ocular involvement and, HIV retinopathy (9.2%) being the commonest HIV-associated ophthalmic lesion followed by Dry eye disorder (6.8%) & HIV microangiopathy (6.3%). Heterosexual route (89.7%) was the most common mode of transmission of disease in the patients examined. The correlation between CD4 level and ocular involvement was insignificant except in cases of HIV retinopathy (p value=0.001), HIV microangiopathy (p value=0.020) and CMV retinitis (p value=0.01). Conclusion: HIV retinopathy was the most common ocular manifestation encountered in our study with mild visual deterioration and good immune status of the patient (i.e., high CD4 count). Dry eye disorder and HIV microangiopathy are the next common lesions with varied degrees of visual affection and CD4 count range. There needs to be awareness of ocular involvement among HIV infected individuals and an increased emphasis on regular ophthalmic examination in all HIV patients for timely diagnosis of the vision threatening conditions.

177-179

Authors: Neeraj Sharma, Vandana, Pradeep Shinghal.

Aim: This study is designed to evaluate post-operative astigmatism induced by 3.2 mm temporal clear corneal incision phacoemulsification and compare it with astigmatism induced by temporal manual small incision cataract surgery (SICS). Materials and Methods: This retrospective study was conducted at a medical college and hospital, Gurgaon during academic session 2015 – 2016. The patients were divided into two groups. The patients allotted in group A were operated by temporal manual SICS technique to remove their cataract, whereas group B had temporal clear corneal phacoemulsification to remove their cataract. Best corrected vision and keratometeric values were recorded in Preoperative and postoperative period. Post-operative astigmatism was analysed by using SIA software (SIA calculator version 2.1 by Dr Saurabh Sawhney and Dr Ashima Aggarwal). Results: Mean post-operative astigmatism in group A was 1.08 (±0.55) D and in group B was 0.78 (±0.52) D after 1 month of surgery. At 1 month of follow up, post-operative astigmatism was comparable between the groups. Conclusion: Clinical outcomes of both surgeries were similar, as there was no significant statistical difference in the SIA at one month of follow up.

185-188

Authors: Dinesh P., Pranitha Prabhu, Sundip Shenoy, Pranessh Ravi, Mohammed Hafeez.

Background: Most of the times the oculomotor palsies are referred to an ophthalmologist from various other specialities, as they are often perceived as a sign of serious underlying pathology, like a compression of the oculomotor nerve resulting from an expanding aneurysm at the junction of internal carotid and posterior communicating arteries, one of the few emergency situation in neuro-ophthalmology, so every case has to be evaluated and its probable etiology identified. This study is done in a rural hospital emphasizing the need to identify the cause of the third nerve palsy for its early management. Method: The study was conducted in the Department of Ophthalmology, Adichunchanagiri Institute of Medical Science, B.G. Nagara, Mandya district, Karnataka, from November 2013 to July 2015. Thirty five cases of oculomotor nerve paralysis, presenting themselves directly to the ophthalmology outpatient department or referred from various other departments were studied and analysed. Observations and Results: Isolated oculomotor nerve palsy was observed in 74.28% and multiple cranial nerve palsy was observed in 25.17%. Microvascular ischemia 40% as an etiology was found as the predominant cause, which showed a good prognosis for the complete recovery in 31.42% cases. Conclusion: Predominant mode of presentation was isolated oculomotor nerve palsy, with microangiopathy as the major etiological factor, which has a good prognosis for complete recovery.

192-197

Authors: Debabrata Das, Somedeb Gupta.

Purpose: To evaluate refractive errors among school children with complaints of headache and to compare it with children without headache. Methods: This is a prospective cross-sectional study of 414 school children with complaints of headache, aged between 12 and 18 years and 414 children of same age group without headache as control group. Headache complaints were measured by a structured questionnaire. All children underwent a comprehensive ophthalmological examination. Both subjective and objective refraction was done for all children. They were classified into three groups according to refractive errors; myopia, hypermetropia and astigmatism. Results: The study included 252(60.87%) girls and 162(39.13%) boys with headache and 227(54.83%) girls and 187(45.17%) boys without headache as control group. Mean age of the participants was 13.71± 2.21 years in headache group and 14.45±1.96 years in control group. Among 228(55.1%) children in headache group with refractive errors, 28(12.3%) had myopia, 61(26.8%) had hypermetropia and 139(60.9%) had astigmatism. Out of 72(17.39%) children in control group with refractive errors, 48(66.7%) had myopia, 14(19.4%) had hypermetropia and 10(13.9%) had astigmatism. We observed that refractive error is a risk factor for headache among children with odds ratio 5.38 in comparison to control group and difference was statistically significant (p<0.05). Conclusions: This study enhances our understanding of the relationship of headache and refractive errors to improve opportunities for its treatment and prevention. An ophthalmologist can play a vital role in the control of headache complaints in school children.

202-206

Authors: Babitha V., Padma B. Parbhu, Nadhiya T., Raju K.V..

Purpose: Comparative studies of noncycloplegic automated refraction, cycloplegic automated refraction and cycloplegic refraction among youngsters are scanty. This study aimed to compare noncycloplegic AR, cycloplegic AR and cycloplegic refraction among patients between the age group of 5-25 years. It is a descriptive cross sectional study. Methods: Patients between 5 and 25 years with a visual acuity better than +0.3 logmar unit were included in this study. Noncycloplegic AR, cycloplegic AR and cycloplegic refraction were done for each patient. These results were compared. Results: The study group included 63 patients between the age group 5-25 years. 55.6% (n=35) were females. The mean age of the group was 12.62 years with SD of ± 4.28 years. The mean difference between cycloplegic and noncycloplegic AR was 1.09 D (SD ± 1.1), the mean value of difference between cycloplegic refraction and noncycloplegic AR was 1.11 D (SD ±1.26) and the mean difference between cycloplegic refraction and cycloplegic AR was 0.50 D (SD ±0.52). Conclusion: AR can be considered as a screening tool for refractive errors in youngsters but cycloplegic refraction is the gold standard for accurate measurement of the refractive status. Difference between pre and post cycloplegic AR is helpful in measuring accommodation of an individua

210-213

Authors: Amit Mohan.

separately or together. Here we evaluate the result of combined strabismus and scleral fixated intraocular lens (SFIOL) surgery. Material & Methods: 5 cases of combined strabismus and SFIOL surgery were reviewed to determine if there was increased risk of complications. Results: A review of these cases revealed there were no complications arising from the combined surgery and there were benefits in decreased time of hospitalization and operation, less psychological stress, improved strabismus surgical outcome and avoidance of staged surgery. Combined surgery provides benefit of no conjunctival adhesion . All patients were attained satisfactory ocular alignment within 10 prism dioptres of horizontal deviation with no overcorrection. Visual acuity was improved in all patients. Conclusion: Simultaneous extra ocular muscle surgery and SFIOL is effective and indicated in patients of aphakia with no capsular support and strabismus and good potential of visual acuity. Standard strabismus surgical amounts are recommended.

219-223

Authors: Natasha Radhakrishnan, Gopal S. Pillai, Shilna Babu.

Objective: 1) To analyse normative data from Ephios Handheld Electroretinogram. 2) To compare the obtained normative data with that of existing data of both handheld and table top Electroretinogram. Method: Electroretinograms was measured in 45 normal subjects in accordance with the International standardisation Protocol by ISCEV. The mean, median and standard deviation of each wave was calculated and these were compared with the results from other studies. The repeatability of handheld ERG was also tested by repeating the test in 10 subjects after 3days of first examination. Results: The mean b-wave amplitude of dark adapted 0.01 waves was 124.19 ±47.32uV and implicit time of b-wave obtained was 70.74 ±8.72ms.The average a-wave and b-wave amplitudes and implicit time obtained for dark adapted 0.01 b-wave was 167.16 ±39.3uV, 290.81 ±73.96uV and 18.37 ±2.37ms, 43.72 ±4.33ms. The same obtained for light adapted 3.0wave was 40.15 ±20.89uV, 130.95 ±37.89uV and 15.75 ±1.05ms, 33.41 ±1.99ms. The mean b-wave amplitude and implicit time for light adapted flicker was 114.61 ±32.96uV and 30.13 ±3.6ms. The values represent mean ±standard deviation. Conclusion: Handheld ERG is portable and fully integrated device. It is an easy to use, handy instrument, relatively inexpensive and can be used for testing both adults and children and in bedside patients. However, the use of handheld ERG has not become very widespread and hence normative data is not available. ISCEV recommends that each laboratory establish normal values based on its own equipment and patients. This study aims to bridge these lacunae in our knowledge.

227-230

Authors: Saji Nair A., Accamma Mamman.

Purpose: To evaluate the efficacy and safety of bandage contact lens in various corneal disorders. Methods: Bandage contact lens was applied to patients who required corneal re-epithelialization promotion or pain reduction in various corneal disorders from January 2002 to April 2004 at Regional Institute of Ophthalmology, Thiruvananthapuram. Informed written consents were obtained. Bandage contact lens was applied in the diseased eye. Lens centration and movement was assessed with slit-lamp. Patients were evaluated the next day and then on weekly basis for improvement of ocular condition or occurrence of any complication. After 1 week the lens was carefully removed and cleaned with antibiotic drops. The lens was discarded in case of spoilage or in an event of any complication .The patients were followed depending on their clinical case and usage was stopped on successful outcome. Patients were also put on topical medications according to the case. Results: Immediate pain relief was achieved in almost all patients. Complete corneal re-epitelialization was achieved in about a week. Two patients developed corneal edema and therefore had to discontinue the bandage contact lens. One patient did not tolerate the contact lens and left the study. Conclusion: The results showed that bandage contact lens was rather safe, efficient and performed well in treatment of various corneal disorders. However it should be used with caution and closely monitored for any complications.

234-238

Authors: Kamran Maqbool Hassan, Syed Ali Nasar Waris, S.V. Swamiraj, Syed Asghar Hussain.

Background: Ocular trauma is a major cause of preventable monocular blindness and visual impairment in the world. There is relatively less population based data on the magnitude and risk factors for ocular trauma, especially from developing countries. In an attempt to determine the pattern of ocular injuries in the region, this study was carried out. Methods: This retrospective study was conducted between April 2014 and March 2015 at the SRM MCH & RC, a suburban tertiary care hospital at SRM university campus. All available demographic data with ocular history and eye findings of the patients visiting the hospital during the study period were examined and recorded. Results: Of 20,376 patients seen during the study period, 729 had at least one form of ocular trauma or the other. 82.44% were males while 17.56% were females. Mean age of the study group was 26.71 ± SD 11.04 years (range from 5yrs to 70 yrs.). The younger population between 11-40 years were most affected, of which 47.05% were from age group, 21-30yrs, as in TABLE 1. 45.54% of the trauma cases reported on the same day of injury, i.e. within 24 hours. In our study, 48.69% had visual acuity of 6/6 - 6/12. The most common cause of injury is work place related, 38.41%. Road traffic accident (RTA) 26.34% accounted second most common cause of the injuries followed by Sports 11.52% as in Table 4. Conclusion: In this study, blunt eye injury was the most common type of ocular trauma. The community should be educated and informed about the importance of preventive measures.