Indian Journal of Clinical and Experimental Ophthalmology

398-401

Authors: Sujithra H, Manoj Prathapan, Meenakshi Dhar, Vandhana Sundaram.

Introduction: Determining prevalence of glaucoma in patients with obstructive sleep apnea syndrome (OSAS) could be meaningful from public health point of view in Indian scenario, given that only few studies are reported so far. Aim: To study the prevalence of glaucoma in patients with OSAS. Materials and Methods: This was a prospective, observational study carried out between June 2014 and June 2016 in a tertiary care hospital. The study enrolled patients who were diagnosed with OSAS by the overnight polysomnography, depending upon inclusion and exclusion criteria. The included patients underwent complete ophthalmological evaluation including visual acuity, intra-ocular pressure, slit lamp examination with biomicroscopy, gonioscopy, indirect ophthalmoscopy, automated perimetry and optical coherence tomography. Results: A total of 34 patients diagnosed with OSAS (28 male; mean age 53.94±14.34 year) were included in the study. Among 34 patients, 16 patients had severe, 13 had moderate and 5 had mild OSAS, respectively. Of the 34 patients included in the study, 10 patients had glaucoma (n=5 primary open angle glaucoma and n= 5 preperimetric glaucoma) with prevalence of 29.4%. There is no correlation between severity of OSAS and mean deviation (r= -0.062; p=0.73), pattern standard deviation (r= -0.024; p=0.89) and retinal nerve fibre layer thickness (r= 0.057; p=0.751). Duration of OSAS negatively correlated with RNFL thickness (r= -0.736; p<0.001). Conclusions: Our study demonstrated high prevalence of glaucoma in patients diagnosed with OSAS in Indian scenario. However, further large scale studies are required.

405-411

Authors: Premnath G, Adnan Mohamed M, Manoj Vasudevan, Swathi.

Introduction: Glaucoma is a disease which is asymptomatic in early stages and invariably results in blindness. The inadequacy in awareness among common people which gives rise to non-diagnosis or late diagnosis has been highlighted by various studies worldwide. This study is conducted to evaluate and compare the level of awareness and knowledge among the employees of a medical college and tertiary care hospital. Methods: 750 employees of a tertiary health care institution were involved in this cross sectional study to evaluate and compare the level of awareness and knowledge about glaucoma. Data were entered in Excel work sheets and SPSS 9.2 was used for analysis. Results: Valid responses from 698 participants, including 308 males and 390 females were evaluated. 19.2% staff have not heard about glaucoma out of which 74.2 % were non-medical staff, 18.1% were allied medical staff, 3.1% were dental staff and 0.9% were medical staff. All four groups varied in their responses pertaining to the knowledge of glaucoma. All the results were statistically significant (p<0.009 to 0.001). Conclusion: All employees except medical staff are poor in glaucoma awareness and all staff have poor knowledge of glaucoma which is variable among the different categories. It is inevitable for medical college employees to be aware of glaucoma. Augmentation of awareness and the knowledge of glaucoma among these personnel is the need of the hour.

416-418

Authors: Jyothi P., Sandhya S., Bindu.

Aim: To assess the intrasubject variability of CCT,IOP and VCDR in patients with POAG compared to normal. Design: Cross sectional study. Materials and Methods: A total of 100 eyes of patients on treatment for POAG and 100 eyes of normal individuals were included in the study. All patients underwent a complete ophthalmological examination including CCT corrected IOP, visual field by HFA and disc evaluation using 90D assisted slit lamp biomicroscopy. CCT was measured using ultrasonic pachymetry in all of them. The difference in IOP, Vertical CD ratio and CCT were compared between the two eyes in POAG patients and in normal individuals. Results: The mean difference in IOP was 3.52±3.8 in POAG group compared to 1.06±0.9 in normal .The mean difference in CD ratio was 0.132±0.15 in POAG compared to 0.05±0.07 in normal. The mean difference in CCT was also significantly higher in POAG patients. [8.10±7.4] when compared to normal individuals [5.05±5.17].

422-427

Authors: Pallamreddy Sree Lakshmi, G. Chandrasekhar, C.S. Sandhya.

Background: Diabetic retinopathy was responsible for 11.1% of new cases of legal blindness in all the age group and 19.1% of those in 20-64 years age group. The detection of pre-proliferative and proliferative diabetic retinopathy can prevent the complications if these patients are appropriately treated by photocoagulation of the ischemic retina. This study is meant to determine the role of F.F.A. in detection of diabetic retinopathy changes in diabetic patients. Methods: The present study was conducted for a period of two years. A hospital based cross sectional study of 100 eyes of 50 patients with diabetic retinopathy consisted of detailed anterior segment, and fundus examination clinically with FFA. Each angiogram was studied for the number, size and location of aneurysms, size and shape of foveal avascular zone and type of leakage. Result: The mean age of the patients was 55.65 years, the youngest was 21 years old and the eldest was 80 years old. 30% of total eyes were found to have micro aneurysms only, 20% of eyes were found to have moderate NPDR changes, IRMAS were found in 6% of eyes, 4% of eyes with ischemic maculopathy which was identified only through FFA. 30% of eyes with very severe NPDR turned out to PDR changes by FFA. Conclusion: In this study, we were able to identify the role of FFA in differentiating the lesions and assessing severity of characteristics like capillary loss. The procedure was useful in identifying subtle changes, which are otherwise difficult to appreciate by ophthalmoscopy, like, the number of micro aneurysms and their localization in different areas of fundus, and their size.

436-439

Authors: Arun Kumar Ayoor, Ranjini Kotancheri, Aligar Babu C, Swathi K

Introduction: Diabetes mellitus is emerging as a multisystem disease culminating in various complications especially to the ocular system if not treated at the earliest. The role of various comorbidities in aggravating the severity of diabetic retinopathy is sparsely studied. This study was performed to throw light at this aspect of the need for early identification of comorbidities and its role in progression of diabetic retinopathy. Methods: Study was conducted among 257 diagnosed type 2 diabetic patients with various grades of retinopathy as classified based on ETDRS classification. Clinical history and comprehensive systemic and ocular examination was done and laboratory profile of serum lipids and blood sugar values were collected. The analysis was carried out using SPSS software and results presented in percentages and p value <0.05 taken as significant. Results: 257 patients were studied with a mean age of 58.8+/- 10 years. Male female distribution 129:128. There were 221 non proliferative diabetic retinopathy, 33 proliferative diabetic retinopathy and 3cases of advanced diabetic eye diseases. The study group had 48.6% smokers, 40.5% hypertensives,13.6% coronary artery disease and 45.5% with serum lipid >200mg/dl. Present study revealed a positive association of retinopathy with hypertension (p value 0.034) and smoking (p value 0.002). Conclusion: Comorbidities associated with Diabetes mellitus were contributing to worsening of diabetic retinopathy. Hence the need for prompt identification and control of these should form a part of the routine management of any stage of diabetic retinopathy to prevent sight threatening complications.

444-449

Authors: Rajni Sethia, R N Kothari, Vivan Desai, Aditya Desai, Anjasi Patel.

Introduction: Vernal keratoconjunctivitis is a seasonally recurring, chronic, allergic bilateral inflammatory disorder of the conjunctiva and cornea caused due to immune mediated hypersensitivity reaction. Tacrolimus is an immunomodulator which induces suppression of T lymphocytes activity and causes reduction of ocular inflammation. Hence, in our present study we aim to evaluate the efficacy of 0.1% tacrolimus eye ointment as first line therapy in the management of Vernal Keratoconjunctivitis. Materials and Methods: This was a clinical, prospective and interventional study including 100 eyes of 50 patients with VKC which were serially selected. 0.1% tacrolimus eye ointment was instilled twice daily over a period of 12 weeks. On every fortnightly follow up, patients were assessed for 5 symptoms and 4 signs and the severity was graded as 0 (normal), 1+ (mild), 2+ (moderate), or 3+ (severe)in order to evaluate the efficacy of the drug. Results: There were 50 patients with VKC comprising of 41 males and 09 females. After treatment with Tacrolimus 0.1% eye ointment, there was statistically significant improvement in symptoms of VKC including itching, redness, photosensitivity, foreign body sensation and mucus discharge (P<0.001). Significant improvement in clinical signs of VKC including conjunctival hyperaemia, papillary hypertrophy, giant papillary conjunctivitis and limbal involvement (P<0.001) was seen at the end of the study. No significant adverse effects of tacrolimus were seen in these patients. Conclusion: Topical 0.1% tacrolimus eye ointment is very effective in the treatment of Vernal Keratoconjunctivitis with minimal long term side effects.

454-457

Authors: Hitesh Vyas, Mitul Patel.

Introduction: Cornea is anterior transparent layer of eye and important for image formation. Keratitis (corneal inflammation) and resulting corneal ulcer is important clinical challenge in ophthalmology. Prompt treatment requires identification of organism involved. Insight regarding types of organisms involved, patient demography, antibiotic sensitivity greatly helps in better patient management. Materials and Methods: Patients with clinical diagnosis of ‘Corneal ulcer’, attending Department of Ophthalmology GMERS Medical College, Gandhinagar were selected for this observational study. Total 79 patients were studied. Detailed history and ocular examination were undertaken for each patient. Corneal scrapings from corneal ulcer were taken for pathological and laboratory study to identify type of organism and its antibiotic sensitivity. Data was arranged in tables for analysis. Diverse types of organisms and their frequency of occurrence was calculated. Patients were selected as per predefined criteria. Study recruitment was done after informed consent. Institutional ethics committee clearance was obtained. Discussion: Corneal ulcer is important and serious ophthalmic problem contributing to significant portion of total blindness burden in our country. Understanding types and varieties of organisms gives insight regarding local community conditions. Antibiotic sensitivity study gives accurate guideline regarding precise use of antibiotic thereby shortening treatment period and minimizing antibiotic resistance. Comparison about various similar studies were carried out to elucidate findings. Results: Patient demographics tables and graphs were prepared and analysis presented.

462-466

Authors: Sreelakshmi Kothapalli, Gopala Krishna Ogirala, Jithendra Kandati.

Aims: The purpose of the present study was to identify the common predisposing factors in the region and to identify the common bacterial agents associated with bacterial keratitis and outcome of the condition with regard to individual pathogen. Settings & Design: A prospective hospital based cross sectional study for a period of two years at a tertiary care hospital by the department of ophthalmology in association with department of Microbiology. Material & Methods: 350 patients above >5 years attending the OP of dept. of ophthalmology with clinical signs and symptoms of Bacterial keratitis were enrolled. Demographic data, duration of illness, clinical signs and symptoms were noted. Corneal smears and scrapings were collected by following standard protocol, and were transported to microbiology laboratory for processing and isolation of pathogens. The isolated pathogens were identified by standard biochemical tests and microbiological procedures by following CLSI guidelines. Results: 350 cases of bacterial keratitis with 200 males and 150 females were enrolled as cases, 26-45 years was the most common age group in the study. 31.1% were farmers, 52% belong to low socio economic status. 60.6% had a history of previous injury or surgery to the involved eye. History of corneal injury with paddy husk was noted in 60.57% of cases which was a major risk factor. 315 cases forming 90% of all cases were positive for growth. Staphylococcus aureus was the dominant isolate in the study. Aspergillus niger and Candida albicans were the fungal isolates in the study. Conclusion: Bacterial keratitis is one of the serious ocular conditions which require emergency care and management. Corneal injury remains as the major risk factor and associated ocular disorders, contact lens usage are other risk factors. Old age, anterior chamber infiltration, long duration of illness was associated with significant risk of poor visual outcome in the study. Any programmes directed against this condition should focus on the above factors in prevention of bacterial keratitis and to prevent complications.

470-475

Authors: Rohit Saxena, Poonam Kishore, Sandeep Saxena

Cataract is one of the most important curable causes of blindness in India. Nowadays although the ‘cataract surgery of choice’ is phacoemulsification; manual small incision cataract surgery (SICS) has emerged as an alternative technique owing to its being cost-effective and having all advantages of a self-sealing sutureless incision but with the disadvantage of having higher postoperative astigmatism. The aim of our study was to compare the surgical outcome using two different incision sites – “superior and temporal” in terms of surgically induced astigmatism. After taking Informed consent all the patients were divided randomly into two groups. Group S received Superior incision and group T Temporal incision. All surgeries were performed under peribulbar anesthesia using an incision size of 6 – 6.5 mm. The incision architecture was kept same in both the groups. Postopratively patients were examined on days 1, 7, 30, 45 and 90. Keratometry with Uncorrected and Best corrected visual acuity was recorded on subsequent visits. The surgically induced astigmatism (SIA) was calculated by Vector method. When SIA was compared between the two groups, both in magnitude as well as axis, the change was found to be lower in temporal group as compared to superior group S. It was statistically significant (p=0.004). We therefore conclude that though both the groups had good postoperative visual acuity patients of group S had more postoperative and surgically induced astigmatism and therefore greater dependence on spectacles as compared to group T and this was found to be statistically significant.

480-484

Authors: Soumya Ramani, Thanuja G P, Divya D Sundaresh.

Aim: To analyze the intraoperative complications and postoperative outcome during cataract extraction in traumatic cataract. Methods: A retrospective analysis of all the traumatic cataracts presenting at M.S. Ramaiah Medical College Hospital during the period between January 2011 and December 2015 was done. A total of 41 traumatic cataract cases were seen during the 5-year period. Age, Sex, traumatic sequelae, surgical strategies, intraoperative complications and post-operative outcome were reviewed in all eyes. Results: Records of forty-one patients with traumatic cataract were analyzed. Males accounted for 90.24%, while females, for 9.76%. Thirty-five patients (85.36%) underwent surgery for traumatic cataract. A history of blunt trauma was elicited in 23(56.09%) and 18(43.91%) had a penetrating trauma. It was noted that the presence of corneal changes or iris abnormalities, did not affect the visual outcome. Pupillary changes influenced the visual outcome, with100 % of the patients with a relative afferent pupillary defect and a fixed dilated pupil having a vision worse than CF3m. (p <0.005).Among the intraoperative complications, vitreous loss had a bearing on the post-operative vision. Twelve percent of the patients had a vitreous loss, all of whom had a vision of 6/60 or worse. (p=0.028). The presence of postoperative complications also affected the visual outcome-78.6 % of whom, had a vision 6/24 or worse.(p=0.05). Conclusion: Traumatic cataracts pose a challenge to ophthalmologists, as they have an increased incidence of associated ocular abnormalities and intraoperative complications. Hence, pre-operative counselling of the patient, astute surgical planning, careful surgical management and an intense post-operative follow up regime are imperative in the management of traumatic cataracts, to attain a reasonable visual outcome.

488-490

Authors: Surohi Shah, Hemaxi Desai, Sanjeev Prasad, Krupali Raol

Aim: To evaluate the relationship between the axial length and refractive error and peripapillary retinal nerve fiber layer (RNFL) thickness measured using Stratus optical coherence tomography (OCT) in subjects with high myopia. Materials and Methods: It was a prospective comparative observational study. Eighty eyes of 40 non glaucomatous subjects aged between 18 to 51 years with spherical equivalent ≥ -6 dioptres (D) were examined during a period of 3 years. All subjects underwent a full ophthalmic examination. OCT was performed with OCT model 3000 version 48 (Stratus OCT, Carl Zeiss Meditec Inc.) Total average, quadrantic & mean clock hour RNFL thickness was measured with the fast RNFL (3.4) (768 A-scans in 1.92 seconds) scanning protocol. The same procedure was performed for 80 emmetropic eyes of 40 age matched subjects of the control group. Statistical analysis was performed with SPSS (version 11.5, SPSS, Chicago). Results: Mean age of myopes was 28.4 years (SD +/-10.3). Mean spherical equivalent was -9.48125 (SD +/- 1.73), with mean axial length of 28.72 (SD +/-1.70). In the emmetropic control group, mean age was 26.9 years (SD 9.9) and mean axial length was 23.8 (SD +/-0.4). There was significant difference between axial length (P<0.0001) of the two groups. Mean average RNFL thickness in myopes was 73.27µm with standard deviation (SD) +/-19.33 µm. Mean average RNFL thickness in emmetropes was 98.5µm (SD +/- 12.9 µm). RNFL thickness decreased with higher axial length (overall r2=0.016, P> 0.05), but the correlation was not found to be statistically significant. No statistically significant associations were noted between mean RNFL thickness and age (r2 = 0.017, p > 0.05). Conclusion: High myopic subjects tend to have thin peripapillary RNFL as measured by Stratus OCT. This phenomenon should be considered when interpreting a glaucoma suspect's RNFL measurements compared with the normative database which may be misleading in such cases resulting in a substantial proportion of false positive errors. The variation in the normal population needs to be taken into account to distinguish a pathologically from a physiologically thin RNFL. Stratified normal databases are required for accurate diagnosis of conditions resulting in nerve fiber loss such as chronic glaucoma.

495-499

Authors: Shruti P Hegde, Machireddy R Shekarreddy, Mohan Ram Kumar, Vijay Kautilya D.

Introduction: Diabetic retinopathy is an important microvascular complication of diabetes mellitus & to prevent the vision loss resulting from it, regular screening & timely diagnosis are very important. This study attempts to measure the level of awareness about eye complications of diabetes among patients with type II diabetes mellitus & their knowledge about its effect on vision and the available treatment options. Methods: A cross-sectional hospital based study was carried over a period of 6 months at ophthalmology OPD of a medical college hospital. The data collected was tabulated and is presented here as descriptive statistics, frequencies and ratios. Results and Discussion: Among 100 patients included in this study only 36 patients were aware of eye involvement in Diabetes mellitus. Only 17 patients knew the need for eye checkup even when sugar levels are controlled. 68 patients were getting their eyes tested for the first time. The commonest cause for not getting regular eye checkups, other than lack of awareness, was difficulty in reaching the hospital & time constraints. Conclusion: In spite of increase in incidence of DM in India, the awareness about eye complications & retinopathy remains poor among the affected patients. There is a clear cut difference in perception, between the general diabetic care & eye care, among these patients. Physicians play an important role in referring the patients for eye checkup.

504-506

Authors: Vani Puri, Amit Sethi.

Purpose: Clinical relevance of ocular dominance [OD] lies in its role in success of monovision. This study aims to determine easy and reliable methods to test OD and association of OD with handedness. Methods: Prospective study of 300 patients, with best corrected visual acuity of 6/6, interocular difference of < 1Dioptre, and absence of any ocular, oculomotor or binocular abnormalities. Two subjective tests were done to determine OD - Miles [sighting dominance] and Fogging tests. Handedness was determined by history. Ambidextrous patients and those unable to understand or giving equivocal replies, were excluded. Kappa [k] statistics [inter test agreement], and Chi-Square test and Odds ratio [association between handedness and ocular dominance] were applied. Results: Mean age 35.28 years, spherical equivalent refractive error ranged +2 and -6 D. Both tests had perfect agreement [k=1]. 67.33% patients were Right Ocular Dominant (ROD) whereas 32.67% were Left Ocular Dominant. 65.67% had matched dominance of eye and hand. No significant association between handedness and ocular dominance. Conclusion: Mile’s and Fogging tests are reliable and easy to perform in clinical setting. Since no direct analogy could be established between patterns of eye – hand dominance, assumption of OD cannot be made on the basis of handedness. As 94.33% patients were Right Handed whereas 67.33% were ROD, the results could not be directly extrapolated in patients with dense cataracts where OD cannot be conclusively determined.

513-517

Authors: Charushila Gajapati, R.D. Kulkarni, Nishant N..

Aim: To identify the etiology, clinical profile, management and outcome of cases of orbital cellulitis admitted to a tertiary care hospital during a period of 2.5 years. Methods: A retrospective review of medical records of 24 patients with orbital cellulitis from January 2015 to July 2017 was conducted. The age, sex, duration of symptoms, predisposing factors, clinical findings, laboratory and radiological investigations, treatment provided and complications were recorded. Results were analysed with SPSS software. Results: Sinusitis was the source of infection in 41.7% patients, dacryocystitis, mucormycosis and unknown source in 12.5% each. Diabetes mellitus was the major comorbidity including 41.7% of patients. Cavernous sinus thrombosis developed in 25% of cases, 41.67% of patients recovered without any complications whereas 8.3% patients died. Conclusion: Orbital cellulitis is a potentially dangerous condition causing morbidity as well as mortality. Cavernous sinus thrombosis is a frequent complication. Early diagnosis and prompt treatment with proper antibiotics and / or timely surgical intervention can achieve good prognosis.