Indian Journal of Clinical and Experimental Ophthalmology

3-7

Authors: Jagriti Rana,S P. Singh,Mimansaa Agasti*

Thyroid Eye Disease (TED) or Thyroid Ophthalmopathy or Grave’s Ophthalmopathy is the single most common cause of bilateral proptosis in adulthood. It is associated with orbital involvement in 25-50% of patients and 5-10% of patients may develop serious complications like compressive optic neuropathy improved motility and inflammation. The characteristic clinical signs may include a combination of eyelid signs, lid lag, globe lag, proptosis, restrictive extraocular myopathy and optic neuropathy. Werner’s classification is helpful in summarizing the clinical classification of Grave’s Ophthalmopathy. Various diseases such as myasthenia gravis, orbital myositis, CPEO etc mimic thyroid eye disease and its important to know how they can be differentiated. Finally blood investigations and imaging studies are very helpful in endorsing the clinical signs and help one arrive at the diagnosis. Since various medical and surgical management is amenable to us, establishing the correct diagnosis of TED is extremely important. This disease may have sight threatening complications, if not diagnosed on time, therefore, it is important to know the clinical signs of TED. The management is conservative most of the times and a better understanding of the immunological pathogenesis may propel the medical management of the disease in a different direction.

12-15

Authors: Pooja H.V*,Subrahmanya Bhat K,H T T Venkate Gowda

Purpose: To correlate dry eye status with the duration for which the patient has been diagnosed with type 2 diabetes and severity of retinopathy. Materials and Methods: A prospective study was done involving 384 patients aged above 45 years with Type 2 Diabetes Mellitus of duration more than 5years. A detailed history was taken and ocular and systemic examination was done. Diabetic retinopathy changes graded according to ETDRS classification. Dry eye status was evaluated with TBUT, Schirmer’s test, Fluorescein and issamine green staining of ocular surface and graded as mild, moderate and severe dry eye. Diagnosis was established by positivity of one or more of the tests. Results: The prevalence of dry eye among the diabetics was found to be 19%. Out of them, 93.15% had mild dry eye and 6.85% had moderate dry eye. The prevalence of mild dry eye was 42.86% in those who had DM for more than 20 years duration. The prevalence of mild dry eye among PDR was found to be 66.67%. Conclusion: There was statistically significant positive correlation between the dry eye and duration of diabetes and severity of retinopathy. Early treatment of dry eye should be initiated in dry eye positive individuals in order to prevent potential corneal complications.

20-22

Authors: Sudhir Sudhakar Pendke,Akshay Rajeshwar Padgilwar*,Saud Gafur Deshmukh

Aim: To study the prevalence of diabetes mellitus in common ophthalmic diseases such as glaucoma, cataract and retinopathy. Materials and Methods: This cross sectional, observational study. The study was conducted in a tertiary eye care hospital. Patients with diseases of glaucoma, cataract and retinopathy in this study. Thorough eye examination was carried out in outward patient department at Tertiary eye care hospital. Examination was carried out in ophthalmology department with slit lamp examination, distant direct opthalmoscopy, fundus examination with the help of direct opthalmoscope, indirect opthalmoscope and slit lamp with 90D tonometry with help of applanation tonometer. First anterior segment examination was done with the help of slit lamp, and applanation tonometer after thorough examination of anterior segment, posterior segment was thoroughly examined. Pupils of patients were dilated with the help of Tropicamide 0.5% with Phenylepherine. After full dilatation of pupil fundus examination was done after 30 mins. The patients were evaluated for diabetic retinopathy and findings such as microaneurysm, dot and blot hemorrhages, venous dilatation, intraretinal microvascular aneurysm, neovascularisation at the disk, neovascularisation elsewhere, hard exudates, macular edema were noted. Results: Are during this study a total of 856 patients were included in the study. There were 42% male patients and 54% female patients. Out of 856 patients 75% were affected with cataract, 70% with retinopathy, and 58% with glaucoma. Prevalence of diabetes mellitus in glaucoma is 18.50%. Ocular disorders without diabetes mellitus in patients with cataract is 54.6, in retinopathy is 3.05% and in glaucoma is 11.56%. Conclusion: we then came to the conclusion that one of the most potential risk factor for eye diseaqses is diabetes mellitus. There were most strong association of diabetes mellitus in cataract and glaucoma.

27-29

Authors: Rajasekar Mohan Metri,Amrutha A M*,Vijayalakshmi M,Ashwini K G,Ganashree C P

Introduction: Corneal transplantation is a sight restoring procedure that enhances the recipient’s quality of life. The number of corneal transplants which were done is very low when compared to requirements in India. This is largely due to the inadequate number of corneas collected. Nursing staff can influence eye donation rates. Materials and Methods: A cross-sectional study was conducted among 59 nurses of Basaveshwara Medical College and Hospital, Chitradurga in July 2018. Primary information was collected by interview technique by using a pre-tested semi-structured questionnaire. The data was analysed and presented in simple proportions. Results: Among total 59 nurses, 36 (61%) were aged 21 to 30 years and 18 (30.5%) were aged between 31 to 40 years. Study participants had good knowledge regarding eye donation. 89.8% nurses were willing to donate their eyes. On the whole nursing staff had good attitude towards eye donation. Conclusions: The nursing staff have good knowledge and attitude towards eye donation. Still further research on attitude of nurses and other professionals on good amount of sample and also better health education programs regarding the organ/eye donation process.

35-39

Authors: Rajni Sethia,Palvee Menon*

Aim: To analyse 24 hour variations of central corneal thickness in glaucoma suspects. Materials and Methods: 130 glaucoma suspects were hospitalised and underwent circadian evaluations. Total 6 readings of CCT were recorded over a 24-hour period: Immediately after waking up, 8 am, 11 am, 2 pm, 5 pm, & 8 pm. CCT was measured using an ultrasonic pachymeter. Results: Mean CCT measurement at each time point: Immediate after wake up: 549.21 um; 08 AM: 548.97 um; 11 AM: 545.82 um; 2 PM: 544.41 um; 5 PM: 544.34 um; 8 PM: 543.65 um. The mean CCT was highest just after wake up with a slight decline throughout the day without any statistical significance in both groups (p>0.05). Conclusion: The mean CCT was found to be highest just after wake up in the right eye and at 08:00 AM in left eye with steady decline throughout the day with statistically significance. The average variation in CCT was less than 1.92% in patients with suspected glaucoma from wake up to 8:00 pm.

44-47

Authors: Jitendra Kumar,Jyoti Sharma*

To see the effectiveness of topical anesthesia; topical proparacaine 0.5% versus xylocaine (Lidocaine) gel 2%, during cataract surgery. This Prospective study was carried out in Ophthalmology department, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, for 6 months from Oct. 2017 to March 2018’to evaluate the patients and surgeon’s satisfaction at the end of the procedure. Total 100 number of patients (100 eyes) were included in the study, divided into, Group A receiving Xylocaine Gel 2% as topical anaesthesia and Group B receiving proparacaine 0.5% as topical anaesthesia patients were properly explained about the procedure. All 100 surgeries were conducted by single surgeon and same method of surgery was used in all patients i.e. phacoemulsification with foldable intraocular lens implantation. No patients had severe pain in either group during the procedure; 6% (3 of 50) required use of adjunctive peribulbar anaesthesia in Group B while only 2% (1 of 50) required additional peribulbar block in Group A satisfaction rate for both surgeon and patient were high. There was no eye movement and blepharospasm related problems and no serious complications occurred. Rate of vitreous loss due to posterior capsule tear/rupture was none. Topical anesthesia is a satisfactory and safe alternative to peribulbar block and xylocaine gel 2% has same effectiveness as topical proparacaine 0.5% for cataract surgery by phacoemulsification and IOL implantation.

52-57

Authors: Thokchom Arun,Kamson Anthony*

Aims and Objectives: To clinically evaluate the prevalence of dry eyes after manual small incision cataract surgery based on signs and symptoms and, quantifying them using various test methods. Materials and Methods: Follow up of 150 patients who had undergone SICS was done at regular interval starting at 1st week post-operative and continued up to 3rd months. Evaluation is done by performing Schirmer’s test – I, TFBUT, Rose Bengal test followed by noting the symptoms which were relevant to the dry eyes. The observations were analyzed and graded according to the severity of dryness. Results: Most of the patients had mild to moderate dry eye with male domination the female. Severe to very severe dry eyes was seen at 6th post-operative week, mild to moderate dryness of eyes was seen at 2nd & 3rd. weeks. Conclusion: Dryness of eyes is usually seen after small incision cataract surgery and majority being mild to moderate dryness of eyes. Worsening or aggravation of dryness occurred in 6th week’s post-operative interval. Post-operative management of cataract surgery should also include medication to deal with altered ocular surface tears film.

61-65

Authors: Kshama Popat*,Radhika Natarajan

Purpose: To study the role of collagen crosslinking (CXL) of donor corneal tissue in preventing recurrence of infection after therapeutic penetrating keratoplasty (TPK). Materials and Methods: This was a prospective, clinical, interventional case study done from May 2016 to July 2017. 15 cases and 15 controls were enrolled in the study. Patients who had infectious keratitis and needed TPK were included in the study. Pediatric patients, one eyed patients, perforated ulcers, patients with limbal/scleral involvement or posterior segment involvement or any other significant co-morbidity were excluded. In patients who were enrolled as cases, donor cornea was subjected to CXL using modified Dresden protocol just before TPK. TPK was done as per standard protocol. 3 cases and 2 controls had lens removal and required vitrectomy. All cases and controls were assessed post operatively on day 1, day 7 and 1 month post operatively. Digital slit lamp photos were taken at each visit for documentation of recurrence of infection, if any. The patients were followed up for at least 3 months duration. Results: Etiology was fungal in 13 cases and 2 cases were culture and smear negative. Among controls, etiology was fungal in 10, mixed bacterial and fungal in 1, acanthamoeba in 2, microsporidial in 1 and 1 was culture and smear negative. Recurrence of infection was found in 2 cases and in 4 controls within 1 month of TPK (Odd’s ratio 2.36). Conclusion: CXL done on donor corneal tissue before transplantation has got a positive role in reducing recurrence of infection after TPK.

71-77

Authors: Niharika K Shetty*,Ramya Umarani

Introduction: Glaucoma is defined as an optic neuropathy characterized by specific structural findings in the optic disc. Glaucoma is the second commonest cause of blindness. |Elimination of glaucoma blindness is feasible when adequate measures are taken at all levels of services from the primary level to advanced tertiary level. Health care personnel can be effective in promoting the public awareness of glaucoma provided they have a fair knowledge of the disease. This study was conducted to evaluate awareness about glaucoma amongst the final year nursing students, who will be soon becoming health care personnel. Materials and Methods: All final year GNM and BSC nursing students of Sri Siddhartha nursing college willing to participate in the study were included. Closed ended questionnaire specific to Knowledge regarding glaucoma awareness were used. Awareness was evaluated in 4 aspects, regarding glaucoma disease per se, disease diagnosis, treatment modalities, and the social impact of the disease. It was a cross-sectional study for each batch of students. Ethical clearance was taken from the institutional ethical committee. Observations: In our study knowledge regarding the disease can be said to be fair knowledge among our participants (54.09%). The knowledge regarding the disease diagnosis was poor (42.85%). The overall knowledge regarding disease treatment was found to be Fair (53.58%), however many (8.19%), no responses were provided. Also the knowledge regarding the social impact of the disease was found to be Fair (52.86%). Conclusion: Lack of adequate knowledge regarding glaucoma related blindness, poses a challenge towards the control of this disease. We found the knowledge regarding the disease, treatment modality and social aspect to be fair knowledge regarding disease diagnosis was poor. More emphasis should be given towards dissemination of knowledge regarding the diagnosis of the disease .However there is scope of improvement in the knowledge aspects of treatment modalities and the social rehabilitative aspects of glaucoma in the paramedic seminars, workshops and educational symposias.

82-86

Authors: Rajni Sethia,Parin Mehta*,Vivan Desai,Aakash Patel,Shail Shah

Purpose: To assess quantitative changes of the macula after cataract surgery using optical coherence tomography (OCT) in diabetic eyes and to estimate the incidence of development of macular edema (ME) in type II diabetic eyes. Materials and Methods: In this prospective observational case control study, 100 eyes out of which 50 are of type II diabetic patients and 50 are non-diabetic patients who underwent phacoemulsification surgery with acrylic foldable IOL lens implantation were evaluated at post op day 1, day 7, 1 month and 3 months post operatively. Macular thickness as described in early treatment of diabetic retinopathy study (ETDRS) with OCT was evaluated in 9 zones. 4 patients developed DME at 1 month after surgery and were withdrawn from further analysis. Result: The mean central foveal thickness of the diabetic group preoperatively was 231.06±38.785µ. The increase in central foveal thickness was statistically significant at 1 month postoperatively (p=0.004). The mean perifoveal thickness changes in the inferior and temporal quadrants was also statistically significant at 1 month postoperatively (p=0.002). However, the overall change in macular thickness was found to be insignificant at 3 months postoperatively. The incidence of diabetic macular edema was found to be 8%. Conclusion: We found that after uncomplicated phacoemulsification, changes in macular thickness as measured by OCT was without any significance.

91-94

Authors: Kshama Popat*,Kamal Dodia

Purpose: To study post-operative outcomes of phacoemulsification in 25 cases done by senior resident. Materials and Methods: This was retrospective, interventional study done after obtaining written informed consent from patients. Any patient having immature cataract (up to Grade 3 nuclear sclerosis) and operated by same senior resident for phacoemulsification were included in study. Patient with brown and mature cataracts and any ocular co-morbidities were excluded. A detailed history and examination of visual acuity and best corrected visual acuity (BCVA) for distance and near, anterior segment with slit lamp biomicroscope and posterior segment with direct/indirect ophthalmoscopy was done and cataract was graded. Phacoemulsification was done by divide and conquer technique in all cases. Patient was examined on 1st post-operative day, 1 week post-operatively and 1.5 months post-surgery for BCVA, corneal edema, iridocyclitis, intraocular pressure (IOP) and endothelial cell count (ECC). Visual recovery, duration of full recovery, resolution of corneal edema and iridocyclitis, rise in IOP, count of endothelial cells after surgery were analyzed. Results: All patients got BCVA ? 6/9 at final follow-up, no patient had residual corneal edema or iridocyclitis after 2 weeks. One patient developed IOP rise due to steroid response which was controlled medically. There was 11.6% loss of ECC at final-follow up visit. Conclusion: Divide and conquer method of phacoemulsification is safe in beginner’s hands with no significant difference in long term visual outcomes, however recovery takes long time compared to experienced surgeon.

102-104

Authors: Sheetal*,P Anuradha

Objective: To analyze the various causes of facial nerve paralysis and its ocular complications (which can lead to permanent loss of vision) in our hospital. Design: Prospective study. Materials and Methods: A sample of 32 patients with facial nerve paralysis who attended our hospital for one year from October 2016 to September 2017 were taken for the study. A thorough neurological and ENT examination was done for all cases. Visual acuity, extra ocular movements, Bell’s phenomenon, fluorescein staining of cornea, slit lamp examination and fundus examination was done for all cases. Results: 22 cases were due to Bell’s palsy (68.75%), 5 case were due to complication of mastoid & parotid surgery (15.62%), 3 cases were due to trauma (9.375%) , one case was congenital (3.125) and one case was due to diabetes (3.12%). Only 10 cases (31.25%) showed corneal staining (exposure keratitis) of which only 3 cases required lateral tarsorrhaphy (9.375). Conclusion: Most common cause of isolated facial nerve paralysis was found to be Bell’s palsy. Most common ocular complication was exposure keratopathy and rarely corneal ulceration.

108-113

Authors: Ravindra Banakar,Shruti Muddebihal*

Purpose: A retrospective study conducted to evaluate the profile of patients with conjunctival and epibulbar lesions who underwent surgical excision with or without ocular surface reconstruction. Setting: This study included 126 patients of either sex diagnosed to have benign and malignant tumors of conjunctiva, eyelid and orbit who were subjected to excision biopsy. Materials and Methods: A retrospective chart review of all patients treated between 2009 to 2015 was done. Only those patients whose clinical diagnosis was confirmed by histopathology examination were included. Results: Of the 126 patients 66(552.38%) were males and 60(47.62%) were females with mean age 40.77 years (1-80years). In a total 126 patients conjunctival tumors were found in 46(36.50%), lid lesions in 53(42.06%) and orbital lesions in 27(21.42%).

118-120

Authors: Chaitra Pujar,Shivakumar Hiremath*,Vidya Rudrappa Gadag

Aim: Pseudoexfoliation (PEX) could alter the tear secretion and unstabilize it by modifying the cell morphology in conjunctiva. Abnormalities of tear secretion and tear film have been assessed that can occur in eyes with PEX syndrome as compared to normal eyes. Materials and Methods: A prospective non-randomized study consisting of Group 1 with 60 eyes of 30 normal subjects without PEX material on lens as controls and Group 2 with 60 eyes of 30 patients with PEX material in both eyes as cases were taken. Exclusion criteria included patients with ocular surface disorders, PEX glaucoma, previous ocular surgeries, long term use of eye drops and adnexal abnormalities. Tear functions were assessed by, Schirmer’s 2 test and tear break-up time (TBUT). Results: The mean age in group 1 was 64 years and group 2 was 62 years. There were 14 males and 16 females in group 1 whereas 20 males and 10 females in group 2. Average of Schirmer’s and TBUT in group 1 were 24.02mm and 15.65s respectively, whereas in Group 2 they were 11.6mm and 7.8s and difference was clinically significant. Among the eyes with PEX, 54.2%of cases had PEX material in both zone 1 and zone 3. 30.8% of cases had only in zone 1 and 15% had only in zone 3.Hence 69.2% of cases had PEX material in zone 3. The average mydriasis in eyes with PEX was 5.2 and in eyes without PEX was 6.5. Conclusion: PEX syndrome alters tear film stability and decreases tear secretion.

127-130

Authors: Ram Kumar,Sarswati*

Introduction: There are 1.5 million blind children (corrected visual acuity <20> Aims and Objective: Purpose of this study is to evaluate foldable hydrophilic and hydrophobic acrylic IOLs implantation in pediatric cataract surgery and to know the incidence of complication in both groups. Materials and Methods: it is a randomised prospective study over a period of one year and collection of patients done in outpatient Department of Ophthalmology at BRDMC, Gorakhpur. Results: The study has been carried out on 40 eyes of 27 patient with pediatric cataract divided into two groups (n=20) each group patient undergone phacoaspiration, primary posterior capsulotomy, and anterior vitrectomy by single surgeon with implantation of hydrophilic and hydrophobic iols respectively after one year study we found that The incidence of complications are more in hydrophilic iol than in hydrophobic iol like percentage of PCO was 80% and 20% (p<0>0.05, insignificant). So our study concluded that hydrophobic iols are better than hydrophilic iols.

134-137

Authors: Mohan Kumar H,Sangeetha Jayakumar,Kanthamani Krishnappa,Chirra Reddy Gari Meghana*,Borra Harish Laxman

Aim: To study the ocular manifestations in cerebral venous thrombosis. Materials and Methods: We report a case of a 25-year- old married woman who presented to medical emergency with frank per rectal bleeding and later after two days complained of blurring of vision in both eyes and binocular diplopia. On probing the patient, she also gave history of on and off headache since 6 months. Results: MRI Brain with Venogram was suggestive of intracranial hypertension and non-occlusive thrombus in bilateral transverse and sigmoid sinuses. Conclusion: CVT should be kept in mind in any patient with acute onset of diplopia with papilledema or cranial nerve involvement. Acute blood loss with severe anaemia can precipitate CVT. Imaging modalities like MRI with venogram should be the investigation of choice in all cases of CVT.