Indian Journal of Clinical and Experimental Ophthalmology

118

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. The role of Ophthalmologyin society and, new findings from the frontiers of current researchare always encouraged.

124-129

Authors: Archana Sunil Nikose, Pradnya Mukesh Laddha, Ankita Mahendra Kabra, Bodhraj Dhawan

Aims: To compare the surgical outcome of modified external dacryocystorhinostomy (DCR) with conventional external dacryocystorhinostomy and to evaluate the symptomatic relief of epiphora by Munk’s score. Materials and Methods: A prospective, interventional, comparative study of sixty patients with chronic dacryocystitis. They were divided into two groups; one group underwent conventional dacryocystorhinostomy whereas another underwent a modified technique of anterior flap anastomosis. Follow up period was eighteen months and were evaluated on the basis of sac syringing and Munk’s score. Statistical analysis was done by chi square test. Results: The mean age of the patients in our study in group 1 was 52.5 ±9.45 SD years (range 40-68 years) and group 2 was 51 ±10.15 SD years(range 38-70years) [Table 1].The female patients were more in both groups. The mean surgical time in group1 was 60.47 min ±5.14SD minutes, and group 2 was 84.66 ±3.99SD minutes.Surgical success was defined on the basis of patency of sac on syringing and improvement in Munk’s score at the end of eighteen months. Conclusion: The modified technique is easier to perform and equally effective alternative method for dacryocystorhinostomy.

137-142

Authors: Rinky Saha, Prakash Kumar, Rajendra P. Maurya, Virendra P. Singh, Mahendra K. Singh, Rajesh Kumar

Aims & Objective: To compare the surgical procedures, intra-operative & post operative complications and overall success rate of Endoscopic Dacrocystorhinostomy (Endo-DCR) with External approach Dacrocystorhinostomy (DCR). Materials & Methods: In this randomized, interventional, comparative study, 50 cases of mechanical Endonasal Dacrocystorhinostomy & 30 cases of conventional External Dacrocystorhinostomy were performed from January 2006 to April 2007 in the department of Ophthalmology in conjunction with department of Otorhinolaryngology, Sir Sunder Lal Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh. All patients underwent detailed general, medical and ocular history as well as thorough ocular and ENT examination to rule out any nasal pathology. Level of blockage was diagnosed by lacrimal syringing & probing, Jones dye test and dacrocystography. Surgery was done under local anesthesia except in children and uncooperative patients where general anesthesia was used. For Endo- DCR surgery, 0 & 30 degree rigid endoscope was used. In selected cases silastic sheet were used. The surgical outcomes and complications were analyzed. Results: Functional success and symptomatic relief were equivalent in both procedures. Endo-DCR surgery was found to be quicker to perform than external DCR surgery. The follow-up duration was comparable in both groups. Patient satisfaction was significantly higher in the Endo -DCR group. Conclusion: Endo-DCR surgery offers a very attractive alternative to the well established technique of external DCR surgery for the treatment of primary acquired nasolacrimal duct obstruction with equivalent success rates, shorter surgical time and higher patient satisfaction.

149-155

Authors: Sushil Kumar Aggarwal

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. The role of Ophthalmologyin society and, new findings from the frontiers of current researchare always encouraged.

159-163

Authors: Mridula Prabhu, Anupama Kakhandaki, K R Pravin Chandra, Pramod

Aim: To assess the awareness and practices relating to diabetic retinopathy (DR) in diabetic individuals attending hospital and to report the results of KAP (knowledge, attitude, practice) study which would help in identifying the lacunae in promoting awareness and in improving the practice towards diabetic retinopathy. Design: Hospital based cross sectional study. Methods: This study was conducted on 200 diabetic patients who attended ophthalmology outpatient department (OPD) between Nov 2012 and Jan 2013 regarding their awareness relating to diabetic retinopathy. The study included a semi structured questionnaire based on demographic details, literacy levels, awareness of risk factors and management of diabetic retinopathy. Statistical analysis used: Chi Square test, Fisher Exact probability test, Odds ratios and Logistic regression analysis. Results: Among the 200 diabetic individuals attending our OPD, 145(72.5%) patients were aware of damage to eyes due to diabetes. Out of these 145 patients, 102(52.5%) knew that diabetes could cause a decrease in vision while 65(32.5%) attributed diabetes to total blindness. The mean age was 57.1 years, 124(62%) were males and 136(68%) were literates. 108(54%) patients knew that ocular damage due to diabetes was treatable. However only14 (7%) knew that good control of diabetes was important for prevention of visual impairment and13 (6.5%) knew about surgical options for treatment of DR. Only 31(16.5%) of diabetic patients were referred for an eye examination by the physicians. Conclusion: Our study highlights the need for more awareness camps regarding DR, its risk factors, treatment options and follow up. Role of physicians was alarmingly low in our study which needs to be stressed.

168-174

Authors: Chevuturu Madhavi, YJ Santhi Latha, Divya Pyaraka, M. Ashok Kumar

Aim: To analyze the visual outcomes and the intra and postoperative complications of manual small incision cataract surgery (MSICS) in patients with Pseudo exfoliation (PXF). Materials and Methods: The study included 76 eyes of 76 patients of the rural population in India with cataract and PXF who underwent MSICS surgery. The effect of the parameters like the dilatation of pupil during surgery, nuclear grading at baseline was studied with respect to the final visual outcomes and intra operative and postoperative complications of cataract surgery. The best corrected visual acuity (BCVA) at 4 weeks and 6 weeks after surgery were reported. Results: The mean age of the patients was 64.9 years and there were 44 males and 32 females. The BCVA ranging from 6/6 to 6/9 was seen in 44 (58.1%) eyes at 4 weeks and 46 (60.6%) eyes at 6 weeks. The visual outcomes were lower in patients with higher nuclear sclerosis (NS) of grade IV-V, poor pupil size (≤6 mm) compared to patients with NS I-III and good pupil size (>6 mm). Iris prolapsed 8 (10.9%) and posterior capsular rent 7 (9.2%) intra operatively and corneal edema 34 (44.7%) postoperatively that subsided within 1-2 days were the most commonly reported complications. Conclusion: MSICS technique in cataract patients with PXF is cost effective and is associated with good visual outcomes. Early diagnosis, proper preoperative and postoperative planning, knowledge and surgical skills of handling the possible complications can increase the success rate of cataract surgery in patients with PXF.

181-183

Authors: Rajendra P Maurya, Virendra P. Singh, Mahendra K. Singh, P.Jain, Abihjeet Kuwanr

Meibomian gland carcinomas are very rare and locally invasive eyelid malignancies. It has predilection for upper lid and mostly occurrs in elderly females. An unique case of recurrent mebomian gland carcinoma of lower eyelid is reported in a 54 years male. Tumor and full thickness lid was excised followed by lid reconstruction by Mastarde rotational flap. Histopathology report revealed moderately differentiated meibomian gland carcinoma. One year postoperative recurrence was observed for which patient was again advised for wide surgical excision followed by post operative radiotherapy.

187-188

Authors: Anupriya Singh, Ishan Yadav, Sujit Deshmukh, Rajendra P. Maurya, Shraddha Pandey

HELLP syndrome (hemolysis, elevated liver enzymes and low platelets) is defined as a severe form of preeclampsia which leads to maternal, fetal morbidities and sometimes even death. HELLP syndrome usually occurs in severe preeclampsia; but sometimes it may present with atypical clinical features. Bilateral, serous, non-rhegmatogenous retinal detachment is a rare complication in severe hypertensive disorders of pregnancy, in most of the cases serous detachment is associated with development of hypertensive retinopathy. Here we report a rare case of 24-year-old female who presented at 36 weeks of pregnancy with headache, and diminution of vision in both eyes. Two days after admission a proteinuria of 440 mg/24 h was detected. She had platelet count of 70,000/ cc 3 and elevated liver enzymes. However the patient had normal blood pressure. Her serum was creatinine normal. The patient required a platelet transfusion. Fundus examination revealed exudative retinal detachment involving inferior quadrant. No signs of hypertensive retinopathy were noted. Prompt recovery with good visual acuity occurred after the pregnancy ended.

1-2

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 reports and critical reviews dealing with all sub specialties of Ophthalmology like Pediatric ophthalmology, Neuro-ophthalmology, Ocular Oncology & Oculoplasty, Community Ophthalmology, Ocular traumatology, 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 continued medical education in ophthalmic teaching. The role of Ophthalmology in society and, new findings from the frontiers of current research are always encouraged.

10-17

Authors: Anukul Dixit, Ishan Yadav, Rajendra P Maurya, M. K. Singh, S. K. Singh

Aim: To investigate the visual and tomographic changes in patients undergoing pan retinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) with or without clinically significant macular edema (CSME). Methods: This was a prospective, interventional clinical trial including 78 eyes of 78 patients suffering from diabetic retinopathy (DR). All patients were divided into three groups based on the severity of diabetic retinopathy and presence of clinically significant macular edema (CSME). Laser was administered as per the ETDRS standards. Visual acuity (VA), Central macular thickness (CMT), HbA1c and other parameters recorded pre and post laser. Results: Mean BCVA decreases from 0.24 to 0.33 at one month (p<0.001) and improved to 0.27 (p>0.05) after 4 months in group 1. In group 2 mean BCVA improved from 0.57 to 0.44 at one month (p<0.001) and further improved to 0.39 at four months (p<0.001). In group 3 it deteriorated from 0.63 to 0.67 (p>0.05) but improved to 0.61 at four months (p>0.05). Mean CMT in group one increased from 235μ to 277μ (p<0.001) but decreased to 253μ (p>0.05). From group 2 mean CMT decreased from 379μ to 325μ at one month (p<0.001) and further decreased to 318μ at four months (p<0.001). In group 3 also mean CMT increased from 374 μ to 382μ at one month (p>0.05) and then decreased to 373μ (p>0.05). Conclusion: Laser photocoagulation still remains the gold standard treatment modality in cases of proliferative diabetic retinopathy (PDR) and in treatment of CSME.

25-30

Authors: Ishan Yadav, Rajendra P. Maurya, Prashant Bhushan, Mahendra K. Singh, Virendra P. Singh, Prithvi R.

Intraorbital foreign bodies are relatively rare and are often associated with vision threatening complications. Their clinical presentation and treatment outcome is variable depending on the size and composition of the foreign body. Metallic and inert substances like glass and plastic are relatively well tolerated but organic foreign bodies like wood is poorly tolerated and may lead to severe inflammatory reaction and secondary infection needing prompt surgical intervention. Although identification and removal of wooden foreign bodies is very difficult, we report this case for its unusual presentation, where a large intraorbital wooden foreign body presented with a disfigured scar of right upper eye lid, two years after road traffic accident. The foreign body was removed successfully without any complications.

37-40

Authors: Tarun Arora, Supriya Arora, Vijay Sharma

A 45-year-old male patient presented with necrotizing scleritis after 2 weeks of having undergone ptyregium surgery with bare sclera technique. Examination revealed a scleral thinning measuring 3 x 3 mm with anterior chamber inflammation. Lamellar scleral graft was dissected from the donor sclera and trephined to the approximate size of the scleral melt. Edges of the host scleral melt were freshened and fibrin tissue glue was used to attach the lamellar graft at the site of defect. Conjunctival autograft was simultaneously harvested from superior quadrant and attached over the bare sclera with the help of fibrin glue.Postoperatively the patient was prescribed high dose oral steroids along with topical antibiotics, steroids and lubricants. The patient improved symptomatically and showed good graft apposition.

60-61

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. The role of Ophthalmologyin society and, new findings from the frontiers of current researchare always encouraged.

68-75

Authors: Sujit Deshmukh, Shraddha Pandey, Rajendra P. Maurya, Mahendra K Singh, Virendra P Singh, Ishan Yadav

Background: Fungi can cause devastating ocular infections like keratitis and endophthalmitis; however, there are limited studies available on the epidemiology and risk factors of fungal ocular infections in Northern India. The aim of this study is to determine the epidemiology and factors affecting visual acuity in fungal keratitis, in population of Eastern Uttar Pradesh. Methods: All patients were reviewed for demographic features, predisposing factors, prior therapy, clinical features, microbiological findings, medical and surgical treatment, and outcome of therapy. For microbiological study corneal scrapings were taken by the Ophthalmologist using sterile blades. For the isolation of fungi, samples were inoculated on specific media and KOH mount were done .The identification of fungi was performed by microscopic evaluation and growth on specific media. Different epidemiological factors and risk factors were assed and compared to find association of risk factors to visual acuity in fungal keratitis. Results: Out of total 295 cases of culture-proven keratomycosis at our institute during the study period between June 2010 and March 2015, 254 cases were included in the analysis. In our study most of the patients (61.42%) were male, significant number of patients were from lower socio economic status (89.76%) and from rural background (91.34%). Illiteracy was one of the major factor was found in our patients (85.04%). 48.03% study subjects were having history of ocular trauma while 7.87% patients were Diabetics. Other factors responsible for poor visual outcome were patients age (age > 40 years in 66.15%), delayed Presentation ( > 7 days ,82.22% ), use of topical steroids (90.63% ) and TEM (80.00%), patients having infection caused by septate fungi (74.36%) , hypopyon (89.19%) and central corneal ulcer(78.74%) . Factors could not be assessed in 2 patients less than 1 year of age, so their visual acuity was not recorded. Conclusions: History of trauma, use of topical steroid, diabetes, lid margin disorders are major predisposing factors for fungal keratitis. Age > 40 years, steroid use, late presentation, central location of ulcer with hypopyon and use of traditional eye medication (TEM) were major risk factors for poor visual acuity with corneal opacity beung most common complication.

84-90

Authors: Manav Deep Singh, Chetna Sharma, Akhilandeswari Prasad

Background: Present definition of ‘Primary Open Angle Glaucoma’ considers raised intraocular pressure (IOP) as one of the risk factors for this disease. Association of alterations in ocular blood flow has been considered another risk factor, Moreover the eye being treated for glaucoma could be a part of wider systemic dysfunction of auto-regulation of ocular blood flow. This hypothesis is further backed up with the recognition of normal tension glaucoma as a clinical entity and observation of progressive glaucomatous damage despite IOP control. This study was, thus, undertaken to study retrobulbar blood flow using colour Doppler imaging (CDI) in patients of glaucoma and to see how the control of IOP affected these parameters. Methods: This is a prospective cohort study involving 43 freshly diagnosed patients of POAG and 30 controls. Peak systolic velocity (PSV) and mean end diastolic velocity (EDV) and resistivity index (RI) were studied in ophthalmic artery (OA), in central retinal artery (CRA) and short posterior ciliary arteries (SPCA). Values were compared with those of normal controls and also pre and post treatment among patients of POAG. Results: Mean PSV and EDV were found to be significantly low in OA and CRA only in patients of POAG compared to controls. Once target pressure was achieved, blood flow parameters were similar to non glaucomatous eyes. Conclusions: Blood flow in retrobulbar vessels is reduced among glaucomatous eyes as compared to the normal population. Once target pressure is achieved, blood flow parameters become similar to non glaucomatous eyes suggestive of improved blood flow as a function of reduced IOP. Colour Doppler imaging is not found to be reliable for measuring blood flow in SPCA. Role of RI as a true measure of resistance to blood flow is unclear.

95-99

Authors: Shreya Thatte, Anirudha D Gulanikar, Purvi Garg

Xeroderma Pigmentosa(XP) is an autosomal recessive disorder caused by defect in DNA repair mechanism which is induced by ultra violet rays . These patients have multisystem involvement (skin, eye, neurological and oral lesions with recurrent malignancy. Material and Method: It is a retrospective, observational study of 9 cases of xeroderma pigmentosa (XP) with ocular involvement. Presence of skin and ocular malignancy was the main feature. Skin malignancy diagnosed by histopathology showed squamous cell carcinoma of face, basal cell carcinoma of scalp and nose. Ocular malignancy diagnosed as squamous cell carcinoma and malignant melanoma. Cases with ocular malignancy presented with limbal nodule which was excised surgically along with application of intraoperative cyro and mitomycin C. Apart from ocular malignancy other ocular involvement was conjunctival melanosis and corneal scar. Impression cytology was done in all patients with ocular involvement. Observation: XP was seen more commonly in boys with age group of 5-25 years. Incidence of malignancy was the main feature in these patients. 5 patients had skin and ocular malignancies. Skin malignancy was observed in 2 patients in form of squamous cell carcinoma and basal cell carcinoma while ocular malignancy was seen in 3 patients in the form of squamous cell carcinoma in 2 patients and malignant melanoma in 1 patient. Other ocular feature like conjunctival melanosis was present in 2 cases and corneal scar was seen in 2 patients. Follow up was done up to 6 months to note recurrence of ocular malignancy. Conclusion: Early diagnosis of ocular malignancies is essential to plan treatment modality, which was done by impression cytology, accordingly mitomycin C and cryo was used to prevent recurrence.

104-106

Authors: Rohit Saxena, Digvijay Singh, Anuradha Chandra, Pradeep Sharma

Superior oblique palsy presents with a vertical and torsional deviation and diplopia which is often exacerbated by an ipsilateral inferior oblique over action. The usual surgical approach is defined by the extent of inferior oblique over action and/or vertical deviation and includes weakening of the ipsilateral inferior oblique muscle. If torsional diplopia outweighs the vertical component then, an antero-nasal transposition of the inferior oblique may be undertaken to correct both. We describe a novel surgical technique for adjustable antero-nasal transposition of the inferior oblique muscle for a residual torsional diplopia in one case of a superior oblique palsy.

110-117

Authors: Manav Deep Singh, Harshika Chawla

Centuries of research on Glaucoma have not been able to add any factor to ‘Intraocular Pressure (IOP)’ the modification of which can halt the progression of this blinding disease. Therefore, the need for accurate IOP measurement has always been the interest of researchers and industry. An array of instruments has, thus, been developed, each surpassing the errors of the previous modalities. Although all of them have certain advantages, they have their limitations too. The present article puts light on the various developments in the field of tonometry over two centuries starting digital tonometry to the latest developments. It has also briefly touched the factors affecting intraocular pressure and its measurement.