Anterior Segment Evaluation Research Articles

Study on buckling of intraocular lens haptic in 2 types of intraocular lens material and its effect on vision.

Aim: To study the buckling of intraocular lens (IOL) haptics and its effect on vision in patients implanted with either hydrophilic or hydrophobic lens material.Study design: Prospective, observational and descriptive study.Setting: Tertiary eye care center in India.Material and methods: Patients operated for age-related cataract by phacoemulsification technique implanted with hydrophilic or hydrophobic IOL came either for follow-up surgery or complaints in an operated eye, being examined for visual acuity, refraction, anterior segment evaluation, and retinal examination. The position of IOL in terms of optic and haptics was noted and photographed.Results: 317 patients participated in the study. The mean age (SD) of the patients was 65 years (± 4.5). Of 317 patients, 127 (254 eyes) had bilateral, and 190 (190 eyes) had one eye IOL implantation. Out of 444 eyes, 254 (57.2 %) had hydrophilic and 190 eyes (42.8%) had hydrophobic IOL implantation. Buckling of IOL haptic was seen in 37 (8.3%) eyes of which 34 (13.9%) had hydrophilic, and 3 (1.6%) had hydrophobic IOL. Maximum eyes (n=20) with hydrophilic IOL presented during 1-3 years after IOL implantation. Major complaint for which patients came for follow up was blurring of vision (48.9%) and diminished vision (36.3%). Posterior capsular opacification (PCO) was observed in 2/ 190 (1.1%) eyes with hydrophobic and 28/ 254 (11%) eyes with hydrophilic IOL.Discussion: The present study dealt with the long-term performance of the haptics of the hydrophilic and hydrophobic IOLs in relation to its stability in the capsular bag. Conclusion: Buckling of haptic was seen more in the hydrophilic than in the hydrophobic IOLs. PCO was common in these eyes. Change in refraction occurred in eyes with hydrophilic IOL with buckling.

Pre-retinal haemorrhage: A complication of anemic retinopathy in a patient of microcytic hypochromic anemia

A 20-year old Indian female reported dimness of vision in both eyes since 5-6 days. Her best corrected visual acuity [BCVA] in right eye 6/24 (OD) and left eye 6/6 (OS). Anterior segment evaluation revealed conjunctival pallor. An ophthalmological evaluation revealed bilateral hyperemic disc with venous tortuosity and arterial attenuation, Roth spots in entire periphery in both eye. Pre-retinal haemorrhage over macula in right eye and flame shaped haemorrhage around macula in left eye.Hematological evaluation revealed the presence of anemia due to heavy blood loss in menstruation(with haemoglobin~2.1 gm%). General examination showed severe pallor. Other causes of anemia have been ruled out. She was treated with blood transfusion of four packed cell volume[PCV]. This case documents the rare occurrence of anemic retinopathy in patient of anemia due to menorrhagia.

Congenital hypertrophy of retinal pigment epithelium presenting as incidental finding in a middle aged woman

Introduction: Retinal Pigment epithelial hypertrophy are uncommon benign, epithelial malformation characterised by typical fundus findings, which is almost always congenital in nature. RPE hypertrophy occurs in three varieties: unifocal, unilateral lesion; multifocal unilateral lesion; and atypical multifocal, bilateral lesion. While the atypical multifocal, bilateral lesions are associated with familial adenomatous polyposis syndrome & requires systemic evaluation the other two varieties have benign coarse & doesnot require any intervention. Case Report: A 42yr Female noticed diminished vision in R/E following trivial trauma with fingernail 14 days back, it was not associated with pain, redness or any other symptoms. On evaluation, BCVA was 6/18p, N6 R/E & 6/6, N6 L/E; rest anterior segment evaluation was normal. R/E fundus showed focal, 1 DD sized, well-demarcated, hyperpigmented lesion just temporal to fovea with blocked fluorescence in all phase of FFA. OCT & B-scan showed slightly elevated retinal lesion with optical shadowing. Diagnosis of Retinal pigment epithelial hamartoma (RPEH) was made. Lesion was documented & followed. Discussion and Conclusion: RPE hypertrophy are presumed congenital stationary retinal malformation with characteristic ophthalmic, fluorescerin angiographic & OCT features. These lesions present as asympotomatic incidental findings in childhood or adults with good visual prognosis if located at extrafoveal sites. Gass et al & shields et al had described various types of RPE malformations & their characteristic features in FFA & OCT. In present case, we have reported a rare case of RPEH & also demonstrated the role of ancillary tests for diagnosis & followup. Keywords: Congenital retinal pigment epithelial hypertrophy, RPE hypertrophy, Congenital retinal malformation.

Topical vs Peribulbar Anesthesia: Comparison of Anterior Chamber Depth and the Resultant Visual Outcome After Phacoemulsification.

PurposeTo compare anterior chamber depth and postoperative visual outcome in patients undergoing phacoemulsification under topical vs peribulbar anesthesia.Materials and MethodsProspective, randomized, comparative observational study.Sample size: 110 eyes with 55 eyes each. Group I: Patients undergoing phacoemulsification under topical anesthesia.Group II: Patients undergoing phacoemulsification under peribulbar anesthesia.Once patients were selected, baseline a standard ophthalmic examination was done including best-corrected visual acuity (BCVA), refraction, IOP by NCT, anterior segment evaluation with slit lamp biomicroscopy, keratometry, axial length, and ACD measurement by IOL master. Post-operatively, the patients were reviewed at day 1, week 1, week 6 for the same parameters.Statistics:Quantitative variables: Paired and unpaired t-test.Qualitative variables: Chi square test.A P-value of <0.05 was considered statistically significant.ResultsInter-group comparisons of post-operative change in ACD at 1-week post-op (P-value<0.001) and 6-week post-op (P-value<0.001) were statistically significant when compared to the pre-op values. The mean spherical equivalent in group I was 0.27±0.26 d and that in group II was 1±0.32 d at 1-week post-op. The mean spherical equivalent in group I was 0.23±0.20 d, while that in group II was 0.85±0.64 d at 6-week post-op. This difference was statistically significant both at 1-week post-op (P-value=0.002) and 6-week post-op (P-value<0.001).ConclusionPost-phacoemulsification, the ACD is more after peribulbar anesthesia as compared to topical anesthesia. Post-op refractive outcome is better with the use of topical anesthesia.

PREVALENCE OF DRY EYE IN PREMENOPAUSAL AND POSTMENOPAUSAL WOMEN: A HOSPITAL BASED COMPARATIVE STUDY.

Objectives: This present study was to evaluate the prevalence and severity of dry eye with respect to age in premenopausal and postmenopausal women.&#x0D; Methods: Visual acuity was assessed on Snellen’s chart and anterior segment evaluation was done with slit lamp biomicroscope. Ocular surface Disease Index (OSDI) questionnaire was completed and grading done. Dry eye evaluation was done with Schirmer I, by placing a special filter paper in the lower fornix and Tear film Break-Up time was done by an impregnated fluorescein strip moistened with saline which was instilled into the lower fornix.&#x0D; Results: 64(32%), 42(21%) and 35(17.5%) women were belonged in age group of 61-70 years, &gt; 7o years and 51-60 years respectively. dry eye was seen in 6(6%) premenopausal and 47(47%) in postmenopausal women. Higher prevalence of dry eye 29(45.31%) was seen in age 61-70 years. 11(26.19%) prevalence was seen in age &gt; 70 years. Premenopausal women had mainly 6(100%) mild dry eye. 22(46.81%) Postmenopausal women had 22(46.81%), 14(29.79%) and 11(23.40%) mild, moderate and severe grade of dry eye respectively.&#x0D; Conclusions: Dry eye was commonly seen in older age postmenopausal women. Premenopausal women had mainly mild dry eye. Postmenopausal women had commonly mild to moderate grade of dry eye. Hence, early detection of dry eye is important to arrest the progression of dry eye as well as to prevent the complications that can reduce corneal transparency and reduce vision. Environmental and behavioural modifications such as taking breaks while reading, keeping the computer monitors at eye level, use of UV protective glasses and humidification of the environment can be tried.&#x0D; Keywords: Dry eye, premenopausal, postmenopausal, age group

Assessment of the frequency and biochemical parameters of conjunctivitis in COVID-19 and other viral and bacterial conditions

Abstract Objectives We compared the laboratory and clinical symptoms of coronavirus disease 2019 (COVID-19), other viral (beside COVID-19), and bacterial conjunctivitis patients with the values of controls. Methods Twenty COVID-19, 15 other viral, 15 bacterial patients, and 15 control group were included in the study. COVID-19 was diagnosed with the real time reverse transcription–polymerase chain reaction while the indirect immunofluorescent antibody test was used in the detection of other viral agents. Bacterial agents were determined with the detection of the agent. The ophthalmologic examination of all cases was carried out by direct penlight, and the anterior segment evaluation was performed. The laboratory findings of all cases included in the study were obtained from the hospital records. Results It was determined that 5% conjunctivitis and 5% diplopia developed in patients diagnosed with COVID-19, 20% conjunctivitis developed in patients due to other viral agents, and 66.6% conjunctivitis developed in patients due to bacterial agents. Conclusion The incidence of conjunctivitis in COVID-19 patients was lower than in other viral and bacterial groups. Neutrophil/lymphocyte ratio and C-reactive protein come to the forefront as precious parameters with high specificity and sensitivity that might be useful to distinguish these diseases.

Evaluation of Intranasal Dexmedetomidine as a Procedural Sedative for Ophthalmic Examination of Children With Glaucoma.

This study evaluated 2 doses of intranasal dexmedetomidine (IND) (3.0 and 3.5 µg/kg) as a procedural sedative for postoperative examination of children with glaucoma. A dose of 3.5 µg/kg was more efficacious and obviated the need for repeated general anesthesia. This study was carried out to determine the safety and effective dose of IND as a procedural sedative for postoperative follow-up examinations after glaucoma surgery in children in place of repeated examination under anesthesia. In this prospective randomized double-blinded interventional study, consecutive children aged 6 months to 6 years were randomized to receive 3.0 and 3.5 µg/kg IND using a mucosal atomizer device in the preoperative area of the operating room, under continuous monitoring of vital signs. Intranasal midazolam 0.25 mg/kg was used as a rescue agent in case of inadequate sedation, and general anesthesia was administered in case of persistent failure. All infants underwent a complete anterior and posterior segment evaluation including intraocular pressure and corneal diameter measurements. A total of 30 and 31 children aged 23.9±15.0 and 19.2±10.1 months, respectively, received 3.0 and 3.5 µg/kg IND. Adequate sedation was possible in 18 of 30 (60%) children receiving 3.0 µg/kg and 24 of 31 (77.4%) receiving 3.5 µg/kg IND alone (P=0.17). In combination with midazolam, successful sedations were 86.6% versus 100%, respectively (P=0.052). One patient in the 3.5 µg/kg group had ventricular arrhythmia, reversed with dextrose-saline infusion and injection glycopyrrolate. IND appears to be a safe and effective procedural sedative for postoperative follow-up examinations of pediatric glaucoma patients at doses of 3 and 3.5 µg/kg. The dose of 3.5 µg/kg was successful in more children.

Comparison of astigmatism after phacoemulsification and extracapsular cataract extraction

Objective: To compare astigmatism after phacoemulsification and extracapsular cataract extraction technique. Method: It was a hospital-based cross-sectional study conducted at Zainab Medicare hospital Haroonabad from September 2018 to May 2019. A sample size of 80 patients having cataract, age 41 to 70 years was included in this study. Slit lamp examination was performed for anterior segment evaluation and astigmatism was determined with autorefraction and keratometry. Result: Phaco technique was more reliable. The means and the standard deviation of phaco post op astigmatism was 0.7860 ±.48880 and ECCE post op astigmatism was 3.6310±1.96236 which indicated that the degree of astigmatism increases after extra capsular cataract extraction technique. The significant level was 0.00 which showed that the phaco technique is highly significant. Conclusion: Corneal astigmatism was almost similar in two groups prior to surgery but after the cataract surgery the astigmatism significantly decreased after phacoemulsification group at 2 weeks follow-up, the results indicated that phaco may be considered superior to ECCE. No suturing is required in phaco and hence lesser chances of post op astigmatism.

Evaluation of macula in high myopic fundus using optical coherence tomography

: High myopia is a risk factor for a number of retinal pathologies. OCT is very useful in eyes with high myopia and allows the detection of subtle macular changes that are otherwise undetectable.To evaluate relationship between the axial length, refractive error and macular thickness in subjects with high myopia.Cross sectional observational single centric study. 50 diagnosed patients of high myopia(refractive error&amp;#62;= -6 dioptres and/or axial length&amp;#62;=24 mm) along with a control of 50 emmetropic patients were included. Patient’s anterior segment evaluation was done by slit lamp. Detailed fundus evaluation was done with indirect ophthalmoscopy and with +78 Dioptre lens along with measuring BCVA (Best corrected Visual Acuity). Axial length was measured using contact biometry. OCT was performed with TOPCON SD-OCT. Average macular thickness, central foveal thickness and total macular volume measured using 3D macula scan of all the cases and controls. Unpaired t test.The mean axial length was 27.40 mm among cases (SD±0.99) and 22.84 mm among controls (SD±0.422). The mean macular volume in cases was 6.90 and in controls was 7.82. The macular volume decreased with increasing axial length (ρ=-0.673) and increasing spherical equivalent (ρ=-0.035). The average macular thickness was inversely correlated with axial length (ρ=-0.605) and directly correlated with spherical equivalent (ρ=-0.049).The mean central subfield foveal thickness was 170.10 µm amongcases and 158.34µm among controls. The axial length and central foveal thickness were found to be positively correlated (ρ=0.727).Average macular thickness and total macular volume are inversely correlated to the degree of myopia, whereas central foveal thickness is positively correlated to the degree of myopia.

Clinical Features of Pseudoexfoliative Glaucoma in Treated Polish Patients.

PurposeThe aim of this study was to describe clinical characteristics of glaucomatous optic neuropathy in treated Polish patients with pseudoexfoliative glaucoma.MethodsIn the course of the study, 348 eyes of 231 patients with pseudoexfoliative glaucoma. The patients involved in the study were treated in the Department of Diagnostic and Microsurgery of Glaucoma in Lublin between 2012 and 2019. The following parameters were assessed in the examination: visual acuity, slit-lamp biomicroscopy with evaluation of anterior segment of the eye, gonioscopic examination, stereoscopic fundus examination of the eye, intraocular pressure, visual field, and pachymetry.ResultsThe mean age of all the patients was 73.16 years (SD±8.03). The mean age of women was 74.06 (SD±6.97), and the mean age of men was 71.8 (SD±8.51, p=0.006265). Women represented 37.93% (n=132) of the studied group, while men 62.07% (n=216). In the group of patients younger than 65 years of age, 27.9% were male and 15% female (p=0.0021). In the whole studied group, mean peak IOP was 29.25 mmHg with higher mean values in male patients (M vs F: 33.24 mmHg vs 26.86 mmHg; p=0.000). Peak values exceeding 30 mmHg were significantly more frequent in males (M vs F: 56.5% vs 31.9%; p=0.0000). Peak IOP never exceeding 21 mmHg was observed in 18.6% of the patients. The mean value of MD (Mean Deviation) was −12.85 dB in the whole group. The men were more likely to have more advanced glaucoma, according to MD (M vs F: −16.35 dB vs −11.13 dB; p=0.0000).ConclusionPseudoexfoliative glaucoma was more frequently observed in men with younger age, higher IOP, and more advanced glaucoma. Normotensive glaucoma was observed in 18.6% of the patients with pseudoexfoliative glaucoma.

A novel homozygous frameshift variant in the cellular retinaldehyde-binding protein 1 (RLBP1) gene causes retinitis punctata albescens.

Retinitis punctata albescens is a form of retinitis pigmentosa characterized by white fleck-like deposits in the fundus, in most cases caused by pathogenic variants in RLBP1 gene. The purpose of this work is to report the phenotypic and genotypic data of a patient with retinitis punctata albescens carrying a deletion in the RLBP1 gene. An 8-year-old Caucasian female has been complaining of nyctalopia for the last 2 years. No other ocular symptoms were present. No relevant past medical or familiar history was described. At clinical examination, the patient's best-corrected visual acuity was 20/20 in both eyes. Anterior segment evaluation and intraocular pressure were normal in both eyes. At fundoscopy, multiple punctate whitish-yellow fleck-like lesions were observed in the proximity of temporal superior and inferior vascular arcades. Scotopic electroretinogram demonstrated severely reduced rod response, without improvement or recovery of rod system function after prolonged dark adaptation. Blood DNA samples of this patient and from her parents were screened for causal variants in RLBP1, RDH5, and PRPH2. A probable pathogenic frameshift variant was identified in homozygosity in the RLBP1 gene with an autosomal recessive transmission as another cause of retinitis punctata albescens. This DNA variant will aid ongoing functional studies and add to our understanding of the molecular pathology about RLBP1-associated retinopathies.

Anterior Segment Analysis and Evaluation of Corneal Biomechanical Properties in Children with Joint Hypermobility.

Objectives:To compare anterior segment parameters and biomechanical analysis of the cornea in children with joint hypermobility (JH) and healthy children.Materials and Methods:Cross-sectional case-control study. Fifty eyes of 25 children with JH were compared with 74 eyes of 37 healthy age- and sex-matched controls in terms of refractive, anterior segment topographic, and corneal biomechanical measurements. Axial length (AL) was measured with a Nidek AL-Scan biometry device; corneal-compensated intraocular pressure (IOPcc), Goldmann-correlated IOP (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF) were measured with a Reichert ocular response analyzer (ORA). Central corneal thickness (CCT), anterior chamber depth (ACD), K1/K2 values, iris diameter, and anterior chamber volume (ACV) were measured with a Sirius topography device.Results:Mean age in the JH group was 10.56±4.03 years, while that of the control group was 11.27±2.59 years (p=0.23). Spherical equivalent was -0.22±1.02 diopter (D) in the JH group and -0.12±1.12 D in the control group (p=0.60); CCT was 23.01±0.82 µm in the JH group and 23.17±0.82 µm in the control group (p=0.33). There were no significant differences between the two groups in terms of age, sex, IOP, IOPcc, IOPg, CH, CRF, AL, K1, K2, iris diameter, ACD, and ACV.Conclusion:JH, which causes increased flexibility of the joints, was concluded not to cause a significant change in the corneal biomechanical markers of CRF and CH or in anterior segment topographic parameters.

Demographic and clinical profile of venomous snake bite-related ocular manifestations among the paediatric age group in a tertiary care hospital

Background: The children having high case fatality and working children (10-14 years) actually belong to the high-risk group of snakebite cases. There is a significant lack of knowledge of the clinical-epidemic profile of snakebite cases in the pediatric age group. Objectives: To determine the ocular manifestations as well as the magnitude of long-standing visual impairment following snake bite among the pediatric population. Methods: A prospective observational cross-sectional study was conducted on all the venomous snake bite patients admitted in the pediatric ward of our institution. Bed side ophthalmological evaluation initially by recording visual acuity, ocular position, extraocular movements and anterior segment evaluation were done. Response to treatment and the residual ocular morbidity were also recorded. The collected data were analysed using appropriate statistical methods. Results: A total of 124 patients were presented to the pediatric department and included in the study. It was observed that males (75.81%) are a more common victim of snakebite whereas lower limb (89.50%) being the common site of snake bite. Total no of patients: 15 (12.09%) patients had ocular manifestations, dimness of vision is the most common symptom of neurotoxic snake bite followed by ptosis, external ophthalmoplegia, diplopia, optic neuritis, and significant persisting visual impairment. Sub conjunctival hemorrhage (90.90%) being the commonest manifestation of vasculogenic snake bite followed by retinal hemorrhage, vitreous hemorrhage, lid edema, hyphema, anterior uveitis, and significant persisting visual impairment. Conclusion: Early treatment and close monitoring will help to reduce ocular morbidity. Health education to increase awareness about the hazards of snakebite, early hospital referral, and effective treatment will reduce the global burden of human suffering inflicted by this neglected tropical disease.

Observation and Epidemiology of Ocular Trauma in Children: Hospital based Study

Background: This study was designed to identify the causes, demographic, clinical profile &amp; classify the patients according to the ocular trauma classification group. Method: 60 children of age fifteen year or less, with ocular injury, who had presented to emergency services/out-patient department of the Regional Institute of Ophthalmology (RIO), IGIMS medical college &amp; hospital, Patna (Bihar) were included. Demographic data, nature and cause of injury, duration between injury &amp; presentation to the hospital and diagnosis were recorded. Evaluation of visual acuity, anterior segment and fundus was done. Results: Majority of injuries occurred in children 7yrs and older (64.7%). There were 50 (83.33%) boys and 10 (16.66%) girls. 40 (66.67%) of cases presented within 24hrs of the injury while 20 (33.33%) of cases presented after more than 24 hr after trauma. Rural patients comprised 39 out of 60 (65 %) while urban were 21 out of 60 (35 %). Most of the patients n=36 (60%) belonged to average socioeconomic status fallowed by low socioeconomic status n=20 (33.33%) &amp; high socioeconomic status n=4 (6.67%). Most of the children n=35 (58.33%) were in their primary school. The highest proportion of injuries occurred outside (eg streets, roads, playgrounds, schools) n=40 (66.67 %) followed by home n=20 (33.33%). Conclusions: Eye trauma in children occur most frequently outdoors. Early diagnosis, management and prevention of complications of ocular injuries can be possible by educating parents and children.

Outcome of Trabeculectomy in Early Primary Open Angle Glaucoma in Respect of Retinal Nerve Fiber Layer Thickness and Optic Nerve Head Parameters

Introduction: Glaucoma is the group of acute and chronic multifactorial condition where lowering IOP is the mainstay of the treatment in the patients, but despite of all effort progression of disease is inevitable. The prevalence of primary open angle glaucoma (POAG) in India is 1.62% and increasing with age, where 98.5% were not even aware of the disease. In our study, we assessed the outcome of trabeculectomy using retinal nerve fiber layer (RNFL) thickness measurements and clinical parameters. Material and Method: Twenty seven patients of primary open angle glaucoma undergoing trabeculectomy were included. Ophthalmological examinations including best corrected visual acuity, pupils and anterior segment evaluation, intraocular pressure, fundus and optic disc examination, perimetry and optic coherence tomography were performed preoperatively and 1 week, 1 month and 3 months postoperatively in each and every subject. Results: With mean age of 57.9 years, total of 18 male and 9 female patients were recruited. IOP was decreased by 43.85% from baseline but best corrected visual acuity was increased marginally after 3 months postoperatively. Optic nerve head parameters were improved significantly. Visual Field analysis showed that mean sensitivity and mean deviation were improved from 8.73±4.5493 and 19.044±4.6111 preoperatively to 9.859±5.5606 and 17.926±5.4928 dB postoperatively, respectively. Conclusion: Our data suggested that in early POAG, trabeculectomy provides good IOP control and clinical outcome with little complication rate under experienced hands.

Analysis of ocular trauma due to firecracker injury in oculoplasty clinic at a tertiary care hospital of North India

Purpose: To evaluate the spectrum of ocular injuries, clinical and demographic profile and management patterns following firecracker injury during three days of festive season of ‘Deepavali’. Materials and Methods: A hospital-based, retrospective study of 19 patients, who sustained ocular injuries following firecracker injury during three days of festive season of Deepavali from 28/10/19 to 30/10/19 visiting emergency department of SMIH, Dehradun. All the patients were attended in collaboration with on call ophthalmologists and plastic surgery burn unit team. Vision assessment was done using Snellen’s chart. Slit lamp examination including anterior segment evaluation and fundus examination was done in cases possible. USG B-scan and X-Ray orbit were done in cases required. Patients with severe injuries were advised admission and managed either conservatively or surgically. Surgical intervention included corneo-scleral tear repair and evisceration. Rest of the patients were treated on outpatient basis. Results: The firecrackers causing ocular injuries include Bomb in 37% cases, Flowerpot in 31.5%, Rocket in 21% and Sparkles in 10.5% cases. The spectrum of ocular involvement included periocular burns in 100% cases, corneal abrasion in 74%, corneal perforation and hyphema in 16%, lid and conjunctival laceration and globe rupture in 11%, and iridodialysis and vitreous hemorrhage in 5% cases. The devastating visual outcomes were seen in 10% cases. 89.5% cases underwent medico-legal consultation. Conclusion: Firecracker injury leads to physical and mental trauma to the patients. Adult supervision is very crucial while igniting firecrackers. Appropriate triage management and coordinated treatment was critical to ensure best possible patient outcome. Enforcement of legislations, health education and public awareness are essential in preventing this hazard to ocular health in country. Keywords: Ocular trauma, Firecracker injury, Medicolegal.

Retropupillary fixated iris claw lens -an option for aphakia management

Aim: To study visual and surgical outcome in aphakic patients after implantation of retropupillary fixated iris claw lens. Materials and Methods: Medical records of the patients operated in Bharati Hospital, Sangli for the treatment of aphakia by secondary retropupillary fixated iris claw lens from September 2017 to August 2018 were included in the study. The data collected included the preoperative best corrected visual acuity (BCVA), auto-refractokeratometry, anterior segment evaluation on the slit lamp and posterior segment evaluation done by indirect ophthalmoscopy after pupillary dilatation with tropicamide eyedrops. The patients were also assessed for lacrimal sac patency and Goldmann applantion tonometry for intraocular pressure (IOP). Intraocular lens (IOL) power was calculated by SRK-T formula in aphakic mode by immersion based biometry. At follow up i.e. day 7 and 1 month, findings of patients include in study were BCVA, slit lamp examination and auto-refractokeratometry. Results: 86.66% patients operated by retropupillary fixated iris claw lens had postoperative improvement in visual acuity as compared to preoperative visual acuity. Conclusions: Retropupillary fixated Iris claw lens is an effective method of aphakia management with good visual outcomes and easy learning curve. Keywords: Aphakia, Iris claw lens, Visual acuity.

Longitudinal study on ocular manifestations in a cohort of patients with Fabry disease.

PurposeThis study aims to assess the evolution of ocular manifestations in a cohort of Fabry patients.MethodsThis is a prospective observational study conducted from 2013 to 2017 (5 consecutive exams). All subjects underwent a comprehensive ocular examination including oriented case history, refraction, corneal topography, biomechanical corneal properties and pachometry assessments, aberrometry, anterior segment evaluation, double-frequency visual field (FDT), intra-ocular pressure, and ocular fundus. At baseline, 41 subjects enrolled but 9 dropped-out and 4 files were not kept for analysis (missing data). Remaining 28 subjects were classified into: Group 1 -hemizygotes (HMZ), all on enzyme replacement therapy (ERT) (N = 10); Group 2 -heterozygotes (HTZ) actively ERT-treated (N = 8), and Group 3 -HTZ not treated (N = 10).ResultsThere is a high intra and inter-subjects variability. At baseline, prevalence of the ocular manifestations found is similar to published data: cornea verticillata (89.2%), conjunctival vessels tortuosity (85.7%), corneal haze (67.8%), retinal vessels tortuosity (64.2%), anterior cataract (39.2%) and posterior cataract (28.5%). Prevalence for new elements are found: upper lid vessels toricity (96.4%) and micro-aneurysms (42.8%). At the end, micro-aneurysms (+82%), posterior cataract (+75%) corneal haze (+21%) anterior cataract (+17%) and retinal vessels tortuosities (+4%) evolved in prevalence and severity despite the fact that 68% of the patients were on ERT. Treated heterozygotes evolved more than other groups (p>0.05).ConclusionERT does not seem to halt the clinical evolution of several ocular manifestations. Longer observational time and objective grading systems may be required to fully confirm these findings.

Clinical evaluation of graded Anderson’s procedure in idiopathic infantile nystagmus

ABSTRACTAim: To study the efficacy of graded, bilateral, single, horizontal yoked rectus muscle recession for correction of anomalous head posture (AHP) in idiopathic infantile nystagmus (IIN). We hypothesize that the above procedure would sufficiently correct AHP in IIN.Methods: Case records of patients who presented with IIN and AHP due to eccentric null position were included in a retrospective study following IRB approval. Best-corrected visual acuity (binocular Snellen’s acuity for distance, in both null position and primary position), anterior segment evaluation using slit lamp biomicroscopy, fundus examination, ocular motility examination and stereopsis (using TNO for adults and older children, Titmus fly test for younger children) were recorded. In all cases recession of the yoke muscles was performed with a gradation of recession, depending on the initial head turn as elaborated in Table 1. AHP was recorded before surgery and 1 and 3 months after surgery. Visual acuity and stereopsis before and after surgery were recorded.Results: Mean AHP improved from 22.5 ± 6.12 degrees of head turn preoperatively to 7.58 ± 3.62 degrees at 1-month postoperative visit (p < .001). The mean binocular visual acuity improved from 0.47 ± 0.15 preoperatively to 0.25 ± 0.17 after surgery (p < .001).Conclusion: Graded yoke muscle recession based on the initial head turn was found to be successful in correcting moderate AHP in patients with IIN. This procedure leaves behind two recti muscles for further surgical intervention in cases with residual AHP.

Association of spheroidal degeneration in pseudoexfoliation cases

Purpose: To correlate the association of pseudoexfoliation with spheroidal degeneration, and to identify the type and stage of spheroidal degeneration in pseudoexfoliation patients. Material and Methods: Total of 64 patients between the age group of 40 to 70 years, attending Ophthalmology out-patient department were included in this study. After taking informed consent, demographic details and detailed history were taken from these patients. Comprehensive ophthalmic examination, which included visual assessment by Snellens chart and anterior segment evaluation by slit lamp examination was done. Results: A total of 64 patients (41 male and 23 female), in the age group between 40 and 70years, with pseudoexfoliation were included. Out of the 64patientswith pseudoexfoliation who were screened in our outpatient department, 44(68.75%) patients were diagnosed to havespheroidal degeneration. Among these 28(43.75%) patients were having stage 1, 7(10.93%) patients were having stage 2, 5(7.81%) patients had stage 3 and, 4(6.25%) patients had stage 4 spheroidal degeneration. Conclusion: Pseudoexfoliation cases have higher incidence of spheroidal degeneration association as compared to general population. It was also observed that droplet type (stage 1) of spheroidal degeneration was commonly seen in pseudoexfoliation cases, and the pupillary margin was the common site for pseudoexfoliation material deposition in most of the cases. This poses challenges to measure intraocular pressure effectively, as well as increase the chances of complications when intraocular procedures are done even with experienced hands. Keywords: Cataract, Droplet type, Exfoliation material, Pseudoexfoliation, Phacodonesis, Spheroidal degeneration.