Eye Care Hospital Research Articles

Success Rates of Endoscopic-Assisted Probing Compared to Conventional Probing in Children 48 Months or Older

ABSTRACTBackground: To evaluate the success rates of endoscopic-assisted probing compared to conventional probing in children 48 months or older. Methods: This retrospective study included children 48 months and older with CNLDO who underwent endoscopic-assisted probing or conventional probing between January 2011 to August 2015 at a tertiary eye care hospital in central Saudi Arabia. Probing was considered successful when signals of tearing or discharge disappeared and fluorescein dye disappearance test (FDDT) was normal. Demographic data, clinical features, intraoperative and postoperative variables were correlated to the success rate. Results: One hundred and twelve children with CNLDO undergoing endoscopic-assisted (37 patients) or conventional (75 patients) probing were included. The success rates of endoscopic-assisted and conventional probing were 94.6% [95% confidence interval (CI): 89.5–99.7] and 58.7% [95% (CI): 47.6–69.8], respectively. The success rate was higher with endoscopic probing, especially in older children. Conclusions: Endoscopic-assisted probing can achieve better outcomes to treat CNLDO, even in older children. The significantly higher success rates with endoscopic probing are likely due to the ability to observe and treat associated problems.

Social Transformation of Indian Tribal Community: Unlocking the Potential by Healthcare

The case documents the evolution of an eye care hospital promoted by a not-for profit organization located in Mandvi, Surat, close to the tribal community of Gujarat state, India. In a short span of five years (as of 2016), the trust has evolved as a community hospital. The value proposition of the trust is a portfolio of activities, which includes awareness by education, prevention of eye care diseases through eye screening camps, treatment, and rehabilitation on need basis and addressing direct and indirect healthcare needs of the community. The managerial challenge before the board of trustees is to carefully balance (a) The purpose for which the trust was created, (b) the gap between the ground realities and the need in the relevant tribal community (c) the accomplishments of the eye hospital so far.

Glued intraocular lens implantation for eyes with inadequate capsular support: Analysis of the postoperative visual outcome.

Aim:The aim of this study is to analyze the postoperative visual outcomes of fibrin glue-assisted, suture-less posterior chamber (PC) intraocular lens (IOL) implantation technique in eyes with inadequate capsule support at a tertiary eye care hospital in South India.Setting and Design:This is a retrospective, nonrandomized case series.Patients and Methods:This study analyzes 94 eyes which underwent PC-IOL implantation by fibrin glue-assisted, suture-less technique. All patients who had IOL implants by the fibrin glue-assisted PC-IOL technique from August 2009 to January 2014 were included in the study. Intra- and post-operative complications were analyzed. The postoperative best spectacle-corrected visual acuity (BSCVA) was evaluated and recorded at the end of 6 months.Statistical Analysis:The data were analyzed using SPSS version 16.1 (SPSS Inc., Chicago, Illinois, USA) using two sample paired t-test and independent t-test.Results:A total of 94 eyes of 92 patients that underwent glued IOL implantation over a period of 5 years were analyzed. Out of 94 eyes, 77 eyes (84.6%) maintained or improved on their preoperative BSCVA (P = 0.012).Conclusion:We conclude that glued IOL implantation is a feasible option in rehabilitating patients with aphakia without adequate capsular support.

Management of cataracts and ectopia lentis in children: Practice patterns of pediatric ophthalmologists in India.

Purpose:To analyze the current practice patterns of Indian pediatric ophthalmologists in the management of lens anomalies. This study was conducted in a tertiary eye care hospital and involved an online questionnaire survey for practicing pediatric ophthalmologists in India.Methods:A questionnaire was devised by the authors, which included the various options available for the management of lens anomalies in children. The questionnaire was sent to each of them using an online portal. Commercial software (Stata ver. 13.1; StataCorp, College Station, TX, USA) was used for statistical analysis.Results:In unilateral cataracts in children aged <6 months, 85.42% of surgeons did not prefer to insert an intraocular lens (IOL). In the age group of 6–12 months, almost half of them preferred to insert an IOL. In the age group of 12–24 months and >24 months, 92.63% and 88.54%, respectively, preferred to insert an IOL. In bilateral cataracts, in children aged <6 months, 91.84% of surgeons did not prefer to insert an IOL, whereas in the age group of 6–12 months, 69.39% did not prefer to insert an IOL. In the age group of 12–24 months and >24 months, 80.61% and 90.82%, respectively, preferred to insert an IOL. Seventy-four percent of surgeons preferred to use a single-piece hydrophobic acrylic IOL.Conclusion:The management of lens anomalies by pediatric ophthalmologists in India varies with laterality and appears to be comparable to that followed worldwide.

Mental Health Status of the Keratoconus Patients Visually Corrected with Contact Lens Compared to Spectacles

1.1.Aim of the Study:To analyse the mental health status and psychological well being of the keratoconus patients using rigid contact lenses compared to spectacle corrected ones. The objective is to study if the correcting vision with contact lenses impacts the mental health status of the patients suffering from keratoconus. 1.2.Methodology:In the month of January to April, 2015 a cross sectional study was conducted in Ahooja eye hospital, Gurgaon, Haryana, India and Rajan eye care hospital, Tnagar, Chennai, Tamilnadu, India. Thirty two keratoconus patients were enrolled for the study and subjects were asked to the mental health status questionnaire MHI 38 with informed consent. Fifteen were habitual contact lens wearers and seventeen non contact lens wearers who volunteered to participate this study. Study included those contact lens users who wore lenses all waking hours and had been wearing them for atleast one year. All the questions were score coded for entering the data in Microsoft Excel sheet. The status of mental health was based on eight indicises which provided information on mental well being. 1.3.Results:17 males and 15 females participated in this study. The mean age of the participant was 28.03± 5.56 (range 20-39 years). The mean score of keratoconus patients of non contact lens wearer and contact lens wearer in Anxiety was 32.84 ± 2.99 &18.79 ± 3.67, Depression 13.34 ± 4.08 & 7.71 ± 2.19, Loss of behavioural / Emotion Control 30.29 ± 2.22 & 22.77 ± 6.70, General Positive Affect 49.00 ± 3.86 & 29.73 ± 4.48, Emotion Ties 10.17 ± 1.44 & 5.28 ± 1.71, Life Satisfaction 3.44 ± 0.96 & 4.94 ± 0.73, Psychological Distress 81.28 ± 4.48 & 53.15 ± 9.62, Psychological Well Being 41.15 ± 4.75 & 69.08 ± 5.26, Mental Health Index 119.81 ± 5.53 & 185.82 ± 11.03 respectively. Our results show that P value is <0.05 is statistically significant in all subscales and on the global scale variable of MHI 38. It suggests those who wear contact lenses have significantly better life satisfaction and Mental Health. Proper contact lens option as vision correction in Keratoconus patients improves the mental health status and are more positive in attitude compared to non users. A successful contact lens fit influences the mental health status compared to those who do not opt to wear it. 1.4.Conclusion:Eye care practitioners should motivate and proactively advise contact lenses to patients with Keratoconus as they will have better life satisfaction and psychological well being.

Development and Validation of a Grading Scale for Custom Ocular Prosthesis.

To develop a standardized and universally reproducible grading scale for artistic outcome of a custom ocular prosthesis. A retrospective review of photographs of patients with custom ocular prosthesis. From the ocularistry database of a tertiary eye care hospital, photographs of patients with custom ocular prosthesis (30 random photos with additional 18 repetitions, total n = 50) were selected. Two independent oculoplastic surgeons, on the basis of characteristics of limbus, vascularity, and pigmentation, graded these photos. The photos were adjusted for confounders like magnification and illumination, and both graders used the same display system. The surgeons were blinded to each other. The characteristics were graded on a scale of 0 to 2 and total score was calculated for each photo. Inter-observer and intra-observer agreement was calculated using the kappa statistic. The inter-observer kappa coefficient for the three characteristics (95% confidence interval) were as follows: limbus 0.7 (0.55-0.85), vascularity 0.76 (0.58-0.94), and pigmentation 0.6 (0.34-0.85). The intra-observer kappa coefficient for the first surgeon was as follows: limbus 0.88 (0.7-0.95), vascularity 0.88 (0.73-0.95), and pigmentation 0.82 (0.54-0.93). The intra-observer kappa coefficient for the second surgeon was as follows: limbus 0.8 (0.44-0.93), vascularity 0.55 (0.13-0.8), and pigmentation 0.76 (0.6-0.84). A good intra- and inter-observer agreement was demonstrated. In view of no existing grading for prosthesis, this is a unique system to objectively grade the outcome of custom ocular prosthesis and can be incorporated in ocularistry teaching modules for standardization of outcomes.

English

Ocular infections are widespread and they exert heavy burden on eye health. Virtually, any eye component can be infected by a diversity of bacteria. The present study was performed to determine the prevalence of external ocular bacterial infections and to find out antibiotic susceptibility pattern of bacterial isolates at eye care hospitals in Khartoum, Sudan. Two hundred and four corneal scrape and drained pus materials were received from infected eyes with clinical diagnoses of bacterial conjunctivitis, keratoconjunctivitis, keratitis, blepharo-conjunctivitis, blepharitis, dacryo-cystitis and eye abscess. Culture, microscopy with Gram’s stain of both samples, bacterial colonies and biochemical tests were carried out. Antibiotic susceptibility analysis using Kirby–Bauer disc diffusion test and standard table of antibiotic susceptibility was performed. Out of 204 samples processed, 130 (63.7%) yielded bacterial growth. The most prevalent bacterial eye infection was conjunctivitis (59.2%). Of all the isolates, 75 (57.7%) were Gram’s positive and 55 (42.3%) were Gram’s negative. Coagulase positive Staphylococcus aureus were the most prevalent, 39 (30%) followed by Streptococcus pneumonia 31 (23.8%), Haemophilus influenzae 22 (16.9%), Pseudomonas aeruginosa 13 (10%) and Neisseria gonorrheae 10 (7.7%). Gram positive bacteria were highly sensitive to vancomycin (95%), followed by chloramphenicol and ciprofloxacin (91%) and ceftriaxone (84%), while the majority were resistant to penicillin (72%). Gram-negative organisms were highly susceptible to amikacin (92.7%) followed by ceftriaxone (87.3%) and ciprofloxacin (78.2%). Major resistance was towards cotrimoxazole (82%) and ampicillin (73%). Key words: External ocular bacterial infections, bacterial isolate, antibiotic susceptibility, normal flora, pathogenic bacteria.

Diabetic Retinopathy Diagnosis in Retinal Images Using Hopfield Neural Network

ABSTRACTThe main objective of this work is to develop an artificial neural network (ANN) for automated detection of diabetic retinopathy (DR) in retinal images. Three hundred and thirty images from DR category and two hundred and ten images from normal category are used in this work. These images are taken from patients with ages in the range of (58.218.7) years who were under treatment at the Lotus Eye Care Hospital, Coimbatore, India. A single-layer Hopfield neural network (HNN) is designed to categorize the normal images and the abnormal DR images. The ANN is trained with 165 images from the abnormal DR category and 105 images from the normal category. The testing images are 165 from DR and 105 from normal category respectively. Specific numerical features obtained from these images are used as inputs for the ANN. The performance measures used for the study are accuracy, sensitivity and specificity. It has been observed that the proposed approach has provided accuracy in the range of 97%–98%. Thus, the experimental results suggest the practical feasibility of the proposed approach. A comparative study with existing works for screening of abnormal retinal images is also reported in this work.

Management and Visual Outcome in Patients of Lens-induced Glaucomas at a Tertiary Eye Care Hospital in South India.

ABSTRACTAims: To outline the different characteristics of glaucomas and to determine the risk factors and their consequences on postoperative visual acuity, intraocular pressure (IOP), and inflammation, including corneal changes and optic disk changes.Settings and designs: Longitudinal prospective study done over a period of 1.5 years in a medical college hospital.Materials and methods: Fifty patients of lens-induced glaucoma (LIG) were included. At presentation, visual acuity, IOP, and inflammation, including corneal changes, were recorded. After medical line of treatment, postoperatively patients were followed up regularly at 2 and 7 weeks interval and the same parameters were evaluated including optic disk changes.Statistical analysis used: Paired t-test, chi-square test wherever applicable with p-value < 0.05 as significant.Results: The mean age of presentation was 60.68 years with female to male ratio of 1.7:1. The best corrected visual acuity(BCVA) of 6/18 or more was found in 54% cases, whereas visual acuity of less than 6/60 was seen in 26% of cases. Visual acuity of 6/12 or better was achieved in 72% (p < 0.01) of cases with symptoms less than 2 weeks and in 59.10% of cases with IOP of less than 35 mm Hg at presentation. The mean IOP in cases with duration of symptoms of 2 to 4 weeks was 40.33 ± 9.36 mm Hg. Optic disk of the affected eye suffered damage in 42% of cases and in 80% of cases with symptoms for more than 2 weeks.Conclusion: Early diagnosis and treatment is beneficial in LIG cases.How to cite this article: Sharanabasamma M, Vaibhav K. Management and Visual Outcome in Patients of Lens-induced Glaucomas at a Tertiary Eye Care Hospital in South India. J Curr Glaucoma Pract 2016;10(2):68-75.

Are all children with visual impairment known to the eye clinic?

IntroductionThere is a growing body of evidence that children with special needs are more likely to have visual problems, be that visual impairment, visual processing problems or refractive error. While...

Changing Azole Resistance: A Secondary Analysis of the MUTT I Randomized Clinical Trial.

The development of multiple triazole resistance in pathogenic filamentous fungi has become an increasing clinical concern and has been shown to increase the risk for treatment failure. To determine whether antifungal resistance increased during the Mycotic Ulcer Treatment Trial I (MUTT I), as measured by minimum inhibitory concentrations (MICs) in baseline cultures. This secondary analysis of a double-masked, multicenter, randomized clinical trial included patients with culture- or smear-positive filamentous fungal corneal ulcer and a baseline visual acuity of 20/40 to 20/400. Culture-positive samples with susceptibility testing were included in this analysis. The patients were treated at multiple locations of the Aravind Eye Care Hospital system in South India. Data were collected from April 3, 2010, to December 31, 2011, and analyzed from July 15 to September 1, 2015. Corneal smears and cultures were obtained from all study participants at baseline. Susceptibility testing was performed for each culture-positive specimen. Minimum inhibitory concentration of voriconazole and natamycin in baseline cultures. Of 323 participants with smear-positive specimens (183 men [56.7%]; 140 women [43.3%]; median [interquartile range] age, 47 [38-56] years), fungal-positive cultures were obtained for 256 (79.3%). The MIC data were available for 221 of 323 participants (68.4%), because 35 samples had no growth during susceptibility testing. A 2.14-fold increase per year (95% CI, 1.13-4.56; P = .02) in voriconazole MICs after controlling for the infectious organism was found. This association was not found when looking at natamycin MICs of baseline cultures after controlling for the infectious organism (1.26; 95% CI, 0.13-12.55; P = .85). Susceptibility to voriconazole appeared to decrease during the relatively short enrollment period of the clinical trial. This decrease may be more related to increased resistance of environmental fungi rather than previous treatment with azoles, because presenting with azole treatment was not a risk factor for resistance. clinicaltrials.gov Identifier: NCT00996736.

In focus: Radical changes needed to avert eye health crisis

Optics was invited to present its case to help alleviate capacity pressures on hospital eye care services. Joe Ayling reports from this week's inaugural eye health summit in London.

Clinical features, visual outcome and association with systemic disease in patients with episleritis and scleritis. A study of 50 eyes

Introduction: Episcleritis and scleritis are inflammatory disorders which can have an acute presentation and are frequently encountered by primary care practitioners.Episcleritis is a benign, self-limited disease that resolves within 2 to 3 weeks. Scleritis is painful, causing visual loss due to uveitis, glaucoma, cataract, and retinal detachment. Both are associated with underlying systemic diseases.We aim to report clinical features, visual outcome and association with systemic disease in patients with visual symptoms. Methods: This is a prospective cohort study conducted on 50 patients over 1 year in a tertiary eye care hospital Complete ophthalmic evaluation was performed. Patients were followed up for one year to look for response to treatment and development of complications. Results: In our study, the incidence of episcleritis was more frequent than scleritis. The age group affected was 34 to 52 years and more in women. Most of our patients with episcleritis showed resolution within 3 weeks. Scleritis was associated with decreased vision and more complications. In both forms of inflammation rheumatoid arthritis, systemic lupus erythematosus and psoriasis were the most common etiology.Conclusion: In rheumatoid arthritis, systemic lupus erythematosus and psoriasis patients, episcleritis and scleritis can be the initial clinical presentation. Clinical features are more severe in scleritis and can be diagnosedwith B scan ultrasound. Visual loss in both can be prevented by early treatment. We found the association with rheumatoid arthritis and SLEto be high in our population. Infections were not as common as autoimmune diseases in the population studied.

An analysis of ocular firecracker injuries in five consecutive years during a festive season in a tertiary eye care hospital in South India

ABSTRACTBackground: To analyse the presentation of ocular firecracker injuries during a festival celebration in five consecutive years.Methods: We retrospectively analysed 541 patients with cracker injuries who presented to a tertiary eye care hospital during the fortnight of Deepavali for five consecutive years. The parameters studied were the age and sex, environmental factors, type of firework, eye involved and whether the involved person was a passer-by or actively involved.Results: Children up to 15 years, males and bystanders were seen to be affected more frequently. The most common firework involved was the flower pots.Conclusions: Fire cracker related ocular injuries are an important public health problem in India where celebrations are not complete without lighting crackers. This study brings to light the importance of safety measures and emphasises the need for restrictive firework legislation which has proved to reduce such injuries in countries across the world.

Paediatric infectious keratitis at tertiary referral centres in Vancouver, Canada

ObjectiveTo report the clinical and microbiological profiles of paediatric patients with infectious keratitis in Vancouver, Canada.DesignIn this observational case series, the microbiology results and medical records of 17 eyes with...

The Optimization in Workflow Management

India in 2001 had 7.75 million individuals blinded by cataracts. By 2020, this will rise to 8.25 million, next highest after diabetics. Eye care (ophthalmology) needs an accessible, affordable and high-quality approach. This article treats problems in its workflow, and ways to make it accessible and affordable. The widening demand–supply gap makes waiting long, with major impact on Indian eye care and the management of eye care hospitals. We analyze the causes and solutions for handling waiting time by innovative workflow management methods.

Characteristics and quantification of vascular changes in macular telangiectasia type 2 on optical coherence tomography angiography

BackgroundMacular telangiectasia type 2 (MacTel 2) is a bilateral idiopathic, rare neurodegenerative disease with alterations in the macular capillary network leading to vision loss and is the most common of...

Clinical Service Lines as a Competitive Strategy among Tertiary Eye Care Hospitals in Urban India

Consumers (patients) and caregivers today are more engaged with each other in their healthcare decisions than ever before. With substantial private investments and increased awareness on the need for eye care in urban India, there is also a heightened sense of competition and consumerism in the tertiary eye care hospital space in India. Consequently, the focus has now shifted to quality and cost of service delivery, wherein looking beyond the conventional service delivery model may prove to be crucial. This paper attempts to propose the introduction of clinical service lines as a conceptual model for eye care hospitals to effectively compete. The service line model will pave the way to define and deliver services more attuned to consumer needs, thus creating market-savvy competitors.

Knowledge, attitude and practice about eye donation among medical and paramedical students in tertiary eye care hospital

Background: Eye sight is very important for human life. The World Health Organization (WHO) estimates that every 5 seconds someone goes blind. Globally, 37 million people are blind, and of these nearly 10 lakh blind people are willing for corneal transplantation. Aims: The aim of the study was to assess the knowledge, attitude, and practice regarding eye donation among the students. Materials and Methods: The data were collected by the questionnaire method from medical and paramedical students at Al Ameen Medical College, Bijapur. Data collected from the participants were analyzed using percentage and descriptive statistics. Results: Out of the 250 students, 60.4% were Muslim by religion. The participants were wellaware of eye donation (99.2%) quoting media as a major source of information for their knowledge. Attitude regarding eye donation in few (45.6%) was different as it was against their religious belief, although they said it was a service to the mankind (92%). Out of the 250 students, 48% were willing to pledge and 52% students did not believe in pledging their eyes. Conclusion: The findings of the study showed that overall knowledge about eye donation among students was good, however the attitude and practice showed mixed responses.

Evaluation of visual outcomes after pediatric cataract surgery in a Tertiary Eye Care Hospital in Western Maharashtra

Background: A review of pediatric cataract cases operated between January 2007 and May 2008 in a Tertiary Eye Care Hospital in Western Maharashtra was done. Aim: To evaluate postoperative visual status for distance and near after pediatric cataract surgery. Settings and Design: Retrospective and prospective medical record retrieval type of cohort study. Materials and Methods: The demographic data, preoperative, intraoperative, and postoperative details were noted. The surgical procedure included cataract extraction with intraocular lens implantation with primary posterior capsulorrhexis and anterior vitrectomy in most of the cases. The visual status of eyes was evaluated before and 6 weeks after surgery. Statistical Analysis: Univariate and multivariate type of statistical analysis using SPSS software. Results: Three hundred and sixteen eyes of 250 children were included in the study. Sixty-six children had bilateral, and 184 children had unilateral cataract. Most common were congenital cataracts seen in 124 eyes (39.2%). Distant vision following surgery was more than 6/60 in 86 eyes (49.1%). Aided near vision of N12 and above was seen in 75 eyes (68%). The common causes for noncompliance with spectacles were heavyweight, repeated breakage, and peer pressure. Conclusion: Early detection and management of cataract in children is the key to good visual outcomes. Postoperative care should include a special emphasis on near vision. Improved coordination is needed between parents, school teachers, and the pediatric eye care center to improve the compliance with spectacles.