Eye Care Hospital Research Articles

Boston Keratoprosthesis type 1 (KPro) without contact lens wearing in end-stage corneal disease: The APEC experience.

To report the visual outcomes and survival analysis of keratoprosthesis without contact lens wearing in a tertiary eye care hospital in Mexico City, Asociación Para Evitar La Ceguera (APEC, Coyoacán, México). Retrospective cohort with survival analysis. Twenty-three eyes (22 patients) received KPro type 1 between 2015 and 2020 with a follow-up time of three years. We included analyzed data about past medical history, preoperative diagnosis, best-spectacle visual acuity (BSCVA), postoperative complications and retention rate. Univariate, bivariate and survival analysis were performed and reported. The mean age was 58 ± 13.5 years (SD). 60.86% were male patients (14 eyes). Twelve-eyes (52%) achieved a BSCVA of 20/200 or better in the first and second year of follow-up. At 3 years, only 35% achieved 20/200 or better (BSCVA). Retention rate of Boston type 1 KPro was 87% (20 eyes) at 3 years follow-up. The most common complication was retroprosthetic membrane (RPM) which occurred in 9 eyes (39.1%), followed by corneal melting in 7 eyes (30.4%). We report the results of a retrospective cohort of twenty-three eyes (22 patients) who were implanted with a Boston type 1 KPro without contact lens wearing to treat corneal blindness. BSCVA improved significantly in most patients achieving 20/200 or better at the 2-year follow-up. Retention rate was 87%, with the presence of RPM as the most common complication.

Visual Outcomes & Associated Factors in Patients with Chemical Injury in a Tertiary Eye Care Hospital in Bangladesh

Purpose: To study the clinical profile & visual outcome of ocular chemical injuries. Methods: This observational retrospective study was performed on 50 patients with chemical injuries attending in cornea clinic from January 2022 to December 2022 in a tertiary Eye Institute & Hospital in Bangladesh. A detailed history of the patients and history of presenting complaints was taken. An ocular examination was performed. Visual acuity was recorded by using Snellen’s test-type Chart. A thorough examination was carried out on slit-lamp, direct & indirect ophthalmoscopes. Clinical grading was done by Roper Hall Classification. Other’s ocular investigations were done when required. Results: In the present study, 50 patients were included of which 60% (30) were male and 40% (20) were females. In the present study, 11-20 years of age patients are 18(36%) & 0-10 years of age are 12(24%).Most of the cases were day labor 16(32%), followed by students12( 24%) ,housewife 4(8%) & others are 18 (36%). As per the Roper Hall Classification, most of the eyes sustained grade II chemical injury at 36% (30 eyes); followed by grade IV at 26%: grade III was 20%, and grade I was 18%. The visual acuity at presentation, 17(34%) patients had visual acuity 6/12- 6/24. On the other hand, 14(28%) have a counting finger. Visual acuity at the final follow-up, 19(38%) patients had visual acuity 6/12- 6/24. On the other hand, 16(32%) had a counting finger. The management of chemical injury, AMG + BCL was done on 54% of patients & conservative management was done on 32% of patients. Conclusion: The incidence was more in the younger working population, with a majority of injuries occurring in less than 30 years of age. The severity of chemical burn belonging to grade II and grade IV injuries. Henceforth the visual outcome was better and complications were much less after immediate management. Saline wash & Amniotic membrane Grafting(AMG) with fresh amniotic membrane increases patient comfort and reduces inflammation. Public health initiatives are critical to prevent chemical injuries in mitigating the poor visual prognosis. J.Natl.Inst.Ophthalmol.2023;6(1): 27-31

Effect of Diabetes type-II on Eye disease and its risk factors; A Logit Model Analysis

To know the effect of Diabetes type-II on Eye disease and its risk factors in a tertiary eye care hospital in Karachi. This was a cross-sectional study with retrospective data collection. The data was retrieved from January to June 2019 from the Hospital Information Management System (HIMS) software of the Institute. Non-probability purposive sampling method was used to collect data. Inclusion criteria were all the diabetics type-II patients came for routine check-ups at Diabetes Eye Department irrespective of age, gender and duration of diabetes. Statistical analysis was done using STATA version 13.0 software for windows. A total of 6090 cases were analyzed. Mean age of the participants was 51.01±10.8 years. There were 2954 (48.5%) male and 3136 (51.5%) female observed in this study. Table 1 shows the results of the binary logistic regression analysis with coefficients and their standard errors (S.E.), Wald test values, p values, odd ratios, and 95% confidence intervals for odds ratios. When all explanatory variables treat as continuous variables, we found that all variables which include age, height, random blood sugar (RBS) and duration of diabetes was statistically significant at the significance level 0.05 except weight and fasting blood sugar (FBS) for individual regression slope coefficients. This study reveals findings through binary logistics regression analysis. It indicates that there is an association found in the patients of eye disease with age, height, weight, RBS, FBS. This stated that there were some risk factors observed in these variables related to eye disease. Those who have the disease have risk factor to developed the others associated disease.

Outcomes of reimplantation of a new Glaucoma Drainage Device after explantation of an older implant from exposure-related complications.

To describe the clinical outcome of a series of seven eyes with an explanation of an original Glaucoma Drainage Device (GDD) arising from the complication of plate exposure and consequent reimplantation of another GDD at a second setting. This was a retrospective, interventional, and non-comparative study at two tertiary eye care hospitals in eastern and southern India. Electronic medical record data of the seven eyes where a GDD was explanted and a 2nd GDD was reimplanted over October 2010 and May 2021 was analyzed. Statistical analysis was done by SPSS (ver. 26). The first GDD survived for a mean of 168 days only till the plate got exposed and thereby got explanted. Possible predisposing factors noted were conjunctival and scleral thinning, ischemic conjunctiva, etc., The reimplantation surgery was technically easy in the absence of hypotony-opposite to what is reported in the literature. The final IOP (mean +/- SD) values (mm Hg) were 18.9 (+/-7.9), range = 10-30. The mean number of glaucoma medications reduced from 3.9 (+/-1.2; range, 2 to 5) after the explanation to 3.1 (+/-0.7; range, 2 to 4) after the 2nd GDD implantation, in the final follow-up. The second GDD was found to be stable till the last follow-up (mean = 1149 days). No other significant intraoperative or postoperative complications were seen. Reimplantation of a second GDD in a separate setting after explanations of an original implant due to exposure-related complication is both a safe and effective method.

A Datasheet for the INSIGHT University Hospitals Birmingham Retinal Vein Occlusion Data Set.

Retinal vein occlusion (RVO) is the second leading cause of visual loss due to retinal disease. Retinal vein occlusion increases the risk of cardiovascular mortality and the risk of stroke. This article describes the data contained within the INSIGHT eye health data set for RVO and cardiovascular disease. Data set descriptor for routinely collected eye and systemic disease data. All people who had suffered an RVO aged ≥ 18 years old, attending the Ophthalmology Clinic at Queen Elizabeth Hospital, University Hospitals Birmingham (UHB) National Health Service (NHS) Trust were included. The INSIGHT Health Data Research Hub for Eye Health is an NHS-led ophthalmic bioresource. It provides researchers with safe access to anonymized routinely collected data from contributing NHS hospitals to advance research for patient benefit. This report describes the INSIGHT UHB RVO and major adverse cardiovascular events data set, a data set of ophthalmology and systemic data derived from the United Kingdom's largest acute care trust. This data set consists of routinely collected data from the hospital's electronic patient records. The data set primarily includes structured data (relating to their hospital eye care and any cardiovascular data held for the individual) and OCT ocular images. Further details regarding the available data points are available in the supplementary information. At the time point of this analysis (September 30, 2022) the data set was composed of clinical data from 1521 patients, from Medisoft records inception. The data set includes 2196 occurrences of RVO affecting 2026 eyes, longitudinal eye follow-up clinical parameters, over 6217 eye-related procedures, and 982 encountered complications. The data set contains information on 2534 major adverse cardiovascular event occurrences, their subtype, number experienced per patient, and chronological relation to RVO event. Longitudinal follow-up data including laboratory results, regular medications, and all-cause mortality are also available within the data set. This data set descriptor article summarizes the data set contents, the process of its curation, and potential uses. The data set is available through the structured application process that ensures research studies are for patient benefit. Further information regarding the data repository and contact details can be found at https://www.insight.hdrhub.org/. Proprietary or commercial disclosure may be found after the references.

251 Trachoma in Sudan: Case Series from Two Eye Care Hospitals and a Review of the Literature

Abstract Background Trachoma is a common infectious cause of blindness worldwide. Although it has largely now disappeared from developed countries, it is still endemic in many developing countries. We aimed to highlight clinical stages and common related socio-demographic and household characteristics among patients with trachoma in Sudan. Methods A hospital-based case series descriptive study was conducted at Makah Eye Complex and Abdalfadeel-Almaz hospital in Khartoum, Sudan. We included all Trachoma patients from all age groups attending the two eye care hospitals March-May 2015. Data was collected through clinical examination, hospital records, and face to face interview using a structured questionnaire. Also, we conducted a review of the literature to highlight the epidemiological aspect of trachoma in Sudan, using the databases of MEDLINE (PubMed) and Google Scholar. Results In this case series, we identified 125 patients with trachoma in the study period. Most of them were aged more than 50 years old (78.4%). Half of the participants (56%) were positive for active trachoma, 40.8% of them were having Trachomatous Trichiasis (TT), and 56% of them have Trachoma Follicles (TF). Majority of the patients have low socioeconomic status and poor personal and environmental hygiene (88%), (44%) and (74.4%), respectively. Conclusions Low socioeconomic status and poor personal and environmental hygiene are common socio-demographic and household characteristics among patients with trachoma. Despite the progress that has been made towards disease elimination, trachoma is still a public health problem in Sudan. Our review highlights the magnitude of trachoma and the progress towards its elimination in Sudan.

Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India.

This study aimed to review the demographics, clinical characteristics, and long-term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital. Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow-up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes. The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6-month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three-year follow-up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty. Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.

Indications and types of keratoplasties: Trends in the past 10 years (2011-2020) in Eastern India.

To observe the trends of various types of keratoplasties in different etiologies over a period of 10 years (2011-2020) in a tertiary eye care center of eastern India. A retrospective review of patients undergoing keratoplasties from 2011 to 2020 was performed in a tertiary eye care hospital situated in eastern part of India. Apart from demographic data, primary indication for each surgery and type of procedure carried out was recorded. For comparison, data were divided into two time periods: Group I: Jan 2011 to Dec 2015 and Group II: Jan 2016 to Dec 2020. Over a period of 10 years, a total of 2365 (Group I: 902, Group II: 1463) keratoplasties were performed. The average age of patients was 45.8 ± 19.9 and 46.9 ± 20.9 years in Group I and Group II, respectively. Among all the corneal grafts, 1747 (74%) surgeries were full-thickness. Although optical penetrating keratoplasty (OPK) was most the common indication for full-thickness keratoplasties, Descemet's stripping endothelial keratoplasty (DSEK) remained most performed lamellar keratoplasty. Keratitis, corneal scars, and bullous keratopathies remain to be most common indications in both groups. Number of lamellar keratoplasties increased significantly from Group I to Group II for corneal scars (P = 0.02), bullous keratopathies (P = 0.01), and endothelial dystrophies (P = 0.00). With change in time, the indication and technique of keratoplasty has witnessed a changing trend from full-thickness keratoplasty to lamellar keratoplasty. There is rise in trend of lamellar keratoplasties over the period.

The rapid access eye clinic's playbook: how to cut eye casualty attendance by 50.

Moorfields Eye Unit at the London Borough of Croydon sees over 47,000 outpatient attendances each year, 5894 of which attended the eye walk-in Urgent Care in the 2017- 2018 year, which has become unsustainable. A recent audit found that referrers and patients had limited experience in managing ophthalmic conditions. If triaged according to clinical need only 22% patients attended required same-day hospital eye care. As such the service needed to bereconfigured. This was achieved through extensive collaboration with our local Clinical commissioning groups (CCG), General Practitioner (GP) body, Optometrists and host hospital at the Croydon University Hospital. The Rapid Access Clinic (RAC) was set up in November 2018 to replace the old-style walk-in pathway and provide a streamlined emergency eye care service for patients. RAC demonstrated an efficient and safe triage system which can improve patient flow. Since the launch date of RAC on the 1st November 2018, a 50% sustained decrease in attendances to urgent care was noted. This was achieved without impacting other eye services, by advising the referrers and redirecting referrals appropriately. At the same time the appropriateness of the attendances to our emergency clinic improved from 32% to 68%. Using a digital platform for referrals and data collection allowed up to continuously perform service evaluation. The forward-online triage and our close relationship with community enabled a safe continuation of providing emergency eye care locally. The controlled booked attendance as well as the advice and guidance system enabled us to prioritise true emergencies.

Association between Intraocular Pressure and Myopia Among Children Aged 7 to 16 years

Objectives: To investigate the association between high intraocular pressure and myopia in children and compare it to emmetropia, and to determine the relationship between elevated intraocular pressure and varying degrees of myopia. Study design and Setting: Comparative cross-sectional study was performed at the tertiary eye care hospital, Rawalpindi for six months from July 2021 to December 2021. Methodology: Patients with myopia of greater than 0.5Ds and emmetropes with visual acuity of 6/6 were included. All patients underwent visual acuity, cycloplegic refraction, and fundus examination in order to exclude the myopic patientswith other systemic and ocular disorders. Intraocular pressure and central corneal thickness were measured using a Tonopen tonometer and Pachymeter respectively.Data was entered on SPSS version 26 for analysis. Independent sample T-test and one-way ANOVA was utilized for inferential statistics. Results: A total of 218 subjects were included with a mean age of 11.38 ± 2.602 ranging from 7 to 16 years. Females 50.9% (n=111) were outnumbered by male participants 49.1% (n=107). The mean IOP in emmetropes was 13.35 ± 2.433 mmHg and in myopes was 15.22 ± 3 mmHg and there is a statistically significant mean difference between these groups (P-value <0.05). There is also a statistically significant mean difference between IOP and varying degrees of myopia, that is; low(13.46 ±2.797), moderate(16.62 ± 2.981), and high(19.215 ± 2.184). Conclusions: The IOP was higher in high and moderate myopic eyes as compared to emmetropes. Moreover, a strong association was found between myopia and elevated IOP in children.

Profile of Childhood Glaucoma Attending a Tertiary Eye Care Center in Northern India.

To ascertain the prevalence and clinical features of the various types of childhood glaucoma at a tertiary eye care hospital in Northern India. Retrospective chart review of all children less than 16 years of age with childhood glaucoma who presented from 1st April 2014 to 31st March 2019, who was diagnosed to have any subtype of childhood glaucoma as per Childhood Glaucoma Research Network (CGRN) classification and advised appropriate management. Out of 405 children with childhood glaucoma, 36% had primary glaucoma, whereas the rest had secondary glaucoma. Primary congenital glaucoma (PCG) was the most common form of primary glaucoma. Glaucoma associated with acquired conditions was the most common cause of secondary glaucoma. Primary glaucoma was mostly bilateral in contrast to secondary glaucoma. The most common age of presentation with primary glaucoma was <1 year of age, and in children with secondary glaucoma was 11-16 years. On presentation, 80% of eyes had intraocular pressure (IOP) of >20 mm Hg and 70% had cupping of >0.7. Eyes with PCG were primarily managed surgically. In our cohort, PCG was the most common primary childhood glaucoma. Traumatic glaucoma was the most common secondary glaucoma. Since childhood glaucoma is an important cause of visual morbidity in children, its timely diagnosis and prompt management are essential to prevent irreversible visual loss. Understanding the disease pattern, their presenting features, and the proportion of different types of childhood glaucoma can help in planning appropriate eye care services, create awareness and better allocate resources to plan appropriate management strategies. Screening programs and counseling of parents should also be strengthened. Dubey S, Jain K, Pegu J, et al. Profile of Childhood Glaucoma Attending a Tertiary Eye Care Center in Northern India. J Curr Glaucoma Pract 2023;17(2):68-74.

Accuracy of trained technicians in screening orbital and adnexal diseases at rural vision centers in South India.

To assess the agreement between the diagnosis made by trained technicians at vision centers (VC) and oculoplasty specialists at the base hospital, in patients referred from VC to the orbit and oculoplasty clinic of a tertiary eye care hospital in south India. This was a retrospective study that compared the findings of VC technicians and the specialists of the orbit and oculoplasty services in a base hospital. A total of 384 patients referred from 17 VCs between May 2021 and May 2022 were included. The diseases were categorized according to the site of involvement as diseases of the eyelids (43%), diseases of the lacrimal system (37.3%), orbital diseases (15.6), and others (4.1%). The mean age of the patients was 35.9 years and 50.6% were females. Medical records of all referred patients who attended the orbit clinic were analyzed. Of the 384 patients, 378 (98.67%) were confirmed to have o. bital and adnexal diseases. There was an overall 80% agreement between the diagnosis made by trained VC technicians and oculoplasty specialists; the kappa coefficient was 0.78 (95% confidence interval [CI]: 0.76 to 0.80), with a P value < 0.001. The agreement was the highest for diseases of the lacrimal system (90.9%, kappa coefficient 0.87), followed by eyelid pathologies (80%, kappa coefficient: 0.77). Of these, 54.8% of patients were managed with surgical procedures. There is good agreement between the findings of VC technicians and oculoplasty specialists. Trained technicians can help in the early detection and referral to higher centers. They also help to make sure adherence to treatment and periodic evaluation, especially in resource-constraint settings.

Epidemic retinitis during the COVID-19 pandemic.

To study the impact of the novel coronavirus disease-2019 (COVID-19) pandemic on incidence, seasonal variation, clinical presentation, and disease outcome of epidemic retinitis (ER) and to compare clinical outcomes with positive and negative COVID-19 serology. This is a retrospective, observational study conducted at a tertiary eye care hospital from August 2020 to June 2022. A graph of ER cases against the month of presentation was compared with the graph of the COVID-19 pandemic in the same region. Cases presented before COVID-19 vaccination, with positive COVID-19 serology (Group 1) were compared with cases with negative serology (Group 2). One hundred and thirty-two cases of ER were seen. The least number of cases were seen during and immediately after the peak of the pandemic (May 2021-August 2021). COVID-19 serology was positive in 13 (22 eyes)/60 (21.6%) unvaccinated cases. Along with COVID-19, positive serology for other ER etiologies was seen in 5/13 cases (38.4%). All patients received oral doxycycline with/without steroids. Groups 1 and 2 included 22 and 21 eyes of 13 cases each. Macular edema resolved in 43.6 and 32 days in groups 1 and 2, respectively. Retinitis resolved at 1 month in both groups. Corrected distant visual acuity was 20/50 and 20/70 at the presentation, which improved to 20/20 and 20/25 in groups 1 and 2, respectively. Mean and median follow-up was 6 months and 4.5 months, respectively, in both groups. No complications or recurrences were seen. No significant impact of the COVID-19 pandemic on ER was observed.

A study on ocular fundus changes in women with hypertensive disorders of pregnancy in a tertiary care hospital

The study was conducted to find ocular fundus changes in women with hypertensive disorders of pregnancy, and to study the correlation of ocular fundus changes with severity for hypertension, age, parity of women A prospective observational study was conducted in a tertiary eye care hospital at Hyderabad, Telangana from 12/10/2020 to 14/07/2021, among a total of 150 patients with hypertension in pregnancy at a tertiary care hospital. A detailed history was taken, ocular examination and fundus examination is done.A total of 150 patients were examined. Fundus changes are seen in 31 patients. The mean age of patients is 25.48 years. Patients with Retinal changes seen in 20.66%. Patients grade – 1 hypertensive retinopathy seen in 13.53, grade – 2 hypertensive retinopathy seen in 5.33%, grade – 3 hypertensive retinopathy seen in 0.66%, grade – 4 hypertensive retinopathy seen in 1.33%. In the present study there is a significant correlation between parity of pregnancy and retinal changes with p=0.0000005 and correlation with severity of Hypertension and fundus changes is significant with P =0.0000001.the correlation of age with retinopathy is not significant with p=0.16.Ocular fundus changes has its importance in the course of pregnancy with hypertension as severity of hypertension if increases there can be changes in retina which indicate a harm to the baby and mother and it will be helpful in termination pregnancy. Pregnant women with hypertension are advised to go for screening of eyes and also regular checkups.

Refractive profile of children treated with intravitreal bevacizumab for retinopathy of prematurity.

To study the refractive profile of children after they received intravitreal injection of bevacizumab for retinopathy of prematurity (ROP). The study was conducted at a tertiary eye care hospital in South India. ROP patients of more than 1 year of age, presenting to the Pediatric Ophthalmology Clinic and Retina Clinic and having history of treatment for type I ROP with intravitreal bevacizumab (IVB) or intravitreal bevacizumab and laser photocoagulation were included in the study. Cycloplegic refraction was done, and the refractive status was evaluated. The refractive status of age-matched, full-term children with uneventful perinatal and neonatal history was also recorded and compared to the study group. Among 134 eyes of 67 study subjects, the major refractive error was myopia in 93 eyes (69.4%; spherical equivalent [SE] = -2.89 ± 3.1, range = -11.5 to -0.5 D). There were 75 eyes (56%) with low-to-moderate myopia; high myopia was seen in 13.4%, emmetropia in 18.7%, and hypermetropia in 11.9% of eyes. The majority of them (87%) had with-the-rule (WTR) astigmatism. In 134 eyes, the SE was -1.78 ± 3.2 (range = -11.5 to 4 D); the SE of the 75 eyes with low-to-moderate myopia was -1.53 ± 1.2 (range = -0.50 to -5 D). In the control group, the majority had emmetropia (91.8%). There was no significant association between the age at which IVB had been injected and the development of refractive errors (P = 0.078). The prevalence of low-to-moderate myopia was more than high myopia in patients with zone I and zone II ROP before treatment (60.0% and 54.5%, respectively). Myopia was the major refractive error seen in post-IVB pediatric patients. WTR astigmatism was more commonly seen. The age at which IVB injection had been given had no effect on the development of refractive errors.

The effect of social determinants of health on severity of microbial keratitis presentation at a tertiary eye care hospital in Southern India.

Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation. This was a cross-sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected. Descriptive statistics, univariate analysis, multi-variable linear regression models, and Poisson regression models were utilized. There were 51 patients evaluated. The mean age was 51.2 years (SD = 13.3); 33.3% were female and 55% did not visit a vision center (VC) prior to presenting to the clinic. The median presenting logarithm of the minimum angle of resolution (logMAR) VA was 1.1 [Snellen 20/240, inter-quartile range (IQR) = 20/80 to 20/4000]. The median time to presentation was 7 days (IQR = 4.5 to 10). The average particulate matter 2.5 (PM2.5) concentration, a measure of air pollution, for the districts from which the patients traveled was 24.3 μg/m3 (SD = 1.6). Age- and sex-adjusted linear regression and Poisson regression results showed that higher levels of PM2.5 were associated with 0.28 worse presenting logMAR VA (Snellen 2.8 lines, P = 0.002). Patients who did not visit a VC had a 100% longer time to presentation compared to those who did (incidence rate ratio = 2.0, 95% confidence interval = 1.3-3.0, P = 0.001). Patient SDoH and environmental exposures can impact MK presentation. Understanding SDoH is important for public health and policy implications to mitigate eye health disparities in India.

Pupillary dynamics and accommodative response in mild traumatic brain injury.

To measure the pupillary dynamics and accommodative response in individuals with mild traumatic brain injury (mTBI) as compared to age-matched controls. This prospective comparative study was carried out at the neuro-optometry clinic of a tertiary eye care hospital. Sixty-three subjects with a history of mTBI and ninety age-matched controls were enrolled in this study. Subjects in the age range of 18-35 years were included in the study. A comprehensive neuro-optometric assessment was performed followed by pupillary dynamics and accommodation response measurements using NeurOptics® pupillary light reflex™-3000 and Grand-Seiko WAM-5500 binocular accommodation auto ref/keratometer | shigiya machinery works LTD. A statistically significant difference was noticed for constriction percentage (%): 32.73 ± 9.20 versus 39.93 ± 7.36 (P < 0.001), average constriction velocity (mm/s): 2.24 ± 0.85 versus 2.62 ± 0.68 (P = 0.002), maximum constriction velocity (mm/s): 3.82 ± 1.33 versus 4.42 ± 0.93 (P = 0.004) and T75 (recovery period to 75% of the baseline pupillary diameter in sec): 1.38 ± 0.36 versus 2.0 ± 0.82 (P < 0.001) in mTBI compared to age-matched controls. A statistically significant difference was noted for accommodative response (in D) as well as in the sample as compared to age-matched controls: -1.12 ± 0.64 versus - 1.39 ± 0.47 (P < 0.001). Pupillary constriction velocities and accommodative response are significantly affected in mTBI. These findings have important clinical implications in being able to understand the visual symptoms following an mTBI.

Systemic Risk Factors and Clinical Profile of Retinal Vein Occlusion in a Tertiary Eye Care Hospital in Northern Uttar Pradesh- A Case Control Study

Objective: To assess the various risk factors and clinical presentation in patients with Retinal Vein Occlusion presenting to a tertiary eye care hospital in Uttar Pradesh.

Clinical study of profile of retinal detachment in vasculitis and its management at tertiary eye care hospital.

The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due to vasculitis after surgical intervention. It was an interventional retrospective study of all cases who underwent surgery for RD with vasculitis at a single tertiary eye care center for over a period of 6 years. Patients with retinal detachment due to vasculitis were included in the study. All patients underwent the following surgical procedures: 240 belt buckle with three-port pars plana vitrectomy with membrane dissection and peeling with fluid gas exchange/with endolaser with silicon oil/C3 F8 gas injection. In our study, 83.33% had preoperative vision of less than 6/60, whereas postoperatively 66.66% had vision of less than 6/60. Postoperatively 33.33% patients had vision better than 6/36. Of the six eyes operated for vasculitis with RD, retina was attached in five eyes following surgery. One patient had recurrent retinal detachment due to extensive proliferative vitreoretinopathy changes, and he was advised re-procedure but was lost for follow-up. The anatomical success was 83.33% on the first surgery. The overall anatomic success rate of retina reattachment surgery in vasculitis patient was good, and the visual outcome following the surgery can improve in majority of the cases. Hence, timely intervention is advocated.

Visual outcomes of early enhancement following small incision lenticule extraction versus laser in situ keratomileusis.

To compare visual outcomes of early enhancement following small incision lenticule extraction (SMILE) versus laser in situ keratomileusis (LASIK). Retrospective analysis of eyes (patients operated in the setting of a tertiary eye care hospital between 2014 and 2020) requiring early enhancement (within one year of primary surgery) was conducted. Stability of refractive error, corneal tomography, and anterior segment Optical Coherence Tomography (AS-OCT) for epithelial thickness was performed. The correction post regression was done using photorefractive keratectomy and flap lift in eyes, wherein the primary procedure was SMILE and LASIK, respectively. Pre- and post enhancement corrected and uncorrected distance visual acuity (CDVA and UDVA), mean refractive spherical equivalent (MRSE), and cylinder were analyzed. IBM SPSS statistical software. In total, 6350 and 8176 eyes post SMILE and LASIK, respectively, were analyzed. Of these, 32 eyes of 26 patients (0.5%) post SMILE and 36 eyes of 32 patients (0.44%) post-LASIK required enhancement. Post enhancement (flap lift in LASIK, and PRK in SMILE group) UDVA was logMAR 0.02 ± 0.05 and 0.09 ± 0.16 (P = 0.009), respectively. There was no significant difference between the refractive sphere (P = 0.33) and MRSE (P = 0.09). In total, 62.5% of the eyes in the SMILE group and 80.5% in the LASIK group had a UDVA of 20/20 or better (P = 0.04). PRK post SMILE demonstrated comparable results to flap lift post LASIK and is a safe and effective approach for early enhancement post SMILE.