Eye Care Hospital Research Articles

Retrospective multifactorial analysis of Pythium keratitis and review of literature

Purpose:The aim of this work was to study the demographic profile, clinical diagnostic features, challenges in management, treatment outcomes, and ocular morbidity of microbiological culture-proven Pythium keratitis in a tertiary eye care hospital in South India.Methods:Retrospective analysis of microbiologically proven Pythium keratitis patients was performed at a tertiary eye center from October 2017 to March 2020. Demographic details, risk factors, microbiological investigations, clinical course, and visual outcomes were analyzed.Results:Thirty patients were analyzed. The mean age was 43.1±17.2 years. Most common risk factors were history of injury in 80% and exposure to dirty water in 23.3%. Visual acuity at baseline was 20/30 to perception of light (PL). The most common clinical presentation was stromal infiltrate and hypopyon in 14 (46.6%) patients each. The microbiological confirmation was based on culture on blood agar and vesicles with zoospores formation with incubated leaf carnation method. Seven (23.3%) patients improved with topical 0.2% Linezolid and topical 1% Azithromycin, 19 (63.3%) patients underwent Therapeutic keratoplasty (TPK) and 4 were lost to follow-up. Seven (23.3%) patients had graft reinfection, and 3 (10%) developed endophthalmitis. The final visual acuity was 20/20- 20/200 in 6 (20%) patients, 20/240-20/1200 in 5 (16.6%) patients, hand movement to positive perception of light in 16 patients and no perception of light (Pthisis Bulbi) in 3 (10%) patients.Conclusion:P. insidiosum keratitis is a rapidly progressive infectious keratitis with prolonged and relapsing clinical course. It usually results in irreparable vision loss in majority of the patients. Prompt diagnosis, clinical awareness, and specific treatment options are needed for successfully managing this devastating corneal disease.

A questionnaire based study on knowledge, awareness, and willingness towards corneal donation among the paramedical staff, public and students from Southern district of Tamil Nadu, India

Background: To determine the knowledge, awareness, and willingness towards eye donation among paramedical health care providers, public and students from schools and colleges around Tirunelveli district, Tamil Nadu, Southern India.Methods: It was a cross-sectional, observational study conducted from November 2019 to January 2020. A structured questionnaire regarding knowledge (K), awareness (A), willingness (W) for eye donation was used to elicit responses in the age group of more than 16 years. Participants were paramedical health care providers working in tertiary eye care hospital, school and college students, and attenders accompanying patients (addressed as public). Responses were collected from 1803 participants and analyzed statistically.Results: Most of the participants had knowledge about the facts of eye donation, such as 96.8% knew that it could be donated after death, and 55% knew that eyes were enucleated within 6 hours after death. 56.2% admitted that lack of awareness is the reason for not donating eyes; 23.8% said that the family members are objecting to eye donation. Social media was proposed as the best source of information about eye donation. Subjects with an age of fewer than 30 years were willing to donate (the odds ratio was 1.90). However, they had less knowledge (p value=0.105) and awareness (p value=0.02) about eye donation than more than 30 years.Conclusions: Even though awareness and knowledge about eye donation and willingness to pledge eyes are there, self-conscience regarding the need for donor corneas to meet the requirement of corneal blindness plays a pivotal role.

Visual Outcome After Pediatric Cataract Surgery In A Tertiary Eye Care Hospital

Visual Outcome After Pediatric Cataract Surgery In A Tertiary Eye Care Hospital

Agreement of findings of glaucoma screening between trained vision center technicians and glaucoma specialists at a tertiary hospital in South India.

Purpose:To study the agreement of findings of glaucoma screening between trained vision center (VC) technicians and glaucoma specialists in patients referred from VC to the glaucoma services of a tertiary eye care hospital in south India.Methods:This was a retrospective study comparing the findings of the VC technicians and the specialists of the glaucoma services in the base hospital, in patients referred from 13 VCs between January and June 2019. Medical records of 277 referred patients (out of 533 referrals) who attended the glaucoma clinic were analyzed.Results:Of the 277 patients, 111 (40%) were confirmed having glaucoma, 133 (48%) were suspects, 29 (10.4%) were normal, and four (1.4%) had other pathology. The mean age of the patients was 59.7 ± 13 years and 60.6% were females. There was no statistically significant difference between the mean intraocular pressure (IOP) measured (17 ± 7.2 mmHg at the VC and 18 ± 8.7 mmHg at the clinic, p = 0.16) and the cup-to-disc ratio (CDR) (0.7 ± 0.13 at the VC and 0.6 ± 0.18 at the clinic, p = 0.57). Bland–Altman plots with 95% limits of agreement supported that mean differences were close to zero, and the intraclass correlation coefficient at 95% CI showed good consistency between the measurement of IOP (0.78 [0.74 to 0.81]) and CDR (0.90 [0.88 to 0.92]) at the base hospital and vision center.Conclusion:There is good agreement between the findings of VC technicians and glaucoma specialists. VC technicians can help in detecting glaucoma in the community.

To study the role of platelet rich plasma as treatment in various etiologies of dry eye

To evaluate the effect of platelet rich plasma as treatment modality in various etiologies of dry eye.: A prospective study was conducted at a tertiary eye care hospital on 65 eyes of 40 patients for a duration of three years, who presented with the complaints of dry eye due to various etiologies. Platelet rich plasma (PRP) was made from the patient’s serum and they were advised to be instilled in topical eyedrop form six times a day. The study included 29 men and 11 women. The mean age was 40yrs (34.45±15.17), range 10 – 60 years. Dry eye symptoms like burning sensation, itching, dryness, blurred vision and redness were studied and were found to be significantly reduced (p=0.0001)post treatment with PRP after one month. The improvement in symptoms was most likely due to indirect reduction of inflammation. Around 30.7% eyes had improvement in visual acuity of atleast one line. The Schirmer’s test also showed improvement with Schirmer values before treatment being 5.34mm± 2.18 mm to 15.90 mm±7.75mm after treatment. Around 46.87% right eye and 39.9% left eye also had improvement with tear break up time more than 10 sec.The use of PRP eye drops for the treatment of various etiologies of dry eye was shown to be effective in reducing the symptoms of dry eye without any significant complications.

School-based vision screening in Quetta, Pakistan: a qualitative study of experiences of teachers and eye care providers

BackgroundVisual impairment in children is a significant public health problem affecting millions of children globally. Many eye problems experienced by children can be easily diagnosed and treated. We conducted a qualitative study with teachers and optometrists involved in a school-based vision screening programme in Quetta district of Pakistan to explore their experiences of training, vision screening and referrals and to identify factors impacting on the effectiveness of the programme.MethodsBetween April 2018 and June 2018, we conducted semi-structured in-depth interviews with 14 teachers from eight purposefully selected schools with high rates of inaccurate (false positive) referrals. Interviews were also conducted with three optometrists from a not-for profit private eye care hospital that had trained the teachers. Interviews were audio recorded and professionally transcribed. NVIVO software version 12 was used to code and thematically analyze the data.ResultsFindings suggest that the importance of school-based vision screening was well understood and appreciated by the teachers and optometrists. Most participants felt that there was a strong level of support for the vision screening programme within the participating schools. However, there were a number of operational issues undermining the quality of screening. Eight teachers felt that the duration of the training was insufficient; the training was rushed; six teachers said that the procedures were not sufficiently explained, and the teachers had no time to practice. The screening protocol was not always followed by the teachers. Additionally, many teachers reported being overburdened with other work, which affected both their levels of participation in the training and the time they spent on the screening.ConclusionsSchool-based vision screening by teachers is a cost-effective strategy to detect and treat children’s vision impairment early on. In the programme reviewed here however, a significant number of teachers over referred children to ophthalmic services, overwhelming their capacity and undermining the efficiency of the approach. To maximise the effectiveness and efficiency of school-based screening, future initiatives should give sufficient attention to the duration of the teacher training, experience of trainers, support supervision, refresher trainings, regular use of the screening guidelines, and the workload and motivation of those trained.

Ocular involvement in metastatic and systemic malignancies is not rare.

BackgroundMetastatic disease to the eye most commonly involves choroid followed by orbit leading to varied ocular manifestations. By comparison, it is relatively rarer than primary malignancies of eye as well as metastasis in other parts of the body.AimThe aim of this study is to evaluate the common eye and orbital structures involved in secondary ocular and metastatic disease, to describe its clinical manifestations and outline the management done.MethodsA retrospective study of newly diagnosed cases of ocular metastasis in last 2 years conducted in our recently established department of ocular oncology at a tertiary eye care hospital in Nepal. Demography, age and sex distribution were noted. The patients were segregated into those with secondary or metastatic ocular malignancies. Detail study on the metastatic disease to eye was made in regards to presenting symptoms, signs, primary site of cancer, and the treatment done. Details of the investigations done, like biopsy and imaging were also recorded.ResultsThere were a total of 28 patients, whose age group ranged from 9 years to 69 years with median age of 43 years. Females constituted 46% of total patients. Both the eyes were involved in 9 patients (32%). Eye was secondarily involved by paranasal sinus tumors and Non Hodgkin lymphoma (7 patients each). Ocular metastasis was commonly seen from broncogenic carcinoma in four and breast carcinoma in three patients. Simultaneous metastasis to other parts of the body was also seen in 61% of our patients. Diminution of vision in 49% was the most common presenting feature followed by proptosis in 16% and palpable mass in 14% of patients. Orbit in 43% cases is the commonest ocular structure involved. Histopathologic diagnosis was done in 32% only while rest was based on imaging alone. The most common treatment done was chemotherapy in 57% patients.ConclusionOcular metastasis can display a wide variety of clinical and imaging features and therefore a high degree of suspicion is required. It is often associated with simultaneous metastasis to other parts of the body as well, hence the importance of earlier diagnosis and metastatic workup.

Prevalence of pediatric eye diseases in Assam, India — a hospital-based retrospective data

Background: In a hospital setting, paediatric eye disease manifests itself in a complex network. It is essential to comprehend the scope of many common eye disorders in order to develop new evidence-based strategies for mitigating such disorders. The study aimed to investigate the hospital-based prevalence of pediatric ocular disorders of patients attending a tertiary eye care hospital. Material and methods: A three-year data from 2017–19 were extracted from the electronic medical records of Chandraprabha Eye Hospital, Assam, India. Refining the data was further carried out using the age criteria up to 18 years. The diagnosis for all the study subjects was taken into consideration and was further analyzed. The inclusion criteria included subjects within the range of 0–18 years reporting to the hospital during the study period. Subjects diagnosed with non-ocular problems, incomplete ophthalmological assessments, and those aged more than 18 years were excluded. Results: A total of 11807 relevant medical records were reviewed. Among the study subjects, 58.52% (n = 6910) were males. The mean (SD) age was 11.9 (4.8) years. Of the subjects 21.28% (n = 2513) were in age group 0–5 years, 42.39% (n = 5006) — in 6–11 years, and 36.31% (n = 4288) in 12–18 years. A total number of 152 pediatric ocular abnormalities were identified from the reviewed files. Myopia alone accounted for 19% of all, followed by vernal keratoconjunctivitis with 14.7%, followed by asthenopic presentation associated with non-strabismic binocular vision anomalies (7.4%), congenital nasolacrimal duct obstruction (2.9%), amblyopia (2.8%), and ocular injuries (2.7%). Conclusions: Refractive errors, allergic conjunctivitis, ocular injuries, amblyopia and squint, uveitis, congenital cataract, and non-strabismic binocular vision anomalies were identified as the most common pediatric ocular abnormalities seen in routine clinical practice, laying the groundwork for a standard protocol to evaluate and assess visual function in any case of pediatric anomaly.

Role of Concomitant Internal Limiting Membrane (ILM) Peeling During Rhegmatogenous Retinal Detachment (RRD) Surgery in Preventing Postoperative Epiretinal Membrane (ERM) Formation.

Objective:To investigate the role of concomitant Internal Limiting Membrane (ILM) peeling during surgery for macula off Rhegmatogenous Retinal Detachment (RRD) in preventing postoperative Epiretinal Membrane (ERM) formation; and its effect on the visual acuity.Methods:This was a prospective, quasi-experimental study conducted from August 2018 to July 2019 at LRBT Tertiary Eye Care hospital, Karachi. Fifty-six patients with macula off RRD were divided into groups A (with ILM peeling) and B (without ILM peeling) via non-probability convenience sampling. All patients underwent standard 3 ports pars plana vitrectomy with silicon oil tamponade. In Group-A, ILM was stained using 0.5% ICG. Patients were evaluated clinically and by spectral domain optical coherence tomography (SD-OCT), pre- and post-operatively. Main outcomes recorded were best corrected visual acuity (BCVA) and occurrence of ERM on SD-OCT.Results:There were 26 patients in Group-A and 30 patients in Group-B. At six months’ follow-up, ERM had not developed in any case in Group-A compared to five patients (16.7%) in Group-B. There was no statistical difference in mean BCVA change from baseline.Conclusion:ILM peeling during vitrectomy for RRD prevents the formation of macular ERM post-operatively. This may reduce the need of a second vitrectomy. However, visual outcomes were comparable to the non-ILM peeling vitrectomy.

Impact of a structured training program to enhance skills in phacoemulsification surgery.

Purpose:The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases.Methods:This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 (n = 33), who underwent training before the introduction of the structured program, and Group 2 (n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done.Results:Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1.Conclusion:A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.

Donor corneal tissue utilization and factors responsible for rejection in tertiary eye care hospital in North India

Purpose: To evaluate the donated cornea and find out the pattern & factors influencing the utilization of corneal tissue. Study design: Retrospective, non-comparative observational study. Material and Methods: Data of 1273 donor eyes collected from all over the Haryana under Hospital Cornea Retrieval Programme (HRCP) and those collected from voluntary donors at their residence from April 2011 to March 2020 were analyzed including the cause of death, gender, age, place of tissue procurement, Death to Enucleation time, grades of tissue and various utilization parameters. Results: A total number of 1273 of eyes were procured out of which 774 (60.8%) were fit for corneal transplantation while 499 (39.19%) were not fit. Conclusion: Utility of the donor cornea depends upon various factors like age, death enucleation time, cause of death, maintenance of cold chain and technique of tissue procurement.

Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile.

Purpose:The aim of this study was to describe epidemiological and clinical characteristics of pediatric ocular motor cranial nerve palsy.Methods:This was a retrospective record-based study, carried out at a tertiary eye care hospital in India, between January 2011 and January 2015 and included patients up to 16 years of age at the time of presentation, diagnosed with third, fourth, sixth nerve palsy or a combination of these with other cranial nerve palsy. Data analyzed included demographic details, etiologies, presence or absence of amblyopia, relevant investigations, and management.Results:A total of 90 cases were included in the study. Eighty patients (88.88%) presented with isolated nerve palsy. Forty-three patients (47.77%) had congenital nerve palsy. The most common nerve involved was third (n = 35, 38.88%) followed by sixth (n = 23, 25.55%) and fourth nerve (n = 22, 24.44%). Most common cause of third and fourth cranial nerve palsy was congenital (n = 18, 51.42% and n = 17, 77.30%, respectively), while it was trauma for the sixth nerve (n = 7, 30.40%). Amblyopia was most frequently associated with third cranial nerve palsy (n = 27, 77.14%). The radio-imaging yield was maximum (n = 7, 70%) for combined cranial nerve palsy. Overall 44 (48.88%) patients were managed conservatively, while 46 (51.11%) patients needed squint with or without ptosis surgery.Conclusion:The most common ocular motor cranial nerve involved in the pediatric population was the third cranial nerve, and it was found to be the most amblyogenic in this age group. The neuroimaging yield was maximum for combined cranial nerve palsy. The most common conservatively managed nerve palsy in this study group was the fourth nerve palsy.

Visual outcomes of cataract surgery: An observational study of ten years from a tertiary eye care hospital in Pakistan

Objectives:To observe and analyze the visual outcomes of cataract surgery of ten years at a tertiary eye care hospital, Karachi.Methods:An observational study with retrospective data search was conducted in Al Ibrahim Eye Hospital (AIEH), Karachi. Data of all adults (above 16 years) who underwent cataract surgery from 2010-2019 was retrieved from HIMS. Presence of opacity in the lens was labelled as cataract. Surgery was advised when patient’s BCVA was found to be ≤ 6/18. Visual assessments of the patients were done on day 01, one week and six weeks postoperatively. Postoperatively, 6/6 – 6/12 was considered as good, 6/18 as mild visual impairment, < 6/18 to 6/60 as moderate visual impairment and < 6/60 as severe visual impairment.Results:A total of 1,027,840 patients visited AIEH with different eye diseases. Among 1027840 individuals, cataract was identified in 88443 (8.6%). Surgery was advised to 58371 and performed in 38616. Records of operated cases (38616) were retrieved. Mean age of patients was 54.96±14.22 years. There were 20578 (53.29%) males and 18038 (46.71%) females who underwent surgery . At the end of sixth week, 3561 (18.4%), patients were found to have “good vision”, 12242 (63.43%) had mild visual impairment, 2676 (13.86%) had moderate visual impairment and 822 (4.26%) had severe visual impairment. Corneal Complications was the commonest cause (33.56%) at sixth week.Conclusions:The institution achieved WHO recommended criteria of “good visual outcome” (6/6 to 6/18) of 81.83% which is near to recommended ≥ 90% and severe visual impairment of 4.26%.

Epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases of refractive error in pediatric population visiting a tertiary eye care center

Purpose: This study aimed to evaluate the epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases in children visiting a tertiary care eye center in southern India. Materials and Methods: This prospective study was conducted on 367 children, ≤15 years of age, with significant refractive error who visited our tertiary eye care hospital over a period of 1 year. Every child underwent detailed ocular examination. Significant refractive error was defined as myopia of ≥−0.75 diopter (D), hypermetropia of more than +2 D, and astigmatism of more than 0.75 D. Descriptive statistics were computed for better and the worse eye. Statistical tests were applied between the worse and better eyes using Chi-square test. Results: A total of 367 children (38.8%) were diagnosed for the first time of having refractive error. Only 146 (39.8%) children presented with visual complaints. With respect to the vision in the worse eye, 65.9% (n = 240) had moderately subnormal vision. There was no statistically significant difference (P = 0.057) between age distribution and visual acuity in the worse eye. Two hundred and thirty-eight children (64.9%) had significant astigmatism as compared to 161 myopic (43.9%) children. There was a statistically significant difference between reasons of visit and different age groups. Conclusions: Astigmatism was the most prevalent refractive error and uncorrected astigmatism the most significant amblyogenic factor. Since majority of children, especially in the younger age group, present with nonvisual complaints, involvement of pediatricians and parents will help us to reduce morbidity due to uncorrected refractive error and amblyopia.

To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India

<i>Aim:</i> To study presentation of ocular cysticercosis and to evaluate its demographic data, diagnosis, treatment and outcome in hill population of Northern India. <i>Materials and methods:</i> This is a retrospective study carried out in Dehradun, Uttarakhand in a tertiary eye care hospital over 4 years from 2016-2020. The study involved 38 patients who presented with unilateral eye disease and were diagnosed to have ocular or adenexal cysticercosis. We analysed retrospectively their geographical data, clinical presentation, serology, imaging, response to treatment and clinical outcome. <i>Results:</i> Age of patients ranged from 16-54 years. Male to female ratio was 1:3.75. Total no. of eyes affected were 38. All were unilateral presentation. 30 eyes (78.94%) presented with extraocular cysticercosis and 8 eyes (21.05%) with intraocular cysticercosis. 27 of the patients (71.05%) were from lower socioeconomic status with poor hygiene and sanitation conditions. 32 (89.21%) patients gave history of association with non-vegetarian diet. Extraocular cysticercosis group had restriction of ocular motility as most prevalent presentation seen in 16 eyes (53.33%) and proptosis as the most prevalent sign seen in 17 eyes (56.66%). Cyst prevalence was most frequently detected in superior rectus muscle seen in 14 eyes (53.84%). Intraocular cysticercosis group had blurring of vision as the most prevalent presenting symptom in 8 eyes (100.0%). Panuveitis in 6 eyes (75%) and presence of subretinal cyst in 4 eyes (50%) was the most prevalent sign seen in intraocular cysticercosis group. Enzyme linked immunosorbent assay test confirmed serology in 35 cases (92.10%). The USG B-scan detected presence of scolex in 36 eyes (94.73%). Magnetic resonance imaging (MRI) confirmed deep seated extraocular cysticercosis lesions and neurocysticercosis (NCC) undetected by computerized tomography (CT). CT was diagnostic for NCC in 5 cases (13.15%). Oral Albendazole and prednisolone were successful in management of extraocular cysticercosis. Intraocular cysticercosis was treated well with pars plana vitrectomy surgery with good visual recovery. <i>Conclusion:</i> Extraocular cysticercosis was more prevalent than intraocular cysticercosis. Early diagnosis and treatment made a difference in final outcome of the two groups. Imaging studies of orbital B-scan ultrasonography (USG B scan), CT and MRI with immune serological test of enzyme linked immunosorbet assay (ELISA) and Western blot for anticysticercus antibodies helped in confirming the diagnosis. Extraocular cysticercosis can be managed well medically with good clinical outcome. Intraocular cysticercosisis is best treated surgically. Safer and modern vitreoretinal surgical techniques promise good surgical outcome and visual recovery. Timely intervention and frequent postoperative follow up would help in keeping a watch on development of complications and maintenance of good vision.

Strengthening the referral Chain and providing one window diabetes eye care facility to people with Type-2 Diabetes: A six-year follow-up study from Pakistan.

Objective:To report the results of implementation of two-pronged system for strengthening of referral and receiving end of referral chain for people with Type-2 diabetes mellitus (T2DM) at a tertiary eye care hospital in Karachi.Methods:This observational, cross sectional study was conducted from the data collected in “Strengthening Pakistan’s response to Diabetic Retinopathy” project. Peripheral referral was improved through community awareness camps (n=48), refreshing knowledge of primary healthcare professionals (PHCP) and conducting retinopathy screening camps (n=85) in the community. T2DM patients with best corrected visual acuity (BCVA) <6/18 or had retinopathy sign on screening were referred to tertiary center. The receiving end of the referral was improved by establishing “one window facility” at tertiary eye care center. Facility consisted of eight stations starting from registration, visual assessment, fundus photographs, consultation with ophthalmologist, anthropometry measurement, consultation with diabetologist to finally meeting with diabetes educator. At every station, patient’s information was directly entered in HIMS software.Results:A total of 50,595 patients attended tertiary center over six years. Among all 34685 (68.5%) were new registration and 15910 (31.4%) were follow ups. During first year (2014-15) out of total registered individuals with DM, newly registered were 4414 (89.5%) and 518 (10.5%) were follow-ups. In the final year (2019-20) new cases registered reached to 62% (n= 7916) with 38% (n=4852) follow-ups. Patients referred by PHCP increased from 6.5% in 2014-15 to 43.7% in 2019-20. An increased uptake of all treatment modalities for retinopathy like laser (increased by 16.76%), intra-vitreal injections (by 14.72%) and vitrectomy (by 51.47%) were also observed.Conclusion:Implementation of two prong system resulted in improved service uptake, better referral system, enhanced follow-ups and increased intervention uptake.

Can the postoperative follow-up visit be deferred up to four weeks after an uneventful cataract surgery? - A randomized controlled trial.

Purpose:The aim of this study was to compare the postoperative visual outcome after a Day 0 examination in patients with two follow-ups, one between Day 3 to Day 7 and other between Day 25 to Day 30 to those with a single ophthalmic follow-up directly after 25–30 Days and to assess the safety of deferral of the first follow-up visit at 1 week.Methods:Randomized Controlled Trial was conducted at a tertiary eye care hospital, with 848 patients enrolled for the study. Patients meeting the inclusion criteria were selected. Their pre-operative and post-operative data was collected and the patients were divided into groups based on the type of cataract surgery and the postoperative follow-up protocol through randomization.Results:No significant difference was observed in the postoperative visual outcome in patients that underwent postoperative review at Day 3–7 and Day 25–30 as opposed to those that followed up directly at Day 25–30 after a mandatory Day 0 examination for all patients.Conclusion:In patients with no preexisting ocular or systemic comorbidity undergoing an uneventful cataract surgery, the postoperative follow-up visit can be safely deferred until 4 weeks, without any impact on the postoperative visual outcome, thereby conserving the available resources which can be deviated towards better eye care services.

Pediatric uveitis: a retrospective analysis at a tertiary eye care hospital in South India.

Purpose:To analyze the demographics, etiology, complications, treatment modalities, and visual outcomes in pediatric uveitis patients at a tertiary eye care hospital.Methods:A retrospective review of medical records of pediatric uveitis patients who presented with us from January 2014 to January 2020 was evaluated.Results:Out of the 178 pediatric uveitis patients, 65 children were included in the study. The most common age group was 6–10 years (46%). Of the included patients, 36 (55.4%) were male and 29 (44.6%) were female. Presentation was bilateral in 39 (60%) and unilateral in 26 (40%). Anterior uveitis was seen in 19 (29.23%), intermediate in 18 (27.69%), posterior in 16 (24.62%), and panuveitis in 12 (18.46%) patients. There were 2 cases of masquerades. Non-infectious uveitis was the most commonly seen, in 48 (73.84%) of total cases, among which 21 (43.75%) were idiopathic and 7 (14.58%) were associated with juvenile idiopathic (JIA) arthritis. Infectious uveitis was present in 17 (26.15%); the most common etiology was toxoplasmosis. Baseline visual acuity was low in 22 (33.84%) children. After initiating treatment, 37 (56.92%) showed improvement in vision and 10 (15.38%) had worsening of vision. Intraocular pressure (IOP) rise was seen in 5 (7.69%) children; 51 (78.46%) children required medical management and 16 (24.61%) children required surgical intervention; 46 (70.76%) children had uveitis related complications out of which most of them 30 (65.21%) were present at baseline.Conclusions:Anterior and intermediate uveitis were the most common types observed in our study. Toxoplasmosis was the most common type of infectious uveitis and JIA the most common cause in non-infectious type apart from idiopathic uveitis. Posterior uveitis had low visual acuity at baseline and follow-up. Children presented to us with poor visual acuity and complications at baseline, hence an early referral to a tertiary eye hospital and management accordingly can improve the quality of vision and visual rehabilitation.

Effect of dexmedetomidine on intraocular pressure as an additive in peribulbar block during glaucoma surgery.

Purpose:The purpose of this study is to assess the effect of dexmedetomidine on intraocular pressure (IOP) as an additive in peribulbar injections in glaucoma surgeries.Methods:A prospective, randomized, double-blind, parallel assignment interventional study was conducted for patients undergoing glaucoma surgeries at a tertiary eye care hospital in North India. Patients were randomized to two groups, Dexmed group and Placebo group. In the Dexmed group, dexmedetomidine (0.4 μg/kg body weight) was given as an additive along with peribulbar block. The primary outcome was change in IOP pre- and postperibulbar injections (IOP before the block, and after 5 and 15 min of the block). Secondary outcome measures were onset of block, adverse effects (bradycardia, hypotension, respiratory depression, and level 4 sedation), and surgeon satisfaction.Results:A total of 104 patients were randomized, 52 each in the Dexmed group and Placebo group. The percentage decrease in IOP was significantly more in the Dexmed group than in the Placebo group both at 5 and 15 min' post block (P < 0.05). At 5 min, the mean percent decrease in IOP in Dexmed group was -10.48, whereas it was 2.85 in the Placebo group. At 15 min, the mean percent decrease in IOP was -22.59 and -9.42 in the Dexmed and Placebo group, respectively. There was no significant difference between the two groups in the onset of block and adverse effects. Surgeon satisfaction was significantly greater in the Dexmed group than the Placebo group (P < 0.05).Conclusion:Dexmedetomidine lowers IOP significantly in patients undergoing glaucoma surgeries with safe hemodynamic changes and sedative effect.

Slit-lamp measurement of anterior chamber depth and its agreement with anterior segment optical coherence tomography and Lenstar LS 900 in pseudoexfoliation and normal eyes.

Purpose:There is a considerable lack of awareness of slit-lamp measurement of anterior chamber depth (ACD) by the Redmond Smith method (SACD) in present day-to-day clinical practice, which may provide rapid assessment in pseudoexfoliation (PXF) when assessing for angle closure and planning for cataract surgery. This assumes importance not only in outreach clinics but also in the ongoing pandemic caused by the highly contagious novel coronavirus, where social distancing is advocated to contain the spread. We aimed to compare the axial ACD in PXF and normal patients by SACD, and its agreement with the anterior segment optical coherence tomography (ASOCT) and LenstarLS-900.Methods:A prospective comparative observational study was done at a tertiary eye care hospital. A PXF group and a normal group of controls were recruited. All eyes were phakic with normal cornea. Any eye with previous intraocular/refractive surgery and cause of other secondary or uncontrolled glaucoma was excluded. SACD was measured clinically via slit-lamp method and also via ASOCT and Lenstar; agreement between the methodologies was plotted.Results:Fifty patients were recruited in each group. Mean age was 66.82 ± 4.88 years in PXF patients and 65 ± 5.46 years in controls (P = 0.2). ACD was found to be greater in controls compared with the PXF patients; this difference was statistically significant (P < 0.001) across all methodologies. A good agreement with narrow 95% limits of agreement was found between these methodologies.Conclusion:Redmond Smith slit-lamp methodology of estimating the axial ACD is recommended as a rapid, quantifiable, noncontact screening technique during routine examination, especially in primary outreach centers, and is also advantageous during the ongoing pandemic by reducing expendable investigations.