Ophthalmic Hospital Research Articles

A comparative study of endothelial cell loss in small incision cataract surgery versus phacoemulsification cataract surgery by using specular microscope at tertiary care ophthalmic centre in Bengaluru, Karnataka

Most commonly performed surgical procedure in Ophthalmology is cataract extraction by MSICS and Phacoemulsification. It has always been associated with damage to endothelium of cornea, a layer which is vital for maintaining corneal transparency. The corneal endothelium regulates stromal hydration and maintains the transparency of the cornea by constantly removing the fluid out of the corneal stroma. The density of corneal endothelial cells and its integrity is an important determinant for corneal transparency. Post-operative corneal decompensation leading to reduced visual acuity can occur as a result of this surgical trauma. Hence it is necessary to determine the surgical technique safest to corneal endothelium. Specular microscopy helps to determine this corneal endothelial cell density. A hospital based longitudinal study was done from November 2017 to May 2019 in 124 patients at Minto Ophthalmic Hospital. 62 patients underwent MSICS and 62 phacoemulsification. After a written informed consent patients were evaluated with detailed history, slit lamp examination, direct and indirect ophthalmoscopy, biometry, lacrimal syringing, IOP measurement with tonometry and endothelial cell count was evaluated using non contact specular microscopy preoperatively and postoperative 1 week and 6 weeks. Statistical data analysed by unpaired – t test. The mean ECC (cells/mm) in MSICS and phacoemulsification group preoperatively was 2486.82 + 152.730 and 2433.71 + 192.692 respectively. The mean endothelial cell loss (cells/mm) was 314.61 + 64.428 and 324.31 + 30.67 at 1 week and 345.71 + 66.68 and 354.95 + 53.885 at 6 weeks postoperatively between the two groups. The endothelial cell loss was not statistically significant at 1 week (p -0.28) and 6 weeks (p-0.39) postoperatively between the two groups. There was no clinically or statistically significant difference in the endothelial cell loss between MSICS and Phacoemulsification. As MSICS is economical and less dependent on technology, it can be a safe option in developing world.

The Effects of Donor-Recipient Age and Sex Compatibility in the Outcomes of Deep Anterior Lamellar Keratoplasties.

PurposeCorneal transplantations are the commonest allogenic transplant surgeries performed worldwide. Transplantable grade donor cornea is a finite resource. There is thus an impetus for eye banks to optimize the use of each harvested cornea, and clinicians to minimize the risks of graft rejection and failure. With better survival and lower rejection rates, anterior lamellar keratoplasty has gained popularity as an alternative technique to full-thickness penetrating keratoplasty, for the treatment of corneal stromal diseases. This study evaluated the effects of donor-recipient age- and sex-matching on the outcomes of eyes that had undergone deep anterior lamellar keratoplasty (DALK) surgeries.DesignObservational cross-sectional study (national corneal graft registry data).SubjectsAll DALK surgeries performed in a tertiary ophthalmic hospital over an 11-year period.MethodsTo analyse the effects of donor-recipient sex-matching, transplantations were classified as “presumed H-Y incompatible” (male donor to female recipient) or “presumed H-Y compatible” (all other donor-recipient sex combinations). For age-matching, differences in donor and recipient ages were calculated. Cox proportional hazards regressions were used to evaluate the influence of donor-recipient sex-matching and age-matching on graft failure and rejection.Main Outcome MeasuresRates of graft failure and rejection within each group.Results401 eyes were included. 271 (67.6%) transplants were presumed H-Y compatible. 29 (7.2%) grafts failed and 9 (2.2%) grafts rejected. There were trends of lower hazard ratios (HRs) in graft failure and rejection in the presumed H-Y compatible group [HRs: 0.59 (95% CI 0.20–1.77, p = 0.34) and 0.93 (95% CI 0.22–3.89, p = 0.926), respectively]. Median difference in age between recipients and donors was 15.0 years (IQR −2.8–34.3). The HRs of graft failure and rejection were not influenced by donor-recipient age [HRs per 1-year increase in age difference: 0.995 (95% CI 0.98–1.01, p = 0.483) and 1.01 (95% CI 0.99–1.03, p = 0.394), respectively].ConclusionIn eyes that had undergone DALK surgeries, no significant influence of donor-recipient sex- or age-matching on graft rejection and failure was observed. Without strong evidence and the limitations of obtaining sample sizes required for an adequately powered study, the benefits of sex- and age-matching of donors and recipients during graft allocation for DALK surgeries is currently inconclusive.

Teleconsultation at a public ophthalmic teaching hospital during the COVID-19 pandemic.

To analyze teleconsultation at a public ophthalmic teaching hospital during the COVID-19 pandemic in Brazil. Medical records of patients who requested ophthalmological teleconsultation between June 2020 and March 2021 were reviewed. The main outcomes included demographic data, eye disease symptoms, hypothesized diagnosis, and management. Moreover, the results of a satisfaction survey administered after the consultation were analyzed. Medical records of a total of 161 patients were reviewed. The mean age was 45.98 ± 17.57 (8-90) years, and most were women (113, 70.20%). Only 57 (35.60%) of the patients had made previous follow-up visits to the hospital. The most frequent reason for consultation was the need for a new eyeglass prescription (73, 45.34%), followed by dry eye symptoms (16, 9.93%) and pterygium (13, 8.07%). Other reasons were the monitoring of previously diagnosed eye diseases, such as glaucoma, retinopathies, strabismus, and keratoconus. Regarding the satisfaction survey, 151 (93.78%) patients answered the online questionnaire. Most reported that they were satisfied with the teleconsultation (94.03%) and would participate in a future teleconsultation (90.06%). Teleconsultation could be widely used to assist patients in public ophthalmology healthcare and teaching hospitals. Even though new eyeglass prescriptions are a frequent reason for ophthalmological appointments, patients tend to be satisfied with teleconsultation, as it also provides guidance.

Outcome of cataract surgery with 1 h of preoperative antibiotic regimen: A strategy during COVID-19 Pandemic: Study from a tertiary eye care hospital

Purpose: This study aims to describe the visual and surgical outcomes of 810 eyes of 805 patients who underwent unilateral cataract surgery on the same day with 1 h of preoperative antibiotic regimen. Setting: Tertiary Care Ophthalmic Hospital. Design: Retrospective, descriptive study. Methods: This study comprised of consecutive adult patients who underwent preoperative cataract work up, received 1 h of preoperative antibiotic regimen, and underwent cataract surgery on the same day of consultation with a minimum 3-week follow-up period. This study describes the demographic profile, preoperative, intraoperative details, postoperative (PO) best-corrected visual acuity (BCVA), and surgical outcomes of these patients. Results: 810 eyes of 805 patients with a mean age of 61.0 ± 9.7 years, 50% had systemic and 9% had ocular comorbidities. The mean preoperative BCVA was 0.8 ± 0.7 LogMAR. Phacoemulsification was performed in 90.1%. Intraoperative complications had occurred in 8 (1%) eyes. The mean PO BCVA of the study group on PO day 1 (POD1) and PO 3 weeks was 0.13 ± 0.3 LogMAR and 0.07 ± 0.3 LogMAR, respectively. Our study showed that 95.68% had improvement in vision, while 96.8% achieved BCVA 6/18 or better. None had PO endophthalmitis. Comparison between preoperative and both POD 1 day and PO 3-week BCVA showed statistically significant improvement (P < 0.001). Conclusion: Our study results satisfied the benchmark set by the World Health Organization (WHO) for PO BCVA with good surgical outcome. Preoperative antibiotic applied 1 h before cataract surgery provided safety and comfort and with low risk for endophthalmitis. This strategy can be adopted to tackle the backlog of cataract surgeries due to COVID-19 (or any other emergency situation) in developing countries.

Topical Chlorhexidine 0.2% versus Topical Natamycin 5% for the Treatment of Fungal Keratitis in Nepal: A Randomized Controlled Noninferiority Trial

PurposeTo investigate if topical chlorhexidine 0.2%, which is low cost and easy to formulate, is noninferior to topical natamycin 5% for the treatment of filamentous fungal keratitis.DesignRandomized controlled, single-masked, noninferiority clinical trial.ParticipantsAdults attending a tertiary-level ophthalmic hospital in Nepal with filamentous fungal infection confirmed on smear or confocal microscopy.MethodsParticipants were randomly allocated to receive topical chlorhexidine 0.2% or topical natamycin 5%. Primary analysis (intention-to-treat) was by linear regression, using baseline logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity (BSCVA) and treatment arm as prespecified covariates. Mixed fungal-bacterial infections were excluded from the primary analysis but included in secondary analyses and secondary safety-related outcomes. The noninferiority margin was 0.15 logMAR. This trial was registered with ISRCTN, number ISRCTN14332621.Main Outcome MeasuresThe primary outcome measure was BSCVA at 3 months. Secondary outcome measures included perforation or therapeutic penetrating keratoplasty by 90 days.ResultsBetween June 3, 2019, and November 9, 2020, 354 eligible participants were enrolled and randomly assigned: 178 to chlorhexidine and 176 to natamycin. Primary outcome data were available for 153 and 151 of the chlorhexidine and natamycin groups, respectively. Of these, mixed bacterial-fungal infections were found in 20 cases (12/153 chlorhexidine, 8/151 natamycin) and excluded from the primary analysis. Therefore, 284 patients were assessed for the primary outcome (141 chlorhexidine, 143 natamycin). We did not find evidence to suggest chlorhexidine was noninferior to natamycin and in fact found strong evidence to suggest that natamycin-treated participants had significantly better 3-month BSCVA than chlorhexidine-treated participants, after adjusting for baseline BSCVA (regression coefficient, −0.30; 95% confidence interval [CI], −0.42 to −0.18; P < 0.001). There were more perforations and emergency corneal grafts in the chlorhexidine arm (24/175, 13.7%) than in the natamycin arm (10/173, 5.8%; P = 0.018, mixed infections included), whereas natamycin-treated cases were less likely to perforate or require an emergency corneal graft, after adjusting for baseline ulcer depth (odds ratio, 0.34; 95% CI, 0.15–0.79; P = 0.013).ConclusionsTreatment with natamycin is associated with significantly better visual acuity, with fewer adverse events, compared with treatment with chlorhexidine. Natamycin remains the preferred first-line monotherapy treatment for filamentous fungal keratitis.

Анализ микротравм медицинского персонала на рабочем месте в лечебном учреждении хирургического профиля

The article presents an analysis of microtraumas at the workplace of medical workers of an ophthalmic surgical hospital based on the results of dynamic observation for 10 years. The structure and dynamics of microtraumas, the categories of medical workers most at risk of emergencies at the workplace are given. The structure of non-infectious diseases of patients has been determined

Refractive amblyopia among children aged 4-12 years in a hospital-based setting in Gaza Strip, Palestine.

Refractive amblyopia is the most common cause of amblyopia in the Gaza Strip. However, the pattern of this condition has not yet been studied in this region. This study aimed to determine the pattern of refractive amblyopia in Gazan children aged 4‒12 years. This was a hospital-based cross-sectional study using a purposive sampling method. Children aged 4‒12 years who attended the Children's Unit at Gaza Ophthalmic Hospital, Gaza Strip, Palestine from September 2019 to July 2020, were examined. A comprehensive eye test was conducted for all participants. Those who failed the eye examinations and were diagnosed with refractive amblyopia were included in the study. Demographic data and amblyopic refractive error patterns were analyzed accordingly. Of the 107 children, 72.9% were newly diagnosed with refractive amblyopia. The mean (standard deviation [SD]) of age of the children who participated was 7.85 (1.55) years. Approimately two-thirds of the patients were female (57.9%). Unilateral amblyopia was predominant in 60.7% of the cases. Moderate amblyopia was common (81.9%). A total of 149 amblyopic eyes were examined in total, with a mean (SD) (range) of best-corrected distance visual acuity and spherical equivalent of 0.45 (0.19) (0.2 to 1.3) logarithm of the minimum angle of resolution and + 0.76 (4.51) diopters (- 10.25 to + 11.50). Astigmatism was the most common amblyogenic factor (53.7%) among children with amblyopia. The frequency of refractive amblyopia was 72.9%, and meridional amblyopia accounted for the highest percentage. Girls were more commonly affected than boys. The majority were in the 7-year-old age group. Most cases were unilateral with moderate refractive amblyopia. Our study yields insights into the patterns of refractive amblyopia among children in the Gaza Strip.

Impact of application of queuing theory on operational efficiency of patient registration

BackgroundHospital administrators are often challenged with overcrowding at hospitals. The study hospital receives referred patients; however, they have to wait in long queues even for getting registered. This was a cause of concern for hospital administrators. The study was undertaken to find an amicable solution to the queues at registration using Queuing Theory. MethodThis observational and interventional study was carried out in a tertiary care ophthalmic hospital. In the first phase, data of service time and arrival rate was collected. The queuing model was built using the coefficient of variation (CoV) of the observed times. Server utilization for new patient registration was found to be 1.21 and was 0.63 for revisit patients. Scenario-based simulation carried out using free software for optimal utilization of both types of servers. Recommendations made to combine the registration process and to increase one server were implemented.In the second phase, after one year, patient registration data were collected and compared for the number of patients registered using SPSS 17. ResultsNumber of patients registered within the registration timings increased whereas the number of patients registered after the registration timings decreased significantly at 95% CI with a p-value of less than 0.001. Queues finished early and more number of patients were registered in the same time. ConclusionUsing queuing theory, the bottleneck of the systems can be identified. Scenario and software-based simulations provide solutions to the problem of queues. The study is an application of Queuing Theory with a focus on efficient resource utilization. It can be replicated in an organization with limited resources facing the challenge of queues.

Management of Keratoconus in Down Syndrome and Other Intellectual Disability.

The purpose of this study was to assess an intellectual disability (ID) cohort with keratoconus (KC) regarding ophthalmic (visual acuity and corneal tomography) and systemic characteristics and to describe an appropriate clinical algorithm for investigation and management of KC in this setting. This was the retrospective cohort study of patients with ID (Down syndrome, autism, and other) in the cornea department of a tertiary referral ophthalmic hospital in Dublin, Ireland. Retrospective chart review was conducted on people with ID undergoing examination under anesthesia or crosslinking under general anesthetic. Key outcome data included corneal examination findings, corneal tomography, visual acuity, and examination findings (eg, type of ID, general anesthetic, and cardiac status). Mean age of the 24 patients was 31.9 years (66.7% male). ID type was Down syndrome (66.7%), autism (25%), and other (8.3%). KC was diagnosed in 98% of eyes, with 45.8% having untreatable advanced disease (57.1% of these bilateral), 39.6% amenable to corneal collagen crosslinking (35.7% of these bilateral), and 6.3% having corneal transplantation. Congenital heart defects were present in 37.5% of the Down syndrome group. There were no serious ocular or systemic adverse events. KC is strikingly prevalent in the ID population. Ireland has the highest rate of Down syndrome in Europe (26.3:10,000 live births). This group is rarely suitable for corneal transplantation, and corneal collagen crosslinking is an effective intervention to prevent progression to advanced KC in this already socially restricted group. We propose an algorithm for investigation/treatment and also recommend uniform pediatric KC screening/treatment in ID populations.

A Retrospective Comparison of Trabeculectomy, Baerveldt Glaucoma Implant, and Microinvasive Glaucoma Surgeries in a Three-Year Follow-Up

ABSTRACT Purpose: This retrospective study aimed to evaluate the safety and efficacy of MIGS (Xen® and Cypass®) compared to trabeculectomy and Baerveldt® implants. Patients and Methods: This single-center study included patients from the Ophthalmic Hospital of Turin between January 2015 and 2018. Efficacy was assessed based on the intraocular pressure and the number of medications necessary to control IOP at 1, 3, 6, 12, 24, and 36 months and the potential complications. Complete surgical success was defined as IOP ≤ 21 mmHg, with no medication or additional glaucoma surgery. Qualified success was defined as IOP ≤ 21 mmHg with the reintroduction of topical medications. Our third measure of success was a delta IOP reduction greater than 20% compared to baseline. Results: The delta IOP compared to the baseline was significant at every instance, except in the Xen® implant group. The average IOP distribution at different time points was significant, except at 1 and 12 months. The delta of the medication number compared to the baseline was significant at every instant. All three methods of success were analyzed using a Kaplan-Meier survival curve that identified a significant difference on the success rates of Xen®-trabeculectomy, Xen®-Baerveldt®, and Cypass®-Baerveldt®. Conclusion: MIGS can reduce the number of medication classes, thus increasing patient compliance and reducing topical ocular toxicity and general costs. Trabeculectomy remains the most effective option but still presents a percentage of failures that might increase during follow-up.

A probable case of aggressive extranodal natural killer T-cell lymphoma in a 19th century Qing Dynasty painting

“Ashun of Ko Tung aged 34, a carpenter. The disease commenced a little more than a year ago. Formerly it communicated both with the mouth and nose, and discharged a yellowish fluid. On a former occasion he performed an operation upon himself, and with the aid of his knife and looking glass, evacuated its contents; but the disease returned”. So wrote Reverend Dr Peter Parker (1804–88), an American medical missionary and graduate of Yale University (New Haven, CT, USA) in his notes on March 5, 1836, in Reports of the Ophthalmic Hospital at Canton (China; figure).

Clinical study: Evaluation of the effect of topical nepafenac on central foveal thickness and visual acuity post panretinal photocoagulation in diabetic retinopathy

Objectives: To study the effect of topical nepafenac in patients with diabetic retinopathy following PRP in terms of Central foveal thickness (CFT) and Best corrected visual acuity(BCVA). Materials and Methods: This is a hospital based randomized control study conducted in Minto ophthalmic hospital, Regional institute of ophthalmology and Bowring and Lady Curzon hospital, from November 2018 to May 2020. Patients with proliferative diabetic retinopathy (PDR) without macular edema were subjected to PRP after detailed clinical evaluation and were divided into test and control groups. All the patients in two groups were matched based on: age, gender, type of diabetes, HBA1C levels and duration of type II diabetes. All patients underwent three sittings of PRP with a gap of one week interval between the sittings. Nepafenac eye (Nevanac, Alcon Laboratories Inc, Texas, USA) drops were used three time a day for a month followed by two time a day for three months in the test group and moxifloxacin eye drops (placebo)(moxicip, Cipla Ltd, India) three time a day for a month followed by two times for 3 months were used in the control group following PRP. Results: The patients in both test and control group were followed up at 1,2 and 4 months after PRP completion and the changes in CFT and BCVA were recorded. There was increase in CFT on each follow up visit in both test and control group. However increase in CFT in test group was less compared to control group which is statistically significant.(p=0.0001) There was worsening of BCVA in the test group was less compared to control group which is clinically significant but statisticially insignificant. Conclusion: Using topical Nepafenac eye drops following PRP for PDR is effective in reducing central foveal thickness and preventing the corresponding worsening of BCVA. Keywords: Panretinal Photocoagulation, OCT, Central Foveal Thickness, Nepafenac.

A study of modified and economical approach to canalicular tear using intravenous cannula in tertiary care centre

Purpose: Study aims to demonstrate and evaluate a modified and economical way of repairing canalicular tear using intravenous cannula in tertiary care centre. Materials and Methods: 32 patients with canalicular tear admitted in Minto Ophthalmic Hospital, regional institute of ophthalmology were taken in the study. Patients were operated for canalicular tear repair using intravenous cannula of 24G size. Functional and anatomical success of the procedure evaluated during the follow up. Data collected and analysed using descriptive statistics. Results: Out of 32 patients, 24 were males and 8 females. Right eye was involved in 22 patients and left eye in 10 patients. Various mode of injury includes dog bite, Road Traffic Accidents, assault, self-injuries, domestic violence, cooker blast in varying percentages. Functional and anatomical success was seen in 93.75% of the patients. Conclusion: Using intravenous cannula is an economical way of canalicular tear repair with easy availability and no extra cost to the patient. With the least complications, this technique can be adapted in Government set up as this is more economical. Keywords: Canalicular tear, Eye lid injury, Intravenous cannula.

Study of awareness, perception about strabismus and social impact of strabismus in adults attending tertiary care centre

Aim: Strabismus is the common condition seen in children and adults in our society. Strabismus has variety of psychosocial impact that can affect the quality of life of the patients. Proper education and awareness regarding the condition can help to rule out the myths associated with strabismus and also building up the personality of the patients. This study was done to know the level of awareness, knowledge about the strabismus in our population and the social impact of strabismus in patients life. Material and Methods: Cross sectional study conducted on 196 patients with strabismus attending outpatient department of Minto Ophthalmic Hospital, regional institute of ophthalmology were included in the study. After taking informed consent, face to face interview conducted asking questions from structured questionnaire prepared. Data collected and analysed with descriptive statistics. Results: Out of 196 patients included in the patients, 128 were males and 68 females. About 9.6 % of patients, were unaware of the condition of strabismus, 56.3% were unaware that squint can cause visual disturbance, 63% were unaware of that strabismus can be treated, 37% of people felt like surgery is the only mode of treatment for strabismus. 60% of the study population expressed that they were rejected for being married due to strabismus because of cosmetic affect, 42.4% felt like squint can hinder the social leadership, 36 % had difficulty in getting job, 28% of the patients expressed being criticized by their friends that lowered their confidence, 75% of the patients felt that they look ugly because of strabismus. Conclusion: Strabismus apart from causing ocular problems, is associated with many psycho-social impact on life of patients. There is lack of awareness regarding the strabismus in our population. Attitude and perception of society towards patients with strabismus will affect the overall confidence, personality of the patients and hence affect quality of life. Hence awarenes

John Zachariah Laurence: ‘forgotten luminary’

John Zachariah Laurence was one of the four medical staff appointed in 1860 to the new “Hospital for the Paralysed and Epileptic,” at 24 Queen Square, London. A prize-winning graduate of UCH he was known for his high intellect and skills in general surgery and in ophthalmology. After a brief period at Queen Square he left to found the South London Ophthalmic Hospital that became the Royal Eye Hospital, and the “Ophthalmic Review”, the first British journal of ophthalmology; he later served at Barts. Highly accomplished in the arts, literature and research his achievements were sadly neglected by his contemporaries.

Retrospective analysis of visual outcomes in retropupillary iris-suture-fixated rigid intraocular lens in a tertiary eye center in southern India.

To report clinical outcomes of retropupillary iris-suture-fixated rigid intraocular lens (IFIOL) SETTING: Tertiary care ophthalmic hospital DESIGN: Retrospective study METHODS: This study included all eyes undergoing IFIOL with a minimum follow-up of 6months between April 2017 and January 2019. Patients with preexisting anterior or posterior segment pathologies causing defective vision, uveitis or history of previous intraocular surgeries with exception of cataract surgery were excluded from the study. Data were retrieved from electronic medical records, and we documented demographics, history, position of cataractous lens or IOL, primary/secondary surgery and its complications. Postoperative visual acuity, pupillary response, diplopia, centration of IOL, inflammation were also recorded at the baseline visit and at 1month, 3months and 6months postoperatively. One hundred and ten eyes of 110 patients that underwent IFIOL were evaluated. Twenty-two patients (20%) underwent primary IFIOL, whereas 67 (60.9%) patients had secondary IFIOL. In 18 patients (16.36%), IFIOL was done to reposition decentered/dislocated IOLs. At the final follow-up, there was a significant improvement in corrected distance visual acuity (CDVA) with 87 patients (79.09%) achieving CDVA of 6/12 or better. IFIOL was stable and centered in 101 eyes (91.81%). Two patients (1.81%) had intraoperative complications. Postoperative iritis was seen in 7 patients (6.36%), and 4 patients (3.63%) had rise in IOP. This is a safe, reliable, reproducible technique for aphakia rehabilitation and decentered IOL stabilization with good clinical outcome, especially in a limited resource setting.

A Case Series of “Solitary Idiopathic Choroiditis” and Proposal of a Nomenclature Change to “Idiopathic Scleroma”

Objective: To define the characteristics of solitary idiopathic choroiditis (SIC) in a consecutive series of patients and propose a nomenclature change to idiopathic scleroma. Materials and Methods: Electronic patient records were retrospectively interrogated to identify all patients diagnosed with SIC between 2002 and 2019 in a tertiary referral ophthalmic hospital in the United Kingdom. Results: Thirty-four eyes of 34 patients were found to have SIC. The mean age at diagnosis was 48 years (range 24–78) and 23 patients (68%) were female. All lesions were located posterior to the equator, most frequently in the inferotemporal quadrant (13 eyes, 38%). The lesions had a mean largest basal diameter of 1.2 ± 0.4 disc diameters (range 0.5–2) and their distance to the optic disc had a mean of 1.2 ± 0.9 disc diameters (range 0–3.3). All lesions were intrascleral on enhanced depth imaging optical coherence tomography, demonstrating a hypo-reflective zone within the sclera, with an underlying hyper-reflective zone in some cases. No lesion enlarged or developed features consistent with active inflammation after a median follow-up time of 0.9 years (range 0–16.8). Discussion/Conclusion: Optical coherence tomography shows SIC to be an intrascleral lesion. Furthermore, we found no evidence of any inflammatory component. A nomenclature change to idiopathic scleroma is appropriate to prevent unnecessary investigation.

Ophthatome\u2122: an integrated knowledgebase of ophthalmic diseases for translating vision research into the clinic

BackgroundMedical big data analytics has revolutionized the human healthcare system by introducing processes that facilitate rationale clinical decision making, predictive or prognostic modelling of the disease progression and management, disease surveillance, overall impact on public health and research. Although, the electronic medical records (EMR) system is the digital storehouse of rich medical data of a large patient cohort collected over many years, the data lack sufficient structure to be of clinical value for applying deep learning methods and advanced analytics to improve disease management at an individual patient level or for the discipline in general. Ophthatome™ captures data contained in retrospective electronic medical records between September 2012 and January 2018 to facilitate translational vision research through a knowledgebase of ophthalmic diseases.MethodsThe electronic medical records data from Narayana Nethralaya ophthalmic hospital recorded in the MS-SQL database was mapped and programmatically transferred to MySQL. The captured data was manually curated to preserve data integrity and accuracy. The data was stored in MySQL database management system for ease of visualization, advanced search functions and other knowledgebase applications.ResultsOphthatome™ is a comprehensive and accurate knowledgebase of ophthalmic diseases containing curated clinical, treatment and imaging data of 581,466 ophthalmic subjects from the Indian population, recorded between September 2012 and January 2018. Ophthatome™ provides filters and Boolean searches with operators and modifiers that allow selection of specific cohorts covering 524 distinct ophthalmic disease types and 1800 disease sub-types across 35 different anatomical regions of the eye. The availability of longitudinal data for about 300,000 subjects provides additional opportunity to perform clinical research on disease progression and management including drug responses and management outcomes. The knowledgebase captures ophthalmic diseases in a genetically diverse population providing opportunity to study genetic and environmental factors contributing to or influencing ophthalmic diseases.ConclusionOphthatome™ will accelerate clinical, genomic, pharmacogenomic and advanced translational research in ophthalmology and vision sciences.

Dense laser at the papillomacular bundle does not cause loss of visual function.

Juxtapapillary laser (JPL) photocoagulation in the region of the papillomacular bundle, temporal to the optic nerve, has become routine care in disorders such as optic disc pit maculopathy. Despite evidence demonstrating safe and effective use of this approach, there is still a lack of consensus in the literature, due to the perceived risk of loss of visual function. Instances of such misplaced caution could result in inadequate treatment protocols. An observational series of five cases of optic disc pit maculopathy, treated with dense temporal juxtapapillary endolaser, in a single tertiary ophthalmic hospital. None of the reported cases of optic disc pit maculopathy treated with dense juxtapapillary laser demonstrated anatomical or perimetric findings consistent with nerve fiber layer damage in the region of the papillomacular bundle. This series demonstrates that dense laser photocoagulation, in the vicinity of the papillomacular bundle, does not cause structural damage to the nerve fiber layer or associated loss of visual function in optic disc pit maculopathy. Appropriate application of juxtapapillary laser is a safe and effective treatment for various macular pathologies.

Assault-related severe ocular chemical injury at a London ophthalmic referral hospital: a 3-year retrospective observational study

ObjectivesTo understand the incidence, causes, management and outcomes of intentional (assault) and unintentional severe ocular chemical injuries (SOCI) at an urban tertiary referral centre in the UK.DesignRetrospective observational study.SettingA London...