Ophthalmology Outpatient Department Research Articles

Estimation of the pattern of ocular manifestations, risk factors, and imaging of rhino-orbital-cerebral mucormycosis in COVID-19 patients

ABSTRACT Purpose: To estimate the pattern of ocular manifestations, as observed clinically and radiologically, and associated risk factors in cases of coronavirus disease 2019 (COVID-19)-related rhino-orbital cerebral mucormycosis (ROCM) during the second wave at presentation to the hospital in northern India. Materials and Methods: A total of 35 patients of ROCM associated with active cases of COVID-19 or recovered cases of COVID-19 presenting to the Ophthalmology outpatient department or admitted in the COVID ward of the hospital with clinical features suggestive of ROCM. They were confirmed as mucormycosis on KOH and fungal cultures of nasal scrapings and histopathology of debrided tissue. This is an ambispective study with retrospective medical records review for COVID-19 analysis and prospective assessment of ROCM-associated COVID-19 during the second outbreak of the COVID-19 pandemic. Results: The total patients included were 35, which ranged in the age group of 52.91+/- 11.93 years, and the male-to-female ratio was 24:11. The duration between the first positive COVID report and onset of COVID-19-associated ROCM was 9.46+/-11.63 days. The majority (82.9%; n-29) either were diabetics or had high blood glucose levels during the recent COVID-19 infection. 45.7% of patients gave a history of steroid therapy. The most common ocular clinical features were ptosis (80%) and loss of vision 48.7%, respectively. There was diffuse involvement of sinuses in 18 cases (51.4%). Staging based on magnetic resonance imaging scans showed that 7 (20%) had stage II, 20 (57.1%) had stage III, and 28.7% had stage IV disease. Ten patients had varied intracranial extension ranging from meningitis and cavernous sinus thrombophlebitis/thrombosis to brain abscess. Conclusions: COVID-associated ROCM was very rapidly spreading and more destructive. Ptosis and loss of vision related to third nerve involvement and CRAO, respectively, were alarming signs and bad prognostic indicators to the patient. Intracranial involvement and CRAO were poor prognostic features in this type of mucormycosis.

CONJUNCTIVAL CYST (CASE REPORT)

Conjunctival cysts, benign fluid-filled sacs on the eyes conjunctiva, often pose cosmetic concerns and cause discomfort, prompting surgical evaluation. This case report discusses a 30-year-old female who presented to the Ophthalmology Outpatient Department at Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, with a gradually enlarging conjunctival cyst in the right eye, leading to irritation and discomfort. The patient underwent a detailed clinical examination, confirming a benign-appearing cyst. Given its size and symptomatic nature, surgical excision was chosen as the definitive treatment. The surgical intervention involved precise dissection and removal of the cyst, preserving adjacent tissues and minimizing risks. The procedure was successful, with no postoperative complications, and the patient experienced complete symptom resolution. Follow-up assessments demonstrated no recurrence, underscoring the efficacy of meticulous surgical management. This case adds to existing evidence that supports surgical excision as the gold standard for managing symptomatic conjunctival cysts, particularly those with a history of recurrence. Conservative treatments, such as needle aspiration or cauterization, often result in incomplete resolution and higher recurrence rates. The report emphasizes the importance of individualized treatment, considering cyst characteristics and patient symptoms, to ensure optimal outcomes. It also highlights the role of thorough preoperative assessment using slit-lamp examination and other diagnostic tools to differentiate conjunctival cysts from similar ocular lesions. The findings contribute to the literature by reinforcing surgical excision as a safe, effective, and reliable treatment for conjunctival cysts. Future research should focus on comparing surgical and non-surgical modalities to establish clear guidelines, aiming to optimize patient-specific care.

A Study on the Prevalence of Dry Eye Disease in Newly Diagnosed Autoimmune Disorders in a Tertiary Eye Care Hospital

INTRODUCTION: The aims of the study were to assess the prevalence and severity of dry eye in autoimmune disorders. The objectives included studying the prevalence of dry eye in patients with autoimmune disorders and assessing the severity of dry eye in each individual with an autoimmune disorder.AIM: To assess the prevalence and severity of dry eye in patients newly diagnosed with Autoimmune disorders.OBJECTIVES: • To study the prevalence of dry eye in patients newly diagnosed with Autoimmune disorders.• To assess the severity of dry eye in each patient with an Autoimmune disorder.MATERIAL AND METHODS: The study design is a cross-sectional study. The study population included hospital-based population newly diagnosed with autoimmune disorders. The study was conducted in the state of Tamil Nadu, with the study setting being the Ophthalmology Outpatient Department at SBMCH. The study period was 11/2 years from Jan 2023 to June 2024. Ethical considerations include obtaining approval from the Medical Ethical Committee of Sree Balaji Medical College and Hospital before commencing the study. The resources and funding for the study was self-funded.RESULTS: The mean age of the study participants were 32.34±9.05 years. Gender-wise, 43.8% were males, and 56.2% were females, indicating a female preponderance. Among the autoimmune disorders studied, Rheumatoid arthritis (32.9%), Psoriasis (27.4%),and Sjogren’s syndrome (12.3%) were the most prevalent. Tear film meniscus height results revealed that 80.8% had TFMH <0.25% and 19.17% had TFMH 0.25-0.50mm.Tear film breakup time (TBUT) results revealed that 64.4% had TBUT more than 10 seconds, and 35.6% had 5 to 10 seconds. The Rose Bengal test showed positive results in 43.8% and was negative in 56.1% of patients. Schirmer’s test 1 showed 35.6% had moderate dry eye followed by 32.8% had mild dry eye and 17.8% had severe dry eye. Schirmer’s test 2 also showed 36.9% of patients had moderate dry eye,31.5% had mild dry eye and 20.5% had severe dry eye. Ocular surface disease index questionnaire (OSDI) indicated 38.4% had mild dry eye,30.1% had moderate dry eye,15.1% had severe dry eye and 16.4% had normal tear function.CONCLUSION: The study provides a valuable understanding of the prevalence and characteristics of dry eye syndrome in a diverse population with various autoimmune conditions. The findings highlight important demographic patterns, ocular manifestations, and tear function parameters among individuals with autoimmune diseases.

Ocular Duction Measurement Using Three Convolutional Neural Network Models: A Comparative Study.

This study primarily aimed to compare the accuracy of three convolutional neural network (CNN) models in measuring the four positions of ocular duction. Further, it secondarily aimed to compare the accuracy of each CNN model in the training dataset versus the ophthalmologist measurements. This study included 526 subjects aged over 18 who visited the ophthalmology outpatient department. Ocular images were captured using mobile phones in various gaze positions and stored anonymously as JPEG files. Ocular duction was measured by assessing corneal light reflex deviation from the central cornea. Ductions were classified into 30, 60, and 90 prism diopters (PD) and full ductions from the primary position. Three CNN models, MobileNet, ResNet, and EfficientNet, were used to classify ocular duction. Their predictive ability was evaluated using the area under the receiver operating characteristic (AUROC) curve. The dataset was divided into the training (2,001 images), evaluation (213 images), and testing (190 images) groups, which were reconstructed using the routine follow-up data of volunteers at the Ophthalmology Department of Phramongkutklao Hospital between February 2023 and June 2023. To evaluate the data, the MobileNet_V3_Large, ResNet101, and EfficientNet_B5 models were utilized to measure duction angles with the receiver operating characteristic (ROC) curves. The training times for MobileNet, ResNet, and EfficientNet were 5.54, 9.56, and 26.39 minutes, respectively. In the testing phase, MobileNet, ResNet, and EfficientNet were used to measure each duction position: 30 PD with corresponding ROC curve values of 0.77, 0.5, and 0.58; 60 PD with ROC curve values of 0.71, 0.83, and 0.81; 90 PD with ROC curve values of 0.7, 0.73, and 0.81; and full duction with ROC curve values of 0.91, 0.93, and 0.94, respectively. Analysis of variance revealed no significant difference in the mean AUROC curves among the models, yielding a p-value of 0.936.MobileNet has the narrowest confidence intervals for average prediction accuracy across three CNN models. The three CNN models did not significantly differ in terms of efficacy in detecting various duction positions. However, MobileNet stands out, with a narrower confidence interval and shorter training time, which indicates its potential application.

A Cross Sectional Study of the Prevalence of Retinopathy in Patients with Chronic Kidney Disease on Hemodialysis in a Tertiary Care Centre in Chengalpattu District, South India

Context: Many studies have reported varying proportions of retinopathy among cases with chronic kidney disease (CKD). Cases with severe grades of CKD were more likely to develop ocular complications, especially diseases which occurs due to small vessel pathology. Aim: To estimate the prevalence of various types of retinopathies in patients with CKD undergoing hemodialysis in a tertiary care centre in South India. Settings and Design: The outpatient Department of Ophthalmology and Hemodialysis unit of Nephrology, Karpaga Vinayaga Institute of Medical Sciences from January 2022 to June 2023 A cross-sectional hospital-based observational study in a low resource setting. Methods and Material: The study consists of 28 patients who were known cases of CKD on hemodialysis. Patients underwent complete ocular evaluation and findings were noted. The pre hemodialysis values of blood urea and serum creatine, hemoglobin, liver function tests and vital parameters were also noted. Data analysis was done utilising version 20 of Statistical Packages for the Social Sciences (SPSS). Results: 56 eyes of 28 patients on hemodialysis were studied. The mean age was 53 years + 10.9 with a male preponderance. 31.6% had retinopathy of which 26.3% had hypertensive retinopathy and 5.3% had diabetic retinopathy. This is contrary to the previous studies that have reported a higher incidence of diabetic retinopathy in patients with end stage CKD. Hypertension resulted in CKD earlier than diabetes. Conclusion: The results emphasize the importance of frequent eye examination in patients with CKD to identify retinopathy earlier, thus potentially averting permanent vision impairment.

The impact of family history on corneal donation and transplantation attitudes: a survey-based study.

To assess how having a first-degree relative who underwent corneal transplantation influenced people's attitudes regarding corneal donation and transplantation. The cross-sectional study was conducted between March 15 and April 15, 2023, in the Ophthalmology outpatient department and cornea division of Necmettin Erbakan University Faculty of Medicine Hospital, Konya, Turkiye, and comprised first-degree relatives of patients who had undergone corneal transplantation in group A and controls matched age and gender without family history of transplantation in group B. All the participants filled out a 13-item survey form regarding socio-demographic characteristics and their perspectives on corneal transplantation and donation. Data was analysed using SPSS 20. Of the 263 subjects, 133(50.6%) were in group A; 78(58.6%) females and 55(41.4%) males with mean age 46.5±15.2 years. There were 130(49.4%) subjects in group B; 70(53.8%) females and 60(46.32%) males with mean age 44.3±15.8 years (p>0.05). There were 110(82.7%) participants in group A and 72(55.4%) in group B who knew what corneal transplantation meant (p<0.001). In group A, 81(60.9%) subjects wanted to donate their corneas after death compared to 40(30.8%) in group B (p<0.001). In group A, 108(83.7%) participants stated that a first-degree relative's corneal transplantation positively affected their view of organ and tissue donation. Individuals whose first-degree relatives had had a cornea transplant showed higher awareness of cornea transplantation and willingness to donate their corneas.

Artificial Intelligence in Detecting the Severity of Diabetic Retinopathy

BACKGROUND Diabetic retinopathy (DR) is the leading cause of visual impairment and blindness among individuals with diabetes mellitus. Early detection and timely intervention are crucial for preventing irreversible vision loss. However, traditional methods of DR screening are labor-intensive and reliant on the availability of skilled personnel, posing challenges in resource-constrained settings. Objective This study aims to evaluate the effectiveness of artificial intelligence (AI) in detecting the severity of DR compared to conventional ophthalmological assessments. METHODS A hospital-based observational study was conducted at the ophthalmology outpatient department of Tertiary care hospital, India over a six-month period. A total of 300 diabetic patients were included, and fundus photographs were obtained using a fundus camera. The images were then analyzed using an AI model trained on a diabetic retinopathy dataset. The severity of DR was graded according to established criteria, and the accuracy of the AI model was compared to that of ophthalmologist grading. RESULTS The AI model demonstrated an accuracy rate of 95.25% in grading the severity of DR. Comparison between AI and ophthalmologist grading showed close sensitivity and specificity rates across different DR grades, with the AI model slightly outperforming in certain categories. CONCLUSIONS Artificial intelligence shows promise as an effective and efficient tool for the screening and diagnosis of diabetic retinopathy. Its integration into healthcare systems could enhance early detection and treatment of DR, particularly in underserved regions with limited access to ophthalmological services. Further research and validation are warranted to optimize the use of AI in diabetic eye care and ensure its equitable distribution and ethical use.

To study efficacy of tacrolimus (0.03%) Eye ointment, cyclosporine (0.1%) eye drops and fluorometholone (0.1%) eye drops in vernal keratoconjunctivitis

VKC (Vernal keratoconjunctivitis) is a chronic, bilateral ocular inflammatory disorder that primarily impacts young patients. Management of VKC is challenging due to its complex immunological etiology and chronic inflammatory components. This prospective, single-center, randomized study was executed at the Outpatient Department of Ophthalmology, SGT Medical College, Hospital and Research Institute (FMHS), Budhera, Gurugram, for a duration of 18 months. A total of 102 clinically diagnosed VKC patients, aged above 5 years, have been then randomly divided into 3 groups (34 each). Group A received fluorometholone (0.1%) eye drops, Group B received cyclosporine (0.1%) eye drops, and Group C received tacrolimus (0.03%) eye ointment. Patients were evaluated at days 0, 7, 14, 28, 35, and two weeks post-medication using the Clinical Scoring System by Bleik and Tabbara to assess TSSS (Total Subjective Symptom Score) and TOSS (Total Objective Ocular Sign Score). Most patients were between 6-10 years old, with over 78% being males. Group A showed significant symptom reduction from the first week (mean TSSS reduction from 2.29±0.46 to 0.21±0.41, p&amp;#60;0.0001), while Groups B and C showed significant improvements from the second week (Group B: mean TSSS reduction from 2.5±0.51 to 0.12±0.33, p&amp;#60;0.0001; Group C: mean TSSS reduction from 2.29±0.46 to 1.00±0.00, p&amp;#60;0.0001). Conjunctival hyperemia and tarsal papillae improvements were more pronounced in Group B as compared to Groups A &amp; C. No ocular complications were found, except for dose-dependent irritation in Group C. While fluorometholone (0.1percent) eye drops provided early symptom relief, its effects were not sustained. Cyclosporine (0.1percent) eye drops and tacrolimus (0.03percent) eye ointment showed delayed but sustained efficacy, making them suitable for long-term treatment of moderate to severe VKC. Fluorometholone may be used initially alongside immunomodulators for rapid symptom relief, followed by tapering as immunomodulators take effect.

Accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders in a rural-based hospital: A descriptive study

Background: In India, there is an unequal distribution of eye health care, and tele-ophthalmology promises to be a potential tool to provide accessible, affordable, and good-quality health care to the population residing in the rural and remote areas of our country. Aims: The aim of the study was to study the accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders at a rural-based hospital. Setting and Design: A hospital-based descriptive study was conducted for 18 months. The study was carried out in the outpatient department (OPD) of ophthalmology at a rural health training center (RHTC), attached to a tertiary care hospital. Materials and Methods: Inclusion-A routine examination was carried out in the ophthalmology OPD at the RHTC. The off-site assessment was done based on the smartphone camera (iPhone Xs Max) images and videos captured on-site, which were remotely shared with two independent blinded observers to make the diagnosis which was compared with the clinical (on-site) diagnosis. Statistical Analysis: The agreement between the expert’s finding and the clinical examination finding was determined using Light’s Kappa coefficient. Accuracy of the photographic method was carried out in terms of sensitivity and specificity, considering clinical findings as the gold standard. Results and Conclusion: The diagnostic accuracy of smartphone imaging was the highest for the diagnosis of cataracts, followed by anterior segment conditions. The clinical diagnosis and smartphone imaging agreement were almost perfect for anterior segment disorders, while it was moderate for glaucoma and other disc pathologies.

A comparative study of central corneal thickness using an ultrasonic pachymeter and a noncontact specular microscope in adult patients coming to the ophthalmology outpatient department in a tertiary care hospital in Western India

Objective:To evaluate and compare the accuracy of measuring central corneal thickness (CCT) using an ultrasonic pachymeter and a noncontact specular microscope and whether they can be used interchangeably in adult patients with healthy cornea.Methodology:A comparative and observational study was carried out in adult patients coming to the ophthalmology outpatient department (OPD) in a tertiary care hospital in Western India. In all patients, CCT is measured using an ultrasonic pachymeter and a noncontact specular microscope to perform a comparative study. Statistical analysis was done using pairedt-test. Two-tailed hypothesis was applied.Results:This study included a sample size of 300 eyes of 150 adult patients. We want to test whether CCT values by Ultrasound Pachymeter and Noncontact specular Microscope is significantly different for right eyes and left eyes of the same patients, therefor we applied pairedt-test for statistical analysis.Tvalue for the right eye CCT measurement was −0.4 and the value ofPwas 0.69.Tvalue for the left eye CCT measurement was −0.79 and the value ofPwas 0.43.P&gt; 0.05 suggested that the results were nonsignificant.Conclusion:Our study suggests that the noncontact specular microscope produces CCT values that do not vary significantly from ultrasonic pachymeter. In subjects with healthy cornea, ultrasound pachymeter and specular microscope can be used interchangeably.

A STUDY TO EVALUATE THE TYPE AND CAUSE OF BLINDNESS/LOW VISION IN APPLICATIONS FOR BLINDNESS CERTIFICATE PRESENTING IN CHAMBA DISTRICT OF HIMACHAL PRADESH

Objective: This study aims to assess the prevalence, causes, and socio-economic impacts of visual impairment in the Chamba District of Himachal Pradesh, India. It seeks to identify the major factors contributing to visual disability and the role of literacy and employment status in influencing the lives of the visually impaired. Methods: A cross-sectional, hospital-based study was conducted over a period of one year, enrolling patients from the outpatient department of ophthalmology who were applying for visual disability certification. The study utilized a randomized sampling method and a semi-structured interview along with an examination form for data collection. Ethical approval was obtained, and the study adhered to ICMR and Helsinki Declaration guidelines. Participants underwent comprehensive ophthalmic evaluations, and data were analyzed using SPSS version 17.0. Results: Among the 270 participants evaluated, a higher prevalence of visual impairment was observed in males (n=149) compared to females (n=121), particularly within the age group of 21-40 y. The leading causes of visual disability included Corneal Opacity (16.25%), Retinitis Pigmentosa (15.83%), and Congenital Malformation (14.17%). Furthermore, literacy played a crucial role in employment opportunities, with 75.83% of the literate participants being employed, indicating a significant impact on the socio-economic status. Conclusion: The study highlights the multifaceted nature of visual impairment in the Chamba District, emphasizing the need for integrated public health strategies to address the identified challenges. Enhancing preventive measures, improving access to healthcare, and supporting rehabilitation services are essential steps towards mitigating the burden of visual impairment.

Importance of ocular examination as a prerequisite in renal dysfunction patients prior to renal transplantation - A case report

Alport’s syndrome is a heterogeneous genetic disease involving the basement membrane of the glomeruli, inner ear, retina, and lens capsule. A 30-years-old male patient, recently diagnosed with chronic kidney disease (CKD) stage 5 awaiting for renal transplantation presented to the ophthalmology outpatient department with a complaint of gradual decrease in vision in both eyes since 2 years. Patient has a history of anemia, hypertension for the past 3 years and was on medication for both. On ocular examination, unaided vision was counting fingers (CF)- 2 meters in both eyes with pinhole improvement to 6/60 in both eyes. On slit lamp examination, bilateral anterior lenticonus was seen after pupil dilation. On detailed history taking, the patient has a history of hearing loss since the past 6 months. ENT consultation was done, and the patient was found to have bilateral moderate sensorineural hearing loss. The presence of ocular abnormalities, bilateral sensorineural hearing loss and renal failure is highly suggestive of Alport’s syndrome. When a genetic disorder is identified, it aids in identifying the cause of renal dysfunction in that patient but also enables us to screen other family members for the same before deciding on the potential living donor. Keywords: lenticonus; hematuria; deafness; renal failure; Alport’s syndrome

Pattern of Medicolegal Ocular Trauma in Cases of Assault and Its Visual Outcome in An Outpatient Department of a Tertiary Care Hospital

Purpose: To determine the pattern of medicolegalocular traumaand its visual outcome in cases of assault presenting in the outpatient department of ophthalmology. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Abbasi Shaheed Hospital, Karachi Medical and dental college (KMDC), from January, 2020 to June, 2022. Methods: This study included 199 patients of assault, registered as medicolegal cases and referred for examination by a police surgeon.Findings were recorded on a pre designed proforma and categorised according to Bermingham Eye Trauma Terminology (BETT). The results were presented in frequencies. Results: The study analyzed ocular injuries in a group of participants, predominantly male (81.9%), with a mean age of 34 years. The majority of injuries were closed-globe (70.4%), primarily occurring in Zone 1. Pre-treatment visual acuity was generally high, with 85.4% of patients having 20/20-20/40 vision, which improved slightly to 87.4% post-treatment. Open-globe injuries were rare (1.0%) and also confined to Zone 1. The most common trauma setting was the home, and the most frequent cause of injury was assault using a fist. Conclusion: Majority of the patients were young males who suffered trauma at home and fist was the most common causative agent. The study highlights the prevalence of closed-globe injuries, the effectiveness of treatment in preserving visual acuity, and the domestic nature of most ocular traumas.

Correlation of axial length and anterior chamber depth with stature in young adults in tertiary care hospital

Abstract Aim: The aim of the study was to correlate axial length (AL) and anterior chamber depth (ACD) with stature. Materials and Methods: The study was conducted among 100 patients attending the ophthalmology outpatient department, including both males and females aged between 20 and 40 years, with clear media and without any systemic or ocular pathology. The first comprehensive ophthalmic examination was done on each subject, including vision assessment, refraction, slit lamp examination, and fundus examination. Then subjects were enrolled in this cross-sectional and purposive study depending on the inclusion and exclusion criteria and were divided into four groups depending on their heights (in cm). Data analysis was performed using SPSS to correlate AL and ACD with stature in young adults in tertiary care hospitals. Results: Although the mean values of the height group 179–189 cm are found to be higher, the P value was found to be insignificant (P = 0.343). There was a positive correlation with P being 0.019 and 0.001 in height groups 159–169 and 169–179 cm, respectively, indicating that there is statistical significance in these groups with the ALs. The correlation was significant with P = 0.026 in the group 159–169 cm. Therefore, the height group 159–169 cm has statistical significance with ACD. Conclusion: In the present study, we found that there was a statistical correlation between the stature of an individual with their ALs and the anterior chamber of the eyeball. We found that taller young adults tend to have longer AL and ACD.

Ultrasonography in Detecting the Posterior Segment Pathology in Pre-Operative Cataract Patient

Background: Cataract is the leading cause of blindness globally, accounting for approximately 47.8% of blindness worldwide and 51.5% in Pakistan. The opacity of the lens in cataract patients obstructs the visualization of the posterior segment, making it challenging to predict visual outcomes post-surgery. Ultrasonography, particularly B-scan, plays a crucial role in identifying posterior segment pathologies before cataract surgery, aiding in surgical planning, and improving postoperative visual prognosis. Objective: This study aimed to evaluate the effectiveness of B-scan ultrasonography in detecting posterior segment pathologies in patients with dense cataracts, thus assisting in preoperative planning and predicting visual outcomes. Methods: This descriptive cross-sectional study was conducted at the Outpatient Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, from August 15th, 2019, to February 15th, 2020. A total of 260 eyes from patients with dense cataracts were included. Patients of all age groups and both sexes, including those with traumatic and non-traumatic cataracts, were examined. Exclusion criteria included transmittable ocular surface infections, penetrating ocular trauma, previous glaucoma or vitreoretinal surgery, and siliconized eyes. B-scan ultrasonography was performed using an 8-10 MHz frequency probe. The eye globe was assessed in axial, longitudinal, and transverse positions. Data were recorded and analyzed using SPSS version 25. Ethical approval was obtained from the institutional review board, and the study adhered to the Declaration of Helsinki. Results: Out of 260 eyes examined, 97 (37.3%) were right eyes, 105 (40.4%) were left eyes, and 58 (22.3%) had bilateral involvement. Normal findings were observed in 215 eyes (67.8%), while 32.2% showed posterior segment pathologies. The most common pathology was posterior vitreous detachment (PVD), found in 24 eyes (7.6%). Retinal detachment and vitreous hemorrhage were each observed in 15 eyes (4.7%). Other findings included asteroid hyalosis (18 eyes, 5.7%), vitreous inflammation (11 eyes, 3.5%), intraocular foreign body (3 eyes, 0.9%), persistent hyperplastic primary vitreous (1 eye, 0.3%), and posterior staphyloma (2 eyes, 0.6%). Conclusion: B-scan ultrasonography is an effective tool for detecting posterior segment pathologies in preoperative dense cataract patients, significantly influencing surgical strategies and postoperative visual outcomes. Routine use of ultrasonography in cataract patients can enhance surgical planning and improve patient counseling and prognosis.

How severe are ocular surface abnormalities 3 months following cataract surgery? An observational study

Aim: The aim of this study was to detect the pattern of ocular surface changes seen 3 months after undergoing phacoemulsification or manual small-incision cataract surgery (SICS) and match them with age-matched normal individuals. Materials and Methods: A prospective observational study was conducted in the ophthalmology outpatient department (OPD) in a tertiary care center. Consecutive patients coming to OPD were grouped into three study groups – Group 1 included 25 patients who had undergone manual SICS, Group 2 included patients who had undergone clear corneal phacoemulsification surgery, and Group 3 included age-matched controls. Patients with ocular and systemic diseases were excluded. All the patients underwent Schirmer’s test, tear film breakup time, ocular surface staining, and ocular surface disease index score. One-way analysis of variance test was used for the comparison of data, and P = 0.05 or less was considered to indicate a significant difference. Results: Significant dry eye changes after 3 months of cataract surgery were present in SICS and Phacoemulsification groups as compared to age-matched normals (p-value &lt; 0.05), but there was no significant difference between SICS and PHACOEMULSIFICATION surgery groups in the incidence of dry eye incidence. Conclusion: Dry eye symptoms are significant following cataract surgery irrespective of the type of surgery either SICS or phacoemulsification.

Vision-Related Quality of Life Among Diabetic Retinopathy Patients in a Hospital-Based Population in the Sultanate of Oman.

The global prevalence of diabetic retinopathy (DR) among individuals with diabetes is 22.27%. This highlights the likelihood of developing burden of retinopathy within the at risk population and can have a detrimental impact on an individual's quality of life (QoL). The aim of this study is to assess the vision-related QoL in individuals with (DR) in a hospital-based population in the Al-Buraimi governorate, Sultanate of Oman. The study was conducted in the Ophthalmology Outpatient Department of Al Buraimi Hospital and Polyclinic. This study enrolled 218 patients (114 males, 104 females) diagnosed with DR. The NEI-VFQ-25 questionnaire was adopted in this study. The patients were classified into different groups according to their type of diabetes and other relevant demographic information. A total of 218 patients responded to the NEI-VFQ-25 questionnaire. The mean age of the participants was 57.49 ± 12.3 years, 52.3% were male, and 47.7% were female. The overall QoL score was 41.53± 20.8. Patients aged more than 75 years had the lowest QoL scores compared with the other age groups (p = 0.02). The results showed that the duration of diabetes had no significant impact on the overall QoL scores (p = 0.06). A higher QoL score was observed among patients with type II diabetes mellitus (DM) than with type I diabetes mellitus (p = 0.01). Patients diagnosed with proliferative DR (PDR) had a significantly lower QoL score than those diagnosed at other stages (p < 0.001). The QoL of the population with DR is negatively affected by various factors, including demographics, disease severity, and in patients with DM type II. It is important to consider these factors to enhance QoL in patients with DR. Regular evaluation of an individual's QoL is beneficial for both physicians and healthcare teams.

Snellen iPad App versus Traditional Light-Box Snellen Chart in Distance Visual Acuity.

This study aimed to discover distance visual acuity (VA) assessments through the display of the Snellen chart on the iPad tablet. The findings are equivalent to those obtained using the conventional light-box Snellen chart. In this work, the Snellen iPad app and Eye Chart HD iOS app are utilized among the participants in the Ophthalmology Outpatient Department (OPD) for determining VA. A cross-sectional method was used for the examination, which included 100 new patients who were chosen by random selection. The age requirement for new patients was 8 years and up for both genders. Patients with a VA of less than 6/30 were disqualified from the experiment. Two testing modalities are used to measure VA, such as the iPad Mini 2 with the iOS software Eye Chart HD and the classic Snellen light-box chart. The observation revealed that the Snellen iPad app and the classic light-box Snellen chart produced equivalent findings. The classic Snellen chart may have been memorized by participants before their eye examination, undermining the accuracy of the conclusions of the initial testing modality used. Patient-related variables were also identified as confounders. Future studies should adjust the brightness of the iPad Mini 2 and the traditional light-box Snellen chart to make sure that neither experiment modality's brightness affects the accuracy of the findings. Future research should also investigate the use of premium apps, use both devices, and employ a bigger sample size.

Clinical profile of esotropia patients in a tertiary care center with application of the CEMAS classification

Abstract Aims: This studyaims to study the clinical profile of patients with esotropia (ET) in a tertiary care centre. Materials and Methods: A cross-sectional observational study was carried out on 94 patients with ET seen in the ophthalmology outpatient department of a tertiary care center from December 2018 to June 2020. Results: A female preponderance was noted with male:female ratio of 0.8:1. Although 79 patients (84.04%) had noticed the onset of ET in the first decade of life, only 50 (53.19%) of the patients presented to the ophthalmologist in the first decade of life. Family history of ET was present in only 7.44% of patients. Amblyopia was present in 31 (32.97%) patients. The most common refractive error seen was hypermetropia followed by hypermetropic astigmatism. Based on the Classification for Eye Movement Abnormalities and Strabismus (CEMAS), there were 36 (40.42%) patients with refractive accommodative ET, 15 (15.95%) of infantile ET, 13 (13.82%) patients had ET due to visual/neurological disease, 16 (15.95%) patients had cranial neuropathy and there was one child with neuromuscular cause – Duane’s retraction syndrome (Type 1). Conclusion: Most of the patients in the study sought consultation for the management of ET late in life though it was noticed in early childhood. Majority of the patients had refractive accommodative ET. These can be managed appropriately if diagnosed early. A significant number of patients had amblyopia as sequelae of untreated ET. Early diagnosis and appropriate management at the right time are very important in patients with ET to prevent the development of amblyopia and maintain binocularity.

Topography: A Mandatory Screening Tool for Ocular Allergies

ABSTRACT Purpose: Assess the need of corneal topography as a diagnostic tool for corneal ectasia in patients with allergic conjunctivitis. Subjects and Methods: Cross-sectional, descriptive study in which 90 children who are clinically diagnosed with allergic keratoconjunctivitis of age 6–18 years of both gender coming to ophthalmology outpatient department at a tertiary care eye hospital underwent detailed ophthalmic examination and corneal topography on Pentacam (Oculus, Wetzlar, Germany). Results: The maximum number of patients was in the age group of 6–10 years (48.88%) with a mean age of 11.28. The M: F ratio was 2.6:1 highlighting male preponderance. The most common history given by patients was diminution of vision and seasonal variation. 99.88% patients presented with congestion but 0.03% had positive Munson. 8.89% eyes presented with astigmatism of ≥−3. 3.88% had K-Max ≥49 D and 16.12% participants had K-Max between 46 and 48.9 on topography, suggestive of steep corneas. In our study, the most common axial curvature pattern found was symmetrical Bowtie (35.56%). Patterns suspicious of keratoconus like asymmetrical bowtie (23.89%), superior steepening (21.67%), inferior steepening (12.77%), symmetrical and asymmetrical bowtie with skewed radial axis (1.67%) was also noted. 15.56% patients had B-A outside normal limits which classifies them as keratoconus suspects. 27.23% eyes showed pachymetry between 499 and 450 μm and 7.78% showed pachymetry &lt;450 μm, all these parameters indicate the paramount need to do an early corneal topography in all patients with allergic conjunctivitis. These patients also warrant regular follow-up with corneal topography to look for progression in thinning to confirm the diagnosis of keratoconus. Conclusion: The study highlights the importance of doing corneal topography in diagnosed cases of allergic keratoconjunctivitis for the early diagnosis and treatment of keratoconus. More aggressive management of allergic conjunctivitis can prevent their progression to established keratoconus.