Posterior Segment Evaluation Research Articles

PREVELANCE OF HORIZONTAL STRABISMUS FOUND IN PEDIATRIC POPULATION IN A TERTIARY CARE EYE HOSPITAL IN EASTERN NEPAL

PURPOSE:To determine the prevalence of horizontal strabismus in patients less than 15 years of age. METHODS:A retrospective analysis of data of children attending pediatric OPD from January 2016 to December 2020 was done. A proforma was made and following information was entered information : history, clinical presentation, ocular examination including visual acuity, anterior and posterior segment evaluation,extraocular motility, cover tests, Prism bar cover test,worth four dot test,Bagolini's striated glasses test,Lang test,cycloplegic refraction. RESULTS: A total of 1,17,700 attended the pediatric OPD in 5 year period, prevalence of horizontal strabismus was 1.43%. Exotropia was more common than esotropia. Concomitant deviation was more common than incomitant deviation. CONCLUSION: strabismus is frequently encountered in pediatric clinics now. Proper training of pediatric ophthalmologists is required to give excellent care to these children.

Influence of serum lipids on clinically significant macular edema in type 2 diabetic retinopathy cases

Background: Diabetic retinopathy (DR), a paramount microvascular complication of diabetes mellitus (DM), has a significant impact on the world’s health system. Up to 30 percent of patients with clinically significant macular oedema (CSME) will develop moderate visual loss. Other than diabetes, several systemic factors like dyslipidemia play an important role in the pathogenesis of DME. Thus, addressing these additional risk factors, in addition to adequate control of blood glucose helps to prevent and reverse maculopathy to some extent, thereby preserving their vision. Materials and Methods: This study was done on 150 patients with type 2 diabetes mellitus, presenting to the outpatient department of ophthalmology of a tertiary care hospital, with CSME in either or both eye(s). A detailed history of each of these patients was taken and a comprehensive ophthalmic evaluation of anterior and posterior segments was done. Following Biochemical tests were carried out: 1. fasting blood glucose and post prandial blood glucose, 2. fasting lipid profile (serum total cholesterol, serum triglycerides, LDL-cholesterol, HDL-cholesterol, and VLDL-cholesterol). Dyslipidaemia was defined by using national cholesterol education program–adult treatment panel III (NCEP ATP III) guidelines. Accordingly, dyslipidemia was identified, when at least one of the Fasting lipid profile parameters crossed the desirable range. Statistical Analysis: Data obtained from Diabetic Retinopathy cases was analysed using chi-square test. Results: A total of 150 patients of either gender, between the age groups 30-70 years, were enrolled into the study after applying inclusion and exclusion criterias. Dyslipidemia was present in 101/150 (67.3%) patients. LDL-cholesterol level was significantly high, whereas Total Cholesterol, Triglycerides and VLDL showed borderline high values. Further, the occurrence of CSME showed a statistically significant correlation with LDL in majority of

Recurrent Episodes with Serous Retinal Detachment and Anterior Uveitis in a Patient Using Nivolumab (Anti -PD-1 Antibody) Therapy: A case report and literature review

ABSTRACT Aim: Nivolumab is an immune checkpoint inhibitor that has recently been widely used for metastatic malignant melanoma. We report a case who developed multiple different ocular immune-related side effects (iRAEs) related to nivolumab. Case Presentation: A 60-year-old man on nivolumab treatment for metastatic malignant melanoma developed a decrease in vision in both eyes several days after the third infusion. The initial best-corrected visual acuity (BCVA) was counting fingers in both eyes. Slit-lamp examination revealed no abnormal findings in the anterior segment of both eyes. Posterior segment evaluation showed serous retinal detachment, including the whole macula and inferior retina in both eyes, and optical coherence tomography (OCT) confirmed the diagnosis. On en face OCT analysis, hyperautoflorescent dots were noticed on the whole macular region but more intense at the inferior quadrant corresponding to serous retinal detachment. On Fluorescein Angiography (FA), no abnormality was observed. Oral corticosteroid treatment was administered. Subretinal fluid resolved one week after treatment in the right eye and two weeks after treatment in the left eye. BCVA was 20/20 in both eyes at first month of treatment. After that, oral corticosteroid treatment was tapered and stopped at the end of the second month. The patient was followed monthly. Two months after the treatment patient presented with an anterior uveitis episode with mild vision loss. Slit-lamp examination revealed 3+ cells in the anterior chamber and posterior synechia in both eyes. Posterior segment examination was normal. The patient was treated with topical corticosteroid and cycloplegic for two months. Hyperautoflorescent dots formed with serous detachment disappeared six months after the onset of serous detachment, and they did not occur during anterior uveitis episodes. Conclusions: This is the first clinical report of nivolumab-associated ocular iRAEs presenting with recurrent episodes presenting with serous retinal detachment and anterior uveitis. En face OCT imaging may help diagnose and show the activity of the posterior segment manifestation. When managed properly and observed closely following general and ocular conditions, it is possible to held iRAEs and overcome them by oral and/or topical corticosteroid therapy without interrupting the nivolumab.

Comparison between Plusoptix A09 and gold standard cycloplegic refraction in preschool children and agreement to detect refractive amblyogenic risk factors.

BACKGROUND:The preschool children hardly complain about their vision problems. It is of paramount importance to screen them with an objective tool and compare with the gold standard technique.AIM:To compare the values obtained with Plusoptix A09 and cycloplegic refraction in 3–6 years children and agreement to detect refractive amblyogenic risk factors.SUBJECTS AND METHODS:A cross-sectional study was conducted in the Outpatient Department of Ophthalmology in a tertiary care hospital. Informed consent from parents and verbal assent from children were obtained. Each subject had monocular vision assessment with Lea symbol chart, stereo acuity measurement with Frisby, refractive screening with Plusoptix A09, squint assessment, and anterior segment evaluation before administering Homatropine hydrobromide (homide) 2% eye drops. Cycloplegic refraction and posterior segment evaluation were performed for final diagnosis.STATISTICAL ANALYSIS:Descriptive statistics were used to summarize the data. Spearman correlation coefficient and kappa statistics were also employed.RESULTS:In total, data of 94 children were analyzed. The correlation values obtained between plusoptix and cyclorefraction values for spherical, cylindrical, spherical equivalent were 0.508 (P < 0.0001), 0.779 (P < 0.0001), and 0.407 (P < 0.0001), respectively. Refractive errors were seen in 32% and amblyopia in 17% of eyes. Kappa value was κ = 0.974 in detecting refractive amblyogenic risk factors.CONCLUSION:Good correlation was found between the plusoptix and cyclorefraction values. Cylindrical values showed a better correlation. Refractive errors and amblyopia were the major ocular disorders observed. There was significant agreement between the refractive techniques in detecting amblyogenic risk factors.

Technique for posterior segment evaluation in paediatric cases undergoing cataract surgeries

We have devised a novel technique for intraoperative fundus assessment which we routinely use in our paediatric cataract surgery cases. After the routine steps of paediatric lens aspiration, just before...

Evaluation of Intranasal Dexmedetomidine as a Procedural Sedative for Ophthalmic Examination of Children With Glaucoma.

This study evaluated 2 doses of intranasal dexmedetomidine (IND) (3.0 and 3.5 µg/kg) as a procedural sedative for postoperative examination of children with glaucoma. A dose of 3.5 µg/kg was more efficacious and obviated the need for repeated general anesthesia. This study was carried out to determine the safety and effective dose of IND as a procedural sedative for postoperative follow-up examinations after glaucoma surgery in children in place of repeated examination under anesthesia. In this prospective randomized double-blinded interventional study, consecutive children aged 6 months to 6 years were randomized to receive 3.0 and 3.5 µg/kg IND using a mucosal atomizer device in the preoperative area of the operating room, under continuous monitoring of vital signs. Intranasal midazolam 0.25 mg/kg was used as a rescue agent in case of inadequate sedation, and general anesthesia was administered in case of persistent failure. All infants underwent a complete anterior and posterior segment evaluation including intraocular pressure and corneal diameter measurements. A total of 30 and 31 children aged 23.9±15.0 and 19.2±10.1 months, respectively, received 3.0 and 3.5 µg/kg IND. Adequate sedation was possible in 18 of 30 (60%) children receiving 3.0 µg/kg and 24 of 31 (77.4%) receiving 3.5 µg/kg IND alone (P=0.17). In combination with midazolam, successful sedations were 86.6% versus 100%, respectively (P=0.052). One patient in the 3.5 µg/kg group had ventricular arrhythmia, reversed with dextrose-saline infusion and injection glycopyrrolate. IND appears to be a safe and effective procedural sedative for postoperative follow-up examinations of pediatric glaucoma patients at doses of 3 and 3.5 µg/kg. The dose of 3.5 µg/kg was successful in more children.

Prevalence and causes of visual impairment among older persons living in low-income old age homes in Durban, South Africa.

BackgroundVisual impairment (VI) increases with age and has been reported to be more prevalent among older adults living in old age homes than in the general population.AimTo determine the prevalence and causes of VI among older adults living in low-income old age homes in Durban, South Africa.SettingThis study was conducted at low-income old age homes in Durban.MethodsThis cross-sectional study of 118 residents aged 60 years and older, collected socio-demographic data, presenting visual acuities (VAs) for each eye, and binocularly. Anterior segment eye examinations were conducted with a penlight torch and a portable slit-lamp, while posterior segment evaluation was conducted with direct and indirect ophthalmoscopy. Objective and subjective refractions were performed, and the best-corrected distance and near VAs were measured in each eye. VI was defined as presenting VA < 6/18 and included moderate VI (< 6/18−6/60), severe VI (< 6/60 –3/60) and blindness (< 6/120).ResultsThe mean age of the participants was 73.3 years and included 80.5% females and 19.5% males. The prevalence of VI and blindness was 63.6%. Optical correction significantly reduced the prevalence of VI and blindness by 19.5% (p < 0.05). The main causes of non-refractive VI and blindness were cataract (54.5%), posterior segment disorders (25.5%) and corneal opacities (20%).ConclusionThe prevalence of VI and blindness is high among residents in low-income old age homes living in Durban. Refractive correction and surgical cataract intervention can significantly reduce the burden of VI and blindness among the elderly residents.

CASE REPORT Management Cataract Complication and Malignant Glaucoma After Viterectomy Surgery and C3F8 Gas Tamponnade

Report a clinical presentation of patient with rhematogenous retinal detachment by viterectomy and high myopia with C3F8 gas tamponade. A 20-year-old female came into the outpatient clinic with blurry vision on the right eye as her chief complaint. It had been happening since 1 month ago. In examination, we found result of visual acuity RE 1/300 and LE 1/60 correction Sferis-16.00 5/7.5, anterior segment in a normal range. In posterior segment evaluation, there were RE detachment on 3-11 o’clock position and hole on 6 and 8 o’clock position. Then we performed vitrectomy and C3F8 gas tamponade. The first day after surgery, we found IOP 19,6 mmHg and Von Herrick III. Then after the second day, we found a pain on the right eye, TIO 47.3 mmHg, Von Herrick 0 and opaque lens. Then we performed iridectomy and intravitreal gas aspiration. After it were done, we found IOP 17.3 mmHg and Von Herrick 0. In anterior segment OCT evaluation, we found a narrow angle anterior segment. Then we planned to do a cataract extraction with using viscoelastic to perform the anterior chamber.Malignant glaucoma can occur in cases after vitrectomy action due to aqueous misdirection and emphasis on gas expansion on tamponade. Cataract extraction and gas aspiration can help open the anterior chamber and the intraocular pressure returns to normal

SURGICAL MANAGEMENT ON POSTERIOR UVEITIS WITH VITREOUS OPACITY SUSPECTED RETINAL DETACHMENT

Introduction: Posterior uveitis entities are varies between infective or non-infective in aetiology. It can affect the adjacent structures such as retina, vitreous, optic nerve head and retinal blood vessels. Vitreous opacity is the most common features of posterior uveitis and posterior segment evaluation is critical to determine the aetiology and management. &#x0D; Methods: Case report of 32-year-old male with gradual visual loss on right eye since 2 years ago and getting worse 1.5 months before admission. Visual acuity (VA) was hand movement. Posterior segment evaluation revealed vitreous opacity and ultrasound examination showed membrane shaped lesion attached to the optic nerve suggested retinal detachment. &#x0D; Result: Vitrectomy was done for diagnostic and therapeutic purpose. VA was remarkably improved by 6/6 and persist until 6 months post vitrectomy, and progressive improvement on posterior segment. &#x0D; Conclusion: Surgery in the management of posterior uveitis can be divided based on indication, either for therapeutic or diagnostic purposes or to manage its complications. Vitrectomy is one of the modality to manage vitreoretinal complications associated with uveitis

Association of cataract and sun exposure in geographically diverse populations of India: The CASE study. First Report of the ICMR-EYE SEE Study Group

To determine the prevalence of cataract and its association with sun exposure and other environmental risk factors in three different geographically diverse populations of India. Population based cross sectional study during 2010-2016. People aged ≥ 40 years residing in randomly sampled villages were enumerated (12021) and 9735 (81%) underwent ophthalmic evaluation from plains, hilly and coastal regions (3595, 3231, 2909 respectively). A detailed questionnaire-based interview about outdoor activity in present, past and remote past, usage of sun protective measures, exposure to smoke, and detailed ophthalmic examination including assessment of uncorrected and best corrected visual acuity, measurement of intraocular pressure, slit lamp examination, lens opacities categorization using LOCS III and posterior segment evaluation was done. Lifetime effective sun exposure was calculated using Melbourne formula and expressed as quintiles. These were supplemented with physical environmental measurements. Lifetime sun exposure hours, smoking, indoor kitchen smoke exposure and their association with cataract and subtypes. Prevalence of cataract calculated based on lens opacities or evidence of cataract surgery. Cataract was identified in 3231 (33.3%) participants. Prevalence of cataract in males (32.3%) and females (34.1%) was similar. Nuclear cataract was the commonest sub-type identified in 94.7% of affected eyes. Sun exposure had a significant association with cataract with odds ratio (OR) increasing from 1.6 (95% Confidence Intervals [CI]: 1.4, 1.9) in 3rd quintile, to 2.6 (CI: 2.2, 3.1) in 4th quintile and 9.4 (CI: 7.9, 11.2) in 5th quintile (p<0.0001). Cataract also showed a significant association with smoking (OR: 1.4, CI: 1.2, 1.6) and indoor kitchen smoke exposure (OR: 1.2, CI: 1.0-1.4). Nuclear cataract showed a positive association with increasing sun exposure in 3rd (β coefficient 0.5, CI:0.2-0.7), 4th (β: 0.9, CI: 0.7-1.1) and 5th (β: 2.1, CI:1.8-2.4) quintiles of sun exposure, smoking (β: 0.4, CI: 0.2-0.6) and indoor kitchen smoke exposure (β: 0.3, CI: 01-0.5) while cortical cataract showed a positive association with sun exposure only in 5th quintile (β: 2.6, CI:1.0-4.2). Posterior subcapsular cataract was not associated with any of the risk factors. Cataract is associated with increasing level of sun exposure, smoking and exposure to indoor kitchen smoke.

Retropupillary fixated iris claw lens -an option for aphakia management

Aim: To study visual and surgical outcome in aphakic patients after implantation of retropupillary fixated iris claw lens. Materials and Methods: Medical records of the patients operated in Bharati Hospital, Sangli for the treatment of aphakia by secondary retropupillary fixated iris claw lens from September 2017 to August 2018 were included in the study. The data collected included the preoperative best corrected visual acuity (BCVA), auto-refractokeratometry, anterior segment evaluation on the slit lamp and posterior segment evaluation done by indirect ophthalmoscopy after pupillary dilatation with tropicamide eyedrops. The patients were also assessed for lacrimal sac patency and Goldmann applantion tonometry for intraocular pressure (IOP). Intraocular lens (IOL) power was calculated by SRK-T formula in aphakic mode by immersion based biometry. At follow up i.e. day 7 and 1 month, findings of patients include in study were BCVA, slit lamp examination and auto-refractokeratometry. Results: 86.66% patients operated by retropupillary fixated iris claw lens had postoperative improvement in visual acuity as compared to preoperative visual acuity. Conclusions: Retropupillary fixated Iris claw lens is an effective method of aphakia management with good visual outcomes and easy learning curve. Keywords: Aphakia, Iris claw lens, Visual acuity.

Evaluation of Vascular Morphological Changes in The Superficial and Deep Retinal Plexuses by Optical Coherence Tomography Angiographyin Cases of Acute Phase Branch Retinal Vein Occlusion

Background: Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy and an important cause of visual morbidity and blindness Aim of the work: was to detect if there are diagnostic signs in the two intra retinal layers superficial network layer and deep network layer by Optical coherence tomography angiography (OCT-A) to diagnose branch retinal vein occlusion. Patients and Methods: an observational cross-sectional study included a total of ten patients with branch retinal branch retinal vein occlusion of recent onset within three months attending at the Ophthalmology Department AlAzhar University Hospitals, Cairo. Demographic data such as age, gender, sex and hypertensive history were obtained. A detailed evaluation of cases including complete anterior segment evaluation and posterior segment evaluation was done. OCT-A and fluorescein angiography (FA) were used to study the vascular morphological changes in the branch retinal vein occlusion (BRVO)area. Results: As regarding 5 disc area of retinal ischemia FA detected ischemia in 2 cases (20%), detected no ischemia in one case (10%) and was not able to evaluate ischemia in 7 cases (70%) compared to OCT-A, that detected the ischemia in the superficial retinal plexus (SCP) in 4 cases (40%) and detected no ischemia in 6 cases (60%), but it detected the ischemia in the deep retinal plexus (DCP) in 6 cases(60%) and detected no ischemia in 4 cases (40%). Conclusion: It could be concluded that that OCT-A was superior to FA in detection of macular ischemia, macular ischemia detected by OCT-A had stronger negative relation with V.A. than macular ischemia detected by FA and retinal ischemia in the DCP was more evident than that of SCP by OCT-A.

ROLE OF VITAMIN D IN ENDOTHELIAL CELL OF RETINA

Vitamin D deficiency is a common health problem worldwide. Many parts of the human eye, including the epithelium of the cornea, lens, ciliary body, and retinal pigment epithelium, as well as the corneal endothelium, ganglion cell layer, and retinal photoreceptors, contain vitamin D receptor. Physiological effects of vitamin D From an ocular point of view, the role in macular and retinal health had been advanced, as well as the involvement in corneal inflammatory response, wound healing, and dry eye disease. The most important effect of vitamin D is on, phosphorus, calcium metabolism and on bone mineralization. Recently, it was observed that vitamin D deficiency and insufficiency are related with common cancers, cardiovascular diseases, metabolic syndromes, infectious, and many chronic diseases including autoimmune disease. Benefits of vitamin D may be amplified through synergistic interaction with topical corticosteroids which accelerates improvement in corneal shape and optics, substantially benefiting the control of ocular surface disease and dry eye symptoms. Aqueous humour is the primary source responsible for the feeding of corneal endothelial layer hence endothelial abnormalities can be expected due to accumulated inflammatory cytokines and multiple toxic products in the aqueous humour of the patients with vitamin D deficiency.&#x0D; MATERIAL AND METHODS: Subjects were selected with vitamin D deficiency in the age group of 20–55 years. 50 patients having serum vitamin D levels &lt;15 ng/ml were included in the study. Serum vitamin D levels of &lt;15 ng/ml were included in the control group. Vitamin D levels in tear fluid were measured by direct competitive chemiluminescent enzyme linked immunoassay. A complete ophthalmic evaluation was performed in all participants which includes assessment of visual acuity, anterior segment evaluation and posterior segment evaluation. Specular microscopy was performed on the eyes of the patients with vitamin D deficiency and healthy control group individuals. Corneal endothelial cell density (CD) and central corneal thickness (CCT) values were calculated automatically using the software of the specular microscope. &#x0D; RESULTS: The study group included 23 male and 27 female subjects while study group included 24 male and 26 female. Mean age of male in study group was 46.4 ± 12.56 and female was 45.6 ± 11.77. In control group mean male age was 48.5 ± 9.25 and female age was 49.56 ± 12.55. In study group Mean Corneal endothelial cell density (CD) was observed as 2632.89 ± 189.25 cells/mm 2 and Mean central corneal thickness (CCT) was 587.2 ± 25.89 μ. In control group Mean Corneal endothelial cell density (CD) was observed as 2954.97 ± 116.89 cells/mm 2 and Mean central corneal thickness (CCT) was 546.0 ± 36.22 μ. Vitamin D levels of Tears in study group was 8.4 ± 1.7 ng/ml and in control group it was 16.2 ± 2.3 ng/ml.&#x0D; CONCLUSION: It has been observed that there is statistically significant difference in the corneal endothelial cell density (CD) and central corneal thickness (CCT) in patients with vitamin D deficiency. It was observed that Vitamin D is present in tear fluid and there is significant difference in the levels of vitamin D in study and control group.

Open Globe Injury in a Tertiary Care Hospital

Introduction: Open Globe Injury (OGI) is a type of mechanical eye injury in which there is a full thickness defect of the outer fibrous coat of eye ball. The Prognosis in the eyes with OGI has improved in these days. 2.4% of blindness in Nepal was due to ocular trauma in 1981. The aim of this study was to describe epidemiological profile, clinical profile and treatment outcome in eyes with open globe injury.&#x0D; Methodology: It is the prospective interventional non randomized hospital based study on the patients of open globe injury presented to the Nepalgunj Medical College, Nepalgunj from April 2017 to May 2018. Visual acuity, anterior and posterior segment evaluation, site and size of wound were recorded. All the eyes were underwent primary repair surgery. Postoperative visual acuity, anterior and posterior segment evaluation was carried out on all follow up. Second surgery was done if required.&#x0D; Results: 0.4% of ophthalmic and 0.016% of all hospital patients had open globe injury. Most of the victims were young males. The mean age of study population was 10.98±17.1 year. Playing (62.5%) was the most common time of injury and wooden stick (50%) was most common agent of injury. Zone I involvement (87.5%) and penetrating type (91.7%) was found in most of cases. 87.5% of eyes were blind, 4.2%were visually impaired and 8.3% had normal vision at the time of presentation. 79.2 % of eye were improved after treatment on visual function, 12.5% remained unchanged while 8.3% deteriorates and leads to pthysis bulbi.&#x0D; Conclusion: The incidence of open globe injury was 0.4% among ophthalmic patients and 0.016% among all patients of Nepalgunj Medical College Teaching Hospital, Nepalgunj. Early Primary repair, use of systemic antibiotics and postoperative care provides encouraging anatomical and functional outcome in these eyes with OGI.

Bilateral simultaneous acute angle closure in an adult Nepalese woman

Purpose: To report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause.&#x0D; Methods: Observational case report.&#x0D; Results: A 50-year-old Nepalese woman presented with decreased vision, pain, redness, and watering in both eyes with associated coloured haloes, nausea, and vomiting for 10 days. At presentation, her visual acuity was 20/400 in the right eye and hand motions close to face with accurate projection of rays in the left eye. Intraocular pressure was 38 mmHg in the right eye and 48 mmHg in the left eye without any antiglaucoma medications. A slit-lamp examination revealed bilateral circum-corneal conjunctival congestion, corneal edema, and shallow anterior chambers. Both pupils were mid-dilated and non-reactive to light. Gonioscopy showed closed angles in all four quadrants bilaterally. Posterior segment examination revealed normal optic disc with cup-disc-ratio of 0.3 in the right eye, and blurring of disc margin with cup-disc-ratio of 0.3 in the left eye. The patient was started on systemic acetazolamide 250 mg 4 times a day, topical brimonidine 0.2% and timolol 0.5% 2 times a day, and topical dexamethasone 6 times a day in both eyes, following which IOP reduced to 11 and 12 mmHg, respectively, the corneal edema subsided, but the anterior chamber remained shallow. Laser peripheral iridotomy was performed in the right eye and surgical peripheral iridectomy was performed in the left eye. After two weeks, vision improved to 20/30 in both eyes with normal intraocular pressure off antiglaucoma medications. Anterior chambers deepened significantly with clear corneas bilaterally. Gonioscopy at this stage showed essentially open angles with appositional closure in superior and temporal quadrants in the right eye and open angles in all four quadrants in the left eye. Posterior segment evaluation revealed normal optic disc in both eyes.&#x0D; Conclusions: Bilateral simultaneous acute angle closure is a rare presentation with very few reported secondary causes. We report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. The case was successfully managed with laser peripheral iridotomy in the right eye and surgical peripheral iridectomy in the left eye.&#x0D;

Evaluation of Capillary Network Abnormalities in Branch Retinal Vein Occlusion by Optical Coherence Tomography Angiography

Objectives: Is to detect the vascular morphological changes in the two intra retinal; layers superficial network layer and deep network layer by optical coherence tomography angiography (OCT-A) in cases with acute onset branch retinal vein occlusion (BRVO). Study Design: An observational cross-sectional study in new Kafer El-Sheikh Ophthalmology Hospital. Population: This study included ten patients with (BRVO) of recent onset within the last three months. Methods: Demographic data such as age, gender, sex and hypertensive history were obtained. A detailed evaluation of cases including complete anterior segment evaluation and posterior segment evaluation was done. OCT-A and fluorescein angiography (FA) were used to study the vascular morphological changes in the (BRVO) area. Results: As regarding 5 disc area of retinal ischemia FA detected ischemia in 2 cases (20%), detected no ischemia in one case (10%) and was not able to evaluate ischemia in 7 cases (70%) compared to OCT-A, that detected the ischemia in the superficial capillary plexus (SCP)in 4 cases (40%), and detected no ischemia in 6 cases (60%), but it detected the ischemia in the deep capillary plexus (DCP) in 6 cases (60%) and detected no ischemia in 4 cases (40%). Conclusion: Our study demonstrated that OCT-A was superior to FA in detection of macular ischemia in cases with acute onset branch retinal vein occlusion (BRVO), macular ischemia detected in the DCP by OCT- A had stronger negative relation with V.A. than that of SCP. By OCT-A macular edema (ME) was present mainly in the DCP compared to SCP.

Need for optical intervention in children attending a school for the blind in Eritrea

PurposeTo identify the need for optical intervention including spectacles and low vision devices (LVDs) in children attending the only school for the blind in Eritrea.MethodsA total of 92 children were examined using the World Health Organization Prevention of Blindness program form for the recording of children with blindness and vision impairment. Examination included distance and near visual acuity (VA), refraction, trial of LVDs and evaluation of anterior and posterior segments. All the children who showed at least one line improvement in distance or near VA with refractive correction and/or LVDs were provided with these devices.ResultsSix children had distance VA of ≥6/18 (no vision impairment, NVI) at presentation and were excluded from analysis. For the remaining 86 children, male to female ratio was 1.2:1.0 with a mean age of 11.8 ± 2.8-years (range: 6–17-years). At presentation, 47 (54.7 per cent) children were blind (VA <3/60) and 24 (27.9 per cent) were severely visually impaired (VA <6/60–3/60), which reduced to 42 (48.9 per cent) and seven (8.1 per cent) children after refraction, respectively. A further 5.8 per cent (five children) achieved NVI with refractive correction. Using distance LVDs, 26 (30.2 per cent) and 16 (18.6 per cent) children had NVI and moderate vision impairment (VA <6/18–6/60), respectively. In terms of near vision, eight (9.3 per cent) children had near VA better than 1.00-M at presentation, which improved to 11 (12.8 per cent) with refractive correction and 19 (22.1 per cent) with near LVDs. A total of 29 spectacles and 42 LVDs were provided.ConclusionA significant number of children at the school for the blind benefited from refractive correction and LVDs. With such optical intervention, many of these children could study at mainstream schools with print media. A system including comprehensive vision examinations before admission to the school, refractive services and low vision rehabilitation is required to ensure that children with adequate residual vision do not have to be limited to learning in Braille media.

Pattern of ocular morbidity in patients attending ophthalmic OPD at tertiary care hospital, Valsad, Gujarat

Background: Vision is the most important special sense in human being. Normal vision is essential for normal physical, mental, psychological development and education. Causes of the preventable blindness are often the result of a combination of factors such as poverty, lack of education and inadequate health-care services. The objectives of the study were to determine the pattern of ocular morbidity in patient attending ophthalmic OPD and to find out the association of most common ocular morbidity with different variables. Methods: The cross sectional study was conducted in ophthalmic department at GMERS medical college, Valsad, Gujarat, India. It is a part of the research activity during internship period in Community Medicine department. All patients who attended ophthalmic OPD in third week of April at this hospital were enlisted in this study with their consent. The patients were seen in ophthalmic OPD by ophthalmologist, proper anterior and posterior segment evaluation was done. Data includes registration number, name, gender, education, locality, occupation, H/o systemic illness, refractive error and the diagnosis. Results: In majority of patients attending ophtahlmic OPD were with occular morbidity specifically refractory error and cataract i.e. 54% and 50% respectively. The prevalence of cataract is significantly lesser in &lt;40 years of age, as it is an age related disease. Second most common occular morbidities observed in our study period was conjunctivitis. Cataract has correlation with age, rural locality and female preponderance. Conclusions: Majority of ocular morbidity were either preventable or treatable. Cataract (65 patients out of 130) being the commonest. If detection is early in the course, prevalence of ocular morbidity can be greatly reduced. The leading causes of ocular morbidity in our study were cataract, a conjunctivitis, and refractive error. A large number of OPD patients were constituted by follow up of cataract surgeries.

Ophthalmologic Findings in Patients with Neuro-metabolic Disorders.

Purpose:We aimed to present the ophthalmic manifestations of neuro-metabolic disorders.Methods:Patients who were diagnosed with neuro-metabolic disorders in the Neurology Department of Mofid Pediatric Hospital in Tehran, Iran, between 2004 and 2014 were included in this study. Disorders were confirmed using clinical findings, neuroimaging, laboratory data, and genomic analyses. All enrolled patients were assessed for ophthalmological abnormalities.Results:A total of 213 patients with 34 different neuro-metabolic disorders were included. Ophthalmological abnormalities were observed in 33.5% of patients. Abnormal findings in the anterior segment included Kayser–Fleischer rings, congenital or secondary cataracts, and lens dislocation into the anterior chamber. Posterior segment (i.e., retina, vitreous body, and optic nerve) evaluation revealed retinitis pigmentosa, cherry-red spots, and optic atrophy. In addition, strabismus, nystagmus, and lack of fixation were noted during external examination.Conclusion:Ophthalmological examination and assessment is essential in patients that may exhibit neuro-metabolic disorders.

Ultrasonographic assessment of paediatric ocular emergencies: A tertiary eye hospital based observation.

The purpose of this study is to assess the utility of ocular ultrasound B scan in the emergency at the first point of care for detecting posterior segment and orbital pathologies in cases of paediatric ocular emergencies. A prospective observational study involving 122 paediatric patients presenting to eye emergency over a period of ninety days were assessed with ultrasonography for the posterior segment as well as orbital pathology whenever indicated. The ocular ultrasound was performed gently over closed eyelids. Posttraumatic globe injuries were the most common indication for posterior segment evaluation, which constituted 80 (65.57%) eyes. Among these 52 patients had an anechoic posterior segment and 28 patients had variable findings such as vitreous haemorrhage (8.19%), retinal detachment (6.55%), choroidal detachment (4.91%), posteriorly dislocated clear lens (0.81%) and retained intraocular foreign body (5.73%). Non-traumatic cases constituted around 42 (34.42%) eyes, which included corneal ulcer (7.37%), retinoblastoma (6.55%), endophthalmitis (4.91%), extra-ocular muscle cysticercosis (4.91%), orbital cellulitis (4.09%), periocular haemorrhage (2.45%), proptosis(1.63%), paediatric cataract (1.63%) and cryptophthalmos (0.81%). No adverse events of performing the ultrasound was noted. First point ultrasonography in paediatric ocular emergencies is a cheap, portable and an effective tool in the assertion of significant posterior segment and orbital diseases.