Regional Institute Of Ophthalmology Research Articles

Comparison of Corneal Endothelial Cell Loss during Manual Small-incision Cataract Surgery using Visco-expression versus Irrigating Wire Vectis-assisted Nucleus Removal: A Prospective Randomised Study

Introduction: Age-related cataract is the leading cause of curable blindness in India, and Manual Small-Incision Cataract Surgery (MSICS) is a machine-independent and cost-effective alternative to phacoemulsification for handling this significant burden. In every cataract surgery, some endothelial cell loss is inevitable. Therefore, the present study was conducted to compare endothelial cell loss in the two most commonly practiced methods of nucleus delivery in MSICS. Aim: To compare and analyse endothelial cell loss during MSICS using viscoelastic/viscoexpression-assisted nucleus removal versus irrigating wire vectis-assisted nucleus removal. Materials and Methods: A prospective randomised interventional study was conducted at the Regional Institute of Ophthalmology, Postgraduate Institute of Medical Sciences (PGIMS) Rohtak, Haryana, India. The study duration was three years, from May 2018 to May 2021. A total of 250 patients with uncomplicated senile cataract over 40 years of age, with nuclear sclerosis of grade 2 or higher and “with the rule” astigmatism, were included in the study. The patients were randomly divided into Group A and Group B (125 each), who underwent MSICS using visco-expression (Group A) versus irrigating wire vectis-assisted (Group B) nucleus removal. Visual Acuity (VA), keratometry, astigmatism, pachymetry, and Endothelial Cell Density (ECD) were recorded in every patient preoperatively and postoperatively on day 1 and day 40. The Shapiro-wilk test was used to assess the normality of the data, and student’s t-test was performed to identify significant differences in continuous factors between the two groups. Chi-square test was used to find the association between factors and techniques, with a p-value <0.05 considered statistically significant. Results: The mean age of the patients was 68.5±9.4 years (range 52-89 years) with a significant male preponderance. The mean LogMAR visual acuity on Postoperative Day (POD)-1 was 0.3±0.1 for Group A, while for Group B, it was 0.5±0.2, showing a statistically significant difference (p=0.004). However, on day 40, visual acuity was comparable in both groups, with Group A (0.1±0.2) and Group B (0.1±0.1), and no significant difference (p=0.09). On POD-1, the percentage change in Endothelial Cell Density (ECD) was 4.2% in Group A and 10.6% in Group B, with a statistically significant difference (p=0.0017). On day 40, it was 2.1% and 4.8% in Group A and Group B, respectively, also showing a statistically significant difference (p=0.003). On postoperative day 40, the mean Surgically Induced Astigmatism (SIA) in Group A and Group B was 0.67±0.24 and 0.74±0.41, respectively, but this difference was statistically insignificant (p=0.074). Intra and postoperative complications such as hyphema, iridodialysis, and corneal oedema were more common in Group B than Group A. Conclusion: The study concludes that there was a statistically significant endothelial cell loss in the irrigating wire vectisassisted nucleus delivery method compared to the viscoexpression of the nucleus during MSICS. The present method also showed delayed visual rehabilitation and a higher risk of intra and postoperative complications. Therefore, viscoexpression of the nucleus should be the preferred method of nucleus delivery in every MSICS where feasible.

Effect of Corneal Collagen Crosslinking with Riboflavin in Patients of Progressive Keratoconus: A Prospective Cohort Study

Introduction: Keratoconus is a non inflammatory disease characterised by progressive corneal thinning that results in a cone-like ectasia, irregular astigmatism, and decreased vision. Advanced disease can result in corneal scarring and blindness, necessitating penetrating keratoplasty. The only treatment believed to have the ability to stop or decrease the progression of keratoconus is Collagen Cross-Linking (CXL). Aim: To evaluate the efficacy of corneal collagen cross-linking with riboflavin (C3R) in patients with keratoconus by studying the outcomes in terms of Uncorrected Visual Acuity (UCVA), Best Corrected Visual Acuity (BCVA), manifest refraction, and corneal topography. Materials and Methods: A hospital-based prospective cohort study was conducted at the Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala, India from June 2017 to June 2018. Fifteen eyes of 12 patients who underwent corneal collagen cross-linking for progressive keratoconus were included. Routine ophthalmological examinations was done for all patients. Patients under the age of 35 years with progressive keratoconus, an average K value not exceeding 60 D, and who had not undergone any other surgical modalities of treatment were included in the study. Patients with scarred cornea or hydrops, active ocular infection, or pachymetry <400 µm were excluded. Detailed informed consent was obtained from all patients before surgery. Preoperative UCVA, BCVA cylinder, Spherical Equivalent (SE), and topography values were obtained. All patients were followed-up at three and six months postoperative period to look for changes in UCVA, BCVA, manifest refraction, and corneal topography. Data were expressed as the mean±Standard Deviation (SD) pre- and postoperatively and analysed statistically using the paired t-test, with p<0.05 considered statistically significant. Analysis was conducted using Statistical Package for Social Sciences (SPSS) version 16.0. Results: On follow-up at six months post-treatment, UCVA (log MAR) improved from 0.87±0.40 to 0.65±0.35 (p-value=0.001), and BCVA (log MAR) changed from 0.37±0.21 to 0.17±0.22 (p-value=0.001). K max decreased from 54.90±6.05 to 52.67±5.02 (p-value=0.001), and K min decreased from 48.14±4.24 to 45.93±4.07 (p-value=0.001). Astigmatism and SE also showed statistically significant improvement post-procedure (p-value 0.001 and 0.002, respectively). Astigmatism reduced from -3.50±1.58 to -2.90±1.37. SE reduced from -4.93±3.92 to -4.28±3.48. No significant complications were noted in any of the patients. Conclusion: The CXL is an effective procedure for stabilising the progression of keratoconus, thus reducing the burden of preventable blindness and the need for keratoplasty.

Minto ophthalmic hospital and the regional institute of ophthalmology: Tale as old as time.

Minto ophthalmic hospital and the regional institute of ophthalmology: Tale as old as time.

Dr. K. Bhujang Shetty: In Memoriam.

Dr K. Bhujang Shetty, Founder-Chairman and Managing Director of Narayana Nethralaya was a dynamic ophthalmologist with an indomitable spirit. Dr Shetty had humble beginnings in a small village near Kundapur. At Baldwin Boys High School, Dr Shetty was the perfect student—the school captain, and sports captain, known for his athletic skills in the football and hockey team. As he grew older, he found himself drawn from the green of the sports ground to the white of the operation theater. He completed his MBBS from Bangalore Medical College and postgraduation from Minto Ophthalmic Hospital and Regional Institute of Ophthalmology, Bangalore. Soon after his residency, he started his own private practice in Srirampur in 1982, which then moved to its current premises in 1993. He nurtured a silent dream to serve the community, and patience and perseverance were his virtues. The transformation of this young ophthalmologist into a consummate professional and a visionary leader was the result of his positive and focused mindset, pious humbleness, sheer hard work, and innate financial wisdom. Today, Narayana Nethralaya is one of the leading multi-specialty eye hospitals in the country delivering world-class eye care by the highly trained ophthalmologist and utilizing cutting-edge technology. The Institute provides high-quality education and training in ophthalmology. Under Dr Shetty’s leadership, Narayana Nethralaya has intuitively invested in an ecosystem conducive to ground-breaking research and innovation. The new knowledge that it constantly produces and disseminates has ushered in paradigm changes in the basic understanding of several diseases and the way we practice ophthalmology today. Dr Shetty successfully involved Kannada superstar Dr Rajkumar to promote and create awareness about eye donation and founded the Dr Rajkumar Eye Bank. This is the State’s largest Eye Bank with more than 65,000 eye pledges and 10,000 tissues donated. The movie star pledged to donate his eyes which the family fulfilled. Even after the untimely death of his son Puneeth Rajkumar, his corneas were donated to Narayana Nethralaya and used for transplantation and restoring sight in four patients. Dr Shetty helped initiate the Karnataka Internet Assisted Diagnosis for Retinopathy of Prematurity (KIDROP) program to tackle blindness caused by Retinopathy of Prematurity, which was undertaken as a Public Private Partnership. It is the world’s largest telemedicine program and has screened more than 80,000 infants. Dr Shetty recently founded the Narayana Devalaya, a 5-storied eye hospital, with no cash counters, to fight against correctable blindness in the poor. Dr Shetty in his late 60s, took up research related to the reversal of diabetes. He met weekly with researchers at the GROW Research Laboratory at Narayana Nethralaya to discuss ideas to take it forward. He himself followed and shared his scientific methods of diabetic control through diet and lifestyle changes that could benefit thousands of people. Dr Shetty has shown what a bright young ophthalmologist with an ignited but uncluttered mind can do to build an outstanding legacy. The entire ophthalmic fraternity mourns the loss of this monumental figure.

Regional Institute of Ophthalmology and Government Ophthalmic Hospital: The Heart of Heritage

Regional Institute of Ophthalmology and Government Ophthalmic Hospital: The Heart of Heritage

ASSOCIATION BETWEEN CENTRAL SEROUS CHORIORETINOPATHY [CSCR] AND CORONARY HEART DISEASE [CHD] IN PATIENTS ATTENDING THE OUTPATIENT DEPARTMENT OF REGIONAL INSTITUTE OF OPHTHALMOLOGY KOLKATA: A CASE CONTROL STUDY

Introduction: Central serous chorioretinopathy [CSCR] a disease characterized by localized and serous detachments of neurosensory retina with or without focal pigment epithelial detachments[PEDs] and altered retinal pigment epithelium[RPE].The disease is usually idiopathic and often resolves spontaneously with visual recovery, although occasionally neurosensory retinal detachment persists or relapses and leads to permanent damage of the retinal pigment epithelium [RPE] and photoreceptors with subsequent visual impairment.Aims: In this Study CSCR patients and a control group were evaluated for the presence of CHD by means of Electrocardiogram [EKG], and echocardiogram and by further investigations if needed. Materials and Methods:The Institution based retrospective case control study. This Study was conducted from 12 months at Department of OPD at Regional Institute of Ophthalmology, [RIO] and Kolkata. Result: In our study, case group 25 [12.5%] patients had CHD and in control group, 12 [6.0%] patients had CHD which was statistically signicant [p=0.0248]. Conclusion: We concluded that association between Central Serous Chorioretinopathy (CSCR) and Coronary Heart Disease [CHD] was statistically signicant. CSCR had a signicantly higher CHD rate than those without CSCR, indicating that CSCR may be a potential risk factor for the development of CHD

Clinical Profile and Visual Outcome of Traumatic Glaucoma Patients Following Closed Globe Injury in the Rural Part of Eastern Uttar Pradesh at a Tertiary Eye Care Centre: A Retrospective Cohort Study

Introduction: Glaucoma is a significant cause of ocular morbidity following ocular trauma, particularly Closed Globe Injury (CGI), which frequently leads to elevated Intraocular Pressure (IOP). This type of trauma can result in various tissue damages such as radial sphincter tears, iridodialysis, angle recession, cyclodialysis, trabecular meshwork tears, zonule separation, or peripheral retinal dialysis. Damage in these areas can lead to early or delayed onset glaucoma. Aim: To evaluate the clinical profile, assess visual outcomes, and analyse management strategies in post-traumatic glaucoma with CGI. Materials and Methods: The retrospective cohort study was conducted at a tertiary eye care centre in Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Sitapur, Uttar Pradesh, India. from January 2020 to December 2022. Retrospective data of patients presenting with CGI and developing elevated IOP (>21 mmHg) were collected. Only patients with a minimum follow-up of three months were included. Various parameters, including demographics, IOP, Best-Corrected Visual Acuity (BCVA), and the effects of medical and surgical treatments on IOP and BCVA, were analysed. The Ocular Trauma Score (OTS) was also calculated. Statistical analysis was performed using Microsoft excel and Statistical Package for Social Sciences software version 21.0, with a significance level of 5%. Continuous variables were described as mean±Standard Deviation (SD), and an unpaired t-test was used for comparisons between pre- and postmanagement visual acuity and IOP. Results: Out of 259 eyes with ocular trauma, 93 (35.90%) were diagnosed with CGI and developed elevated IOP. The most common causes of elevated IOP were hyphema (37.63%) and angle recession mechanisms (32.25%). The median IOP at presentation was 35 mmHg (range: 12 to 71 mmHg) and decreased to 16.5 mmHg (range: 4 to 52 mmHg) at the last follow-up (p-value <0.001). Surgical management was required in 30 (32.25%) eyes, with 13 (13.97%) eyes undergoing trabeculectomy. Conclusion: Post-traumatic IOP elevation occurred in 93 (35.90%) eyes with CGI, and 13.97% of these eyes required glaucoma filtering surgery for IOP control. Overall, medical management was necessary in 67.74% of eyes, while 32.25% required surgical intervention. Eyes with posterior segment involvement had poor visual acuity. Poor baseline vision and vitreo-retinal involvement increased the risk of a poor visual outcome.

Progression of Diabetic Retinopathy during COVID-19 Pandemic: A Retrospective Study

Introduction: Emergence and subsequent exponential spread of Coronavirus Disease-2019 (COVID-19) infection during 2020 forced the Government to issue countrywide lockdown from March 2020. Diabetic Retinopathy (DR) is one of the debilitating diseases of the eye which requires regular follow-ups and timely intervention to prevent permanent vision loss. The impact of countrywide lockdown on prevalence and progression of DR needs to be evaluated. Aim: To assess the effect of COVID-19 pandemic situation on the prevalence and progression of DR and analyse the possible risk factors for progression of DR in the ongoing pandemic period by comparing retrospective data from immediate prepandemic quarter with post lockdown quarter. Materials and Methods: This retrospective study was conducted in the Department of Opthalmology at Regional Institute of Ophthalmology, Kolkata, West Bengal, India. The study was done during the prepandemic period, from November 2019 to February 2020. In the present study, a cohort of 83 diabetic patients with pre-existing DR was selected from past medical records and compared with post lockdown period during November 2020 to February 2021. Data regarding prevalence of various types of DR, mean Central Macular Thickness (CMT), mean Visual Acuity (VA), proportion of patients requiring >3 doses of monthly anti-Vascular Endothelial Growth Factors (VEGF) and additional laser therapy or vitrectomy, VA improvement and reduction of mean CMT were gathered and compared between those two quarters. The data was analysed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The prevalence of moderate Non Proliferative Diabetic Retinopathy (NPDR) (13% vs 25%), severe NPDR (19% vs 8%), Proliferative DR (PDR) (18% vs 7%), Advanced Diabetic Eye Disease (ADED) (4.8% vs 1%) and Diabetic Macular Oedema (DME) (62% vs 28%) increased several folds during post lockdown quarter in comparison to prepandemic quarter. There was a statistically significant difference (p-value<0.05) in baseline mean LogMar Best Corrected Visual Acuity (BCVA) (0.4±0.08 vs 0.9±0.07), mean CMT (386.4±26.8 to 421.8±21.6) positive correlations of some of the possible risk factors for poor visual outcome among the same cohort of patients in the post lockdown period: poor socioeconomic status (35%; Odds Ratio (OR):3.59, Relative Risk (RR):2.68), irregular diabetic medication (52%; OR:3.56, RR:2.23), residence more than 100 km from the hospital (38%; OR:3.03, RR:2.26). Conclusion: The present study, concludes that, the status of DR stage among study subjects in the post lockdown period has deteriorated when compared with the prepandemic period.

Anatomical and Functional Outcome of Retinal Detachment Surgery

Objective: To study the anatomical status and functional outcome of Pars Plana Vitrectomy surgery in rhegmatogenous retinal detachment (RRD) at a tertiary eye care center in India.
 Material, Patients and Method: This is a prospective, noncomparative, consecutive, interventional study of rhegmatogenous retinal detachment managed with Pars Plana Vitrectomy surgery performed in the Regional Institute of Ophthalmology, Prayagraj, India. 40 patients of 40 eyes (26 phakic 65%, 14 pseudophakic 35%) with retinal detachment were treated by primary pars plana vitrectomy with 6 months of follow-up.
 Result: A total of 40 patients (40 eyes) were operated, 18 males and 2 females, with age, ranges from 17 years to 90 years. After surgery, anatomically retinal reattachment was achieved in 40 (100%). Improved best-corrected visual acuity (BCVA) was seen in 38 (90%) patients, whereas in 2 (5%) patient BCVA was not improving and deteriorated from pre-operative in another 2 (5%) patient. There was no significant difference was found in the pseudophakic and phakic eye in functional outcome.
 Conclusion: Rhegmatogenous retinal detachment is one of the common causes of visual impairment and blindness. Timely surgical management with Pars Plana Vitrectomy surgery can give good anatomical and visual outcome.

Assessment of visual disability, clinical and demographic profile from Unique Disability Identification Details (UDID) card applicants in Regional Institute of Ophthalmology (RIO) in South India

To ascertain the degree and causes of visual disability, clinical and demographic data of UDID card applicants at RIO MOH Karnataka South India.It is a cross-sectional observation study, data collected from the UDID PORTAL where applicants applied between July 2019 to March 2020. Totally 551 applicants details were collected. Degree of visual disability and its causes, demographic details like age, gender, education, marital and employment status, annual income along with that other clinical details were ascertained. Among the 551 applications, 368 were men and 183 were women highlighting a significant gender bias. Almost 2/3 of applications were in the age group 20 to 50. 60% of applicants were married. 95% of applicants were in the blind category while only 4.3% were certified as having low vision. 47% of applicants were BPL Card holders and were dependent on the family member for livelihood. 47% of the applicants had completed basic education (10 std/SSLC). Retinitis pigmentosa was the top cause of blindness. Retinal pathologies constitute the leading cause among them majority had Retinitis pigmentosa. Genetic counseling plays a significant proactive role in the prevention of the disease. Creating awareness among employers to provide adequate protective equipment could help in reducing the disease burden of phthisis bulbi. Government and NGOs should prepare appropriate plans and implement them to rehabilitate individuals with visual disabilities. There is a need to create better awareness about the benefits of UDID CARDS in the community in general and among people with blindness and low vision in particular.

English

BACKGROUND The prevalence of rheumatoid arthritis (RA) in India is 0.28% to 0.7%, 15-45% of patients with RA develop ocular manifestations. Ocular disabilities can be reduced with timely interference by an ophthalmologist. Keratoconjunctivitis sicca (Sjogren’s syndrome) is the most common ocular association of RA. This study was done to find out various ocular manifestations in rheumatoid arthritis patients. METHODS A cross sectional study was conducted among the patients attending the rheumatology clinic at Government Medical College, Trivandrum. Patients in the age group of 18-60 years were screened and further evaluated at regional institute of ophthalmology, Trivandrum. Screening for RA was done using the American Rheumatism Association criteria. A complete ophthalmic examination was done for those who satisfied the criteria. The various ocular manifestations in RA are described and presented as proportions. RESULTS Ocular manifestation was found in 38% of total patients attending the rheumatology clinic. There were 54 females (80.5%) and 13 males (19.4%). Age group mainly affected were in 46-50 yr (17.9%). The duration of rheumatoid arthritis ranged from few months to 25 years. Keratoconjunctivitis sicca was the commonest manifestation found, detected in 22(84%) patients, episcleritis was noted in two patients (7.6%), scleritis in 1 patient (3.8%) and marginal furrowing in 1 patient (3.8%). CONCLUSIONS In this clinic-based study there was a high proportion (38%) of ocular involvement in RA and hence it is essential to include ophthalmic evaluation as a routine in RA patients. The most common manifestation was keratoconjunctivitis sicca followed by episcleritis, diffuse anterior scleritis and marginal corneal furrowing. KEY WORDS Rheumatoid Arthritis, Keratoconjunctivitis Sicca, Ocular Manifestations, Scleritis, Episcleritis

HOSPITAL BASED STUDY ON OCCURRENCE AND RISK FACTORS OF RETINOPATHY OF PREMATURITY

Retinopathy of prematurity, previously known as retrolental broplasia is a vasoproliferative disease that affects premature infants. Premature retina when exposed to high oxygen concentration , followed by abrupt withdrawal ,easily undergoes uncontrolled vasculo brotic proliferation and eventually results in retinal detachment.. AIM: 1.To determine the incidence of ROPin neonates of gestational age less than 34 completed weeks; weighing less than 2000g 2.To determine its association with various clinical risk factors. MATERIALS AND METHODS: This hospital based, prospective study was done in Regional Institute of Ophthalmology, Guwahati Medical College and Hospital. A total of 168 eyes of 84 babies were evaluated and the results were statistically analysed. The period of study was from June 2020 to May 2021. The results were statistically analysed using sher's exact test or chi square test for independence. RESULTS: In a total of 84 babies(168 eyes) the incidence of ROP was found to be 14.28%. The risk factors which had signicant association with ROP in this study are: Prematurity, low birth weight, supplemental oxygen, respiratory distress syndrome. In addition, however, risk factors like gestational diabetes, phototherapy and sepsis also show signicant association with ROP.

Retinal Manifestations in Rhinoorbito-cerebral Mucormycosis: A Cross-sectional Study

Introduction: Rhino-orbito-cerebral Mucormycosis (ROCM) is an uncommon but devastating fungal infection caused by Mucoraceae family fungi, which are angiotropic and filamentous, with significantly high morbidity and mortality despite treatment. Post Coronavirus Disease-2019 (COVID-19), there was a sudden surge in ROCM cases nationwide due to immunologically and metabolically compromised status. Aim: To describe retinal manifestations in ROCM in a tertiary eye care centre of Northern India. Materials and Methods: An analytic, cross-sectional and hospitalbased study was conducted in Regional Institute of Ophthalmology, PGIMS Rohtak, Haryana, India, from May 2021 to September 2021. This study was conducted on 200 admitted patients of RCOM in the institute, which was only designated Nodal centre in Haryana, India. Detailed history was recorded in every patient regarding presenting symptoms, history of COVID-19, hospital stay, oxygen inhalation, steroid intake and immunisation. Thorough ocular examination was done in every patient including visual acuity, ocular movements and pupillary reactions. Dilated fundus examination was done by Indirect Ophthalmoscopy (IDO) for posterior segment evaluation. Contrast Enhanced Magnetic Resonance Imaging (CE-MRI) brain with orbit and Paranasal Sinus (PNS) was done in every patient to see the extent of spread and planning further management. Results: Out of 200 patients of ROCM, majority of patients (64/200) were of 51-60 year age group (32%) followed by 41-50 year age group (28%). Out of 200 cases of ROCM, 146 patients (73%) had history of COVID-19 infection in past and 134 (67%) patients had history of hospital stay during COVID-19 infection. Oxygen (O2 ) supplementation was given to 98 patients either at home or during hospital stay. History of steroid intake was present in 34 patients and 46 patients received injection Remedsivir. Only 12 patients had vaccine against COVID-19 and none of them were fully vaccinated. Most common presenting symptom was unilateral nasal stiffness (22%) followed by loss of vision (17%). Most common predisposing factor was Diabetes Mellitus (DM) in 78 patients (39%) followed by steroid intake in 34 patients (17%). Out of 200 patients, only 60 patients had retinal manifestations and most common was Central Retinal Artery Occlusion (CRAO) (35/60) and the main mechanism is the direct infiltration of central retinal artery due to angioinvasion of fungi from the orbit. Conclusion: CE-MRI brain with orbit is an important tool in diagnosing and monitoring progression of RCOM but it cannot provide information regarding retinal findings like CRAO, central retinal venous occlusion (CRVO), disc pallor and optic atrophy. Thus, the fundus examination of every ROCM patient should be emphasised, as it not only helps in categorising ROCM but also tells about the visual potential of affected eye. Patients with CRAO and combined vascular occlusion should be considered for exenteration on urgent basis, so that intracranial spread can be prevented and patient’s life can be saved.

English

BACKGROUND Colour vision is a function of three types of cone pigments present in the retina. Colour vision deficiency is an important disorder of vision that may pose a handicap to the performance of an affected individual. The prevalence of colour blindness varies in different geographical areas. The identification and estimation of the prevalence of colour vision deficiency in school-going children will help to educate and guide the caregivers to help the children in selecting their profession. This study was done to estimate the prevalence, sex distribution, and types of colour vision deficiency among school-going children of 5 to 15 years. METHODS A cross-sectional observational study was done among 500 students to evaluate the colour vision during the period from 1st January 2018 to 30th June 2019 at the Regional Institute of Ophthalmology, Kolkata. Ishihara’s pseudo isochromatic colour vision chart 38th edition was used to assess the school children for colour vision status. The children who were found to be colour blind were further classified into degree and types of colour vision deficiency. RESULTS A total of 500 students (250 male & 250 female) of surrounding schools, in the age group of 5 years to 15 years, were screened. 480 students (96 %) had normal colour vision while 20 (4 %) students were found to have defective colour vision. Prevalence (4 %) for colour blindness was found to be higher in males (3.6 %) than females (0.4 %). It was observed that out of 20 (4 %) colour-blind subjects 3.6 % were protanopes and 0.4 % were deuteranopes. CONCLUSIONS The present study shows the prevalence of colour blindness found to be quite low (4 %) and more common in males (3.6 %) in comparison to females (0.4 %). Protanomaly (3.6 %) was more common than deuteranomaly (0.4 %). KEYWORDS Colour Blindness, Protanomaly, Deuteranomaly, School Children

Efficacy and Cost-Effectiveness of Anti-VEGF for Treating Diabetic Retinopathy in the Indian Population.

PurposeIn the present study, we aimed to evaluate the efficacy, safety, and cost-effectiveness of the anti-vascular endothelial growth factor (anti-VEGF), namely ranibizumab (RBZ) or bevacizumab (BVZ), after either focal or grid or scatter laser photocoagulation, for the treatment of diabetic macular edema (DME) in the Indian population.MethodsRetrospective data were collected in the Regional Institute of Ophthalmology, Kolkata, India between January 2018 and June 2019. Seventy-seven eyes received 3 consecutive monthly intravitreal injections of RBZ (0.5 mg) and were followed by prompt laser photocoagulation (within 7–10 days after the third injection). Similarly, 51 eyes received 3 consecutive monthly intravitreal injections of BVZ (1.25 mg), an off-label drug, and were followed by prompt laser therapy. Safety assessments of the therapy, as well as surrogate markers of biochemical derangements related to diabetic retinopathy (DR), were also investigated at the end of 12 months.ResultsSeventy-seven subjects who were given a treatment of RBZ+laser therapy showed average 6.87±5.53 letters gain in their best-corrected visual acuity (BCVA) score, whereas the ones treated with off-label BVZ+ laser therapy demonstrated improvement in BCVA of an average 6.82±5.76 letters in “Early Treatment Diabetic Retinopathy Study” (ETDRS) chart. The study also highlights the cost-effectiveness of both RBZ+laser and BVZ+laser therapies for the treatment of DME in DR. The results demonstrated that a subject has to pay 20.951 times more cost (in INR) for RBZ+laser therapy compared to BVZ+laser therapy, to get an almost similar outcome.ConclusionBVZ is found to be the more attractive option for treating DME in DR for its cost-friendliness over RBZ in terms of BCVA outcome, as well as the safety perspectives, at least for the economically backward population in developing countries, like India.

Epidemiology, clinical profile, complications and treatment outcomes of chronic dacryocystitis in a tertiary care hospital in post lockdown era: An observational study

to study the epidemiological factors, clinical features, complications and treatment outcomes of chronic dacryocystitis in Odisha after nationwide lockdown in 2020. An observational study was designed from July 2020 to December 2020 in Regional Institute of Ophthalmology, Cuttack, Odisha. Total of 187 patients presenting with chronic dacryocystits were evaluated thoroughly in various epidemiological parameters. The history and clinical features were noted. After proper evaluation and conservative treatment, those patients were subjected for surgery and the surgical outcomes are followed-up upto 3 more months, i.e. March 2021.: The prevalence of chronic dacryocystitis was around 1.224%. Among the 187 patients, 112 were females (59.9%). The disease was found in highest proportion in the age group of 51-60 years (30.5%) followed by 25.7% in the age group of 61-70 years. 90.4% were from rural population. Socioeconomic status and living standard was found to be a significant factor, people belonging to class 4 & 3 were affected more. Majority of the affected were housewives (39.6%) and farmers (21.9%) followed by small businessmen (13.9%) and wage laborers (12.9%). Epiphora was the commonest presenting symptom in 71.6%, followed by mucopurulent discharge in 29.9% and swelling near the medial canthus in 12.3% cases. Complications like conjunctivitis, keratitis, preseptal cellulitis, cutaneous fistula were present in 6.4%, 8.4%, 7.5% and 5.9% cases respectively in our study group. The success rate of external DCR was reported as 85.8% in this study. Chronic Dacryocystitis, though a common problem of lacrimal drainage system, is much less recognized disease, specially in rural population and in lower socio-economic community in Odisha. Thus patients may present late with one or more complications, e.g. conjunctivitis, keratitis, preseptal cellulitis, lacrimal abscess, mucocele, cutaneous fistula, which is the current scenario in post-lockdown 2020 era. Maintaining all precautions and guidelines for COVID-19, we should not delay treating these patients with surgical measures. The surgical success rate (85.8%) however was not affected much in spite of all these factors.

English

BACKGROUND Open angle glaucoma forms a major proportion of glaucomas which is a leading cause of irreversible blindness worldwide. Anatomical variations in ocular structures and consequent secondary open angle glaucoma occurs in significant number of patients afflicted with pseudoexfoliation syndrome. Hence, a detailed workup and identification of glaucoma and appropriate management is essential to prevent further visual loss. We wanted to evaluate the incidence of open angle glaucoma among patients having pseudo exfoliation syndrome at Regional Institute of Ophthalmology, Trivandrum, Kerala. METHODS A cross sectional study comprising 142 individuals with pseudo exfoliation syndrome was conducted in Regional Institute of Ophthalmology, Trivandrum, Kerala, over a period of one year. Sociodemographic variables were collected through structured interviewer administered questionnaire followed by detailed ocular work up and visual field analysis. Data was analysed using Statistical Package for Social Sciences, SPSS 16. RESULTS Among 142 subjects, 70.4 % were males and 29.6 % were females. The mean age of participants was 65 years. In studied population, 83.1 % represented rural population. Incidence of open angle glaucoma among studied population with pseudoexfoliation was 10.56 % (95 % confidence interval; 5.50 % - 15.61 %). No case of normal tension glaucoma was identified during the study period. 29.57 % of subjects showed bilateral pseudoexfoliation. But among patients with pseudoexfoliation (PEX) glaucoma, 78.9 % had bilateral disease. Mean intra ocular pressure in eyes with PEX glaucoma was 27.38 ± 5.75 mm Hg and in PEX eyes without glaucoma was 23.20 ± 1.6 mmHg. Pupillary dilatation was observed to be less than the normal eyes and was 5.62 mm. 4 % of eyes with PEX had some form of zonulopathy. CONCLUSIONS Hospital based incidence of open angle glaucoma among patients with pseudo exfoliation is 10.56 %. KEYWORDS Pseudoexfoliation, Open Angle Glaucoma, Incidence, Intraocular Pressure, Gonioscopy

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.

English

BACKGROUND Retinitis pigmentosa is a group of hereditary disorders characterised by difficulty of seeing at night, bony spicule pigmentation in mid retinal periphery, progressive visual field loss and abnormal electroretinogram (ERG) responses. Cataract surgery in patients with retinitis pigmentosa is associated with poor visual outcome with higher incidence of intraoperative and postoperative complications. This study was done to find the visual and surgical outcome of phacoemulsification and intraocular lens (IOL) implantation in patients with retinitis pigmentosa. METHODS This was a retrospective, non-comparative, observational study done at Regional Institute of Ophthalmology, RIMS Ranchi, India. Consecutive patients of retinitis pigmentosa who underwent phacoemulsification and IOL implantation between July 2015 to December 2019 were retrospectively analysed. Intraoperative and postoperative complications, visual and refractive outcomes were analysed. RESULTS Fifty six eyes of 48 patients (29 male, 19 female) with mean age 46.62 ± 8.45 years were included in study. Mean follow up was 17.92 ± 10.62 months. The types of cataract were posterior subcapsular in 30.35 %, cortical in 14.2 %, mixed in 51.8 % and nuclear sclerosis in 3.5 % of eyes. Intraoperative posterior capsular rent (PCR) was noted in 2 eyes (3.57 %) and zonular dehiscence in 3 eyes (35.35 %). Preoperative mean log minimum angle of resolution best corrected visual acuity (MARBCVA) was 1.45 ± 0.49 which improved to 1.24 ± 0.28 postoperatively at 4 weeks (P-value < 0.05). Postoperatively, vision improved in 46 (82.14 %) eyes, unchanged in 7 (12.5 %) eyes and worsened in 3 (5.35 %) eyes. Postoperative cystoid macular oedema (CME) was noted in 5 eyes (9.07 %). Significant posterior capsular opacification (PCO) was noted in 15 eyes (26.78 %) and anterior capsular phimosis was noted in 3 eyes (5.35 %). CONCLUSIONS Cataract surgery improves vision in most of the patients with retinitis pigmentosa. The incidence of PCR, zonular dehiscence, CME, PCO and anterior capsular phimosis is higher in these patients. KEYWORDS Retinitis Pigmentosa, Cataract, Capsular Phimosis

English

BACKGROUND Lens induced glaucoma is common in India. By early identification and removal of cataract, vision loss due to lens induced glaucoma can be prevented. Of the 12.5 million blind people in India, 50 - 80 % is due to cataract. In developing countries like India financial, cultural, and psychosocial constraints still exist to access excellent surgical services. This study was undertaken to determine factors affecting postoperative visual acuity in patients with lens induced glaucoma and to estimate the proportion of cases attaining good visual acuity. METHODS This prospective cohort study was conducted in 85 cases of lens induced glaucoma admitted in Regional Institute of Ophthalmology during a period of 1 year from May 2018 - April 2019. All patients underwent a complete ophthalmic examination preoperatively as well as postoperatively. All patients underwent cataract surgery and postoperatively patients were followed up regularly at 1 day, 1 week and 4 week and were evaluated. RESULTS Majority of patients were in the age group of 70 - 79 years (35.3 %). Females outnumbered males by 13 %. Most of the patients had a preoperative intraocular pressure between 21 – 30 mmHg (37.6 %). On analysis of the impact of duration of symptom on postoperative visual acuity, 70.4 % patients attained visual acuity > 6 / 24 when presented within 3 days. This was statistically significant with a P value of 0.011. When preoperative visual acuity was hand movements vision or better, 79.2 % patients attained visual acuity > 6 / 24 and it was significant with a P-value of < 0.01. CONCLUSIONS Delayed presentation, elderly age and sustained rise in preoperative intraocular pressure are the factors leading to poor visual prognosis. As majority of the patients were pseudophakic in the fellow eye, it is necessary to council all patients regarding timely surgery in the second eye at the time of discharge. KEYWORDS Cataract, Secondary Glaucoma, Visual Outcome