Routine Ophthalmic Examination Research Articles

Risk factors and outcomes of patients with ocular involvement of candidemia.

BackgroundOcular involvement of candidemia can result in serious complications, including vision loss. This study investigated the risk factors for ocular involvement in patients with candidemia and the outcomes of treatment.MethodsEpisodes of candidemia in hospitalized adults who underwent ophthalmic examinations within 2 weeks of candidemia onset between January 2014 and May 2017 were retrospectively reviewed. Their demographic characteristics, antifungal treatments, and visual outcomes were evaluated.ResultsDuring the study period, 438 adults were diagnosed with candidemia, with 275 (62.8%) undergoing ophthalmic examinations within 2 weeks. Of these 275 patients, 59 (21.5%) had fundoscopic abnormalities suggestive of ocular involvement, including 51 with chorioretinitis and eight with Candida endophthalmitis. Eleven patients were symptomatic. Persistent candidemia (adjusted odd ratio [aOR], 2.55; 95% confidence interval [CI], 1.29–5.08; P = 0.01), neutropenia during the preceding 2 weeks (aOR, 2.92; 95% CI, 1.14–7.53; P = 0.03), and C. albicans infection (aOR, 2.15; 95% CI, 1.09–4.24; P = 0.03) were independently associated with ocular involvement. Among the 24 patients with neutropenia, 41.7% had ocular involvements at the initial examination. Ophthalmologic examination even before the neutrophil recovery was positive in one-third of neutropenic patients. Out of the 37 patients in whom ocular outcomes after 6 weeks were available, 35 patients showed favorable or stable fundoscopic findings. Two patients had decreased visual acuity despite the stable fundoscopic finding.ConclusionNeutropenia within two weeks of candidemia was a risk factor for ocular involvement. More than 80 percent of patients with ocular involvements were asymptomatic, emphasizing the importance of routine ophthalmic examinations. The median 6 weeks of systemic antifungal treatment resulted in favorable outcomes in 89.2% of patients.

Guide to ophthalmology in rabbits

Background: Ophthalmic disease is a common reason for rabbits to be presented to the general veterinary practitioner.Aim of the article: This article provides a guide of normal eye anatomy, routine...

ROUTINE FUNDUS SCREENING OF FAMILIES OF CHILDREN WITH RETINOBLASTOMA: A Prospective Study of 131 Consecutive Families.

To discuss the importance of routine ophthalmic examination of parents and siblings of retinoblastoma (RB) patients. Prospective nonrandomized observational/interventional case series of consecutive families of 131 RB patients. Routine ophthalmic examination of families (parents and siblings) of 131 consecutive newly diagnosed RB patients, including 262 parents and 23 siblings, revealed spontaneously regressed RB in at least 1 parent of 10 (8%) patients and active RB in at least 1 sibling of 3 (2%) patients. Of the 10 parents with spontaneously regressed RB, the lesions were unilateral (n = 7) or bilateral (n = 3). The regression patterns (n = 13) were comparable with postirradiation regression patterns Type 1 (n = 3), Type 2 (n = 2), Type 3 (n = 2), and Type 4 (n = 3), and spontaneous phthisis bulbi (n = 3). Fundus screening of siblings revealed active RB in at least 1 sibling of 3 (2%) patients. Of these 3 siblings, 2 had unilateral and 1 had bilateral disease. The mean age at detection of RB was 15 months (median, 6 months; range, 2-36 months). The disease was unilateral in 2 and bilateral in 1 patient. Based on International Classification of Intraocular Retinoblastoma, the tumors (n = 4) were classified as Group A (n = 2) and Group B (n = 2). Routine fundus screening of siblings allows for early detection of RB in otherwise asymptomatic children. Detection of spontaneously regressed RB in parents may act as a surrogate marker for germline RB1 mutation and is helpful in genetic counseling.

Ocular manifestations in patients with cerebrovascular accidents in India: a cross-sectional observational study.

To assess ophthalmic manifestations in patients with stroke and emphasize the importance of a formal screening for visual problems in stroke patients in hospital and rehabilitation settings. This was a cross-sectional study of 50 newly diagnosed patients with stroke with Glasgow Coma Scale (GCS) > 8 examined within 3days of onset. A detailed ophthalmic examination was performed for each patient including visual acuity, fields, ocular motility, slit lamp and fundus examination, line bisection tests and cranial nerve assessment. Radiological investigations were reviewed and anatomically correlated. A total of 50 patients (41 male and nine female) were included in the study. Mean age of the stroke cohort was 51.36years. Twenty-nine patients (58%) had a subcortical stroke, while 42% (n = 21) patients had a cortical stroke. Nineteen patients (38%) demonstrated visual field defects. Twenty-one patients (42%) had a gaze palsy. Vertical gaze palsy (n = 8) was more common in cortical stroke, while internuclear ophthalmoplegia (n = 2), horizontal gaze palsies (n = 4) and Parinaud's syndrome (n = 1) were seen more commonly in those with subcortical stroke. Twenty-four percent (n = 12) patients had nystagmus. Twelve percent (n = 6) patients had diplopia. Thirty-eight percent (n = 19) patients had convergence insufficiency. Sixteen patients (32%) complained of visual impairment. Retinal abnormalities were seen in 58% (n = 29) of patients. Ophthalmic manifestations were seen in 90% of stroke survivors. Their presence in majority of the patients in our cohort suggests that earliest routine ophthalmic examination should be mandatory in all patients with acute stroke.

The incidence of endophthalmitis or macular involvement and the necessity of a routine ophthalmic examination in patients with candidemia.

BackgroundThe incidence of ocular candidiasis (OC) in patients with candidemia varies across different reports, and the issue of whether routine ophthalmoscopy improves outcomes has been raised. This study investigated the incidence of OC and evaluate whether the extent of OC impacts the clinical outcomes.MethodsThis retrospective study included non-neutropenic patients with candidemia who underwent treatment at one of 15 medical centers between 2010 and 2016. Chorioretinitis without other possible causes for the ocular lesions and endophthalmitis was classified as a probable OC. If signs of chorioretinitis were observed in patients with a systemic disease that causes similar ocular lesions, they were classified as a possible OC.ResultsIn total, 781 of 1089 patients with candidemia underwent an ophthalmic examination. The prevalence of OC was 19.5%. The time from the collection of a positive blood culture to the initial ophthalmic examination was 5.0 ± 3.9 days in patients with OC. The leading isolate was Candida albicans (77.9%). Possible OC was associated with unsuccessful treatments (resolution of ocular findings) (odds ratio: 0.354, 95% confidence interval: 0.141–0.887), indicating an overdiagnosis in patients with a possible OC. If these patients were excluded, the incidence fell to 12.8%. Endophthalmitis and/or macular involvement, both of which require aggressive therapy, were detected in 43.1% of patients; a significantly higher incidence of visual symptoms was observed in these patients.ConclusionEven when early routine ophthalmic examinations were performed, a high incidence of advanced ocular lesions was observed. These results suggest that routine ophthalmic examinations are still warranted in patients with candidemia.

The Assessment of Blood Flow Velocities in Retinal Collaterals in Diabetic Retinopathy.

Diabetic retinopathy (DR) is a microvascular disease characterized by capillary dropout and resultant retinal ischemia which then leads to retinal vascular remodeling. Our goal was to assess blood flow velocities in retinal collateral vessels in healthy and diabetic subjects with various stages of DR. In our pilot study, we enrolled five eyes of five healthy subjects (H), five eyes of four subjects with diabetes and no retinopathy (DM), three eyes of three subjects with mild non-proliferative diabetic retinopathy (MDR), and five eyes of four subjects with proliferative diabetic retinopathy (PDR). Following routine ophthalmic examination, all subjects were imaged using a retinal function imager (RFI; Optical Imaging Inc., Rehovot, Israel). The built-in software of the RFI was used to identify and segment retinal collaterals with measurement of the blood flow velocities (BFV). One-way ANOVA was performed for BFV, followed by Newman-Keuls post hoc test. The level of significance was set at 5%. The total number of collateral segments involved in the study was 30, 31, 21, and 39 in the H, DM, MDR, and PDR groups, respectively. The BFVs in the collaterals were significantly lower in PDR (H: 1.86 ± 0.67, DM: 1.91 ± 0.71, MDR: 1.71 ± 0.53, PDR: 1.37 ± 0.58 mm/s). The PDR group showed a statistically significant difference in the comparisons to all groups (p = 0.012, p = 0.008, and p = 0.043 for the H, DM, and MDR groups, respectively), while no other comparisons between the groups were significant. We observed decreased BFV in retinal collaterals in PDR that may be due to the extensive capillary dropout and retinal ischemia. Further studies are needed for the noninvasive functional assessment of retinal microvascular changes in DR to better understand the underlying pathophysiology.

The correlation of routine hematological indices with pterygium.

Purpose:Increased systemic/local inflammation and oxidative stress play a key role in the pathophysiology of pterygium, but there is limited information regarding routine hematological indices’ levels in patients with pterygium. In this study, we aimed to evaluate the levels of complete blood count parameters in patients with pterygium.Material and Method:In all, 61 patients with pterygium (pterygium group; mean age = 51.4 ± 13.8 years) and 55 healthy individuals (control group; mean age = 50.2 ± 13.1 years) were included in the study. Participants were given routine ophthalmic examinations; complete blood count parameters were assayed.Results:Compared to the control group, red cell distribution width level was significantly higher in patients with pterygium (p = 0.009), but the difference between the groups in terms of the other complete blood count parameters was not statistically significant. However, high-density lipoprotein cholesterol level was significantly lower in the pterygium group than control group (p = 0.015). In the pterygium group, low-density lipoprotein cholesterol levels were lower, but this difference was not statistically significant (p = 0.079).Conclusion:Red cell distribution width levels were significantly increased in patients with pterygium. Our data support the idea that inflammation cytokines and oxidative stress may play an important role in the pathogenesis of this disorder.

MRI Results of Patients with Acute Isolyted Cranial Nerve Palsies.

To investigate the magnetic resonance imaging (MRI) results of patients complaining from diplopia with ocular nerve palsy. A routine ophthalmic examination was performed, a neurological consultation was requested, and cranial MRI was performed for all patients. The image results were sorted into four groups: ischemic lesions, demyelinating disease lesions, tumors, and no lesions. White matter gliosis and cerebral infarcts were included in the ischemic lesion group. The medical histories of the patients were acquired from medical records. The chi-squared test was used to analyze the relationship between age and cranial MRI images and to analyze the relationship between the image and paresis type. The statistical significance threshold was set at p < 0.05, unless otherwise stated. Ischemic MRI images were the most common image type seen in our study. Third nerve paresis was significantly correlated with ischemic cerebral lesions observed by MRI (p=0.009). Furthermore, lesions were significantly correlated with patients aged above 50 years (p=0.004). There were no significant correlations between fourth or sixth nerve paresis and cranial ischemic images (p=0.680 and p=0.678, respectively). There were two instances of cerebral artery aneurysm, three instances of cerebral infarct, and one instance of intracranial mass, all in patients aged over 50 years. Although our patients had minimal or nonexistent neurological symptoms, some had serious cranial pathologies. These pathologies were commonly seen in patients aged over 50 years. We recommend performing MRI on all patients with binocular diplopia.

Evaluation of strabismus surgery effects on anterior segment measurements using pentacam

To evaluate and compare preoperative and postoperative anterior segment parameters in patients who underwent unilateral or bilateral medial rectus muscle surgery.Fifty-one eyes of 30 patients were enrolled in the retrospectively designed study. Anterior segment parameters were measured via Pentacam prior to surgery and after the surgery. Besides anterior segment evaluation detailed routine ophthalmic examination was also performed for each participant. All patients had successful surgery correction. No complication was observed during follow-up period. No changes were noted in visual acuity and intraocular pressure. Statistical changes were observed in corneal astigmatism (P=0.009/0.005), corneal volume (P=0.012), and anterior chamber volume (P=0.024). Strabismus surgery might cause anterior segment parametric changes in short-term follow up, which might be reversible through the compensation process. Scheimpflug imaging is an anterior segment imaging system and these changes can be measured by Pentacam.

Longitudinal Change in Peripheral Anterior Chamber Depth of Eyes with Angle Closure after Laser Iridotomy.

Purpose To investigate longitudinal changes in peripheral anterior chamber depth (pACD) of eyes with angle closure after laser iridotomy (LI) and factors related to prognosis. Design Retrospective cohort study. Methods Eyes with primary angle closure (PAC), acute PAC, or chronic angle closure glaucoma (CACG) that underwent LI (LI group) and eyes that underwent phacoemulsification and intraocular lens insertion (PEA + IOL group) were employed. Longitudinal changes in pACD were evaluated with a scanning peripheral anterior chamber depth analyzer (SPAC) in addition to routine ophthalmic examination. Results Forty-eight eyes of LI groups (69.8 ± 8.5 years) and 21 eyes of PEA + IOL group (65.6 ± 12.7 years) were enrolled. Mean follow-up times of LI group and PEA + IOL group were 43.4 ± 12.7 months and 36.5 ± 2.5 months, respectively. LI significantly increased pACD as indicated by the SPAC grade change from 3.8 ± 1.1 to 4.6 ± 1.2 (p < 0.001). However, SPAC grade was gradually reduced and reached the pre-LI level by the third year of follow up. PEA + IOL also significantly increased SPAC grade from 6.7 ± 1.6 to 8.7 ± 2.0 (p < 0.001), but no time-related change was observed. Twenty-three cases of LI group presented with deterioration of glaucoma control. The type of angle closure, plateau iris configuration, peripheral anterior synechia, and glaucomatous visual field defects were significantly associated with prognosis of glaucoma after LI. Conclusions Peripheral ACD is temporarily deepened by LI, but returns to the pre-LI level in approximately three years. The type of angle closure and some factors may be related to glaucoma prognosis after LI.

INTRA OCULAR PRESSURE

Introduction: The ideal optical properties of the eye requires support of state of the eye-ball which is normally regulated by the intraocular pressure (IOP). There is variation in the measurements of IOP with Goldmann applanation tonometry if the thickness of the central cornea is not uniform, the IOP is high when cornea is thicker and vice versa. Therefore, the central corneal thickness (CCT) is thought to affect the IOP readings, however, as shown, the evidence available remains controversial. The aim of the study was to determine correlation between CCT and IOP. Objectives: To determine the correlation between the Central Corneal Thickness (CCT) and Intra Ocular Pressure (IOP). Study Design: A cross-sectional study. Placeand Duration: Department of Ophthalmology, Aga Khan University Hospital, Karachi from July to December, 2014. Methodology: During the study period of six months total 431 participants were purposively sampled according to the set criteria. Variables included were age, gender, CCT, and IOP. Correlation between IOP and CCT was assessed by using Pearson correlation test, P value of &lt; 0.05 was considered significant. Results: Out of 431 participants, 239 (55.5%) males and 192 (44.5%) females. The mean age was 34.9 ranging from 20 to 50 years. The mean central corneal thickness of right eye was 529 μm with SD ± 39.5 and range of 473-591 μm. The mean intraocular pressure of right eye was 14.7 μm, SD ± 3.1 with a range of 9-21 mmHg. The left eye mean central corneal thickness was 533, SD ± 29.6 with range of 481-589 μm. The mean intraocular pressure of left eye was 15.6, SD ± 3.1 with a range of 10-21 mmHg. Strong positive correlation was found (P-value &lt; 0.001) between central corneal thickness andintra ocular pressure for both eyes. Conclusion: There is positive correlation between CCT and IOP. Therefore, along with the routine ophthalmic examination for intraocular pressure measurements pachymetry should also be considered for accurate interpretation of the results.

Retinal astrocytic hamartoma in tuberous sclerosis complex in an elderly person: a case report

BackgroundSpectral domain optical coherence tomography (SD-OCT) is proposed as a way of predicting the development and likelihood of retinal astrocytic hamartoma (RAH) in tuberous sclerosis complex (TSC) in elderly patients.Case presentationThis report describes a case of RAH in TSC in an elderly patient. The patient was a 62-year-old woman and experienced pain in the lower left abdomen for two years. Bilateral renal angiomyolipoma, multiple hepatic angiomyolipoma and multiple pulmonary nodules were demonstrated using computed tomography (CT). Brain CT showed bilateral multiple calcification near by the cella lateralis. A clinical diagnosis of TSC was made. Visual acuity (decimal) in the right and left eye was determined to be 0.6 and 0.8, respectively. SD-OCT revealed a retinal tumour in the inner layer of the retina in the right fundus and a pre-retinal membrane which may have evolved later.ConclusionsA routine ophthalmic examination is advised for patients suspected of having TSC to prevent this condition from being overlooked. In addition, an OCT examination can be used to predict the development and likelihood of RAH.

Neuropathic-Like Ocular Pain and Nonocular Comorbidities Correlate With Dry Eye Symptoms.

To evaluate the association between dry eye (DE) symptoms and neuropathic-like ocular pain (NOP) features, chronic pain conditions, depression, and anxiety in patients presenting for routine ophthalmic examinations. Two hundred thirty-three consecutive patients ≥18 years of age presenting to a comprehensive eye clinic between January and August 2016 were included in this study. Information on demographics, chronic pain conditions, medication use, DE symptoms (dry eye questionnaire, DEQ5), NOP complaints (burning; wind, light, and temperature sensitivity), depression, and anxiety indices (patient health questionnaire 9, PHQ-9 and symptom checklist 90-revised, SCL-90-R) were collected for each individual. Pearson correlation was used to evaluate strengths of association. Logistic regression analysis examined risk factors for any (DEQ5≥6) and severe (DEQ5≥12) DE symptoms. The mean age of the population was 46.3 years (±13.0); 67.8% (n=158) were female. Per the DEQ5, 40.3% (n=94) had mild or greater DE symptoms and 12% (n=24) had severe symptoms. Severity of DE symptoms correlated with NOP complaints: burning (Pearson r=0.37, P<0.001); sensitivity to wind (r=0.37, P<0.001), sensitivity to light (r=0.34, P<0.001), and sensitivity to temperature (r=0.30, P<0.001). Sex, race, and ethnicity were not significant risk factors for DE symptoms. Risk factors for mild or greater DE symptoms included a greater number of chronic nonocular pain conditions (odds ratio [OR]=1.38, P<0.001), arthritic pain (OR=6.34, P<0.001), back pain (OR=2.47, P=0.004), headaches (OR=2.14, P=0.02), depression (OR=1.17, P<0.001), and anxiety (OR=1.13, P=0.02). Dry eye severity positively associated with NOP complaints, comorbid chronic pain conditions, and symptoms of depression and anxiety.

How Cataract Extraction Helps in Improving Aqueous Outflow

Purpose: To assess changes in Anterior Chamber angle depth and width induced by phacoemulsification and intraocular lens implantation in normal population using anterior segment optical coherence tomography (AS-OCT). Study Design: Quasi experimental study. Study Place and Duration: Eye Department of DHQ-Teaching Hospital Gujranwala, from January, 2018 to June 2018. Material and Methods: All patients of both genders with senile cataract, having uneventful cataract surgery were randomly included in this study. After routine ophthalmic examination, pre-operative intraocular pressure (IOP) using Goldmann applanation tonometer along with anterior segment OCT for measuring angle parameters was done in the temporal quadrant of respected eye at the time of admission. Post-operatively the same procedure was repeated at the time of discharge. A P-value ? 0.05 was considered to be statistically significant. Results: Out of 82 patients, 44 (53.7%) were male and 38 (46.3%) were female. Mean Axial length recorded was 23 ± 1.2 mm with mean IOL power of 22.0 ± 3.2D. Mean Pre-op Trabecular Iris Angle (TIA) was 41.5 ± 8.7° that widened to 48.6 ± 8.3° post-operatively while Mean pre-op Angle opening distance (AOD-500 µm) recorded was 447.5 ± 149.8 µm that increased to 609.5 ± 169.8 µm post-operatively. Similarly, Mean pre-op IOP recorded was 16.8 ± 2.8 mm Hg that reduced to 15.1 ± 2.9 mm Hg post-operatively. P-value of all three parameters turned out significant (< 0.05). Conclusions: Cataract extraction and IOL implantation causes an increase in anterior chamber angle depth and width along with a reduction in intra-ocular pressure which is a direct evidence of improved aqueous outflow. Key Words: Anterior chamber, Trabecular Meshwork, Angle, OIptical coherence tomography.

The impact of Nd: YAG laser posterior capsulotomy by the use of "the circular pattern with vitreous strand cut" technique on anterior chamber parameters.

The purpose of this study is to identify the effect of Nd: YAG laser posterior capsulotomy using an anterior chamber morphology. This study included 42 eyes of 33 pseudophakic patients with visually significant PCO after uncomplicated cataract surgery. Exclusion criteria were complications related to cataract surgery, corneal pathology, pseudoexfoliation, glaucoma, uveitis, previous ocular surgery or trauma, and posterior segment pathology. All patients underwent routine ophthalmic examinations. The AS-OCT measurements were performed using NIDEK RS-3000 Lite retinal scan with anterior segment module. The anterior chamber depth (ACD) was measured by Monitor A&B Scan biometer. Nd: YAG laser posterior capsulotomy was done in a single session by the circular pattern with rupture of vitreous strands. Anterior chamber depth (ACD), central corneal thickness (CCT), and intraocular pressure (IOP) were measured. Anterior chamber angle (ACA), angle opening distances (AOD) at 500mm (AOD500), AOD at 750mm (AOD750), trabecular-iris space area at 500 (TISA 500), and TISA at 750 (TISA 750) were measured both nasally and temporally. The mean patient age was 55.56 ± 6.33years. There were non-significant changes in IOP, ACD, and CCT with P values 0.395, 0.153, and 0.541, respectively. ACA, AOD500, AOD750, TISA 500, and TISA 750 highly significantly increased with P value < 0.001 for all. Nd: YAG laser posterior capsulotomy with the circular pattern with vitreous strand cut technique is a safe technique for laser posterior capsulotomy.

Reduction in Ocular Hypotensive Eyedrops by Ab Interno Trabeculotomy Improves Not Only Ocular Surface Condition But Also Quality of Vision.

Purpose To investigate the effect of ab interno trabeculotomy using the Trabectome surgical system on tear film stability and functional visual acuity (FVA). Patients and Methods Adult glaucoma patients who underwent Trabectome surgery alone or Trabectome surgery combined with phacoemulsification with intraocular lens insertion were included in this study. Corneal epithelial defects, tear film breakup time (TBUT), tear meniscus height, tear film spreading grade, tear interferometry grade, and FVA were assessed before and after surgery in addition to routine ophthalmic examinations. Changes in ocular surface conditions and visual acuity as a result of the Trabectome surgery were investigated. Results Thirty eyes of 22 patients with a mean age of 72.2 ± 7.9 years, including 8 males and 14 females, were enrolled. The Trabectome surgery significantly reduced the intraocular pressure (IOP) from 20.3 ± 5.2 to 15.0 ± 3.3 mmHg (P < 0.001) and the number of different types of ocular hypotensive eyedrops used from 3.2 ± 0.7 to 1.1 ± 0.7 types (P < 0.001). The surgery significantly improved corneal epithelial defects, the tear spreading grade, the tear interferometry grade, and FVA. The surgery also improved the visual maintenance ratio among all enrolled patients, including those who underwent Trabectome surgery only. Conclusion Trabectome surgery may be beneficial not only for IOP reduction but also for improving ocular surface conditions and FVA.

Diagnostic occlusion test for acquired esotropia

ObjectiveTo assess the effect of the 45-minute diagnostic occlusion test (DOT) on the measured esodeviation in patients with acquired esotropia. MethodsAfter the routine ophthalmic examination, 67 patients with acquired esotropia were randomly assigned to either the patch group (37 subjects) or the control group (30 subjects). For both groups the mean distance and near deviations before and after 45 minutes were compared. ResultsThe mean pre- and post-DOT measurement at distant target for the patch group was an esodeviation of 6.7 ± 7.5 prism diopters (PD) and 13.2 ± 11.7 PD, respectively. The 45-minute DOT induced an average increase of the esotropia of 6.4 ± 5.9 PD in the patch group (p = 0.0001). For the control group, the first and second mean measurement were similar, 9.2 ± 7.6 PD and 9.1 ± 6.5 PD, respectively (p = 0.103). The mean pre- and post-DOT esodeviation at near distance for the patch group were 10.1 ± 10.1 PD and 18.7 ± 13.7 PD (p = 0.001). Following the DOT, >5 PD change was noted in 26 (70.1%) from a near distance target (p = 0.001). For the control group, the mean near first and second measurements were 13.9 PD and 15.0 PD, respectively. ConclusionPerforming DOT in acquired esodeviations may help to reveal the full deviation and ultimately decrease the risk of surgical undercorrection by eliminating tonic fusional divergence. The DOT can be applied clinically for acquired esotopia to accurately measure the angle of deviation.

Prevalence and clinical characteristics of dry eye disease in community-based type 2 diabetic patients: the Beixinjing eye study

BackgroundThis study was performed to evaluate the prevalence and clinical characteristics of dry eye disease (DED) in community-based type 2 diabetic patients and to identify the associated factors related with DED.MethodsA total of 1360 type 2 diabetic patients in the Beixinjing community were randomly selected. All participants were given a questionnaire that assessed basic information and subjective symptoms.DED was diagnosed using the revised Japanese DED diagnostic criteria. All subjects underwent a routine ophthalmic examination, corneal sensitivity test, tear film break-up time(BUT) test, Schirmer I test, fluorescein and lissamine green staining(FL) and fundus photography. Diabetic retinopathy (DR) was graded according to the International severity scale of diabetic retinopathy and diabetic macular edema.ResultsOf the 1360 subjects, 238 (17.5%) were diagnosed with DED. There was a significant association between the presence of DED and higher blood glucose (P < 0.001, OR1.240) as well as higher levels of glycosylated hemoglobin HbA1c (P < 0.001, OR1.108). Corneal sensitivity was negatively correlated with the prevalence of DED (P = 0.02, OR0.973).ConclusionsThe prevalence of DED in this community-based study was 17.5%, which was lower than that observed in hospital-based studies. Diabetic patients with poor metabolic control were more likely to present with DED. A dry eye examination should be added to the routine screening of diabetes.

EYE HEMODYNAMICS IN YOUNG AND MIDDLE-AGED PATIENTS WITH RETINAL VEIN OCCLUSION

Actuality. Regional hemodynamics сcontravention is one of the key factors in the development of retinal vein occlusion. The available methods estimating the ocular component of oculoorbital blood flow include opthalmoplethysmography and opthalmorheography. The value of opthalmosphygmography is in question due to the dependence of the results obtained from the orbital component of eye hemodynamics. Assessment of the vascular bed in the fluorescein angiography also gives an indirect assessment of ocular blood flow. The objective is to estimate hemodynamics indices and informativity of used methods in young and middle-aged patients with retinal vein occlusion. Materials and methods. The study included 30 patients with retinal vein occlusion. In all patients, routine ophthalmic examination was performed and ocular blood flow was additionally estimated using ophthalmoplethysmography, ophthalmorheography, ophthalmosphygmography, and fluorescein angiography. Results. Insignificant decrease of ocular blood flow indices was found on the eye with RVO in young and middle-aged patients with retinal vein occlusion. High values of factors weight of opthalmoplethysmography and opthalmorheography was found, which were significantly exceed the contribution of ocular pulse amplitude of pressure. Conclusions. There was a tendency to decrease all hemodynamic parameters on the eye with RVO in young and middle-aged patients with retinal vein occlusion. The received high values of factors weights reflect the comparable informativity of opthalmoplethysmography and opthalmorheography. The researchers are more informative, which results were less affected by the blood flow in the orbital tissues.

English

INTRODUCTION: Binocular single vision (BSV) is one of the hallmarks of the human race that has bestowed on it the supremacy in the hierarchy of the animal kingdom. BSV is accomplished by a perfect sensorimotor coordination of the two eyes both at rest and during movement. The two dimensional images of an object formed at the fovea of each eye, transmitted to the respective visual cortex are processed and perceived as three dimensional percept. This requires constant and controlled activity of the appropriate muscles to maintain fixation on the object. It also requires the accomodational mechanism to maintain clear view even as the object moves closer or farther. HISTORICAL REVIEW: Hippocrates, the father of medicine differentiated between concomitant and paralytic squint and stressed the hereditary aspects. 1743-George.L.deBuffon recommended occlusion of the normal eye to force the squinting eye to use. 1900 Worth and Black invented the amblyoscope 1914 Ettles introduced synoptophore 1978 Campbell introduced CAM treatment for stimulating the macula of the eye with eccentric fixation. AIM OF THE STUDY: To study the efficiency of transposition of the horizontal and the oblique muscle surgeries in correction A-V pattern. MATERIALS AND METHODS: In this prospective study, 25 cases A-V patterns that underwent surgery at the regional institute of ophthalmology, Chennai were studied. INCLUSION CRITERIA: 1. Primary non paralytic heterotropia with A&V pattern. 2. 2-25yrs age group with A&V pattern. EXCLUSION CRITERIA: 1. Paralytic exotropia 2. Severe Amblyopic cases 3. Restrictive syndrome 4. Cases that had undergone previous surgery 5. Cases associated with congenital anomalies. A routine ophthalmic examination and a thorough orthoptic evaluation were carried out in all the patients. The deviation at different distances and different gazes was quantitated. using the prism bar cover test. The status of binocular single vision was assessed using the synoptophore, Worth four-dot. The type of fixation as to whether it was central or eccentric was assessed. Refraction was done using atropine 1% or cyclopentolate 0.5% drops. Pre-operative orthoptic treatment was given when considered necessary. SUMMARY: Analysis of the efficiency of transposition surgery of horizontal and oblique muscle in correction A-V pattern yielded the following inferences. A-V pattern with no oblique overaction Vertical upshifting and downshifting of medial and lateral recti along with recession – resection had a favourable outcome in A-V patterns with no oblique overaction. A-V patterns with minimal oblique overaction Vertical upshifting and downshifting of horizontal recti along with recession – resection was also effective in patients with A-V patterns with minimal obliqure over action. For whom weakening of oblique muscle was not needed. A-V pattrns with severe oblique overaction Weakening of oblique muscle in A-V Patterns with severe oblique overaction along with recession – resection surgery had a favourable outcome. Improvement in visual acuity: Transposition of horizontal oblique muscle surgeries yielded an improvement in visual acuity postoperatively in both A-V patterns with and without oblique over action. Improvement of amblyopia: Transposition of horizontal and oblique muscle surgeries also yielded an improvement of vision in amblyopic cases in both A-V patterns with and without oblique over action. Gain in binocular single vision: Transposition of horizontal and oblique muscle surgeries showed gain in BSV in patients with A-V patterns with and without oblique over action. CONCLUSIONS: 1. Vertical transposition of horizontal muscle along with recession and resection was effective in A-V patterns in no oblique muscle over action. 2. Vertical transposition of horizontal muscle along with recession-resection was also effective in A-V patterns with minimal oblique muscle over action. 3. Oblique muscle weakening was not necessary in A-V patterns with minimal oblique muscle overaction. 4. Weakening of oblique muscle was effective in patients with A-V patterns with severe oblique muscle overaction along with recession – resection surgery. 5. Patients who underwent transposition of horizontal and oblique muscle surgeries for AV patterns had an improvement in visual acuity. 6. Patients who underwent transposition of horizontal and oblique muscle surgery for AV patterns also had an improvement in amblyopia. 7. Patients who underwent transposition of horizontal and oblique muscle surgery for AV patterns also had a gain in BSV.