Tertiary Care Ophthalmic Center Research Articles

Resistant corneal ulcers in a tertiary care ophthalmic center in Egypt: 10 years epidemiological study.

To investigate the magnitude of problem caused by resistant corneal ulcers and its epidemiological characteristics. Patients with corneal lesions were selected and carefully examined and cases with resistant corneal ulcers were further investigated and data were recorded using a specific data sheet designed in hospital. Then, collected data from patients were statistically analyzed. Totally 1939 cases were included in the study, including 816 fungal cases (42.1%) and 1123 (57.9%) non-fungal cases. Age of the participants ranged from 18 to 73y. Fungal cases were more common in middle age (35-55y). Men were more affected (53.5%) of cases included in the study. Keratomycosis affected more unskilled personnel (75.1%), large families with small houses (higher crowding index 73.9%), rural (64.5%) residence. Patients with sanitary water sources (34.8%) and waste disposal (24.4%) were less affected. Keratomycosis is more frequent in unskilled personnel, rural locations, outdoor water sources and insanitary waste disposal systems. Corneal trauma and contact lens are common risk factors.

Management and surgical outcomes of pediatric retinal detachment associated with familial exudative vitreoretinopathy - Our experience at a tertiary care ophthalmic center in North India.

Purpose:To report the clinical profile, management, and long-term anatomical and visual acuity (VA) outcomes of pediatric macula-off rhegmatogenous retinal detachment (RRD) secondary to familial exudative vitreoretinopathy (FEVR).Methods: This was a prospective, interventional study of 14 eyes of 13 children aged ≤18 years with macula-off FEVR-RRD. The primary outcomes were anatomical reattachment and VA changes.Results: The mean (±SD) age of the study population was 12.14 (±3.23) years (range 6–18 years) with a male preponderance (M:F – 10:3). Of the 14 eyes, 10 underwent vitrectomy with silicone oil injection, while four underwent scleral buckling surgery. Significant improvement in VA was noted at a mean (±SD) follow-up duration of 3.32 (±1.34) years, with the mean (±SD) LogMAR VA improving from 1.42 (±0.48) (Snellen equivalent 2/60; range from 6/36 to counting finger close to face [CFCF]) to 0.6 (±0.31) (Snellen equivalent 6/24; range 6/9–6/36) (P < 0.00001) at the final visit. Successful anatomical reattachment was achieved in 13/14 eyes (92.85%). Screening of the other eye and family members was performed for FEVR and treated with laser photocoagulation when deemed necessary (7/10 contralateral eye; 12/20 siblings; 0/24 parents).Conclusion: To conclude, RRD may arise in eyes with FEVR at a young age and with a male predilection in Indian population. Timely surgical intervention by scleral buckling procedure or vitrectomy, based on the patient profile, can achieve excellent anatomical and VA outcomes. Careful clinical and angiographic screening of the other eye and family members is vital.

Spectrum of bacterial keratitis in North India: A retrospective analysis of six years at a tertiary care eye center.

Purpose:To analyze the pattern of bacterial pathogens causing infective keratitis and their resistance to the recommended antibiotics over six years.Methods:It was a retrospective study of 9,357 cases of bacterial keratitis from January 2015 to December 2020, at a tertiary care ophthalmic center. A total of 9,547 corneal specimens were obtained from the study subjects. Demographic details of the patients, pathogenic bacteria isolated, and their antimicrobial susceptibility were noted and analyzed.Results:Bacterial pathogens were identified in 23.52% of the specimens. The most common isolates were coagulase-negative Staphylococci (60.75%), followed by Pseudomonas aeruginosa (14.23%), Staphylococcus aureus (13.92%), gram negative bacilli of the family Enterobacterales (8.64%), Streptococcus spp. (1.72%), Acinetobacter spp. (0.13%), and other non-fermenting gram-negative bacilli (0.57%). In Staphylococci, 55–80% of isolates were resistant to erythromycin, and 40–70% to fluoroquinolones, while no resistance was observed against vancomycin. 40–60% of isolates of P. aeruginosa were resistant to cephalosporins, 40–55% to fluoroquinolones, and 30–60% to aminoglycosides. Also, 40–80% of isolates of Enterobacterales were resistant to cephalosporins, and 50–60% to fluoroquinolones. Most gram-negative isolates were susceptible to carbapenems and polymyxin B.Conclusion:To the best of our knowledge, our study is the largest compilation of microbiological profile of bacterial keratitis from North India. It highlights the current trend of the bacterial pathogens that cause infectious keratitis. Staphylococci and Pseudomonas were found to be the most common pathogens. Increased resistance was seen against some of the commonly prescribed empirical antibiotics. Such evidence is useful for restructuring the empirical prescription practices from time to time.

Clinicopathological study of parasitic lesions of the eye and ocular adnexa in a tertiary care ophthalmic center in South India.

Purpose:To study clinical and pathological features of parasitic lesions in the ocular adnexa in a tertiary care ophthalmic center in south India.Methods:43 cases of ocular parasitosis were analysed clinically and correlated with the pathological findings (gross morphology and histopathology) over a period of five years (2015–2020).Results:Among the 43 cases, the age group ranged from 9 months to 78 years (mean age of 41.6 years). Female patients were more common than male patients, with a percentage of 63% (27) and 37% (16) respectively. Cystic lesion in the lid or orbit was seen in 23 cases (53.4%); solid mass lesions were seen in 17 cases (39.5%); subconjunctival worms in three cases; and subretinal parasite in one. Gross examination and histopathologic study showed Dirofilaria in 23 cases (53.5%), followed by Cysticercus in six cases (14%) and Microfilariae in four cases (9.3%). Exact species identification was not possible in ten cases (23.25%). Correlation between the type of lesion and type of inflammatory cells with the specific parasite was done.Conclusion:Our study showed that important clinicopathological correlations can be made from the parasitic lesions in the eye and adnexa, which can aid in definitive diagnosis and prompt identification of the parasite for patient management.

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

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

Barriers to the acceptance of cataract surgery in a hospital based population: A descriptive study

Introduction: Cataract is a leading cause of blindness in low and middle income countries like India. Despite free cataract services available in most government institution as part of national health program to curb blindness, there are certain barriers among people which prevent them from utilizing health services. Aim: To determine the possible reasons for delay in acceptance of cataract surgery at tertiary care ophthalmic centre. Materials and Methods: This is a questionnaire based descriptive study done at outpatient setting at tertiary care ophthalmic centre in northern India. The patient who were aware of the presence of cataract with visual acuity of Result: The study enrolled 356 patients with mean age of 58.6+6.23years. There were 199 (55.89%) males and 157 (44.11%) females. Mostly they belong to low socioeconomic class. The important barriers which came out in the study were ability to manage daily routine work 244(68.54%), additional cost of surgery 221 (62.07%), fear for surgery 216 (60.67%), ability to see with other eye 202 (56.74%), busy with work 181 (50.84%), and cataract not mature 136 (38.2%). Conclusion: There is need for individual and community health counseling regarding the cataract surgery so as to allay the fear and anxiety among the patients. Keywords: Barrier, Cataract, Surgery.

Spectrum of mycotic keratitis in north India: Sixteen years study from a tertiary care ophthalmic centre

IntroductionTo analyse the fungal culture results of patients with fungal keratitis over sixteen years and look for variations in the trends over years and distribution across ages, gender and seasons. Materials and methodsClinical and demographic records and microbiology reports of 18,898 patients of fungal keratitis from 2001 to 2016 were analysed. ResultsOverall fungal culture positivity was 21.5%. 67.3% were males and 32.7% were females. Maximum numbers of samples (17.9%) were received from age group 41–50 years, and maximum fungal culture positivity was seen in age group 31–40 years (30.8%). Most common fungus was Aspergillus species (31.1%), followed by Fusarium species (24.5%), Alternaria (10.5%), Curvularia (10.2%), Helminthosporium (5.7%), Bipolaris (5.4%), Penicillium (4.5%), Candida (4.4%), Acremonium (1.2%), Rhizopus (1.0%), Paecilomyces (0.8%), Rhodotorula (0.5%) and Mucor (0.2%). Fungal culture positivity and relative frequency of fungi remained almost stable over the study duration, except Rhodotorula spp, which showed a rise 2014 onwards. Highest numbers of culture proven fungal keratitis cases were seen in monsoon season. ConclusionsTo the best of our knowledge, our study is the largest compilation of epidemiological and microbiological features of fungal keratitis, throwing light on important attributes relevant to management of mycotic keratitis patients.

The role of sex in intraoperative floppy-iris syndrome

To compare the incidence of intraoperative floppy-iris syndrome (IFIS) between male and female patients undergoing phacoemulsification cataract surgery, evaluate risk factors for its appearance in each sex, and assess any differences in the final visual outcomes. 2nd Department of Ophthalmology, Aristotle University of Thessaloniki, Greece. Comparative retrospective case-control study. Cataract patients with recorded IFIS of any severity occurring over 4years in a tertiary care ophthalmic center during phacoemulsification surgery were identified and enrolled in a multivariate analysis. The study comprised 3811 eyes of 3213 patients. Of the 1678 female patients (1937 eyes) undergoing cataract surgery, IFIS was observed in 25 eyes (1.29%), whereas the incidence of IFIS in male eyes during the same period was statistically significantly higher (97 [5.17%] of 1874 eyes) (P<.0001). No statistically significant difference in age was found between male patients (72.92years±6.5 [SD]) and female patients (72.04±7.1years) (P=.56). An intake of α1-receptor blockers was identified in 70 (72.2%) of 97 male IFIS cases and in none of the 25 female IFIS cases (P<.0001). The posterior capsule rupture rate was significantly higher in 7 (28%) of the 25 female IFIS cases compared with 9 (9.28%) of the 97 male IFIS cases (P=.02). The posterior capsule rupture incidence and final corrected distance visual acuity (with spectacles) were shown to correlate with the IFIS severity grade only in female patients (P<.001 and P=.02, respectively). Although the incidence of IFIS is rarer in female patients, it might significantly affect an increase in the intraoperative events rate and affect the final visual outcome correlating with the severity grade of its appearance. Predisposing risk factors differ between the sexes and surgeons should always be aware of the potentially catastrophic consequences of unforeseen IFIS.

Effect of Lens Fragmentation Patterns on Phacoemulsification Parameters and Postoperative Inflammation in Femtosecond Laser-Assisted Cataract Surgery

ABSTRACTPurpose: To evaluate intraoperative and postoperative outcomes with “chop” or “matrix” lens fragmentation patterns in femtosecond laser-assisted cataract surgery.Methods: Prospective comparative study of 66 eyes with grade III–IV nuclear sclerosis was conducted at an apex tertiary care ophthalmic center. Cases were randomly allocated to undergo femtosecond laser pretreatment using matrix pattern (group I; n = 33) or chop pattern (group II; n = 33) of lens fragmentation (LenSx laser platform), followed by phacoemulsification. The primary outcome measures were intraoperative phacoemulsification parameters and postoperative anterior chamber (AC) flare. Secondary outcome measures were intraoperative complications, postoperative central macular thickness, visual acuity, and endothelial cell counts. Follow-up was performed on postoperative day (POD) 1 and 30.Results: Phacoemulsification parameters including cumulative dissipated energy (p = 0.008), ultrasonic time (p = 0.001), aspiration time (p < 0.001), and total duration (p = 0.001) were significantly less in group I. The AC flare was 9.8 ± 4.6 in group I and 15.4 ± 6.0 in group II (p < 0.001) on POD 1, and the difference persisted at 1 month. A highly significant positive correlation was observed between the total duration of phacoemulsification and AC flare (p < 0.001). No case developed cystoid macular edema. The postoperative specular counts were significantly less in group II on POD 1 (p = 0.036) and POD 30 (p = 0.02). There was no difference in visual acuity between the two groups, and intraoperative complications were not observed in any case.Conclusion: A decrease in phacoemulsification time and energy is observed after femtosecond laser pretreatment with the matrix pattern of lens fragmentation as compared to the chop pattern. The endothelial cell loss and postoperative inflammation is significantly less with the matrix pattern, and the inflammation correlates with the duration of phacoemulsification.

Ocular morbidities in pediatric outpatient population at a tertiary care ophthalmic centre: a descriptive study

Background: Ocular problems in children are unique and different from adults, because of their inability to express their problems and potential to develop amblyopia. Screening at the level of schools cover school age going children only while congenital and infantile disorder can cause significant morbidity if remain untreated . Hence the present study was conducted to determine the pattern of Ocular morbidities in children uptil 15 years of age.Methods: It is a hospital based retrospective study. Outpatient department (OPD) records of all new patients aged 15 years and younger were reviewed. The age at presentation, sex and clinical diagnosis were recorded from OPD records. Data was recorded and analyzed.Results: Total of 480 children was enrolled with ocular problems. Majority belong to 11-15 years of age group. Conjunctival morbidity was most commonly encountered in 146 (30.41%) children followed by refractive error 82 (17.07%) and lid problems in 81 (16.87%) patients. Ocular trauma constitutes 54 (11.25%) children of the total.Conclusions: In view of high prevalence of Conjunctival and refractory errors in pediatrics population, there is a need of health counseling of parents regarding ocular hygiene, protection and regular refraction of children to identify the ocular morbidity at the earliest and prevent the long term complications.

Role of hyperhomocysteinemia in proliferative diabetic retinopathy: A case-control study.

Purpose:Hyperhomocysteinemia has been postulated as a potential risk factor for the development and progression of diabetic retinopathy. The aim of this study was to determine the association of hyperhomocysteinemia with proliferative diabetic retinopathy (PDR).Methods:This was a hospital-based, case–control study, conducted at a tertiary care ophthalmic center in South India. Thirty-nine patients with proliferative diabetic retinopathy were enrolled as cases, and 39 age- and gender-matched patients with no diabetic retinopathy (No DR) were enrolled as controls. Fasting serum homocysteine estimation, as well as baseline investigations, were done in all participants. Data regarding demographic profile and risk factors were documented. Data were analyzed using Chi-square test and independent t-test, as appropriate.Results:The prevalence of hyperhomocysteinemia was higher in PDR (59%) compared to “No DR” (48.7%); however, this difference was not statistically significant (P = 0.36). Similarly, the mean serum homocysteine level in cases was higher than in controls, but this was not statistically significant (17.98 + 6.26 μmol/L vs. 17.71 + 8.17 μmol/L; P = 0.87). Longer duration of diabetes, hypertension, anemia, and renal dysfunction were found to be significantly associated with PDR.Conclusion:The prevalence of hyperhomocysteinemia as well as the mean serum levels of homocysteine were found to be higher in the cases with PDR, compared to the controls with No DR, although the difference was not statistically significant. Longer duration of diabetes, hypertension, anemia, and renal dysfunction were significantly associated with PDR.

A Study on After effects of Holi: Color Injury, Ocular Trauma, and Assault at a Tertiary Care Ophthalmic Center in North India

A Study on After effects of Holi: Color Injury, Ocular Trauma, and Assault at a Tertiary Care Ophthalmic Center in North India

Learning Curve of Small Incision Lenticule Extraction: Challenges and Complications.

To describe the intraoperative complications observed during the initial learning curve of small incision lenticule extraction (SMILE) and their management. Prospective evaluation of 100 consecutive eyes (50 patients) undergoing SMILE was performed at an apex tertiary care ophthalmic center. Patients older than 18 years with a stable refractive error ranging from -1.0 to -10.0 D myopia and up to 3.0 D astigmatism were included. Any intraoperative complications and their management were noted. Postoperative examination including visual acuity was performed on day 1, 1 week, and 1 month. Intraoperative difficulties observed in the initial 100 eyes included suction loss (2%), black spots (11%), opaque bubble layer (19%), epithelial defect (2%), and difficult lenticule extraction (9%). Difficult lenticule dissection and extraction was the most surgically challenging step and resulted in posterior stromal damage, anterior cap tear (1%), side-cut tears (4%), partially retained lenticule (1%), and completely retained lenticule (2%). Its incidence decreased from 16% (8/50) in the initial 50 cases to 2% (1/50) in the next 50 cases. Two eyes with completely retained lenticule were re-treated with flap-based excimer laser ablation after 3 months. Optimal visual and anatomical outcomes could be achieved, and no sight-threatening complication was observed in any case. The learning curve of SMILE is surgically challenging. Lenticule dissection and extraction is the most difficult step and leads to a multitude of complications. Most complications that result in delayed visual recovery are observed in the initial 50 cases.

Assessing the impact of a program for late surgical intervention in early-blind children

ObjectiveMany blind children in the developing world are unable to obtain timely treatment due to lack of financial and medical resources. Can public health programs that identify and treat such children several years after the onset of blindness enhance their quality of life? The notion that visual development is subject to an early ‘critical period’ argues against this possibility. However, there are inadequate empirical data from humans on this issue. To address this need, we examined the quality of life of children living in India and who were treated for early-onset blindness (before one year of age), due to cataracts or corneal opacities. Study designSurvey study. MethodsAs part of an ongoing scientific effort named Project Prakash, we screened over 40,000 children in rural northern India to identify those suffering from early-onset blindness. They were provided eye surgeries in a tertiary care ophthalmic center in New Delhi. We subsequently surveyed 64 Prakash children, ranging in age from 5 to 22 years and obtained their responses on a multi-dimensional quality of life questionnaire. ResultsNearly all of the subjects indicated that their quality of life had improved after treatment. Children reported marked enhancement in their mobility, independence, and safety, and also in social integration. Surprisingly, we found no significant correlations between quality of life metrics and factors such as age at treatment, gender, time since treatment, and pre-surgery and post-surgery acuity. ConclusionsA key question for public health policy makers is whether a program of surgical intervention for older blind children is likely to be beneficial, or if the resources are better spent on rehabilitation via vocational training and assistive devices. The marked improvements in quality of life we find in our data strongly argue for the provision of surgical care regardless of a child's age.

Neovascular glaucoma: a retrospective review from a tertiary center in China

BackgroundThe purpose of this study is to report the prevalence, etiology, treatment and outcomes of neovascular glaucoma (NVG) in a tertiary care ophthalmic center in China.MethodsMedical records of patients diagnosed as NVG at the Wenzhou Medical University between 2003 and 2014 were reviewed. Success was defined as IOP between 6 and 21 mmHg without topical or systemic glaucoma medications with retention of presenting visual acuity (VA).ResultsNVG was diagnosed in 483 of 8306 (5.8 %) of all glaucoma patients. Etiology is reported for all 310 eyes of 284 patients managed in the department. Interventions depended on insurance as well as personal finances; outcomes are reported for the 149 eyes of 138 patients with complete data that met follow up requirements. Diabetic retinopathy (DR,39.7 %) was the major cause of NVG. Kaplan Meier survival analysis showed a success rate of 84.8 % at 1 year, 47.5 % at 3 years and 21.9 % at 5 years. Major interventions included glaucoma drainage device (GDD) in 103 eyes and trans-scleral cyclophotocoagulation (TSCPC) in 22 eyes. Complications were more common in the GDD group.ConclusionsNVG comprised 5.8 % of glaucoma patients seen in a tertiary Chinese hospital. DR was identified as the commonest cause and probably reflects the increasing prevalence of diabetes in China. Surgical interventions were partly determined by insurance status and personal finances. GDD was the commonest surgical intervention used and also had the most complications.

Combined ceftazidime and amikacin resistance among Gram-negative isolates in acute-onset postoperative endophthalmitis: prevalence, antimicrobial susceptibilities, and visual acuity outcome

BackgroundThe purpose of this study is to evaluate the prevalence, antimicrobial susceptibilities, and visual acuity outcome of acute-onset postoperative Gram-negative bacterial endophthalmitis cases resistant to both ceftazidime and amikacin seen between 2005 and 2010 at L. V. Prasad Eye Institute, a tertiary care ophthalmic Centre in South India. Medical records of all patients with Gram-negative bacterial endophthalmitis resistant to both amikacin and ceftazidime between 1 January 2005 and 31 December 2010 were reviewed in this non-comparative, consecutive, retrospective case series. Favorable outcome was defined as a best-corrected visual acuity of ≥20/200.ResultsSixty five (39.6%) of 164 culture-positive postoperative endophthalmitis were caused by Gram-negative organisms. Among these 65 isolates, 32 (49%; 95% confidence interval (CI) 37% to 61%) were resistant to ceftazidime, 17 (26%; 95% CI 15% to 37%) to amikacin, and 12 (18.5%; 95% CI 9% to 27%) to both ceftazidime and amikacin. Eight Pseudomonas isolates, three Enterobacter isolates, and one Haemophilus isolate were resistant to both ceftazidime and amikacin. The isolates were sensitive to fluoroquinolones (42%) and imipenem (50%). Presenting visual acuity was light perception in 10 (83.3%) cases. A final visual acuity ≥20/200 was achieved in 5/12 (41.7%) of these patients.ConclusionIn the current study, Pseudomonas was the most common Gram-negative bacteria resistant to both amikacin and ceftazidime. The emergence of multidrug-resistant bacteria causing endophthalmitis is a matter of concern in India. Alternative antibiotics like imipenem or fluoroquinolones may be considered for the management of these resistant organisms.

Sociodemographic Features and Risk Factor Profile of Keratomalacia in Early Infancy

To study the clinical spectrum and etiopathogenesis of keratomalacia in infants younger than 6 months. Case records of children younger than 6 months presenting with keratomalacia to cornea services of a tertiary care ophthalmic center in India from June 2007 through April 2010 were reviewed. The parameters evaluated were age, sex, anthropometry, nutritional status, socioeconomic status, antenatal history, maternal nutrition, systemic associations, immunization, and dietary history. Comprehensive ocular examination with emphasis on ocular adnexa, conjunctiva, cornea, and anterior chamber was performed. Overall, 33 infants (24 male and 9 female) with mean age of 2.8 ± 1.3 months (range = 1-6 months) were included. Eighty-eight percent (29 of 33) had associated protein energy malnutrition. A total of 31 of 33 children (94%) belonged to poor families, and nearly, three fourth of the children were not fully immunized as recommended for their age. Inadequate breastfeeding was the precipitating cause in 100%. Maternal nutritional status was poor in 82% of the cases. The reason for not breastfeeding the infant was inadequate milk production in 89.4% of mothers, 64.7% were ill informed, and 1 mother had adopted a child. Feeding practices included diluted cow's milk (1:1-1:5) in 21 infants (63.6%), toned dairy milk in 9 infants (27.3%), infant lactogen in 2 infants (6.1%), and skimmed milk powder in 1 infant (3.0%). Keratomalacia in early infancy can be attributed to inadequate breastfeeding. Important contributory risk factors include lower socioeconomic status, poor maternal nutrition, and lack of knowledge about recommended feeding guidelines.

Systemic associations of anterior uveitis in a tertiary care ophthalmic centre in south India

Anterior uveitis is the most common form of uveitis in most regions of the world. A recent study reported that 50% of patients with anterior uveitis have a related systemic illness. The most common cause of anterior uveitis to date remains idiopathic (45-50%), followed by HLA-B27-positive acute anterior uveitis. Ours is a retrospective study of the clinical records of 42 patients with anterior uveitis seen at a tertiary care eye hospital in south India. To diagnose the associated systemic disease, the investigations carried out were erythrocyte sedimentation rate, red and white blood cell counts, anti-nuclear antibody (ANA) analysis and HLA-B27 antigen determination. Based on clinical features, patients were also investigated for serum angiotensin-converting enzyme, high-resolution computed tomography scan, Mantoux test and QuantiFERON-TB Gold test. American College of Rheumatology criteria were followed to diagnose spondyloarthropathies and juvenile idiopathic arthritis (JIA). Of the 42 patients, 14 (33.33%) were HLA-B27-positive and the remaining 28 (66.66%) HLA-B27-negative. Overall, 32 of the 42 had no causative association, three patients were diagnosed with JIA, two with ankylosing spondylitis, two were associated with systemic tuberculosis, two with sarcoidosis and one with Vogt-Koyanagi-Harada syndrome. Our case series shows the incidence of various systemic diseases associated with anterior uveitis. Though the overall incidence of HLA-B27-positive acute anterior uveitis in our series (33%) is similar to that in the Western literature, only 14% of such patients were positive for a spondyloarthropathy. A few interesting cases like HLA-B27-positive, ANA-negative JIA presenting with chronic persisting anterior uveitis were also seen.

Comparison of endothelial cell loss after cataract surgery: Phacoemulsification versus manual small-incision cataract surgery: Six-week results of a randomized control trial

To compare endothelial cell loss in cataract surgery by phacoemulsification and by manual small-incision cataract surgery (SICS). Tertiary care ophthalmic center, India. A complete ophthalmologic examination and endothelial specular microscopy were performed preoperatively and 1 and 6 weeks postoperatively in patients having cataract surgery. The endothelial cell count (ECC) was calculated manually and automatically using an LSM 12000 specular microscope. Patients were randomly allocated to have SICS or phacoemulsification using a random number table. Phacoemulsification was performed using the stop-and-chop technique and SICS, by viscoexpression. The study evaluated 200 patients, 100 in each group. The mean preoperative ECC by the manual counting method was 2950.7 cells/mm(2) in the phacoemulsification group and 2852.5 cells/mm(2) in the SICS group and by the automated counting method, 3053.7 cells/mm(2) and 2975.3 cells/mm(2), respectively. The difference at 6 weeks was 543.4 cells/mm(2) and 505.9 cells/mm(2), respectively, by the manual method (P = .44) and 474.2 cells/mm(2) and 456.1 cells/mm(2), respectively, by the automated method (P = .98). The corrected distance visual acuity at 6 weeks was better than 6/18 in 98.5% of eyes in the phacoemulsification group and 97.3% of eyes in the SICS group. There were no clinically or statistically significant differences in ECC loss or visual acuity between phacoemulsification and SICS, although there was a small difference in the astigmatic shift.

Clinical Profile and Risk Factors for Keratoplasty and Development of Hydrops in North Indian Patients With Keratoconus

To review the profile of Indian patients with keratoconus and evaluate risk factors for keratoplasty and development of hydrops. In this prospective observational study, 120 consecutive patients with bilateral or unilateral keratoconus presenting to the cornea services of a large, tertiary care ophthalmic center were evaluated. A detailed history including information about the age at onset of symptoms, nature of ocular complaints, and so on was taken. Investigations included visual acuity, slit-lamp examination, keratometry, pachymetry, and videokeratography. There were 76 males and 44 females (mean age at presentation was 20.07 +/- 6.4 years). Five percent families revealed a positive family history. Earlier age at onset (P = 0.002) and eye rubbing (P = 0.02) were found significantly associated with increased risk for surgery. Eyes undergoing surgery had steeper corneas, lower best-corrected visual acuity, corneal scarring, and vernal keratoconjunctivitis were significant risk factors (P values: 0.001, 0.0001, and 0.04, respectively). Hydrops represents a significant independent risk factor for surgery (P = 0.0001). Patients with younger age at onset (P value 0.01), history of eye rubbing (P value 0.02), and atopy (P value 0.01) had higher risk for developing corneal hydrops. This knowledge of risk factors should enable clinicians and patients to make more informed decisions regarding the management of keratoconus.