Tertiary Eye Care Hospital Research Articles

Impact of a structured training program to enhance skills in phacoemulsification surgery.

Purpose:The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases.Methods:This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 (n = 33), who underwent training before the introduction of the structured program, and Group 2 (n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done.Results:Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1.Conclusion:A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.

Donor corneal tissue utilization and factors responsible for rejection in tertiary eye care hospital in North India

Purpose: To evaluate the donated cornea and find out the pattern & factors influencing the utilization of corneal tissue. Study design: Retrospective, non-comparative observational study. Material and Methods: Data of 1273 donor eyes collected from all over the Haryana under Hospital Cornea Retrieval Programme (HRCP) and those collected from voluntary donors at their residence from April 2011 to March 2020 were analyzed including the cause of death, gender, age, place of tissue procurement, Death to Enucleation time, grades of tissue and various utilization parameters. Results: A total number of 1273 of eyes were procured out of which 774 (60.8%) were fit for corneal transplantation while 499 (39.19%) were not fit. Conclusion: Utility of the donor cornea depends upon various factors like age, death enucleation time, cause of death, maintenance of cold chain and technique of tissue procurement.

Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile.

Purpose:The aim of this study was to describe epidemiological and clinical characteristics of pediatric ocular motor cranial nerve palsy.Methods:This was a retrospective record-based study, carried out at a tertiary eye care hospital in India, between January 2011 and January 2015 and included patients up to 16 years of age at the time of presentation, diagnosed with third, fourth, sixth nerve palsy or a combination of these with other cranial nerve palsy. Data analyzed included demographic details, etiologies, presence or absence of amblyopia, relevant investigations, and management.Results:A total of 90 cases were included in the study. Eighty patients (88.88%) presented with isolated nerve palsy. Forty-three patients (47.77%) had congenital nerve palsy. The most common nerve involved was third (n = 35, 38.88%) followed by sixth (n = 23, 25.55%) and fourth nerve (n = 22, 24.44%). Most common cause of third and fourth cranial nerve palsy was congenital (n = 18, 51.42% and n = 17, 77.30%, respectively), while it was trauma for the sixth nerve (n = 7, 30.40%). Amblyopia was most frequently associated with third cranial nerve palsy (n = 27, 77.14%). The radio-imaging yield was maximum (n = 7, 70%) for combined cranial nerve palsy. Overall 44 (48.88%) patients were managed conservatively, while 46 (51.11%) patients needed squint with or without ptosis surgery.Conclusion:The most common ocular motor cranial nerve involved in the pediatric population was the third cranial nerve, and it was found to be the most amblyogenic in this age group. The neuroimaging yield was maximum for combined cranial nerve palsy. The most common conservatively managed nerve palsy in this study group was the fourth nerve palsy.

Epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases of refractive error in pediatric population visiting a tertiary eye care center

Purpose: This study aimed to evaluate the epidemiology, clinical profile, and pattern of refractive error in newly diagnosed cases in children visiting a tertiary care eye center in southern India. Materials and Methods: This prospective study was conducted on 367 children, ≤15 years of age, with significant refractive error who visited our tertiary eye care hospital over a period of 1 year. Every child underwent detailed ocular examination. Significant refractive error was defined as myopia of ≥−0.75 diopter (D), hypermetropia of more than +2 D, and astigmatism of more than 0.75 D. Descriptive statistics were computed for better and the worse eye. Statistical tests were applied between the worse and better eyes using Chi-square test. Results: A total of 367 children (38.8%) were diagnosed for the first time of having refractive error. Only 146 (39.8%) children presented with visual complaints. With respect to the vision in the worse eye, 65.9% (n = 240) had moderately subnormal vision. There was no statistically significant difference (P = 0.057) between age distribution and visual acuity in the worse eye. Two hundred and thirty-eight children (64.9%) had significant astigmatism as compared to 161 myopic (43.9%) children. There was a statistically significant difference between reasons of visit and different age groups. Conclusions: Astigmatism was the most prevalent refractive error and uncorrected astigmatism the most significant amblyogenic factor. Since majority of children, especially in the younger age group, present with nonvisual complaints, involvement of pediatricians and parents will help us to reduce morbidity due to uncorrected refractive error and amblyopia.

To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India

<i>Aim:</i> To study presentation of ocular cysticercosis and to evaluate its demographic data, diagnosis, treatment and outcome in hill population of Northern India. <i>Materials and methods:</i> This is a retrospective study carried out in Dehradun, Uttarakhand in a tertiary eye care hospital over 4 years from 2016-2020. The study involved 38 patients who presented with unilateral eye disease and were diagnosed to have ocular or adenexal cysticercosis. We analysed retrospectively their geographical data, clinical presentation, serology, imaging, response to treatment and clinical outcome. <i>Results:</i> Age of patients ranged from 16-54 years. Male to female ratio was 1:3.75. Total no. of eyes affected were 38. All were unilateral presentation. 30 eyes (78.94%) presented with extraocular cysticercosis and 8 eyes (21.05%) with intraocular cysticercosis. 27 of the patients (71.05%) were from lower socioeconomic status with poor hygiene and sanitation conditions. 32 (89.21%) patients gave history of association with non-vegetarian diet. Extraocular cysticercosis group had restriction of ocular motility as most prevalent presentation seen in 16 eyes (53.33%) and proptosis as the most prevalent sign seen in 17 eyes (56.66%). Cyst prevalence was most frequently detected in superior rectus muscle seen in 14 eyes (53.84%). Intraocular cysticercosis group had blurring of vision as the most prevalent presenting symptom in 8 eyes (100.0%). Panuveitis in 6 eyes (75%) and presence of subretinal cyst in 4 eyes (50%) was the most prevalent sign seen in intraocular cysticercosis group. Enzyme linked immunosorbent assay test confirmed serology in 35 cases (92.10%). The USG B-scan detected presence of scolex in 36 eyes (94.73%). Magnetic resonance imaging (MRI) confirmed deep seated extraocular cysticercosis lesions and neurocysticercosis (NCC) undetected by computerized tomography (CT). CT was diagnostic for NCC in 5 cases (13.15%). Oral Albendazole and prednisolone were successful in management of extraocular cysticercosis. Intraocular cysticercosis was treated well with pars plana vitrectomy surgery with good visual recovery. <i>Conclusion:</i> Extraocular cysticercosis was more prevalent than intraocular cysticercosis. Early diagnosis and treatment made a difference in final outcome of the two groups. Imaging studies of orbital B-scan ultrasonography (USG B scan), CT and MRI with immune serological test of enzyme linked immunosorbet assay (ELISA) and Western blot for anticysticercus antibodies helped in confirming the diagnosis. Extraocular cysticercosis can be managed well medically with good clinical outcome. Intraocular cysticercosisis is best treated surgically. Safer and modern vitreoretinal surgical techniques promise good surgical outcome and visual recovery. Timely intervention and frequent postoperative follow up would help in keeping a watch on development of complications and maintenance of good vision.

Can the postoperative follow-up visit be deferred up to four weeks after an uneventful cataract surgery? - A randomized controlled trial.

Purpose:The aim of this study was to compare the postoperative visual outcome after a Day 0 examination in patients with two follow-ups, one between Day 3 to Day 7 and other between Day 25 to Day 30 to those with a single ophthalmic follow-up directly after 25–30 Days and to assess the safety of deferral of the first follow-up visit at 1 week.Methods:Randomized Controlled Trial was conducted at a tertiary eye care hospital, with 848 patients enrolled for the study. Patients meeting the inclusion criteria were selected. Their pre-operative and post-operative data was collected and the patients were divided into groups based on the type of cataract surgery and the postoperative follow-up protocol through randomization.Results:No significant difference was observed in the postoperative visual outcome in patients that underwent postoperative review at Day 3–7 and Day 25–30 as opposed to those that followed up directly at Day 25–30 after a mandatory Day 0 examination for all patients.Conclusion:In patients with no preexisting ocular or systemic comorbidity undergoing an uneventful cataract surgery, the postoperative follow-up visit can be safely deferred until 4 weeks, without any impact on the postoperative visual outcome, thereby conserving the available resources which can be deviated towards better eye care services.

Strengthening the referral Chain and providing one window diabetes eye care facility to people with Type-2 Diabetes: A six-year follow-up study from Pakistan.

Objective:To report the results of implementation of two-pronged system for strengthening of referral and receiving end of referral chain for people with Type-2 diabetes mellitus (T2DM) at a tertiary eye care hospital in Karachi.Methods:This observational, cross sectional study was conducted from the data collected in “Strengthening Pakistan’s response to Diabetic Retinopathy” project. Peripheral referral was improved through community awareness camps (n=48), refreshing knowledge of primary healthcare professionals (PHCP) and conducting retinopathy screening camps (n=85) in the community. T2DM patients with best corrected visual acuity (BCVA) <6/18 or had retinopathy sign on screening were referred to tertiary center. The receiving end of the referral was improved by establishing “one window facility” at tertiary eye care center. Facility consisted of eight stations starting from registration, visual assessment, fundus photographs, consultation with ophthalmologist, anthropometry measurement, consultation with diabetologist to finally meeting with diabetes educator. At every station, patient’s information was directly entered in HIMS software.Results:A total of 50,595 patients attended tertiary center over six years. Among all 34685 (68.5%) were new registration and 15910 (31.4%) were follow ups. During first year (2014-15) out of total registered individuals with DM, newly registered were 4414 (89.5%) and 518 (10.5%) were follow-ups. In the final year (2019-20) new cases registered reached to 62% (n= 7916) with 38% (n=4852) follow-ups. Patients referred by PHCP increased from 6.5% in 2014-15 to 43.7% in 2019-20. An increased uptake of all treatment modalities for retinopathy like laser (increased by 16.76%), intra-vitreal injections (by 14.72%) and vitrectomy (by 51.47%) were also observed.Conclusion:Implementation of two prong system resulted in improved service uptake, better referral system, enhanced follow-ups and increased intervention uptake.

Effect of dexmedetomidine on intraocular pressure as an additive in peribulbar block during glaucoma surgery.

Purpose:The purpose of this study is to assess the effect of dexmedetomidine on intraocular pressure (IOP) as an additive in peribulbar injections in glaucoma surgeries.Methods:A prospective, randomized, double-blind, parallel assignment interventional study was conducted for patients undergoing glaucoma surgeries at a tertiary eye care hospital in North India. Patients were randomized to two groups, Dexmed group and Placebo group. In the Dexmed group, dexmedetomidine (0.4 μg/kg body weight) was given as an additive along with peribulbar block. The primary outcome was change in IOP pre- and postperibulbar injections (IOP before the block, and after 5 and 15 min of the block). Secondary outcome measures were onset of block, adverse effects (bradycardia, hypotension, respiratory depression, and level 4 sedation), and surgeon satisfaction.Results:A total of 104 patients were randomized, 52 each in the Dexmed group and Placebo group. The percentage decrease in IOP was significantly more in the Dexmed group than in the Placebo group both at 5 and 15 min' post block (P < 0.05). At 5 min, the mean percent decrease in IOP in Dexmed group was -10.48, whereas it was 2.85 in the Placebo group. At 15 min, the mean percent decrease in IOP was -22.59 and -9.42 in the Dexmed and Placebo group, respectively. There was no significant difference between the two groups in the onset of block and adverse effects. Surgeon satisfaction was significantly greater in the Dexmed group than the Placebo group (P < 0.05).Conclusion:Dexmedetomidine lowers IOP significantly in patients undergoing glaucoma surgeries with safe hemodynamic changes and sedative effect.

Slit-lamp measurement of anterior chamber depth and its agreement with anterior segment optical coherence tomography and Lenstar LS 900 in pseudoexfoliation and normal eyes.

Purpose:There is a considerable lack of awareness of slit-lamp measurement of anterior chamber depth (ACD) by the Redmond Smith method (SACD) in present day-to-day clinical practice, which may provide rapid assessment in pseudoexfoliation (PXF) when assessing for angle closure and planning for cataract surgery. This assumes importance not only in outreach clinics but also in the ongoing pandemic caused by the highly contagious novel coronavirus, where social distancing is advocated to contain the spread. We aimed to compare the axial ACD in PXF and normal patients by SACD, and its agreement with the anterior segment optical coherence tomography (ASOCT) and LenstarLS-900.Methods:A prospective comparative observational study was done at a tertiary eye care hospital. A PXF group and a normal group of controls were recruited. All eyes were phakic with normal cornea. Any eye with previous intraocular/refractive surgery and cause of other secondary or uncontrolled glaucoma was excluded. SACD was measured clinically via slit-lamp method and also via ASOCT and Lenstar; agreement between the methodologies was plotted.Results:Fifty patients were recruited in each group. Mean age was 66.82 ± 4.88 years in PXF patients and 65 ± 5.46 years in controls (P = 0.2). ACD was found to be greater in controls compared with the PXF patients; this difference was statistically significant (P < 0.001) across all methodologies. A good agreement with narrow 95% limits of agreement was found between these methodologies.Conclusion:Redmond Smith slit-lamp methodology of estimating the axial ACD is recommended as a rapid, quantifiable, noncontact screening technique during routine examination, especially in primary outreach centers, and is also advantageous during the ongoing pandemic by reducing expendable investigations.

Comparison of diagnostic ability of standard automated perimetry, short wavelength automated perimetry, retinal nerve fiber layer thickness analysis and ganglion cell layer thickness analysis in early detection of glaucoma.

Purpose:The aim of this study was to compare the diagnostic ability of macular ganglion cell layer (GCL) analysis using spectral domain optical coherence tomography against retinal nerve fiber layer analysis (RNFL), short-wavelength automated perimetry (SWAP), and standard automated perimetry (SAP) in early detection of glaucoma.Methods:Participants fulfilling the inclusion criteria were consecutively enrolled from the glaucoma clinic of tertiary care eye hospital in Western India from November 2015 to October 2016. The subjects underwent a detailed evaluation by trained glaucoma specialists. On suspicion of glaucoma, the patients underwent SAP, SWAP, and SD-OCT for GCL and RNFL analysis.Results:There were 91 patients in total of which experts classified 54 eyes into GON and 37 eyes into nonglaucomatous group. Sensitivity of SAP (42.59%) was significantly lower (P < 0.05) than that of average GCL thickness (79.63%) and average RNFL thickness (72.22%). Specificity and positive LR of SWAP (97.3% and 19.19, respectively) and SAP (94.6% and 7.88, respectively) were greater than those of GCL (81.08% and 4.21) and RNFL (67.57% and 2.23) parameters. Negative LR of average GCL thickness (0.25) was superior to that of average RNFL thickness (0.411), SWAP (0.495), and SAP (0.607).Conclusion:Macular GCL parameters perform better than RNFL parameters in patients with early glaucomatous damage. There is superior ability of SWAP over SAP in detecting glaucomatous changes in glaucoma suspect group. GCL thickness analysis has higher sensitivity and negative likelihood ratio, whereas SWAP had higher specificity and positive likelihood ratio. Thus, combining both tests can lead to better diagnostic ability for early glaucomatous damage.

Commentary: Improving the cataract surgery efficiency and clearing the cataract surgery backlog due to COVID-19 pandemic.

Commentary: Improving the cataract surgery efficiency and clearing the cataract surgery backlog due to COVID-19 pandemic.

Role of Concomitant Internal Limiting Membrane (ILM) Peeling During Rhegmatogenous Retinal Detachment (RRD) Surgery in Preventing Postoperative Epiretinal Membrane (ERM) Formation.

Objective:To investigate the role of concomitant Internal Limiting Membrane (ILM) peeling during surgery for macula off Rhegmatogenous Retinal Detachment (RRD) in preventing postoperative Epiretinal Membrane (ERM) formation; and its effect on the visual acuity.Methods:This was a prospective, quasi-experimental study conducted from August 2018 to July 2019 at LRBT Tertiary Eye Care hospital, Karachi. Fifty-six patients with macula off RRD were divided into groups A (with ILM peeling) and B (without ILM peeling) via non-probability convenience sampling. All patients underwent standard 3 ports pars plana vitrectomy with silicon oil tamponade. In Group-A, ILM was stained using 0.5% ICG. Patients were evaluated clinically and by spectral domain optical coherence tomography (SD-OCT), pre- and post-operatively. Main outcomes recorded were best corrected visual acuity (BCVA) and occurrence of ERM on SD-OCT.Results:There were 26 patients in Group-A and 30 patients in Group-B. At six months’ follow-up, ERM had not developed in any case in Group-A compared to five patients (16.7%) in Group-B. There was no statistical difference in mean BCVA change from baseline.Conclusion:ILM peeling during vitrectomy for RRD prevents the formation of macular ERM post-operatively. This may reduce the need of a second vitrectomy. However, visual outcomes were comparable to the non-ILM peeling vitrectomy.

A Comparison of Scleral Tunnel and Pericardial Graft Implantation Techniques in Patients undergoing Ahmed Glaucoma Valve Implantation

The purpose of this study was to compare the two methods autologous scleral flap (scleral tunnel) and pericardial patch graft of tube covered in Ahmed glaucoma valve (AGV) in refractory glaucoma with respect to the tube exposure, infection, level of Intraocular Pressure (IOP), and any other complications due to applications of each technique. A retrospective chart review of 113 eyes in 102 patients with refractory glaucoma who underwent ahmed glaucoma valve (AGV) implantation (39 eyes in scleral tunnel and scleral flap group &amp;ldquo;first group&amp;rdquo; and 74 eyes in pericardium graft group&amp;rdquo; second group&amp;rdquo;) was performed. The procedures in these eyes were performed between January 2007 and October 2015 in a tertiary eye care hospital in KSA. The mean age was 56 &amp;plusmn; 19 (8 months- 83 years) in the Scleral tunnel group and 50 &amp;plusmn; 27 (1- 78 years) in the Pericardium group (p = 0.023). Fifty-six males and 57 females were included in the study. Medians of the follow-up were 48 &amp;plusmn; 25.5 months (3 &amp;ndash; 89) for the Scleral tunnel group and 29 &amp;plusmn; 21.4 months (2 &amp;ndash; 92) for the Pericardium group, and it is statistically significant (P &amp;lt; 0.001). According to the findings, preoperative diagnosis in the two groups included neovascular glaucoma (NVG) found in 21 eyes (53.8%) in the Scleral tunnel group versus 18 eyes (24.3%) in the Pericardium group (p = 0.009). Exposure of the valve was found in 15 eyes (20.27%) in Pericardium graft group versus 2 eyes (5.12%) only in scleral tunnel group (p = 0.002). These exposed valves lead to endophthalmitis in 5 cases in the second group and no single case in scleral tunnel group was detected (P &amp;lt; 0.001). The postoperative IOP values were statistically insignificant in all different time periods.&#x0D; &#x0D; Scleral tunnel method has less exposure rate than the pericardium graft.&#x0D; &#x0D; The purpose of this study was to compare the two methods autologous scleral flap (scleral tunnel) and pericardial patch graft of tube covered in Ahmed glaucoma valve (AGV) in refractory glaucoma with respect to the tube exposure, infection, level of Intraocular Pressure (IOP), and any other complications due to applications of each technique. A retrospective chart review of 113 eyes in 102 patients with refractory glaucoma who underwent ahmed glaucoma valve (AGV) implantation (39 eyes in scleral tunnel and scleral flap group &amp;ldquo;first group&amp;rdquo; and 74 eyes in pericardium graft group&amp;rdquo; second group&amp;rdquo;) was performed. The procedures in these eyes were performed between January 2007 and October 2015 in a tertiary eye care hospital in KSA. The mean age was 56 &amp;plusmn; 19 (8 months- 83 years) in the Scleral tunnel group and 50 &amp;plusmn; 27 (1- 78 years) in the Pericardium group (p = 0.023). Fifty-six males and 57 females were included in the study. Medians of the follow-up were 48 &amp;plusmn; 25.5 months (3 &amp;ndash; 89) for the Scleral tunnel group and 29 &amp;plusmn; 21.4 months (2 &amp;ndash; 92) for the Pericardium group, and it is statistically significant (P &amp;lt; 0.001). According to the findings, preoperative diagnosis in the two groups included neovascular glaucoma (NVG) found in 21 eyes (53.8%) in the Scleral tunnel group versus 18 eyes (24.3%) in the Pericardium group (p = 0.009). Exposure of the valve was found in 15 eyes (20.27%) in Pericardium graft group versus 2 eyes (5.12%) only in scleral tunnel group (p = 0.002). These exposed valves lead to endophthalmitis in 5 cases in the second group and no single case in scleral tunnel group was detected (P &amp;lt; 0.001). The postoperative IOP values were statistically insignificant in all different time periods.&#x0D; &#x0D; Scleral tunnel method has less exposure rate than the pericardium graft.

Efficacy and safety of glue assisted suture less trans-scleral fixation of posterior chamber intraocular lens (SF- PCIOL)

Context: Scleral-fixated posterior chamber lens implantation (SF-PCIOL) in eyes without sufficient capsular support remains a widely applied surgical procedure. Suture - less scleral IOL fixation, Is a new technique in which PC IOL is placed in eyes with deficient posterior capsule and the haptics are incarcerated in the scleral pocket which is sealed with quick-acting fibrin glue. Aims and Objectives: To evaluate the efficacy and feasibility of fibrin glue-assisted posterior chamber intraocular lens (IOL) implantation method in post cataract surgery. Material and Methods: The study includes 10 Patients presented with inadequate capsular support who underwent Glue assisted SF-PCIOL over a time period of 12 months at a tertiary care eye hospital. Statistical analysis was done on Microsoft excel. Results:In present study of ten eyes the final postoperative BCVA at 3rd month was improved or remained same in nine (90 %) patients and only one patient had reduced BCVA. Conclusion: Lots of complications are encountered with the use of sutures in the operative procedures; bio-adhesives fibrin glue have emerged as a viable alternative for glue assisted suture less transscleral fixation of posterior chamber intraocular lens (SF- PCIOL), over the last three decades. Keywords:Scleral-Fixated Posterior Chamber IOL (SF-PCIOL), haptics, Fibrin glue, Best Corrected Visual Acuity (BCVA)

Congenital ptosis - A clinical and demographic study in a tertiary eye care hospital

Congenital ptosis - A clinical and demographic study in a tertiary eye care hospital - IJOOO- Print ISSN No: - 2581-5024 Online ISSN No:- 2581-5016 Article DOI No:- 10.18231/2581-5016.2018.0040, IP International Journal of Ocular Oncology and Oculoplasty-IP Int J Ocul Oncol Oculoplasty

Analysis of risk factors, clinical features and visual outcome in cases of non-arteritic anterior ischemic optic neuropathy (NA-AION) at a tertiary eye care centre in India

We did an analysis of risk factors, clinical features and visual outcome in cases of non-arteritic anterior ischemic optic neuropathy (NA-AION) at a tertiary eye care centre in India. This is a prospective, observational, clinical study. A total of 60 eyes of 60 consecutive adult patients with disc oedema, due to non-arteritic AION, presenting in the Neuro-ophthalmology clinic of a tertiary care eye hospital, were enrolled over a period of 18 months (in specified period) according to the inclusion criteria. The study, including patient recruitment and data collection, was approved by the Institutional Review Board. All patients provided written informed consent after they received information about the disease and its relevant investigations along with the risks associated. Sample collection was done by application of inclusion and exclusion criteria on the patients presenting to the clinic. The study was carried out for a period of 6 months for each subject. The major outcomes of the study were: Metabolic Syndromes are the most significantly associated risk factors for the occurrence of NA AION. Clinical investigations mainly show the characteristic findings as mentioned in literature, with very little variation. However the importance of clinical examination, mainly pupillary reaction and fundus evaluation by slit lamp biomicroscopy, cannot be overlooked. Visual acuity is highly variable at presentation with cases even presenting with normal or near normal visual acuity. Visual outcome showed significantly improvement within 6 months of presentation. Non arteritic anterior ischemic optic neuropathy (NAION) was the most common form of ischemic optic neuropathy in our study. It is an idiopathic, ischemic insult of the optic nerve head characterized by acute, monocular, painless visual loss with optic disc swelling. The systemic risk factor which we found to be most strongly associated with was diabetes mellitus followed by systemic hypertension. Also an

Traumatic optic neuropathy in a tertiary eye care hospital of India

Traumatic optic neuropathy in a tertiary eye care hospital of India

Etiology of vitreous haemorrhage in a tertiary eye care centre of north India

To study the etiology of vitreous haemorrhage in a tertiary eye care hospital of North India. A hospital based cross-sectional study was done in RIO, PGIMS Rohtak over a period of over 2 years which included 200 patients presenting with vitreous haemorrhage. All patients were evaluated in detail to establish the etiology of vitreous haemorrhage. The data was analyzed using microsoft excel and SPSS 17.0 software. A total of 200 patient presenting with vitreous haemorrhage involving one or both eyes were evaluated. The mean age of patients was found to be 47.40+19.6 years with a range of 6 months to 85 years. Only 24% cases had bilateral involvement. Male were found to be affected more commonly than females with M:F ratio of 2:1. In more than 85% cases, proliferative diabetic retinopathy, retinal vasculitis, branch retinal vein occlusion, central retinal vein occlusion, retinal tear, rhegmatogenous retinal detachment and ocular trauma was the underlying etiology. Proliferative diabetic retinopathy, branch retinal vein occlusion, posterior vitreous detachment with retinal tear are most common causes of vitreous haemorrhage in elderly patients while in young adults, retinal vasculitis is most common cause. While in children, trauma is found to be the most common etiology of vitreous haemorrhage.

Visual outcomes in diabetic macular edema patients after avastin injection

Objective: To determine the visual outcome in Diabetic Macular Edema patients after 3rd Avastin injections attending a tertiary eye care hospital. Materials and methods: This was a cross sectional study with Non probability convenient sampling technique. The study was carried out at Diabetic clinic of Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi-Pakistan. Ethical approval was taken from the institutional review board of Institute. Data collection were done retrospectively from January 2017 to June 2019. Data were retrieved for DME patients who have completed three follow-ups with Avastin injection. Inclusion Criteria were patients with age 30 to 60 years, Patient with PDR and NPDR with diabetic macular edema after 3rd injection. Data Analysis was done using SPSS version 23.0. Results: A total of 40 eyes of 40 patients were included in this study after getting information from the record sheet. Analysis were done in 30 eyes of 30 patients because 10 patients were missed their follow-up due to certain reason which were observed from record sheet. Mean age of patients was found to be 41.25±10.24.Pre-operative Avastin injection best corrected visual acuity (BCVA) was noticed by using Log MAR without glasses was 0.49 and with glasses was 0.40. Post-operative best corrected visual acuity Log MAR without glasses 0.51 and with glasses 0.42 after Avastin injection. Improvement of visual acuity was classified as Improved, worsen and Stable. There were 22 (73.33%) patients observed with improvement in visual acuity, 5 (16.66%) patients retained their vision stable and only 3 (10%) patients worsen their visual acuity after all three Avastin injections. Conclusion: The most common cause of diabetic macular edema is non-proliferative diabetic retinopathy and proliferative Diabetic Retinopathy. The Intravitreal injection play vital role, the timely treatment would improve prognosis of visual outcomes in Diabetic macular edema. So the study significantly shows the improvement in best corrected visual acuity before and after three visits.

In-vitro assessment of first-line antifungal drugs against Aspergillus spp. caused human keratomycoses

Background and objectivesAspergillus keratitis are in the increasing trend and reported as the second most common cause of mycotic keratitis in developing countries. The present study was designed to isolate, identify Aspergillus spp. from the keratits/corneal ulcer patients attending a tertiary care eye hospital, Coimbatore, South India and to assess the minimum inhibitory concentrations (MICs) against ten clinically used first-line antifungal drugs. MethodsA total of seventy-three Aspergillus strains isolated from corneal scrapings were included and assessed for a period of one year. All isolates were identified up to the species level by morphological observations. Antifungal drug susceptibilities were determined against a standard panel of antifungal agents. ConclusionsFive different species of aspergilli, A. flavus (n=53), A. fumigatus (n=14), A. terreus (n=9), A. tamarii (n=6) and A. niger (n=3) were identified based on morphological features. Minimum inhibitory concentration analyses indicated that, voriconazole, natamycin, itraconazole, clotrimazole, econazole followed by ketoconazole shall be the order of choices for the effective treatment for Aspergillus keratitis.