Ophthalmology and Allied Sciences

Background: Cataract is a leading disease with increasing age of visual impairment in and around the Southern part of Rajasthan. Hence, this study was carried out for understanding the type as well as densities of cataract in relation to axial length in cases with myopia in southern part of Rajasthan. Methods: This prospective randomized observational case-control study of 200 eyes in the age group of > 40 years with age-related cataracts was carried out. Myopia subjects with an AXL of > 24.0 mm were taken as cases (n=100 eyes) and subjects with emmetropia with AXL ranging between 21.0–23.99 mm were considered as controls (n = 100 eyes), fulfilling our inclusion and exclusion criteria. Results: On comparison with emmetropic eyes and myopic eyes, they were associated with an increased prevalence of nuclear (OR: 3.64, 95% confidence interval [CI]: 3.72–6.69), but not with cortical (OR: 0.58, 95% CI: 0.68–1.08) and PSC (OR: 0.40, 95% CI: 0.56-1.01). On myopia, there was a significant association between myopia and nuclear cataract (OR: 3.8, 95% CI 2.9–5.2). Subjects between 40–50 years of age, nuclear sclerosis was predominant. Conclusion: Myopic eyes were associated with increased prevalence of nuclear cataract and the density of cataract was also higher in patients with higher axial length. There was significant association between axial length and PSCC (p<0.05).

Keywords: Myopia; Emmetropia; Cataract; Axial Length

Objectives: To study the variations in epidemiological characteristics, clinical features, disease process and various modalities of management in VKC. Materials and Methods: A hospital based prospective study of 150 patients presenting with symptoms of allergic conjunctivitis was done at Out Patient Department of Ophthalmology, ESIC Medical College, Gulbarga, from July 2018 to June 2019. Multiple epidemiological (age, sex) and clinical parameters (type, symptoms, treatment, failure of treatment) were studied. All patients were appropriately managed and reviewed once in fortnight and follow up ranged from a minimum of 3 months to 6 months. Results: In our study, out of 150 patients who presented with symptoms of VKC, predominance of male that was seen in 74%compared to females being 26%. Mean age affected was found to be in range of 10-16 years 66%. In our study 68% patients had seasonal symptoms, 32% complained perennial symptoms, 30% patients had personal or family history of allergic diseases, asthma and rhinitis being common and maximum cases were reported during January to April. In our study, 100% patients complained of itching, 52% had redness, 32% had ropy discharge, 24% complained of photophobia, 18% had burning sensation, 12% had watering. The disease pattern consisted of palpebral form in 63.3%, bulbar form in 21.3% and mixed form in 23% patients. Corneal involvement was seen in 12 (13.33%) patients. Superficial punctate keratitis was the commonest presentation. Bulbar form of the disease was found to be sensitive to Sodium cromoglycate alone. Olopatadine hydrochloride 0.1% E/d and antihistamine E/d were used along with steroids in patients and proved beneficial for long term. Conclusion: VKC is a common form of conjunctivitis in a tropical country like ours. It is a bilateral, recurrent debilitating form of disease found to affect young males below 16 years. VKC is associated with other systemic atopy or family history of allergic disorders. It can be successfully treated with available antiallergic treatment with good prognosis.

Keywords: VKC; OPD.

Introduction: Cataract is a major cause of preventable blindness in India accounting to 62.6% [1,2]. A significant proportion of patients still present with advanced cataract leading to complications like Lens-induced glaucoma. There is an ever-increasing backlog of cataract due to the population explosion, increased life expectancy, and low productivity in terms of utilization of the available surgical services. Late reporting for treatment of cataract leading to serious complications like LIG remains one of the most important cause of irreversible loss of vision,. Aims: The aim is to study the clinical profile of lens induced glaucoma by intraocular pressure pre and post operatively and to assess the final visual outcome in lens induced glaucoma. Materials and Methods: This is a prospective hospitalbased study. Eighty cases were studied, encountered during the period of 3 years. Results: The total number of cases studied were 80, of which 52 were female and 28 were male showing that occurrence of LIG is more common in females and socioeconomic factors play a major role. Most common type was found to be phacomorphic type of lens induced glaucoma. The occurrence of phacoanaphylactic glaucoma and glaucoma due to subluxation of lens was zero in this study. BCVA at 6 weeks post operatively was 6/18 or better in 57.5% patients. Conclusion: Inspite of easy availability of services for cataract surgery socio-economicconditions, poor health education and negligence towards symptoms andwas found to be the main reason for occurrence of LIG. This study signifies that there is a great need to impart health education to thepublic about the importance of timely surgery for better visual outcome.

Keywords: Cataract; Lens-induced glaucoma (LIG); Phacomorphic type.

Introduction: Corneal Opacity is common cause of ocular morbidity. Occurrence of Corneal blindness alters from nation to nation and from population to population. There is even variation within the developing countries like India. Aims: To study the efficacy of penetrating keratoplasty in various corneal disorders which resulted in corneal blindness in my geographical area as well as to improve social life in such poor socioeconomic area. Materials and Methods: This is a hospital based prospective study. Total seventy patients diagnosed with non- healing corneal ulcer, corneal perforation, bullous keratopathy, autoimmune disease, infectious keratitis, trauma to the eyeball including chemical burns as well as other combined disorders were indicated for total penetrating keratoplasty. Results: Total seventy eyes of seventy patients were operated using the technique of total PKP over a period of 2 years. Among all the conditions Non Healing Corneal ulcer was the main indication. The major post-op complication for which the treatment failed was the persistent epithelial defect. Conclusion: Full thickness penetrating keratoplasty was found to be surgical boon and effective tool in the management of various corneal disorders. It was also found that it maintain globe integrity and improve visual acuity as well as social life.

Keywords: Corneal Opacity, Corneal blindness, PKP

Introduction: Posterior capsular opacification (PCO) is the most common delayed complication after ECCE surgery with or without PC-IOL. Neodymium Doped Yttrium Aluminum Garnet (Nd : YAG) laser for posterior capsulotomy is widely used and it has been gradually replacing surgical capsulotomy because it is safe, non-invasive and effective procedure with minimal complications of vitreous loss and endophthalmitis as compared to surgical capsulotomy. Complications of Nd : YAG laser posterior capsulotomy are raised intraocular pressure (IOP), corneal damage, iritis, intraocular lens (IOL) pitting or dislocation, cystoid macular edema (CME), disruption of the anterior vitreous face, retinal detachment (RD), endophthalmitis and vitreous hemorrhage. The purpose of the present study is to to evaluate the complication rate following Nd : YAG laser capsulotomy. Aims and Objectives: To assess the complication following Nd : YAG laser capsulotomy. Material and Methods: The study has been performed in our institute between September 2013 to September 2015. 100 eyes of 100 patients with PCO were considered for Nd : YAG laser capsulotomy after minimum period of 6 months following uncomplicated extracapsular cataract extraction. Following the capsulotomy, all patients were routinely given topical antibioticssteroid combination and topical anti-glaucoma drops. Patients were reviewed after 1 hr for assessment for tonometry, slit lamp biomicroscopy. Anterior chamber reaction were looked. IOP assessment was done after 1hr, 1week, 1month and 6month. Rise in IOP was noted. If IOP was raised for hours and retured to normal at the end of 7 days, it labelled as transient IOP rise. Persistent IOP rise was labeled if sustained high IOP on follow up visits. Patients were also looked for visual acuity, any incidence of iritis, retinal detachment, cystoid macular edema. Results: In our study, most frequent complication was rise in IOP. The immediate IOP rise (IOP one hour after Nd : YAG laser capsulotomy) was recorded in 31% of patients. Mean summated laser energy in a group of patients with immediate IOP rise (62.39) was significantly high as compared to group of patients with normal IOP. In our study, pitting of IOL was seen in 6% of patients. Mean summated laser energy level in patients with pitting of IOL was 80.67 mJ as compared to 52.36 mJ in patients without IOL pitting. The mean summated laser energy was significantly higher (p=0.002) in a group of patients with IOL itting. In our study, iritis was noted in 7% of patients. The mean summated laser energy was significantly higher (p<0.001) in a group of patients with iritis. The mean summated laser energy level in patients with iritis was 85.14J as compared to 51.72 mJ in patients without iritis. In our study, CME was seen in 3% of patients. Mean summated laser energy in patients with CME was 74.67 mJ versus 53.42 mJ in patients without CME (97%). Mean summated laser energy was not significantly higher in patients with CME (p=0.098). In our study, anterior hyaloid face rupture was noted in 9% of patients, but none of the patient had vitreous in anterior chamber. Mean summated laser energy level in patients with anterior hyaloid face rupture was 75.11 mJ which was significantly higher (p=0.002) as compared to 51.98 mJ in patients without rupture of anterior hyaloid face (n=91). Conclusion: Complications with Nd : YAG laser capsulotomy are minimal and transient. Complications such as raised intraocular pressure, pitting of IOL, iritis, anterior hyaloid face rupture more common if mean summated energy level was high. The total laser energy delivered were not risk factor for the development of cystoid macular edema. Healthy pseudophakia eyes generally do not have retinal detachment after Nd : YAG laser capsulotomy. To minimize the complications, lowest possible laser energy level should be used for Nd : YAG laser capsulotomy.

Keywords: Posterior Capsular Opacification (PCO); Nd:YAG Laser; Capsulotomy

Dacryocystorhinostomy (DCR) is the standard surgical treatment for epiphora caused by obstructions distal to the common canaliculus. 102 patients of epiphora with obstruction in nasolacrimal duct secondary to chronic dacryocystitis were treated by endoscopic DCR. Concomitant surgeries were done in selected cases. All cases were diagnosed clinically by regurgitation test and sac syringing. Cases having epiphora due to other causes and due to pre-saccal obstruction were excluded. Average follow up was from 3 months to 1 year. Primary success rate 84.75% at the end of 6 months. Major complications was not found in any case. Adhesions and granulations around neoostium was the most common cause of failure. It was finally concluded that endoscopic DCR is safe and effective procedure for the management of epiphora secondary to nasolacrimal duct obstruction with comparable success rates and with no major complication.

Keywords: Epiphora, Chronic Dacryocystitis; Nasolacrimal Duct Obstruction (NLD); Endoscopic Dacryocystorhinostomy (End DCR).

Introduction: Of the irreversible causes of blindness, glaucoma ranks second which can be treated by early identification of disease and to slow its progression and preserve vision. Aim: The purpose of our study was to calculate the RNFL and ONH parameters using OCT in primary open angle glaucoma (POAG) patients and to determine if any correlation exists between the two. Materials and methods: The study included 95 eyes of 50 patients above 40 years of age with POAG. Central corneal thickness was calculated using optic pachymetry, IOP measurement using applanation tonometry. SD-OCT was used to calculate the RNFL and ONH parameters. Results: The ONH parameters and the RNFL thickness were tabulated and correlation between them was analysed. Superior and inferior quadrants thinning of RNFL was evident in most of the patients. Superior RNFL and the vertical ONH parameters showed best correlation (-0.442, p-value 0.005). Conclusion: The RNFL thickness were well correlated to optic disc parameters. OCT helps in acquiring high resolution accurate images, reproducible RNFL and retinal thickness measurement. OCT has shown to have greater diagnostic accuracy in RNFL measurements, there by helping the ophthalmologists to identify subtle changes of the normal RNFL pattern, ONH parameters before visual field defects develop.

Keywords: RNFL; ONH; POAG; SD-OCT

Human immunodeficiency virus (HIV)/Acquired immune deficiency syndrome (AIDS) is one of the most feared infectious diseases of the late 20th century with Indian estimates of 21.17 lakhs patients living with HIV contributing to highest numbers among the world . Ocular disease continues to be a major cause of morbidity, among HIV-infected population.Introduction of Highly active antiretroviral therapy (HAART) in India led to a dramatic reduction in ocular morbidity . There are only few studies in Indian sub-continent that have evaluated the prevalence of HIV related ocular lesions in patients on HAART. The Purpose of presentstudy is to evaluate ocular manifestations in patients on HAART in a tertiary care hospital. Context: Aims: To study the ocular manifestations among HIV patients on HAART To study the relationship between ocular findings and the duration of HAART Settings and Design: observational study was done in the Anti Retroviral Therapy (ART) centre, Sri Ram Narayan Ruia Government General Hospital (SVRRGGH) attached to Sri Venkateswara Medical college (SVMC), Tirupati between November 2013 to September 2017. The study was approved by the Institutional ethic committee of the Institution. Methods and Material: 1026 HIV positive patients who are on HAART fulfilling the inclusion criteria were examined as per protocol and results were analyzed Statistical analysis used: SPSS 13 Results: 1026 HIV positive patients on HAART were examined during study period out of which 221 (21.53%) patients had ocular manifestations. incidence of ocular manifestations was higher in males compared to females (57.02% vs. 42.98%). The commonest ocular manifestation was HIV retinopathy (14.2%). New manifestations observed were presenile cataract (9.50%). Iatrogenic manifestations observed were Immune recovery uveitis (3.61%), anaemic retinopathy (9.95%). Conclusions: Our study evaluated the prevalence of ocular manifestations in HIV-infected patients on HAART. Screening this patient population is of particular importantance not only because of the high prevalence of ocular manifestations due to disease but also due to the potential for worsening of ocular conditions due to HAART induced IRIS and anemic retinopathy. This shows the importance of ophthalmic evaluation of all HIV patients on HAART.

Keywords: Human Immunodeficiency Virus (HIV); Highly Active Antiretroviral Therapy (HAART); Cytomegalovirus Retinitis (CMV); Cluster of Differentiation 4 (CD4) Cells, HIV Retinopathy; Immune Reconstitution Inflammatory Syndrome (IRIS)

Background: Visual loss is a major symptom in Central Retinal Artery Occlusion, while limited vision field has been described in Branched Retinal Artery Occlusion. Despite great developments in diagnostic, surgical and medical ophthalmology fields within recent years, retinal artery occlusion still remains a disease without approved therapy. Retinal cells consumed the highest oxygen consumption in organs, which makes the retina extremely susceptible to ischemia. Aim and Objective: The aim and objective of this prospective study was to look for effect of hyperbaric oxygen therapy and to evaluate and establish a possible marker for retinal damage. Study Design: Prospective case control study. Place of Study: The study was carried out at the Prana Hyper Baric Oxygen Therapy Centre, located in the Northern parts of Mumbai, in India. Material and Method: Total 62 patients with central retinal artery occlusion were included which were referred to our Prana hyperbaric center Mumbai over a period of three years. The HBO therapy protocol included 90 minutes oxygen breathing at 2 ata twice daily for 3 days and then followed by 1 OD for 4 days. Results and Discussion: The best corrected visual acuity [log MAR] after hyperbaric oxygen therapy compared with baseline showed a significant mean improvement of 0.612 ± 0.64 from 2.16 ± 0.48 to 1.58 ± 0.89 [p<0.0001]. similarly BCVA [log MAR] after HBOT in patients with cherry red spot compared with base line showed a mean improvement of 0.453 ± 0.358 from 2.24 ± 0.32 to 1.87 ± 0.54 [p < 0.0001] also showed a significant finding in non cherry red spot cases where BCVA after HBOT compared with base line showed a mean improvement of 0.78 ± 0.498 from 1.96 ± 0.68 to 1.21 ± 0.71 [p < 0.0001]. Conclusion: From clinical perspective hyperbaric oxygen therapy is an effective treatment for central retinal artery occlusion cases, it also concludes that the cherry red spot as marker of retinal infarction and as long as it is not being developed the prognosis appears to be good.

Keywords: Central Retinal Artery Occlusion; Hyperbaric Oxygen therapy; Cherry Red Spot.

Introduction: Pterygium is a degenerative condition. Pterygium can induce visually significant astigmatic changes or may grow to occlude the visual axis. In the management of pterygium one of the major problems is the high rate of recurrence. Aims: To study the efficacy and complications of limbal conjunctival autografting using sutures, fibrin glue or autologous blood for graft adhesion after pterygium excision and to compare the results. Materials and methods: A total of 120 patients who underwent limbal conjunctival autografting after pterygium excision. Grafts were secured using autologous blood in 40 eyes, fibrin glue in 40 eyes and sutures in 40 eyes.Study was conducted during a period of 1 1/2 year in the Department of Ophthalmology, SVS Medical College and Hospital, Mahabubnagar. Results: Of the 120 eyes the grafts were secured in 40 eyes (33.3%) using autologous blood, 40 eyes (33.3%) using sutures and 40 eyes (33.3%) using fibrin glue according to the patient's choice.The mean time taken for surgery in the various groups of this study was compared and found to be highest with sutures (27.7 min) and least with the autologous blood method (15.70 min). No intra op complications were noticed in the three groups. All patients were followed up for a period of 6 months. Postoperative complications were more with the use of sutures and mild enough to subside with treatment in 1 week. Minimal graft displacement was noticed in 1 eye in the autologous blood method group which did not require any revision surgery.In this study single line improvement in postoperative Snellen's visual acuity was noticed in the three eyes with large pterygia unrelated to the method of graft adhesion. Recurrences were noticed in 3 of the 120 eyes over 6 months' follow up. Conclusion: In this study single line improvement in postoperative Snellen's visual acuity was noticed in the three eyes with large pterygia unrelated to the method of graft adhesion.

Keywords: Sutures; Fibrin Glue; Pterygium.

The present study was done to assess the Contrast sensitivity in patients who underwent Nd :YAG laser capsulotomy for posterior capsular opacification after cataract surgery. The study was conducted on 30 patients, diagnosed as having posterior capsular opacification (PCO) after uncomplicated cataract surgery. Visual acuity and contrast sensitivity assessment wereperformed before and after laser capsulotomy. In our study visual acuity and contrast sensitivity improved significantly post Nd : YAG capsulotomy.

Keywords: Contrast Sensitivity; Posterior Capsular Opacification; Nd :YAG laser Capsulotomy; Pelli Robson Contrast Chart

Aim: To assess the correlation of central corneal thickness (CCT) with the degree of myopia. Methods: This is a prospective observational study. A total 280 patients were enrolled in a refractive surgery clinic. Total ophthalmic assessment including refraction was performed. CCT was determined in each eye of the all patients using ultrasonic pachymeter. Five different reading were taken during morning time and average of it was considered. The correlation of CCT and the degree of myopia in dioptres (D) was identified by Pearson’s correlation coefficient and multiple comparisons Dunnett’s t test. Results: Mean age of patients 24.85 ± 1.41 in males and 24.61 ± 7.77 in females. Mean value of myopia was -5.70 ± 2.12 D and -5.87 ± 3.18 D in males and females respectively. Mean corneal thickness was 539.19 ± 42.42 μM in males while it was 531.46 ± 12.02 μM in females. The correlation between CCT and the degree of myopic spherical equivalent was statistically insignificant (r=20.13, p=0.72). The insignificant (p > 0.05) association was found between the CCT and myopia groups while CCT was divided in to two groups. Conclusion: There is no significant difference noted among myopic refractory error and CCT. There was no significant difference between CCT, which remains nearly same in all degree of myopic eyes. This is clinically irrelevant and it does not affect the management of patients.

Keywords: Pachymetry; Myopia; Central Corneal Thickness.

Introduction: Cataract is defined as any opacity in the crystalline lens of the eye that impairs vision. It can lead to clinically significant reduction in visual acuity, impaired contrast sensitivity, glare disability and monocular diplopia. PCO can be managed in two ways- Surgical capsulotomy and Nd : YAG laser capsulotomy. Aims: Visual outcome, IOP changes and Complications following Nd : YAG laser capsulotomy Materials and Methods: This is a prospective study of 104 patients, attending the regular out-patient department of Ophthalmology, conducted in Mamata General Hospital, Khammam, from November 2015 to September 2017. Results: Improvement of visual acuity was excellent with 80.77% improving more than 3 lines on the snellen's chart, 1 week after the procedure. There was significant difference in IOP before and 4 hours after the laser, but the IOP returned to pre-procedure value 24 hours after laser, since we used 0.5% timolol topical eye drops to blunt the intraocular pressure spikes. There are no cases of endophthalmitis reported in the present study. 95.2% of the patients improved by 3 lines and more. 4.81% of the patients showed improvement by 2 lines. Conclusion: Improvement in visual acuity is excellent post Nd : YAG laser capsulotomy. It is relatively non invasive and can be performed as an out-patient based procedure. This treatment modality is cost effective and relatively safe.

Keywords: Nd : YAG laser capsulotomy; Posterior capsular opacication; Surgical capsulotomy.