Ophthalmology and Allied Sciences

Purpose: To describe a case of non-arteritic anterior ischemic optic neuropathy (NA-AION) secondary to acute angle closure (AAC). Case Report: We present a case of 48 years old female who presented with painful diminution of vision in the OS. After examination of the anterior segment she was diagnosed of having an acute attack of primary angle closure glaucoma. On fundus examination OD was within physiological limits, OS the disc was edematous and pale with superficial haemorrhage at disc margin. Medical management and laser peripheral iridotomy relieved pain but did not improve vision. The visual fields showed superior altitudional field defect. Patient was not a known case of diabetes mellitus or hypertension. The patient was diagnosed with NA-AION secondary to acute angle closure glaucoma. Results: A 48-year-old woman presented with AAC with reduced visual acuity. Investigations revealed concurrent NA-AION with classical disc and visual field findings. Conclusion: NAAION secondary to AAC is a rare clinical entity that can result in severe vision loss. Thus, it is important to look beyond the angle in cases of acute angle closure glaucoma.

Keywords: NA-AION; ACC.

A 52 years old one eyed male presented with history of blurring of in right eye since 7 days which was rapidly progressing in onset and painless. Dilated fundoscopic examination of right eye showed pallid disc edema, venous dilation and a flame shaped superficial retinal hemorrhage in the peripapillary area with inferior altitudinal defect. Left eye was pthysical with no PL. On investigation patient was diagnosed to have diabetes mellitus with morbidly deranged metabolic status. This case was posed a diagnostic challenge as the clinical picture did not typically fit into the diagnosis of optic neuritis as the color vision was normal, RAPD could not be confirmed, disc showed pallid edema: AION was a differential diagnosis because of pallid edemaor the disc, peripapillary hemorrhage & altitudinal defect. The discovery of Diabetes mellitus on routine blood sugar estimation added Diabetic papillopathy to the list of differential diagnoses. However, it was the rapid therapeutic response with oral anti hypoglycemic agents in the form of improved vision & fileds that led to the incidental diagnosis of Diabetic papillopathy.

Keywords: Altitudinal defect; Anterior ischemic optic neuropathy Diabetic Papillopathy; Pallid edema, Pthysis, RAPD.

Aim: To analyze demography, clinical profile & histopathology of eyelid tumours treated in tertiary care Eye hospital in Central India. Study Design: Observational Study. Methodology: Retrospective analysis of 82 cases of lid tumour presented at tertiary Eye hospital from April 11 to 14. Cases analyzed for demography, location, marginal involvement, delay in presentation and histopathology. Results: There were 82 cases of lid tumour, 57 were benign and 25 malignant. Mean age of all cases 48.17 years; for benign 43.98 years & for malignant 57.72 years (p = 0.0023). Male: Female ratio for benign 3.4:1 & for malignant 2.1:1. Commonest location of benign tumour upper lid lateral half (31.58%). Mean delay in presentation for benign tumour 44.32 months (1–240 months) & malignancy 9.96 months (5–18 months) (p = 0.0125). Lid Margin involvement was in 18 (31.58%) in benign & in 24 (96%) in malignancy (p < 0.0001). 48% of malignant tumours were sebaceous gland carcinoma (SGC). Conclusion: Long standing ( > 1 year) mass on upper lid laterally, probably is benign. Surgeon treating malignant tumour (Central India) should have high index of suspicion for SGC.

Keywords: Epidemiological; Pathological; Eyelid & Tumour.

Aim: To study advantages of Ringer’s Lactate Solution (RL) instead of Hydroxypropyl Methylcellulose (HPMC) for Intra-ocular Lens (IOL) implantation in phacoemulsification. Methods: A prospective, randomized, interventional study was performed.100 patients of senile cataract were randomly divided in two groups; one in whom IOL was implanted in RL (ringer group) and one in which HPMC (visco group) was used. Results were evaluated on safety, efficacy, post-operative Intra-ocular pressure (IOP), reaction, endothelial cell count and surgical time. Result: Mean post-operative IOP at 6, 24 and 48 hours in ringer group was 16.02, 13.46 and 12.44 mm Hg respectively; and in visco group it was 22.24, 17.32 and 13.84 mm Hg respectively (p value < 0.0001; significant difference). Mean postoperative reaction at 24 and 48 hours in ringer group was 1.48 and 0.72 respectively; and in visco group it was 1.56 and 1.08 respectively (p < 0.0001). Mean endothelial cell loss in visco group was 143.56 and in ringer group it was 210.68 (p = 0.055). Mean surgical time in visco group was 6.01 ± 0.93 mins and in ringer group it was 5.08 ± 0.76 mins (p < 0.0001). Conclusion: IOL implantation in bag under RL is safe, less time consuming, without significant extra loss of endothelial cells, controls spikes of IOP with less post-operative reaction.

Keywords: Ringer Lactate; Viscoelastics; Phacoemulsification; Intra-Ocular Pressure; Anterior Chamber Reaction; Endothelial Cell Count, Ringer's Lactate solution.

Purpose: To evaluate the visual outcome in patients with hypermature cataracts after small incision cataract surgery. Materials and Methods: This study was conducted in the Department of Ophthalmology, Navodaya Medical Hospital, Raichur, from december 2017 to may 2018. In this study, evaluation of hundered patients with senile hypermature cataract after pre-operative assessment and investigations underwent small incision cataract surgery. Their surgical and post-operative complications were recorded. Their visual outcome was studied at post-operative day 1, 1 week and 6th week. Best corrected visual acuity was obtained at 6 weeks. Results: Total of hundered patients with 42 male and 58 female had small incision cataract surgery. 8 of the eyes had surgery complicated by posterior capsule rupture, vitreous loss, zonular dialysis. On first post-operative day most common complication noted was striate keratitis (39%). Best corrected visual acuity at 6 weeks was 6/18 in 58 (58%) patients. Conclusion: The intraoperative and post-operative complications rate is higher in hypermature cataracts. These complications can be reduced by early removal of cataract before it reaches the stage of hypermaturity. Small incision cataract surgery of hypermature cataract has good results after thorough pre-operative assessment and if performed with expertise.

Keywords: Capsulorrhexis; Hypermature cataract; Manual small incision cataract surgery

Introduction: A significant amount of visual disability and blindness is caused by corneal diseases. The cornea is the clear tissue covering the front of the eye. The vision is dramatically reduced or lost if the cornea becomes cloudy. This loss of vision is referred to as corneal blindness. Eye donation is an act of donating one’s eyes after his/her death. It is an act of charity, purely for the benefit of society and is totally voluntary. The aim of the study is to assess awareness regarding eye donation among medical students of Akash Institute of Medical Sciences and Research Centre, Bangalore. Materials and Methods: This cross sectional descriptive study was conducted in department of Ophthalmology, Akash Institute of Medical Sciences and Research Centre, Bangalore. A total of 150 undergraduate MBBS 2nd year students were assesses for their awareness on eye donation. Results: In this study, 45% students did not know that eyes should be enucleated within 6 hours of death. Lack of awareness on eye donation was the major reason (47%) for not donating eyes. 70% students did not know the correct place and contact for eye donation. Majority of the students reported that Medical Personal as the major source of information (32%) on eye donation. 51% did not know that Cornea is the part which is to be used for eye donation. 71% students did not know that a near relative of the donor should give consent for eye donation. 77% students did not know that anybody can donate eyes. Conclusion: Medical students should be exposed to information about eye donation from 1st year itself as they are the future Doctors. They should be trained to counsel and motivate the relatives of patients for eye donation. There is a need of an intervention in the academic activities to increase awareness in medical students regarding eye-donation.

Keywords: Corneal Blindness; Eye Donation; Knowledge; Medical Students.

Background: Homozygous sickle cell disease is prevalent in tribal population of South Gujarat. Aim: To determine prevalence of different ocular manifestations in pediatric patients with homozygous sickle cell disease in South Gujarat. Setting and Design: Cross sectional study at tertiary level government hospital and primary health centers. Methods: 125 children with homozygous sickle cell disease, who fulfilled the criteria were enrolled, were enrolled in the study during a period from December 2015 to June 2017. We collected data on demography, ocular history, hospitalization history and complete eye examination. We calculated systemic severity index. Statistical analysis used: We used SPSS version 20. p value ≤ 0.05 was considered to be statistically significant. Results: Majority of children were from age group 11–18 years (68.8%) and belonged to schedule tribe with almost equal gender distribution; M: F = 1:1.08. Ocular abnormalities were observed in 43 (34.4%) patients. Anterior segment presentations were: Conjuctival sign-21 (16.8%), Iris atrophy-1 (0.8%). Posterior segment signs were: Retinal venous tortuosity-25 (20%), High cup: Disc ratio-3 (2.4%), Vitreous hemorrhage (Grade 4 Proliferative Central Retinopathy) -4 patients (3.2%), Salmon patch hemorrhage-2 (1.6%), Angioid streaks-2 (1.6%), Drusen-1 (0.8%), Central retinal artery occlusion-1 (0.8%). Ocular manifestations were found to be statistically significant in patients with systemic severity index between 0.8- 1. Blindness was found in 4% cases. Conclusion: Mild ocular morbidities are found in children having homozygous sickle cell disease in most vulnerable communities of South Gujarat. Regular eye check-up is recommended in children having high systemic severity index for early diagnosis and treatment of potential blinding conditions.

Keywords: Homozygous sickle cell disease; Systemic severity index; Venous tortuosity; Conjuctival sickling sign; Vitreous hemorrhage.

Background: Of the glaucoma types primary open angle glaucoma is the most common type. People of Asian origin are more likely to have glaucoma when compared to those of African or European origin. In the last 10 to 15 years many population based studies have been conducted to understand the prevalence of glaucoma in the community. Aims: To understand the prevalence of primary open angle glaucoma among the patients attending our tertiary care center and correlation the disc cup ratio with the change in intra-ocular pressure. Materials and Methods: A cross sectional study was conducted in the department of ophthalmology in Narayana Medical College and Hospital, Nellore from the period of 2010 to 2012. Detailed clinical history and evaluation was done for all the patients and noted in the case record form. Intra-ocular pressure was measured by Goldmann Applanation Tonometry. Gonioscopy was done by Goldmann Three-mirror gonioscope. Statistical Analysis: All the qualitative data was expressed in percentages and quantative data was expressed in mean and standard deviation. Results and Conclusions: The mean age of the sample was 52.15 ± 3.45 years with male preponderance. The most common symptom was headache and diminished vision in the present study. The prevalence of the primary open angle glaucoma increased as the intra-ocular pressure increased. Disc cupping increased proportionately with increase in intra-ocular pressure, thus establishing progression of glaucoma with rise in IOP.

Keywords: POAG; Field defects; IOP; Disc: Cup ratio.

Purpose: Our study assesses the impact of injection ranibizumab on patients with wet ARMD. We take into account OCT parameters pre- and post- administration of injection ranibizumab. We then correlate the effects of these parameters with visual outcome in these patients. Methods: This was a prospective study of 40 eyes of 40 patients in DY Patil Hospital, Nerul, Navi Mumbai over a period of 1 year. All patients were treated with monthly intravitreal ranibizumab injections (0.5 mg/0.05 ml) for 3 months. Changes in foveal photoreceptor layer integrity, choroidal neovascular membrane, diameter, thickness, central macular thickness, subretinal fluid assessment was done by spectral domain OCT at every visit and correlated with final visual outcome. Results: It was observed that intravitreal injection ranibizumab has a significant effect on improvement in OCT parameters of these patients. Also, the patients who had significant improvement in OCT had improvement in visual acuity finally. Conclusion: Intravitreal ranibizumab is a good choice of treatment in wet ARMD patients. Improvements in OCT could be correlated with visual improvement in these patients.

Keywords: Age related macular degeneration; Choroidal neo-vascularization; Ranibizumab.

Purpose: A hospital-based survey was conducted in GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, to study epidemiology of glaucoma. Materials and Methods: Detailed history, ocular examination was done in all patients diagnosed with glaucoma. Intra-ocular pressure was measured by Perkins applanation tonometer. Visual acuity was checked using Snellen’s Chart. After dilating the pupil, the fundus was examined, glaucomatous changes in optic disc were noted diagrammatically. Visual field changes were noted from Humphrey perimetry. Gonioscopy was done by 4 mirror gonio lens to determine type of glaucoma. OCT was done for RNFL. Results: Total 1521 patients attending eye OPD of GCSMCH & RC were diagnosed and treated for glaucoma during the period of three years from May 2015 to April 2018 out of which only 161 patients were consistent throughout the study. Rest 1360 patients were lost to follow up. The maximum percentage of patients were between 45 and 60 years of age. Mean base line intra-ocular pressure was 22 mm Hg (SD = ± 0.20). Average cup-disc ratio was 0.6 (SD = ± 0.20). 111 patients (68.94%) were phakic and 50 patients (31.06%) were pseudophakic. POAG patients were 67 (41.61%), PACG patients were 52 (32.29%), PAC and PACS patients contributed to 22 (13.66%) and 20 (12.42%) respectively. 161 glaucoma patients who were primarily treated included 118 (73.29%) patients with medical treatment, 21 (13.04%) patients treated with laser and 14 (8.69%) patients managed surgically by trabeculectomy with mitomycin and 8 (4.96%) patients by cataract extraction following which the angles opened. During the course of our study, 106 number of patients required change of treatment out of which 75 (70.75%) patients were changed with medical line of treatment, 20 (18.87%) patients were changed to laser form of treatment and 11 patients (10.37%) were operated with trabeculectomy with mitomycin. Conclusion: Initiatives to increase public awareness and comprehensive eye examination by ophthalmologists are the key to reduce or eliminate undiagnosed glaucoma and also increase the compliance of the patients. The high non-compliance rate and high prevalance rate of change of treatment is also suggestive of requirement of close follow up and timely intervention to prevent blindness and morbidity related to glaucoma disease. The overall drop out rate was 89.41%. Also further study needs to be done for the reasons of high glaucoma drop out.

Keywords: Glaucoma; Intra-ocular pressure; Gonioscopy; Phakic; Pseudophakic.

Aim: To evaluate the effect of phacoemulsification and SICS on the endothelial cell count. Introduction: Cataract is an important and prevalent cause of blindness worldwide. Phacoemulsification and manual small incision cataract surgery are widely practiced today. Corneal transparency is maintained by a single layer of endothelial cells, which have the ability to pump out water from corneal stroma against an osmotic gradient. Some degree of corneal endothelial loss following surgery is expected. SICS requires a great deal of maneuvering and thus direct contact with the endothelium leads to cell loss. Cell loss in phacoemulsification is dependent on the anterior chamber depth, phaco energy and method used to emulsify the nucleus, and surgical skill. Materials and Methods: This is one-year observational follow-up study of 100 patients, who were divided into two groups. Group A had 50 patients who underwent phacoemulsification and Group B had 50 patients who underwent SICS. TOPCON specular microscope was used to record the endothelial cell count preoperatively, 7 days postoperatively, and 42 days postoperatively. Results: The mean endothelial cell loss at 1 week and 6 weeks after surgery was more in Group B (278 cells/mm2; 400 cells/mm2) compared to Group A (278 cells/mm2; 400 cells/mm2) respectively, but this difference was not statistically significant. p > 0.05. Conclusion: There was no statistically or clinically significant difference between phacoemulsification or SICS in terms of endothelial cell loss.

Keywords: Endothelial cell count, Phacoemulsification, SICS, Specular microscopy.