Ophthalmology and Allied Sciences

Context: Comparison of characteristics of macular edema and BCVA in STBRVO and ITBRVO and their response to therapy. Settings and design: Institutional setting, Observational study design. Methods and material: 77 eyes of 77 patients of BRVO who met the inclusion criteria were studied for central macular thickness and BCVA both prior to and after Anti-VEGF therapy. Results: Mean BCVA in ST BRVO pre-injection in LogMAR was 1.0093 units and post-injection was 0.50 in cases of IT BRVO it was 0.874 and 0.421 respectively. Commensurate reduction in
CMT occurred in both STBRVO and IT BRVO of 216.87 microns and 232.81 microns. Conclusion: Both are similar in clinical behavior and response to Anti-VEGFs.

Keywords: ST BRVO; IT BRVO; Anti-VEGFs; Central macular thickness.
 

Aim: To determine the role of early vitrectomy versus intravitreal antibiotic injection in patients with postoperative endophthalmitis. Design: Randomized, prospective study. Material and methods: A total of 20 patients who had clinical evidence of endophthalmitis within 6 weeks after cataract surgery were included in the study. Patients
were randomized into two groups. In Group A (n = 7) patients underwent core vitrectomy along with intravitreal antibiotics injection within 48 hours of presentation while in Group B (n = 13) patients received intavitreal antibiotic injection only. Results: In Group A (n = 7), all the patients had improvement in visual acuity. Out of total 7 patients,
5 (71.42%) patients achieved visual acuity of 6/60 or better, while in Group B (n = 13), 5 (38.46%) patients had improvement in visual acuity, 3 (30.76%) patients did not show any improvement or worsening and 5 (38.46%) patients had worsening of initial visual acuity. The media clarity improved significantly in all the patients of Group A (n = 7), in which 6 (85.71%) patients achieved the media clarity of Grade 1, while in Group B (n = 13) 6 (46.15%) patients achieved media clarity of Grade 1 and 2 (15.38%) patients did not have any improvement in media clarity during the follow-up period of 3 months. The complications were more in Group B as 2 (15.38%) patients developed retinal detachment, 1 (7.69%) patient had phthisis and 1(7.69%) patient worsened to panophthalmitis while in Group A only 1 (14.28%) patient developed retinal detachment 2 months after the vitrectomy. Conclusion: Early
vitrectomy when done within 48 hours greatly improves visual acuity and media clarity when compared with intravitreal antibiotics injection alone.
Keywords: Postoperative endophthalmitis; Early vitrectomy and intravitreal antibiotics.

Aim: To evaluate the association of stress with serum cortisol and serum homocysteine levels in patients of CSCR and comparison with age matched controls. Study design: Prospective observational, single centre study. Materials and methods: We have evaluated stress score, serum cortisol and serum homocysteine levels in 35 patients
(33 males and 2 females) of CSCR with the mean age of 33.14 ± 6.78 years and 35 age and sex matched controls.Pearson correlation coefficient (r) was calculated to correlate the stress score with levels of serum cortisol and serum homocysteine in both cases and controls. Results: Mean stress score in cases and controls were 13.11 ± 5.58 and 6.91 ± 4.30 respectively (p < 0.0001). Mean morning serum cortisol levels in patients of CSCR and controls were 12.88 ±
4.95 & 11.12 ± 3.39 (p = 0.0872) respectively and mean evening serum cortisol levels in patients of CSCR and controls were 11.10 ± 4.16 & 8.03 ± 1.94 respectively (p = 0.0002). Mean serum homocysteine levels in patients of CSCR and controls were 26.17 ± 11.52 and 13.06 ± 3.19 respectively (p < 0.0001). Stress score of CSCR patients found to be
weakly correlated with morning and evening levels of serum cortisol (r = 0.058, 0.084 respectively) and strongly correlated with serum homocysteine levels (r = 0.864). There was no correlation between the levels of serum cortisol and serum homocysteine with the severity and duration of CSCR. Conclusion: CSCR is a multifactorial disorder and
raised levels of stress, serum cortisol and serum homocysteine play a pivotal role in the pathogenesis.

Objectives: To reduce the risk of intraoperative complications by using currently available surgical devices. Methods: In a study conducted at a tertiary care hospital, 25 patients with pseudoexfoliation syndrome underwent cataract surgery. Preoperative visual acuity, refraction, slit lamp biomicroscopy, intraocular pressure measurement and fundus examination of all patients was done. From the preoperative planning, to the intraoperative management of the small pupil and phacodenesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated. Result: A planned approach to cataract surgery using the advanced techniques of phacoemulsification, specific ophthalmic viscosurgical devicess, and capsule support devices significantly reduces the risk of complications during cataract surgery in patients with pseudoexfoliation syndrome. Conclusion: Cataract surgery in settings of pseudoexfoliation syndrome carries a significant risk of complications in the form of capsule rupture, vitreous loss, nucleus luxation, and IOL dislocation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc.), the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. Postoperative surveillance is required
to monitor and treat postoperative intraocular pressure, anterior chamber inflammation, IOL decentration, and cystoid macular edema.
Keywords: Pseudoexfoliation syndrome; Phacoemulsification; Iris retractors; IOL dislocation.

Background: Primary open angle glaucoma is distinctly a multifactorial optic neuropathy that is chronic and progressive with characteristic acquired loss of optic nerve fibers. Aims: Recognizing field defects and disk changes among the patients with primary angle glaucoma. Settings and design: 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. Materials and methods: Detailed clinical history and evaluation was done for all the patients and noted in the case record form. Intraocular pressure was measured by Goldmann Applanation Tonometry. Gonioscopy was done by Goldmann Three mirror gonioscope. Disk evaluation was done by both direct ophthalmoscopy and slit lamp biomicroscopy using 78D and 90D lenses. Visual field examination by Humphreys automated field analyzer ii –i series standard white on white perimetry, SITA strategy. 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 study subjects was 4.43 ± 53.34 years with male preponderance. The most common field defect found was biarcuate scotoma. The most common disk change in the present study was advance cupping with total loss of NRR followed by Inferior NRR thinning and superior NRR thinning.
Keywords: POAG; Field defects; Glaucoma.

Aim: The aim of this study was to evaluate clinical and epidemiological profile of traumatic cataract at our hospital setting. Methods: This was a retrospective study which enrolled all the patients diagnosed with traumatic cataract and operated at SGRRIM & HS, Dehradun between January 2015 and December 2018. Preoperative data was recorded in terms of age, sex, time of presentation of the patient, type of trauma, morphology of cataract, preoperative vision and associated anterior and posterior segment ocular injuries. Postoperative data included
uncorrected visual acuity (UCVA) at day one and best corrected visual acuity (BCVA) at 6 weeks. Statistical analysis used was SSPV software. Results: Majority of patients were males (74%), between 16 and 30 years of age group (39.6%) and penetrating trauma (58%) was more common than blunt trauma. Road side accidents (41%) was the
commonest mode of injury followed by domestic violence (34%) and least was industrial trauma. (25%) Most of the patients operated had intraocular lens (IOL) implantation and only 11.3% were left aphakic. Postoperative BCVA at 6 weeks was in range of 6/60 to 6/24 in majority (47.16%) of cases while 39.62% of patients had better (6/18–6/6) visual outcome. Corneoscleral perforation was the most common comorbidity. (43.4%) Retinal detachment(RD), traumatic optic neuropathy (TON) and endophthalmitis were the main causes of poor visual outcome seen in
13.22% of cases. Conclusion: Our study has shown that main cause of traumatic cataract was road side accidents in younger age group predominantly males which could have been minimized by general public awareness of traffic rules, use of helmets and avoiding drunken driving.
Keywords Traumatic cataract; Visual outcome; Penetrating trauma.

Chronic dacryocystitis is an inflammatory process of the lacrimal sac associated with total or partial occlusion of the Nasolacrimal duct and is the most common cause of ocular morbidity accounting for 87.1% of epihora. Dacryocystitis is having a higher incidence among lower socioeconomic status and causes ocular morbidity. Ever since the description of this procedure by Toti in 1905, External dacryocystorhinostomy (DCR) became the gold standard and economical surgical procedure with excellent results compared to other surgical procedures. Whether to do a single flap or double flap technique during external DCR for chronic dacryocystitis depended
on patho-anatomy and the surgeon preferences aiming the best outcome. There is a limited number of studies on this clinical problem in Andhra Pradesh and other states of India in Government institutions. Ambiguity still remains, regarding repair of anterior flap alone or double flap technique of external DCR. In view of that, we have taken up the studies at a tertiary eye care center in Andhra Pradesh. Aims: To assess and compare the outcome of the single flap and double flap techniques of External Dacrocystorhinostomy (DCR) in chronic dacryocystitis.
Settings and Design: A prospective interventional study has been done at the Department of Ophthalmology Sri Ram Narayan Ruia Government General Hospital (SVRRGGH) attached to Sri Venkateswara Medical College (SVMC), Tirupati between October 2015 and October 2018 to evaluate the results of external DCR for chronic dacryocystitis. A comparative study between two methods of performing external DCR is also included in this study, i.e. single flap technique and double flap technique. The outcome is considered as surgical success when there is anatomical and functional patency of the lacrimal drainage system until the end of the follow-up period, i.e. six months. The study was approved by the ethics committee of the Institution. Methods and material: A prospective randomized interventional study conducted. A total of 50 cases with chronic dacryocystitis were undergone. External DCR in this study, fulfilling the inclusion criteria. Patients who underwent single flap surgery were placed in Group A, and those with double flap in Group B and results were analyzed. Statistical analysis used: SPSS 13. Results: A total of 50 cases of
External DCR were performed in this study. Patients who underwent single flap surgery were placed in Group A, and those with double flap in Group B Age of patients was in the range of 21–70 years with a mean age of 43.15 years and 43.13 years respectively with a female preponderance. Anatomical patency is tested by syringing. Functional
patency is assessed by Munk’s score. As per the criteria of surgical success, 24 operations in Group ‘A’ which were done by a single flap technique, were successful with a success rate of 96%. And in ‘B’, the double flap surgery group all 25 operations were successful, giving a 100% success rate. Bleeding of more than usually expected occurred in 6 patients during surgery. Peri-orbital ecchymosis was seen in 5 patients in total, 2 in single flap and 3 in the double flap. Epistaxis observed in one case each in group A and B. Conclusions: Our study compared single flap vs double flap surgery in external DCR among patients with chronic dacryocystitis. Both single flap and double flap techniques
of External DCR are effective methods of treating epiphora due to chronic dacryocystitis. The single flap technique is easier to perform and resulted in functional outcome. There is no statistical significance between surgical outcomes of the single flap and double flap techniques of external DCR. The double flap technique showed a higher success
rate. Results of both single flap technique and double flap technique in this study are comparable with other studies.
Keywords: Dacryocystitis; Dacryocystorhinostomy (DCR); Munk’s Score; Nasolacrimal duct obstruction
(NLDO); Fluoresceine dye disappearance test (FDDT).

Aim: To evaluate the surgical outcome of Suture free, Glue free, Conjunctival Autograft (SFGF-CAG) after Pterygium Excision. Design: Postoperative, Interventional, Hospital based study. Materials and methods: 45 eyes of 45 patients with primary Pterygium were graded and excision was performed by a single surgeon. To prevent recurrence, inferotemporal or inferior quadrant graft from the same eye and bare sclera was covered without the use of suture or fibrin glue, allowing natural autologous coagulation of the recipient bed to act as a bioadhesive. The eye was patched for 24 hours. Postoperatively patients were put on topical eyedrops moxifloxacin 0.5%, loteprednol
etabonate. 50% and Carboxymethyl cellulose 1% for 6 weeks. The outcome was assessed in terms of recurrence, complications and operative time at each follow-up visit on days 1,7,15,30,150 and 180. Results: There were 27 females and 18 males. The mean age of all patients was 36.2 ± 11 years. Range 18–60 years. Cosmetic blemish was the main indicator for surgery. Recurrence occurred in 1 and graft-related complications in 1 eye (Graft dehiscence). Re-surgery was required in 1 eye as the other deferred surgery. No other complication was noted. Average time of surgery was 16 ± 2 mins. Conclusion: The recurrence, complication rate and operative time of SFGF CAG was seen to be comparable with the current techniques in practice.
Keywords: Complications; Pterygium; Recurrence; SFG-CAG.

Purpose: A severity of diabetic retinopathy is well to have a close association with duration of diabetes mellitus, appropriate examinations to eliminate the possibility of diabetic retinopathy is much needed. Therefore, this study is to estimate the prevalence of diabetic retinopathy in recently diagnosed Type 2 diabetes mellitus patients. Methods: This was a hospital based study conducted in the department of ophthalmology. A total of 200 eyes of 100 newly diagnosed diabetic patients underwent detailed ocular examination for diabetic retinopathy. Early Treatment for Diabetic Retinopathy Study (ETDRS) classification of diabetic retinopathy was followed to categorize the severity
of retinopathy. Results: Overall prevalence of diabetic retinopathy was found to be 18%, which includes 77.7% of mild, 16.6% of moderate, 5.5% of severe and no advanced diabetic retinopathy cases. Conclusion: Our study support the strong co-relation of diabetic retinopathy with duration of diabetes mellitus, our study also created awareness among the patients about DR who were evaluated during the course of the study.
Keywords: Diabetic retinopathy; Early Treatment for Diabetic Retinopathy Study (ETDRS); Type 2 Diabetes Mellitus.