Ophthalmology and Allied Sciences

Purpose: To compare Toric IOLs and Peripheral corneal relaxing incisions for correcting pre-operative astigmatism in eyes undergoing cataract surgery. Setting: M. D. Eye Hospital, Regional Institute of Ophthalmology, Prayagraj, India. Design: Prospective Observation study. Method: Eyes with astigmatism of ≥1.5 D undergoing cataract surgery either with the rule astigmatism (WTR) or against the rule astigmatism (ATR) confirmed by corneal topography between November 2018 to October 2019 were included in the study. The same surgeon performed phacoemulsification/SICS with PCRI to reduce pre-existing astigmatism. Result: In our study 35 eyes of 35 patients were included. 10 eyes of 10 patients underwent Toric IOL implant who had >2.00 D of astigmatism & 25 eyes of 25 patients had mild astigmatism and underwent SICS with PCRI. Patients were followed up regularly till 10 weeks. In Toric IOL implant group 90% patients of moderate to higher order astigmatism had BCVA in the range of 6/9–6/6. Eyes underwent SICS with PCRI 60% of the patients had BCVA 6/9-6/6. Only few patients required cylindrical glasses post-operatively. Conclusion: PCRI cannot be used for moderate to high astigmatism. Spectacle dependence of PCRI group was more than Toric IOL group. Although cost wise PCRI is better option over Toric IOL implant for correcting pre-operative astigmatism.

Keywords: With the Rule (WTR) astigmatism; Against the rule (ATR) astigmatism; Peripheral corneal relaxing incision (PCRI).
 

The type of incision is the major contributory factor to the postoperative astigmatism. Different incisions may cause different degrees of astigmatism. It becomes imperative to compare the SIA caused by the commonly used incisions like straight and frown incisions. Objectives: To evaluate and document the best corrected visual acuity and surgically induced astigmatism in patients undergoing manual small incision cataract surgery by straight incision and frown incision. To compare the surgically induced astigmatism following straight and frown incision. Materials and Methods: For this prospective study a total of 96 eyes fulfilling the inclusion criteria were selected and allotted into two groups by simple randomization technique. Group1 – 48 patients – underwent MSICS with straight incision. Group2 – 48 patients – underwent MSICS with frown incision. This study was conducted in the
department of ophthalmology at R. L. Jalappa Hospital and Research, Kolar attached to Sri Devaraj Urs Medical College, between January 2018 and May 2019. Post-operative visual acuity was assessed with Snellen’s chart. surgically induced astigmatism was calculated using SIA calculator version 2.1. Results: The uncorrected visual acuity of group 2 was better when compared to group 1. 13(27.1%) patients achieved postoperative emmetropia in straight incision group while 24 (50%) patients achieved post operative emmetropia in frown incision group. All
patients achieved a BCVA of ≥ 6/18. The mean magnitude of preoperative astigmatism in straight incision was 1.26± 0.92 D and in frown incision was 0.98 ± 0.83 D. The mean magnitude of postoperative astigmatism in straight incision was 1.52±1.17 D and in frown incision was 0.99 ± 0.82D and was found to be statistically significant, p=
0.012. The centroid of SIA for straight incision was 1.4x1° with a coherence of 90% and the centroid of SIA for frown incision was 0.62x2° with a coherence of 70%. Conclusion: The visual outcome of frown incision group was slightly better than the visual outcome in straight incision group. All patients achieved a BCVA ≥ 6/18. The difference in
visual acuity was not found to be statistically different. The SIA of straight incision was significantly more than that of frown incision. (p <0.001).

Keywords: SIA; SICS; Postoperative astigmatism; Straight incision; Frown incision; MSICS.
 

Purpose: To evaluate and document various ocular manifestations in patients with closed head injury and to evaluate and document the neurological status by Glasgow Coma Scale (GSC) score at the time of presentation and to compare the association between them. Materials and Methods: A prospective study was undertaken which included a total of 85 patients of ocular trauma. Conscious status was assessed using Glasgow coma scale. Thorough examination of anterior segment, posterior segment, extraocular movements, visual acuity and investigations were carried out for all patients. Results: The highest incidence of head injuries was in the age group of 21 to 30 years.
There were 60 males and 25 females. The mean age for males was 34.14 ± 14.4 and the mean age for females was 45.43±12.44. In this study, 4.70 % cases of severe head injury cases had posterior segment manifestations. And 3 patients with pupillary abnormalities, i.e 3.52%. And 1.17% patients had traumatic optic neuropathy manifestations.
During follow up visits, there was improvement in ocular manifestations and GSC score. Conclusion: In severe head injury (GCS 3–8), it is important to look for posterior segment findings and neuro-ophthalmic manifestations. A detailed ocular assessment during the first presentation in all cases of head injury patients is mandatory as it helps
in better management and the final outcome could be improved with better diagnosis and management.

Keywords: Closed head injury; Ocular manifestations; GCS score.
 

Introduction: Eye emergencies may range from trivial trauma to sight threatening complications. The number of patients seen in an emergency department, after working hours, has been increasing in the recent times. Ophthalmic inpatient, outpatient, surgical and emergency services in a tertiary care hospital are available round the clock which may be sought for screening, diagnosis and management of ophthalmic & systemic conditions of varied manifestation. Information regarding the profile of ocular emergency reference in each setting is important for strategic planning of efficient service allocation. The aim of this study was to investigate the profile of cases that were referred for emergency ophthalmic consultation: in a tertiary care centre in Kolar, with an effort to identify the true ophthalmic emergencies. Materials and Methods: A retrospective study was conducted over a period of one year, from December 2017 to November 2018 and the data of 1842 was collected from the emergency register of the department of Ophthalmology. Results: This study was conducted among 1842 subjects. Majority
of them were men. The most common presenting age group was in between 21–30 years. Most of the referrals were due to hypertension followed by diabetes. Just 2.9% of the subjects presented with pure ocular complaints, with non-infectious conditions forming a majority. Of those patients presenting with trauma, RTA was the most common cause. Conclusion: In conclusion, the ophthalmologist plays a pivotal role in diagnosing the severity of non-emergency conditions like diabetes, hypertension and papilledema, PIH when referred in a tertiary health care centre. A dedicated ophthalmic emergency care team should be competent to manage primary ophthalmic emergencies, be a part of the emergency trauma team and interdisciplinary health care delivery system

Keywords:  Emergency Ophthalmic Consultation.
 

Background: Pterygium is an abnormal fibrovascular subconjuctival tissue that encroaches upon the cornea causing visual disturbances. Surgical removal is the treatment of choice for pterygium. Aim: To compare the recurrence rate of pterygium in Bare sclera vs Limbal conjunctival autografting and to study the underlying risk factors associated. Materials and Methods: It is a prospective study conducted at Department of ophthalmology, Nalgonda Government Medical College, Nalgonda. Patients who presented with primary pterygium were grouped into 2 categories. Group 1 underwent baresclera technique. Group 2 underwent conjuctival autografting and were followed up for a period of 1 year. Result: In Group 1 showed recurrence rate of 30.50% (18 patients) as compared to Group 2 which showed recurrence rate o f 3.21% across all age groups. Males have recurrence rate of 39.02% (16
patients) in group 1 as compared to 2.43% (1 patient) in group 2. People employed outdoor have recurrence rate of 40.90% (18 patients) in group 1 as compared to 2.27% (1 patient) in group 2. Nasal pterygium has recurrencr rate of 36.8% (14 patients) in group 1 as compared to 2.63% (1 patient) in group 2. Mean recurrence rate was higher in Group 1 (34.66%) as compared to Group 2 (2.53%). Conclusion: Limbal conjunctival autografting is a safe effective procedure for pterygium surgery with lower recurrence rate.

Keywords: Pterygium; Recurrence; Conjunctival autograft; Bare sclera.
 

Introduction: With the increasing use of technology for virtual classrooms, students are exposed to more of screen time be it computers or any Visual Display Terminals (VDT). This has resulted in a serious health issue known as Computer Vision Syndrome(CVS). Computer vision syndrome also referred to as digital eye strain is a condition in which a person experiences diverse set of ocular symptoms as a result of prolonged working on computer or any VDT’s.1 Objectives: This study was designed to evaluate the prevalence of CVS, the associated risk factors and awareness about the condition among the students of engineering college in north bangalore. Materials and Methods: a cross-sectional non interventional questionnaire based study was conducted among engineering students from may 2019 to oct 2019. Data was collected regarding the demography, use of spectacles/contact lens, duration of computer use, hours on computer per day, symptoms of CVS, awareness about CVS. Results: A total of 1000 students were enrolled for this study. The prevalence of CVS was found to be 82.3%. The most prevalent symptom was eye strain followed by headache. Significant association was found between increased hours of computer use and the prevalence of CVS (p<0.01). Though majority of students (76%) were aware of CVS only 24% of them were aware of the correct ergonomics. Conclusion: Extensive use of computers for work and recreational purposes is associated with an alarmingly high incidence of serious visual and other health problems. Clear and correct guidelines are needed to mitigate and reduce this health issue. Keeping this in mind, the health and educational professionals should pay considerable attention to CVS and adopt preventive measures to tackle this global health problem.

Keywords: Computer Vision Syndrome; Digital Eye Strain; VDT(Visual Display Terminal).
 

Aim: To assess the CCT and its relationship with cup disc ratio and RNFL thickness in POAG and PACG patients. Design: Prospective observational study. Material and Method: This study was carried out at the Regional Institute of M.L.N. Medical College and Hospital Prayagraj from December 2018 to November 2019. A total of 43 eyes, 17(29 eyes) patients of POAG , 8 (14 eyes) patients of PACG included. Measurement of CCT done by Specular Microscope and (RNFL) thickness evaluated by OCT. Results: In thinner cornea group (450–500 μm) CCT is more positively correlated with RNFL thickness in both PACG (r = 0.420) and PAOG (r = 0.451) patients. CCT and CD ratio was more negatively correlated in PACG patient (r = –0.652) for vertical and (r = –0.907) for horizontal CD ratio than in PAOG patients (vertical CD ratio r = –0.018 and horizontal r = –0.022). In thicker cornea group i.e.
501–550 μm average RNFL thickness was more positively correlated with the CCT variation in POAG (r = 0.448) than in PACG (r = 0.219 ). CCT was more negative correlated with cup disc ratio in PAOG group (r = –0.447) than in PACG group (r = –0.104 ) of patients. Conclusion: In thinner cornea group (450–500 μm) there is a definite positive correlation between CCT and RNFL thickness. Both average and quadrantric RNFL thickness was more pronounced in PACG Group as compared to POAG group. However in thicker Cornea (501–550μm) group CCT is more positively correlated with RNFL loss in POAG as compared to PACG group. Also POAG group exhibited more rapid increase in cup disc ratio with thinning of cornea.

Keywords: (CCT) Central corneal thickness; (RNFL) Retinal nerve fiber layer; (POAG) Primary open angle glaucoma; (PACG) Primary angle closer glaucoma.