Introduction:To discuss possible factors responsible for ocular inertness without resulting in an inflammatory incitement is the objective of this case study.A 35-year-old female patient presented with visual loss in the right eye following an accidental stick injury at the workplace one year back.Previous medication history includes topical instillation of antibacterial and antifungal agents with cycloplegics that resulted in relief of redness and eye pain.The patient noticed painless progressive visual loss for the past year and is now reported to the outpatient ophthalmic department.The patient was diagnosed to have adherent leucoma that obscured underlying traumatic cataract with the presence of light perception and accurate light projection.Hyper reflective echoic reverberations noticed within the crystalline lens on B-scan ultrasonography suggesting a possible presence of an intra-lenticular foreign body that the egression of the foreign body was confirmed during cataract extraction particularly on performing hydro procedures and cortical cleanup.A provisional diagnosis of traumatic cataract with adherent leucoma was considered and accordingly managed by performing penetrating keratoplasty, cataract extraction and sulcus fixated intraocular lens implantation.Previously controlled infection with antimicrobial topical administration, crystalline lens response of embedding foreign body within opacified lens fibres, ocular, and systemic immunological response are some of the few plausible implications leading to its inertness.Hence, we recommend a B scan investigation in all cases of traumatic cataracts and corneal opacities to diagnose and to formulate action strategic plans for achieving good visual outcomes.
Introduction: Phacoemulsification surgery results in endothelial damage, which is permanent.Several studies have shown that Balanced Salt Solution (BSS) helps to preserve endothelium better than Ringer Lactate (RL) due to its superior composition.Aims & Objectives: To compare the effects of RL and BSS on the corneal endothelium following phacoemulsification cataract surgery.Methodology: 60 patients were randomly allocated into groups using an envelope system, to RL (n=29) and BSS (n=31).Following phacoemulsification, each patient underwent Central Corneal Thickness (CCT) evaluation by pachymetry at postop day 1, week 1 and week 6.Endothelial Cell Density (ECD), Co-efficient of variation of cells (COV), and Hexagonality of cells (HEX) were studied using specular microscopy at the post-op 6 week period.Results: There was no significant difference in the change in CCT between the RL and BSS groups at post-op day1 , week 1 and week 6 periods respectively (p>0.05).The mean decrease in endothelial cell density was 394.72 cells/mm2 (±189.04)and 337.96 cells/mm2 (±165.30) in the RL and BSS groups respectively (p=0.220).The change in COV was 0.21% (±.03.5) and 1.49 (±3.75) % in the RL and BSS groups ((p=0.081)and the change in hexagonality of cells was -2.62 % (±8.77) and -2.61% (±7.59) in the RL and BSS groups respectively.(p=0.997).There was no significant correlation between the change in ECD/COV/HEX/CCT with respect to effective phaco time/ phacoemulsification volume in either group.Conclusion: Both Ringer Lactate and Balanced salt solution were similar in their ability to protect the endothelium following phacoemulsification surgery.
Purpose: Retinal manifestations after a febrile illness irrespective of the etiology can be a common yet enigmatic presentation to an ophthalmologist.Detailed examination and timely diagnosis would go a long way in preventing visual loss in such cases.This study was undertaken to unravel the mystery of fever related retinitis, its clinical course and management.Methods: This was a retrospective study conducted from June 2016-17 in which medical records of 21 patients were collected.All patients had undergone detailed ocular examination that included best-corrected visual acuity (BCVA), color vision, pupillary reactions, anterior and posterior segment evaluation and fundus photography.Fundus Fluorescein Angiography (FFA) and Optical Coherence Tomography (OCT) were done on a need basis.Routine investigations and specific serology for viral diseases were done as and when required.Results: 37 eyes of 21 patients of whom 16 bilateral and 5 unilateral were studied.Most patients presented within1 month following febrileillness.4 patients were Mantoux positive (>20mm). 1 patient each had Dengue IgG and Chickungunya IgG positive respectively.Fundus examination revealed features of retinitis with single or multiple patches with exudation at macula; and all patients were given tapering dose of systemic steroids as per clinical response; specific treatment given as per the cause.Patients with unilateraldiseaseshowedan improvement invision to an average of 6/9 and bilateral cases to an average of 6/24 in the better eye. Conclusion:The clinical presentation and a favorable response to steroids, were strikingly similar in all cases despite the varied etiology.This study shows that inflammation probably may play a major role in the occurrence of retinal manifestations following an attack of febrile illness.
In modern day life, eyes are subjected to number of factors that include air pollution, unhygienic rubbing of eyes, eye cosmetics, contact lenses, preservatives in eye drops which all are potential risk factors for myriad of eyelid disorders like blepharitis, Meibomian Gland Disease (MGD), dry eyes, allergic conjunctivitis, infections etc. the course of which may even result in to sight threatening conditions if left untreated.These conditions can be prevented and controlled with proper eye hygiene practices that integrates eyelid cleansing and massage which are well accepted and recommended in management of many of these conditions.Lacrimal functional unit (LFU) that comprises of cornea, conjunctiva, lids, meibomian&lacrimal glands, and a neural network that connects them is cornerstone to a healthy ocular surface and healthy eyes.Dysfunction of any component of LFU leads to these eyelid conditions which form major burden in routine ophthalmic practice.Eyelids, being an integral part of LFU play very important function of not only protecting eyes in keeping out foreign bodies but also regularly spreading tears on the surface to keep it moist.Eyelid hygiene that integrates eyelid cleansing and massage is well accepted and recommended in management of many of these conditions.However, not much attention has been given to incorporate practice of regular eyelid hygiene in day to day life to help keep these conditions at bay.Thus, there needs to be better awareness to inculcate daily eye hygiene habits aided by products designed for eyelid cleansing that help in keeping lids clean for healthy eyes.
Purpose: To determine different types of surgical procedure and outcome done to treat ectropion.Methods: Retrospective, observational study from Jan 2017 to Dec 2019 was performed on consecutive patients undergone ectropion correction surgery.Follow up was done on day-one, one-week, one-month, three-months, six-months and one-year postoperatively.Single or combined procedure done was noted.Anatomic and functional success was reported.Potential complications were recorded.Results: Total 74 patients who fulfilled inclusion criteria, 45(60.81%)male and 29(39.19%)female, with the mean age of 59.82 ± 21.82 (range 11 -94).42(56.76%)had involutionalectropion, 14(18.92%)Paralytic, 17(22.97%)cicatricial and 1(1.35%) had Mechanical ectropion.Single or combined procedure -Lateral tarsal strip, Medial spindle, LIS, Lazy-T, Wedge resection, Tarsorrhaphy, 3-Snip Punctoplasty, scar release with FTSG were done to correct ectropion.Anatomic success was found in 6(8.11%), functional success in 6(8.11%) and both success in 62(83.78%).Undercorrection was found on paralytic ectropion cases in 10(13.50%).Recurrence was found on 6(8.10%).Conclusion: LTS was the most commonly done procedure.Single or combined procedure according to etiopathogenic cause gives good ectropion correction with patient satisfaction.
Current present-day cataract surgery evolves from a visual restoration to a refractive approach.Greater independence from glasses and improvement of the quality of life were provided after surgery with the appearance of multifocal intraocular lenses (MF-IOLs).Since its creation in the 1980s, MFIOLs has undergone various technical improvements, including trifocal implants and implants with extended depth of vision.Excellent results were achieved thorough pre-operative check, including the visual needs of the patients and the inherent eye anatomy.This analysis offers a broad overview of the various types of Mf-IOLs and rules for optimizing results through full preoperative screening and treatment postoperatively complications.
The eye is an essential visual organ for humans. To reduce the rate of cataracts and blindness in Indonesia, data on the leading causes of cataracts or blindness is critical. This study aimed to determine the role of diabetes mellitus in causing cataracts, especially posterior subcapsular cataracts that occur at the Pasuruan Eye Hospital. The sample used in this study was patients who went to the Pasuruan Eye Hospital from February 2020 to February 2021, experiencing posterior subcapsular cataracts or non-posterior subcapsular cataracts and have a history of diabetes mellitus or non-diabetes mellitus. The sampling technique used in this study is a consecutive sampling technique which is classified as non-probability sampling. The data obtained were then processed and analyzed using a crosssectional design and chi-square test using IBM SPSS 26 software to determine the proportion of data distribution and the relationship between diabetes mellitus and PSC cataracts. In this study, it is known that diabetes mellitus affects PSC cataracts by 39.1%.
Purpose: To investigate the long term results of patients underwent primary pterygium surgery with conjunctival transposition flap method.Material and Methods: Medical records of 27 patients who underwent pterygium surgery by conjuncival transposition flap were reviewed retrospectively.Patients age, gender, mean pterygium size, surgery time, postoperative complications, follow-up time and recurrence rate were evaluated.Results: Mean pterygium size was 2.8 mm, mean surgery time was 15.9 minutes.Mean follow-up time was 72 months (67-82 months).Only 1 case (%3.7) of recurrence was observed in our series.Conclusion: Conjunctival transposition flap technique in primary pterygium surgery is an effective method with low reccurence rate.
Importance: Cost effective way to resolve macular edema in few of the retinal conditions.Background: To evaluate the effect on vision with Posterior Subtenon Triamcinolone acetonide injection for macular edema in various retinal conditions.Design: Prospective type of interventional study.Participants: 60 eyes of 54 patients with macular edema secondary to various retinal conditions.Of 60 eyes,12 BRVO, 23 CSME, 10 CRVO, 3 vitritis, 12 neuroretinitis.Methods: Pre and post injection (of Posterior subtenon Triamcinolone), BCVA and IOP were evaluated at 1st week, 1 and 3 months.Results: The mean age-57.87yrs, 40 % were male and 60% were females.Pre injection Visual Acuity of <6/60 in 24, 6/60 -6/24 in 21 and 6/18 -6/6 in 15 patients.At least 2 line improvement in BCVA was noted in 28 eyes(46%) at the end of study in which 11(39%) BRVO, 3(10%) CRVO, 8(33%)CSME, 4(14%) neuroretinitis and 2(7%)vitritis.3 patients developed IOP of >21mmHg controlled medically.No other complications were observed.Conclusions: Posterior Subtenon Triamcinolone acetonide is a cost effective modality of treatment for macular edema associated with retinal conditions with minimal complications.
Depot steroid, Triamcinolone acetonide (TMA) has been widely used in many ophthalmic diseases and procedures.As intralesional injection in medical management of chalazion [16,17], as retobulbar injection in management of non responding dysthyroid proptosis [18], in management of diabetic macular oedema [19], for visualizing Vitreous during vitrectomy [20], and in treatment
Purpose: To assess the prescribing trends of topical antibiotics for acute infectious conjunctivitis among Ophthalmologists in India and to analyze whether they are using them appropriately or not.Design: Ophthalmologists from various states in India were surveyed by mail using a questionnaire on antibiotic use in acute infective conjunctivitis.Methods: Two hundred fifty ophthalmologists from different parts of India were given printed questionnaire via email.Only 75 responded to the mail.Results of categorical variables were recorded as counts and percentages.Result: The commonest indication for prescribing topical antibiotics was infective conjunctivitis.The most commonly prescribed topical antibiotic was moxifloxacin (65%).The frequency of instillation was 4 times a day by 66.6%.All 75 participants agreed that majority of the cases were viral.93.4% had the knowledge that majority of infective conjunctivitis are viral in origin and self limiting and that there is no need of antibiotic still then 84% would prescribe antibiotic in viral conjunctivitis.60% had the opinion that acute bacterial conjunctivitis are mild and resolve on their own without complications.But in spite of this knowledge 94.7% advised an antibiotic in cases of bacterial conjunctivitis.Wait and see policy was adopted by only 8% and 40% took time for patient education.Conclusion: Acute conjunctivitis is mainly viral in origin and self limiting and even among those with a bacterial cause, antibiotics are seldom required.Most of the ophthalmologist surveyed had this knowledge but there was knowledge action mismatch which may promote antibiotic resistance and increase medical costs.
Brief ReportChondroid syringoma is a rare mixed tumor accounting for only 0.01% of all primary skin tumors [1].Though it's very common occurrence is in head and the neck region, involvement of eyelids is extremely rare [2].These are usually a slowly growing, asymptomatic, solitary, non ulcerating masses ranging between 0.5cm and 3.0cm in size [2].Herein we report another rare case of chondroid syringoma of eyebrow in a young man.
1 Postgraduate Student, Department of Ophthalmology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India. 2 Professor, Department of Ophthalmology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India. 3 Assistant Professor, Department of Ophthalmology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India. 4 Postgraduate Student, Department of Ophthalmology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India. 5 Postgraduate Student, Department of Ophthalmology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India. 6 Postgraduate Student, Department of Ophthalmology, Hassan Institute of Medical Sciences, Hassan, Karnataka, India.
We report a rare complication of posterior scleritis in a 38 year old female, who presented with pain and blurring of vision.She was treated with systemic steroids over a period of 6 weeks with resolution of scleritis & improved vision.A year later she again presented with sudden drop in vision in the same eye and a fundus picture of active large choroidal neovascular membrane (CNVM) in the peri-papillary region extending to the fovea.This is a rarely reported complication, possibly due to structural changes in the choroid-bruch membrane complex secondary to posterior scleritis.
Objectives: To evaluate the magnitude of ocular manifestations in patients suffering from rheumatoid arthritis To establish a statistical significance of age of patients to duration of disease To establish a statistical significance of duration of disease to frequency of ocular manifestations Study Design: Cross sectional observational study. Sample Size: 144. Duration of Study: 18 months. Case control was not required in this study. Investigations: Slit lamp biomicroscopy with 90 D Volk lens was done for anterior and posterior segment examination. Gonioscopy, Applanation Tonometry, Automated Perimetry and Indirect Ophthalmoscopy were done. Dry eye evaluation was done. Statistical Analysis: SPSS version 20 was used with a p value of less than 0.05 taken as significant. Results: Out of 144 patients, females (118) dominated. Ocular manifestations were seen in 53(36.8%) patients, bilateral in 35 (66%) patients and multiple in 32 (60.4%) patients. Dry eye was the most common ocular manifestation (30.5%). The duration of disease was statistically significant (p=0.001) with respect to ocular manifestations and also age groups (p=0.000). Conclusion: Dry eye was the most common ocular manifestation. The duration of disease was statistically significant with respect to ocular manifestations. The duration of disease was statistically significant when co related with age groups. Ocular manifestations are common in Rheumatoid Arthritis and should be evaluated urgently. Earlier diagnosis of Rheumatoid Arthritis helps in reducing ocular morbidity and ophthalmologists should be trained to look for ocular as well as other extra articular manifestations in Rheumatoid Arthritis.
The main objective of this study was to investigate the long-term efficacy, predictability, stability and reliability of PRK applications in hyperopia patients by analyzing pre-op and post-op refraction values, visual acuity and possible post-operative complications. Methods Seventy-six eyes of 42 patients that received PRK treatment in AbstractObjective: To review the long-term efficacy, stability and reliability of photorefractive keratectomy (PRK) treatment in hyperopia patients and to assess the complications that may arise during the follow-up period.Materials and Methods: 76 eyes of 42 patients who underwent PRK treatment for hyperopia were included in this retrospective study.Patients were separated into two groups according to their spherical equivalent (SE) values.Both groups were analyzed and compared in terms of post-operative refraction and vision acuity, post-operative complications, keratometry values, stabilization period and the results of interventions for treatment.Results: Mean age of the patients was 33.97 ± 10.26 (18-51) years and the mean follow-up period was 27.16 ± 8.43 (6-39) months.Preoperative mean SE value was 1.64 ± 0.76D in group 1 and +4.45 ± 1.18D in group 2. In the last follow-up examination, those values were measured as +0.20 ± 1.01D and +1.56 ± 1.37D respectively.Uncorrected visual acuity (UCVA) of both groups were significantly higher in the last control in comparison with pre-PRK period (p=0.002 in group 1, p=0.001 in group 2).After 6 months, 92.5% of the eyes in group 1 and 85.6% of the eyes in group 2 were within ± 1.00 D range.Forty-seven (61.8%) eyes had no corneal haze meanwhile 15 (19.7%) had grade 1, 11(14.4%) had grade 2 and 3(3.9%) had grade 3 corneal haze.There was no difference in terms of haze formation between the groups (p=0.183). Conclusion:In long term, PRK treatment is an efficient, reliable and predictable method that can be used in correcting hyperopia.
We would like to report a rare case of Bardet Biedl Syndrome of a women forty-three years, known case of Retinitis pigmentosa presented for medical report, after ocular and systemic assessment we found she is obese, moon face, and has extra toes of both feet and some other finding which was diagnosed later on Bardet Biedl Syndrome.We documented this rare case for its important in clinical practice for regular systemic follow up and therefore, subsequently requiring management accordingly.
Need for the study: The most common cause of DCR failure is occlusion of the rhinostomy site by soft tissue, common canalicular obstruction, cicatricial ostium closure, formation of synechiae between the ostium and the middle turbinate or the septum, and AbstractAims: To study the effect of silicone tube intubation with and without mitomycin c in revision of external dacryocystorhinostomy following failed dacryocystorhinostomy (DCR) surgery.Settings and Design: A Retrospective study.Materials and Methods: A retrospective review of patients who underwent revision of external DCR between november 2012 and march 2015 at teaching institute.In this study 45 patients of failed DCR were included, 30 of them were endoscopic DCR, and 15 were External DCR.In this study mitomycin c (MMC) was applied in 20/45 patients and silicone tube intubation done in all 45 patients.The tube was removed at 3 months after surgery.Statistical Analysis: Statistical analysis was carried out using SPSS statistical software package (Version 16.0; SPSS).Results: At the last examination, 3 patients still had epiphora 6.67%, and their nasolacrimal passage was obstructed.42 patients had no complaints, and their lacrimal system was patent (93.33%). Conclusion:We concluded that revision of failed dcr surgery with silicone tube intubation and mitomycin c has good results.Mitomycin c can be used in selective cases in which excessive fibrosis and granulation tissue was found intraoperatively.
Wet age-related macular degeneration (wet AMD), a leading cause of vision loss globally, is a late-onset, multifactorial retinal degenerative disease. The characteristic features of wet AMD are neovascularization originating from the choroidal vasculature and spreading to the subretinal pigment epithelium or subretinal space, and increased intraretinal (IRF) or subretinal fluid (SRF) [1-4]. The increased choroidal neovascularization (CNV), IRF and SRF are associated with over expression of vascular endothelial growth factor (VEGF)-A, which promotes neovascularization and leakage leading to wet AMD [5, 6].
