To study the Scheimpflug’s imaging and corneal biomechanics in primary pterygium.

In the present analysis, we aim at probing into many important mechanisms that serve to bridge conceptual gaps to fill up the mosaic of a picture revealing that glaucoma indeed is brain specific diabetes and more appropriately "Diabetes Type 4". Based on this conceptual substance, we weave a novel idea of insulin being a potential remedy for glaucoma. This analysis synthesizes upon the published literature on brain changes in glaucoma, possibility of isolated brain diabetes, insulin signaling glitches in glaucoma pathology, mitochondrial dysfunction and insulin resistance in glaucomatous eyes, insulin mediated regulation of intraocular pressure and its dysregulation in mitochondrial dysfunction. We also look into the role of amyloidopathy and taupathy in glaucoma pathogenesis vis-à-vis insulin signaling. At every step, the discussion reveals that insulin and other allied moieties are a sure promise for glaucoma treatment and management. In this article, we aim at synthesizing a persuasive and all inclusive picture of glaucoma etiopathomechanism centered on "insulin-hypofunctionality" in the central nervous system (i.e. brain specific diabetes). We start with considering the possibility of neurodegenerative diabetes that exists independent of the peripheral diabetes. Once that condition is met, then a metabolic conglomeration of this brain specific diabetes is deliberated upon leading us to understand the development of retinal ganglion cell apoptosis, intraocular pressure elevation, optic cupping and mitochondrial dysfunction. All these are the hallmarks and sufficient conditions to satisfy the diagnostic criteria for glaucoma. Immediate application of this analysis points towards glaucoma therapy centered upon improving what we have termed insulin-hypofunctionality.

To evaluate changes in ocular surface and central corneal sub-basal nerve fiber layer (SBNFL) after topical cyclosporin therapy in chronic glaucoma patients on long-term topical antiglaucoma therapy. A prospective comparative study of ocular surface evaluation of chronic glaucoma patients on long-term topical therapy treated concurrently with a topical cyclosporine 0.05% twice daily for 6 months and controls was done. The study parameters evaluated at recruitment and at the 6-month follow-up included details of topical antiglaucoma medications, visual acuity, intraocular pressure, ocular surface evaluation parameters (TBUT, Schirmers I, ocular surface staining scores and ocular surface disease (OSD) index score (OSDI)), central corneal sensation (Cochet Bonnett aesthesiometer), and central confocal microscopy to study the SBNFL density (SBNFLD). Thirty-two eyes of 16 patients with chronic glaucoma and 30 eyes of 15 normal subjects as controls were studied. Mean TBUT, pre/post CsA treatment was 8.67±3.01/12.24±1.83 s (P=0.007). Mean conjunctival/corneal staining scores pre/post CsA treatment were 3.38±1.93/1.50±0.718 (P=0.00) /5.19±1.82/1.81±0.78 (P=0.098), respectively. Mean OSDI pre/post CsA treatment scores were 30.63±14.61/14.76±6.06 (P=0.007). Mean corneal sensations scores pre/post CsA treatment were 4.64±0.46/4.94±0.39 (P=0.002). Central corneal SBNFLD pre and post CsA treatment was 8811.35±2985.29/10335.13±4092.064 μm/mm2 (P=0.0001). Schirmer’s test, ocular surface staining scores, OSDI, corneal sensations, and corneal SBNFLD showed a statistically significant improvement following a 6-month concurrent topical CsA therapy.

Blebitis with scleral abscess in a case of operated trabeculectomy with mitomycin C and a subcunjunctival ologen implant

INTRODUCTION Myopia presents a significant challenge to the ophthalmologist as myopic discs are often large, tilted, with deep cups and have a thinner neuroretinal rim all of which may mimic glaucomatous optic nerve head changes causing an error in diagnosis. OBJECTIVE To evaluate the retinal fiber layer (RNFL) thickness in low, moderate and high myopia using scanning laser polarimetry with variable corneal compensation (GDxVCC). SUBJECTS AND METHODS One hundred eyes of 100 emmetropes, 30 eyes of low myopes (0 to - 4 D spherical equivalent(SE), 45 eyes with moderate myopia (- 4 to - 8D SE), and 30 eyes with high myopia (- 8 to - 15D SE) were subjected to retinal nerve fiber layer assessment using the scanning laser polarimetry (GDxVCC) in all subjects using the standard protocol. Subjects with IOP > 21 mm Hg, optic nerve head or visual field changes suggestive of glaucoma were excluded from the study. The major outcome parameters were temporal-superior-nasal-inferiortemporal (TSNIT) average, the superior and inferior average and the nerve fibre indicator (NFI). RESULTS The TSNIT average (p = 0.009), superior (p = 0.001) and inferior average (p = 0.008) were significantly lower; the NFI was higher (P less than 0.001) in moderate myopes as compared to that in emmetropes. In high myopia the RNFL showed supranormal values; the TSNIT average, superior and inferior average was significantly higher(p less than 0.001) as compared to that in emmetropes. CONCLUSION The RNFL measurements on scanning laser polarimetry are affected by the myopic refractive error. Moderate myopes show a significant thinning of the RNFL. In high myopia due to peripapillary chorioretinal atrophy and contribution of scleral birefringence, the RNFL values are abnormally high. These findings need to be taken into account while assessing and monitoring glaucoma damage in moderate to high myopes on GDxVCC.

Background: Spinocerebellar ataxia (SCA7) is characterized by neuro-ophthalmic degeneration and occurs due to CAG repeat expansion in exon 3 of ATXN7 in the region of chromosome 3p12-p21.1. The SCA7 mutation has been identified in various ethnic and geographical regions with highest prevalence in South Africa and in the /INS;Scandinavian region.

AIM:To evaluate the technique of eye drop instillation in glaucoma patients.METHODS:Seventy patients with primary open-angle glaucoma or primary angle-closure glaucoma, self-administering topical antiglaucoma medications for at least 6 months were evaluated. All patients instilled a tear substitute in 1 eye using the same technique they used for instilling antiglaucoma medications at home. The parameters that were recorded included time taken to instill the first drop, number of eye drops instilled, drop contact location, any contact with the tip of the bottle, and closure of the eyelids or tear duct after drop instillation.RESULTS:The mean age of the patients was 54.1±10.0 years. The mean time taken to instill the first drop was 14.8±3.7 seconds (range, 8.7 to 23.5 s). The mean number of drops squeezed from the bottle per instillation was 1.8±1.2 drops (range, 1 to 8 drops). In 22 patients (31.43%), the eye drops fell on the eyelids or cheek. Fifty-three patients (75.7%) touched the tip of the bottle to the globe or periocular tissue. Twenty patients (28.57%) closed eyes after instilling drops and 4 patients (5.7%) occluded the punctum. Only 6 patients (8.57%) were able to correctly instill the eye drops (squeeze out 1 drop and instill it into the conjunctival sac without bottle tip contact).CONCLUSIONS:Nearly, 9 of 10 glaucoma patients were unable to instill eye drops correctly. This may be an important cause of unintentional noncompliance in glaucoma medical therapy.

Background: Corneal endothelial damage is a known complication of aqueous shunt surgery. Objective: To describe a new technique for repositioning the Ahmed glaucoma valve tube in a case of tube-endothelial touch. Case: A patient with advanced glaucoma, having undergone Ahmed glaucoma valve (AVG) implantation, developed localized corneal endothelial damage due to contact between the tube and superior corneal endothelium. Two 10-0 prolene anchor sutures were passed over the tube in the anterior chamber, repositioning it away from the endothelium, thus preventing further damage to the corneal endothelium. Resolution of corneal oedema was noted without affecting the tube drainage and intraocular pressure. Conclusion: Intracameral repositioning of the shunt tube using prolene sutures is a useful technique for correcting the tube malposition.

Objective: To evaluate the intra-operative difficulties and postoperative visual outcome following phacoemulisification and intraocular lens (IOL) implantation in eyes with cataract and a coexisting corneal opacity partially obscuring the pupillary area.Materials and methods: The study included 205 eyes of 205 patients with cataract, an extensive corneal opacity partially obscuring the pupillary area and a corrected distance visual acuity (CDVA) of less than 40/200 who had undergone phacoemulisification with IOL implantation by a single surgeon. The patients were followed up on day 1, day 7, 1 month and 3 months postoperatively. Intra-operative and post operative course and CDVA were evaluated.Results: Seventy nine percent of the patients underwent phaco-emulsification via superior clear corneal approach while the rest were operated via temporal clear corneal approach. Trypan blue (0.06%) dye assisted capsulorrhexis was successfully completed in all eyes with additional maneuvers including posterior synechiolysis and sphincterotomy. Nucleotomy with primary chop technique and phacoemulsification were performed uneventfully in all but one eye, which was converted to an extra capsular cataract extraction (ECCE). A foldable intraocular lens was implanted in 76 eyes, rigid IOL in 128 eyes and 1 eye was left aphakic. The pre-operative CDVA of less than 40/200 improved to 20/60 at the end of 3 months follow up.Conclusions: Phacoemulsification and intraocular lens implantation provides ambulatory and useful vision in eyes with coexisting cataract and corneal opacity.

OBJECTIVE:To report the use of trypan blue staining of the filtering bleb to assess its functional status in eyes undergoing phacoemulsification after trabeculectomy. SUBJECTS AND METHODS:This retrospective study was conducted at a tertiary eye care centre in North India and studied 33 eyes of 33 patients ( with previously operated trabeculectomy), who underwent phacoemulsification. Trypan blue dye (0.06%) was used to stain the anterior capsule. After completion of phacoemulsification, the staining of the trabeculectomy bleb was noted as diffuse, patchy, minimal or no staining. RESULTS:Of the 33 eyes, 13 had diffuse staining (39.4%, mean IOP = 9.3 ± 2.2 mm Hg), 7 (21.2%, mean IOP= 15.5 ± 1.8 mm Hg) had patchy staining, 4 had minimal staining (12.1%, mean IOP= 17.5 ± 0.5mm Hg) and nine (27.3%, mean IOP= 19.3 ± 1.6 mm Hg) had no staining. These staining patterns were labeled as groups 1 - 4 respectively. Statistical analysis showed that the difference between the IOPs in Group 1 - 2 and between Group 2 - 3 was not significant statistically (p=0.682 and 0.665 respectively). However the differences between the IOPs between Groups 1 - 3, 1 - 4, 2 - 4, and 3 - 4 were found to be highly significant statistically (p less than 0.0005). CONCLUSIONS:Trypan blue dye can be used to test the amount of sub conjunctival filtration in eyes undergoing phacoemulsification cataract surgery.

Anterior segment OCT imaging in opaque grafts with secondary glaucoma following tectonic penetrating keratoplasty for perforated corneal ulcers

Abstract should be structured for Original Article and unstructured for others. It should not exceed 250 words. Structured abstract should follow the sections: Purpose, Methods, Result and Conclusion. Tables and figures: Each table and figure should be on a separate page and numbered consecutively. Tables should be sent in a separate text file and the images as a jpeg file. References Should be numbered in the order of appearance in the text and should be presented in square brackets, not as superscript or subscript. End note/Footnote tools should not be used for referencing. References should be mentioned in the standard style of Index medicus (Vancouver style)Author 1, Author 2. Title of the article. Name of Journal Year; Volume: Page numbers. (For Journal article) Author 1, Author 2. Title of chapter. In: Names of Editors. Title of book. Publisher name and place, year and edition number; page numbers. (For a book article) Author/s. Title of the article. Address of the website, date last updated, date accessed. (For articles accessed from the worldwide web) Where the authors are more than six, mention the initial six authors followed by et al. Unpublished articles should not be listed as references and should be highlighted in the body of the article as personal communication in parentheses. As far as possible, reference to abstracts should be avoided, but whenever necessary, they should be mentioned in the references as (abs.). Key points 3-5 key points should be provided at the end of the text which highlight the salient features. Disclosure and copyright transfer All manuscripts should be accompanied by the cover letter carrying the disclosure and copyright transfer statement which must be signed and dated by all the authors without which the manuscript will not be accepted for review and possible publication. If the data in the manuscript were presented at a scientific meeting, the place of data of presentation, and name of the meeting should be stated on the title page. Any proprietary or financial interest in any product mentioned in the manuscript should be stated on the title page. Checklist for attachments to the e-mail1. Covering letter duly signed by all authors (scanned document to be attached) The following lines should be a part of the covering letter “The authors are ready to assign the copyright ownership of this manuscript to the “Delhi Journal of Ophthalmology” once the article is accepted for publication in the journal.

Purpose To screen mitochondrial DNA (mtDNA) for nucleotide variations in primary congenital glaucoma (PCG). Methods The entire coding region of the mitochondrial genome was amplified by polymerase chain reaction from 35 PCG patients and 40 controls. The full mtDNA genome except the D-loop was sequenced. All sequences were analyzed against mitochondrial reference sequence NC_012920. Results MtDNA sequencing revealed a total of 132 and 58 nucleotide variations in PCG and controls, respectively. Of 132 nucleotide variations, 42 (31.81%) were non-synonymous and 82 (62.12%) were synonymous changes, and 8 were in RNA genes. The highest number of nucleotide variations were recorded in complex I followed by complex IV, then complex V. Eight patients (22.85%) had potentially pathogenic mtDNA nucleotide changes and twenty (57.14%) had mtDNA sequence changes associated with elevated reactive oxygen species (ROS) production. Mitochondria not only constitute the energy-generating system in the cell, but are also critically involved in calcium signaling and apoptosis. Mitochondrial function can be affected by mutations in mitochondrial and nuclear DNA, chemical insults to components of the electron transport chain, and a lack of substrates such as oxygen. Mitochondrial dysfunction results in an excessive generation of free radicals and reduced mitochondrial respiration. Developing trabecular meshwork (TM) is deficient in antioxidant enzymes, and thus is more susceptible to oxidative stress (OS) induced damage. Previous studies have documented certain mtDNA sequence variations associated with elevated ROS levels and OS. Three such changes (G10398A, A12308G, and G13708A) were present in our patients. Elevated ROS may cause OS. This OS may further damage mtDNA and may cause decreased mitochondrial respiration. This may lead to impaired growth, development and differentiation of TM and consequently trabecular-dysgenesis, which is a characteristic feature of PCG. OS affects both TM and retinal ganglion cells (RGCs) and may be involved in the neuronal death affecting the optic nerve in glaucoma. There are several studies which point to mitochondrial dysfunction in different types of glaucoma and critically participate in RGC death. Recent studies also implicate mitochondrial dysfunction-associated OS as a risk factor for glaucoma patients. It has been reported that elevated hydrostatic pressure causes breakdown of the mitochondrial network by mitochondrial fission and induce cristae depletion and cellular ATP reduction in differentiated RGC-5 cells in vitro as well as in vivo. Conclusions A total of 44 novel mtDNA variations were identified in this study. Non-synonymous mtDNA variations may adversely affect respiratory chain, impair OXPHOS pathway result in low ATP production, high ROS production and impair growth, development and differentiation of TM lead to trabecular-dysgenesis and consequently RGC’s death. Such cases with mtDNA variations and consequent OS may benefit by early diagnosis and prompt management by antioxidant therapy. This may delay OS induced injury to TM and RGCs and hence improve visual prognosis.

Steroid-induced glaucoma is a form of open-angle glaucoma occurring as an adverse effect of corticosteroid therapy.1 It is usually associated with topical steroid use, but it may develop with oral, intravenous, inhaled, or periocular steroid administration by causing decrease in aqueous outflow facility. A number of drugs have been implicated in corticosteroid-induced glaucoma including dexamethasone, betamethasone, prednisolone, medrysone, fluoromethalone, hydrocortisone, cortisone, etc. Glucocorticoids may exert their effect by increased expression of the MYOC (TIGR) gene at Locus GLC1A .2