Articles

Spontaneous Pseudophacocele – A Case Report

ABSTRACT

Subconjunctival dislocation of an intraocular lens (pseudophacocele) is a rare but serious complication following cataract surgery. Spontaneous intraocular lens (IOL) dislocation is uncommon in the absence of trauma. There have been no reports of spontaneous dislocation of IOL into the subconjunctival space. We report an interesting case of spontaneous dislocation of IOL haptic into the subconjunctival space, with no history of genetic disease, ocular trauma, or pseudoexfoliation that might predispose to a zonular abnormality.

KEY WORDS: Cataract surgery, complication, dislocation, pseudophacocele, spontaneous

Intracranial Glioblastoma Multiforme (Stage IV Glioma) Presenting as Papilledema- Two Case Reports

ABSTRACT

Glioblastoma multiforme (GBM) is fast growing invasive gliomas often referred to as Grade IV glioma, arising from astrocyte spreading rapidly into nearby brain tissue and occur most commonly in temporal and frontal lobes. Here, we present case reports of two young female patients who presented to an eye hospital with predominant complaints of a headache and blurred vision, without any other neurological deficits. Comprehensive evaluation revealed intracranial frontal lobe mass lesion (GBM) causing severe papilledema and secondary optic atrophy.

KEY WORDS: Glioblastoma multiforme, headache, loss of vision, papilledema

Dexamethasone Intravitreal Implant in Combination with Laser Photocoagulation for the Treatment of Diffuse Diabetic Macular Edema

ABSTRACT

Purpose: To study the efficacy of dexamethasone (DEX) intravitreal implant followed by macular laser after 1-month for diffuse diabetic macular edema (DDME).

Methods: Interventional case series of 49 eyes of 33 patients with DDME attending the retina clinic from November 2013 to December 2014. All patients underwent detailed ophthalmic evaluation followed by fluorescein angiography and optical coherence tomography. The sequential macular laser was done after 1-month after DEX implant. All patients had a minimum follow-up of 6 months.

Results: Mean age was 58.33 years ± 9.4 years, mean best corrected visual acuity (VA) was 0.5418 logMAR units at presentation improved to 0.4748 at 1-month and maintained 0.4385 at 3 months and 0.4376 at 6 months follow-up (P = 0.01). Mean Central macular thickness was 529.2 μ at presentation reduced to 285.4 μ at 1-month and maintained 296.1 μ at 3 months and 321.1 μ at 6 months follow-up (P = 0.0001). Total macular volume was 11.78 mm3 at presentation reduced to 7.78 mm3 at 1-month and maintained 7.97 mm3 at 3 months and 8.1 mm3 at 6 months follow-up (P = 0.0001).

Conclusion: DEX intravitreal implant followed by macular laser showed favorable results by decreasing macular edema and improving VA in DDME, where the role of laser alone is limited.

KEY WORDS: Dexamethasone intravitreal implant, diffuse diabetic macular edema, macular laser

Critical Review of Public Health Interventions in  Diabetic Retinopathy- Challenges for Karnataka

ABSTRACT

Diabetic retinopathy (DR) is a chronic complication of diabetes mellitus (DM), and its prevention is related to the duration as well as control of DM. The prevalence of diabetes has reached a pandemic proportion which is mostly attributed to rapid lifestyle transitions and by a narrowing in the urban-rural divide in living conditions. In another 15 years, nearly one-fifth of the world’s diabetic population will be in India. This will increase the prevalence of DR-related eye disease that can potentially cause blindness in younger people. Since DM and DR is a public health problem, its management requires public health approaches. This article reviews the various challenges in implementing public health interventions in preventing DR-related blindness.

KEY WORDS: Diabetic retinopathy, public health approaches

RAPDx Expanded Pupil Diagnostics: A new Dimension in Pupil Evaluation

ABSTRACT

Introduction: Relative afferent pupillary defect (RAPD) is an imperative sign to assess the retinal and optic nerve function. However, RAPD is subjective, so leads to discrepancies and hence there is the need for a precise quantification of the same.

Materials and Methods: 80 subjects were enrolled in the study, pupillary reactions were measured using RAPDx Expanded Pupil Diagnostics (Konan Medical USA, Inc., Irvine, CA, USA) and were compared with neutral density filter (NDF) (Gulden Ophthalmics) and swinging flashlight test.

Results: The mean pupillary reactions assessed on NDF was less than 0.3 log units and that assessed on RAPDx was 0.28 log units (P<0.001 spearman’s coefficient).

Conclusion: RAPDx is comparable to NDF and may be used as a screening tool in Ophthalmology clinic, and gives an accurate and precise quantification of pupillary responses.

KEY WORDS: Pupil Diagnostics, RAPD, RAPDx

Optical Quality and Tear Film Analysis after Various Lubricating Eye – Drops

ABSTRACT

Purpose: To compare the optical quality and tear film analysis of normal and dry eye individuals after instilling various lubricating eye drops.

Materials and Methods: A total of 50 eyes of 25 normal individuals and 20 eyes of 10 dry eye patients were studied using LipiView Interferometer (TearScienceInc, Morrisville, North Carolina, USA) Optical Quality Analysis System (OQAS) and HD Analyzer (Visiometrics, Terrassa, Spain). These patients were subjected to randomized use of drop A (polyethylene glycol 400 NF 0.4%, propylene glycol 0.3%), drop B (sodium carboxymethyl cellulose (CMC) and glycerin 0.9%), and drop C (sodium CMC-5 mg). The optical quality and tear film were analyzed at the end of 10 min, 40 min and 1 week.

Results: The average interferometric units measured were 82.36, 74.28 and 71.4 with drops A, B and C, respectively. The average objective scatter index was 0.42 before using any drops and 0.48, 0.38 and 0.42 after drops A, B and C, respectively. The average modulation transfer function was 43.7 before drops and 39, 45.6 and 46 after usage of drops A, B, and C, respectively.

Conclusion: The lipiview analysis suggested that drop A had a beneficial effect on the lipid layer of the tear film. Metrics on OQAS revealed that drops B and C showed improvement in MTF and OSI in normal as well as dry eye patients.

KEYWORDS: Tear film, OQAS, Lipiview

Ocular Myasthenia Gravis: A Review

ABSTRACT

Myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular junction of skeletal muscles. Patients affected with MG may present with ocular features or develop ocular involvement later in the course of the disease, known as ocular MG (OMG). OMG can mimic ptosis, commitant and incommitant strabismus, cranial nerve palsies, gaze palsies and internuclear ophthalmoplegia. Hence, it is important to establish a correct diagnosis and start appropriate treatment. This review focuses on the clinical features, diagnosis, and management of OMG.

KEY WORDS: Antibodies, electrophysiology, management of ocular myasthenia, ocular myasthenia gravis

Management of a case of Traumatic Lateral Rectus Transection – A Surprise

ABSTRACT :A 19-year-old girl, presented with diplopia, bleeding, pain, and tissue hanging out from her right eye after a stick injury. She had uncorrected visual acuity of 20/20 and N6 in both the eyes, right eye esotropia (30 prism diopter), total limitation of abduction (right eye), and diplopia. About 10 mm of lateral rectus (LR) muscle stump was hanging from the insertion over the lid margin. Anterior and posterior segments were normal in both the eyes. The computed tomography (CT) scan showed ruptured and retracted LR. On wound exploration, the proximal part of LR was not retrievable. The cut edge of the muscle stump at the insertion site was sutured to the intermuscular septa and tenons tissue. Post-operatively, diplopia decreased, abduction in right gaze improved dramatically, and eyes were orthophoric 1 year follow-up. Post-operative CT scan was reported to have the presence of intact LR muscle.

KEY WORDS: Intermuscular septa, lateral rectus, transection, traumatic

A Study of Anatomical and Visual Outcome in Primary Scleral Fixated Intraocular Lens Implantation

ABSTRACT
Aims: To study the indications, safety, efficacy, post-operative outcome and complications in patients with primary
scleral fixated IOL implantation.
Materials and Methods: Forty patients, who underwent primary scleral fixated IOL implantation over a period of
2-years were analyzed for demographic data, indications, post-operative outcome, and complications of the procedure.
Results: The study group ranged from 16-30 years. The male:female ration was 1.86:1. Subluxated cataract was the most
common indication. All (100%) of our patients showed improvement in vision postoperatively. Complications were early
complications like corneal odema, hyphema, iritis, and late complications including cystoid macular edema, secondary
glaucoma, and astigmatism No vision-threatening complications including retinal detachment and endophthalmitis were
observed.
Conclusion: SF-IOLs give good anatomical and visual outcome in patients of cataract with inadequate capsular support.
KEYWORDS: Complicated cataract, deficient posterior capsular support, scleral fixation of intra-ocular lens,
subluxated lens

Fraser Syndrome

ABSTRACT

KEY WORDS: Cryptophthalmos, Fraser syndrome, autosomal recessive

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Late Onset Capsular Block Syndrome in a Diabetic Patient: Case Report

ABSTRACT

We report a case of capsular block syndrome in a diabetic patient who had undergone phacoemulsification after circular capsulorhexis and intraocular lens (IOL) implantation in the left eye. Five years later, the posterior capsule had vaulted far posteriorly, the capsular opening was apparently sealed by the lens optic, and fluid had accumulated between the posterior capsule and the IOL. The retrolental fluid was emptied from the capsular bag posteriorly into the vitreous using a neodymium-doped yttrium aluminium garnet laser capsulotomy, and the distended capsule lieved.
KEY WORDS: Continuous curvilinear capsulorhexis, foldable intraocular lens, phacoemulsification

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Retinal Oximetry: The Indian Experience in Healthy and Diseased Eyes

ABSTRACT

To study the alterations in retinal oxygen saturations in healthy and diseased eyes. Patients presenting to our hospital underwent an additional non-invasive procedure to measure oxygen saturation in their retinal vessels. After dilatation,
oximetry was done using the Oxymap T1 retinal oximeter (Oxymap hf, Reykjavik, Iceland). Normal patients and patients with arteriolar and venous occlusions, retinal dystrophies and glaucoma, were evaluated. Arteriolar, venous and arteryvenous saturation difference (AVSD) values were determined for each of the groups. In the normal subjects (n = 98), the average arteriolar saturation was 90.3 ± 6.5, and the venous saturation was 56.9 ± 6.3. The average AVSD was 33.4 ± 5.0.
In arterial occlusions (n = 10), we have seen an initial fall in arteriolar (85.8%) and venous (49.7%) saturations in the acute stage in eyes with central retinal artery occlusion with subsequent increase in saturations. In venous occlusions
(n = 18), there was an initial increase in all global saturation parameters in the acute stage (arteriolar: 105.8%, venous: 62.7%, AVSD: 43.3%), followed by a gradual decrease in saturations in the chronic stage (arteriolar: 99.8%, venous:
60.1%, AVSD: 39.8%). Eyes with retinitis pigmentosa (n=62) showed higher saturations (104.15%) and higher AVSD (44.15%) compared to macular dystrophies (n = 23) (96.7% and 41.61%) and normal controls (90.6% and 33.3%).
Macular dystrophies showed higher global arteriolar values and AVSD but comparable venous values to the control group. In glaucoma (n = 44), we have seen raised arteriolar and AVSD values. Oximetry is sensitive in picking up changes in diseased eyes that are distinct from normal values. In the future, it may prove to be useful in pre-clinical screening studies and in therapeutic decision making.
KEY WORDS: Oximetry, Retinal circulation, Saturation

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Angle Recession Glaucoma

ABSTRACT

Traumatic glaucomas are a very heterogeneous group of entities due to a variety of mechanisms which increase the intraocular pressure in the early or late phase after traumatic injury. Glaucoma after closed globe injury is a major
concern because many cases may go unnoticed and are diagnosed many years later as having irreversible glaucomatous optic nerve damage.[1,2] Angle recession is one of the causes for late onset posttraumatic glaucoma; this condition may be underdiagnosed because the onset is often delayed and because a history of eye injury may be distant or forgotten.
KEY WORDS: Blunt trauma, Angle recession, Glaucoma

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Analysis of Spectral Domain – Optical Coherence Tomography and Fundus Autofluorescence in Typical Retinitis Pigmentosa

ABSTRACT

Purpose: To study fundus autofluorescence (FAF) and spectral domain-optical coherence tomography (SD-OCT) characteristics in patients with typical retinitis pigmentosa (RP) and correlate them to visual acuity.
Design: Retrospective observational case series.
Methods: 110 eyes of 56 RP patients were included. FAF and SD-OCT imaging were done for all eyes. Extent of the autofluorescence ring, central foveal thickness, photoreceptor outer-segment length (PROS), foveal outer segment
pigment epithelial thickness (FOSPET), and inner segment-outer segment (IS-OS) extent were defined and measured and correlated to logMAR best corrected visual acuity (BCVA) using linear regression.
Results: Study included 110 eyes of 56 patients (34 male and 22 female). Mean BCVA was 0.33 logMAR with no difference between genders. The mean age of patients was 15.4 ± 15.1 years. Mean autofluorescence extent was 3590 ± 1994 μm horizontally, and 2880 ± 1836 μm vertically. These values were significantly correlated with preserved IS/OS junction extent (mean values horizontally = 2865 μm and vertically = 2464 μm). Mean central retinal thickness (218.74 μm) and PROS (44.85 μm) were significantly correlated to BCVA with correlation coefficient r = –0.189, P = 0.015; and r = –0.874, P = 0.0001, respectively. FOSPET (mean = 71.15 μm) did not show a significant correlation with BCVA, independent of PROS.
Conclusions: Retinal microstructural changes as studied on SD-OCT, especially PROS length can be used as a surrogate marker to monitor degenerative diseases such as RP. Further, studies are required to clearly delineate the microstructuralfunctional relationship in the human retina.
KEY WORDS: Foveal outer segment pigment epithelial thickness, inner segment – outer segment junction, photoreceptor outer segment length, retinitis pigmentosa

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Comparison of Tele Screening for Retinopathy of Prematurity Screening and Impact of Neonatal Team Support in Government and Private Centers in Rural Bijapur District of Southern India

ABSTRACT

Purpose: To compare the incidence of retinopathy of prematurity (ROP) with neonatal support provided during tele-ROP screening between government and private hospitals in rural Bijapur district of Karnataka.
Methods: One government and four private hospitals under the ROP screening program between July 2011 and July 2012 were included. All infants born <2000 g at birth were imaged on a weekly basis. Centers were classified as “supportive” or “non-supportive” based on the support extended to the visiting team. Yield of enrollment and disease burden were compared between the centers.
Results: Of the 145 infants analyzed, the mean incidence of any stage and treated ROP in the government center was 27.3% and 0% versus 36.6% and 9.7% in the private units, respectively. The proportion of infants enrolled in the
government hospital was 40.7% versus 88.9% (mean) in the private hospitals. In the two “supportive” hospitals, the enrollment was 100% and 159.3% respectively, whereas it was 38.7% and 58.7% respectively in “non-supportive” units.
Conclusions: The incidence of ROP in rural Bijapur is comparable to urban centers in India. Good pediatric and nursing support enhances infant enrollment into an ROP screening program. Private hospitals may have higher treatable ROP because of the sicker infants they admit. The report emphasizes the need to strengthen ROP screening programs in rural India.
KEY WORDS: ROP, prematurity, Tele ROP screening

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Repeatability and Agreement of Four Biometers for Measuring Various Anterior Segment Parameters

ABSTRACT

Purpose: To assess the repeatability and agreement of a new swept source optical coherence tomography (SS-OCT) biometer (IOL Master® 700, Carl Zeiss Meditec), an optical low coherence reflectometer (Lenstar LS 900®, Haag-Streit
AG, Koeniz, Switzerland), a dual scheimpflug ray tracing biometer (Galilei G6®, Ziemer, Switzerland) and a partial coherence interferometer, AL scan® (Nidek Co. Ltd., Japan) to measure the keratometry (K), astigmatism (AST), axial
length (AL), anterior chamber depth (ACD), central corneal thickness (CCT) and white-to-white (WTW) in cataractous eyes in a Cross-sectional study.
Methods: 50 eyes of 50 consecutive patients scheduled for cataract surgery were included. Three consecutive scans were performed using the 4 biometers by a single operator. Within-subject standard deviation (Sw), test-retest repeatability and coefficient of variation for assessing repeatability were assessed. Bland-Altman plots for the agreement between the mean measurements of each machine were examined.
Results: The mean age of patients was 60.2 ± 10.6 years. Dropouts for AL measurement were significantly higher in AL scan® and Galilei G6® compared to IOL Master® 700. There was good agreement between IOL Master® 700 and Lenstar LS 900® for AL and keratometry (P < 0.5). High variability was seen between the 4 machines for AST and WTW.
Conclusion: The new SS-OCT biometer showed valid measurements, good repeatability and good agreement with the optical low coherence reflectometry biometer. The new long range SS-OCT biometer was better than the other three
devices in acquiring AL measurements in denser cataracts due to better penetration.
KEY WORDS: IOL Master 700, Biometry, SS-OCT

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Cut and Paste: No Suture, No Glue Conjunctival Autograft Technique for Pterygium Surgery – Our Experience

ABSTRACT

Background: Pterygium is a common ocular disease and surgical excision with conjunctival autografting is the treatment of choice. However, recurrence is a common problem and use of sutures and glue to secure the autograft is associated with a number of adverse effects. We present an autograft technique for pterygium surgery using autologous fibrin derived from a thin layer of blood.
Aim: To evaluate a sutureless, glue free conjunctival autograft technique for pterygium surgery.
Setting and Design: Prospective interventional case series conducted at Karnataka Institute of Medical Sciences, Hubli.
Materials and Methods: 90 eyes of 84 patients were included. After pterygium excision, the recipient bed was encouraged to achieve natural hemostasis. A thin layer of blood was allowed to cover the recipient bed and provide a source of autologous fibrin. A thin Tenon’s free conjunctival autograft taken at the superotemporal limbus was placed over the recipient scleral bed without sutures or fibrin glue. Patients were followed up for any complications.
Results: Follow-up period ranged from 6 to 15 months (mean 12 months). The mean surgical timing was 13 min. Graft displacement was seen in 8 cases on the 1st post-operative day, which was repositioned. Graft retraction was seen in
2 cases at 1-month post-operative follow-up. A conjunctival granuloma was seen in one case, which was excised. No recurrences were seen during the follow-up period. Cosmesis was excellent.
Conclusion: This simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials such as sutures or fibrin glue. The technique is cost effective and requires less surgical time.
KEY WORDS: Autologous fibrin, conjunctival autograft, gluefree, pterygium, sutureless

 

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Choroidal Neovascular Membrane in a case of Subretinal Cysticercosis

ABSTRACT

This is a photo essay of a 20-year-old boy who presented with a subretinal cyst. The patient first presented to us with a history of decreased vision in his left eye of 2 weeks duration with a visual acuity of 20/20 in the right eye and 20/60 in the left eye.

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Spontaneous Simultaneous Bilateral Late-onset Descemet’s Membrane Detachment after Uneventful Cataract Surgery

ABSTRACT

We report the case of a 76-year-old woman who presented to us with bilateral simultaneous Descemet’s membrane detachment (DMD) after successful uneventful cataract surgery of both eyes in the late post-operative period. The first eye was operated 1-week prior to the second eye. We shall also discuss different hypothesis of an underlying predisposition to DMD and in our case the possible role of a thick arcus senilis in the etiology of DMD. Surgical intervention with 14% octafluoropropane (C3F8) gas injection in the anterior chamber resulted in excellent visual acuity restoration in the patient.

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Middle Meatus Osteotomy with Lacrimal Intubation for Post-traumatic Epiphora

ABSTRACT

Nasolacrimal duct obstruction is common sequel following naso-orbito ethmoidal fractures. After 2 months of receiving conservative treatment, a 24-year-old male patient reported epiphora from the right eye following self-fall from a tree. Lacrimal sac mucocele was diagnosed and mucopurulent regurgitation noted on finger pressure and lacrimal sac syringing. Computed tomography revealed healed old fractures involving right nasal bone, maxillary nasal process adjacent to the medial orbital wall with lytic areas. Possibility of the subperiosteal abscess with osteomyelitis changes was suspected. A thick fibro-osseous (sequestrum) wall formation was noted separating nasal cavity and orbit. Lateral nasal wall adhesions were released by transnasal endoscopy. Two weeks later, the thick wall was fenestrated through external dacryocystorhinostomy approach. Lacrimal sac mucocele opened and bicanalicular silicone intubation performed. Epiphora relieved and lacrimal passage patency maintained and confirmed by lacrimal sac syringing on 3 months follow-up. To evaluate etiopathogenesis and patency, integrity of silicone intubation is the purpose of presenting this case.

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Laser Blended Vision-LASIK for Presbyopia and Initial Clinical Experience in 100 Indian Patients

ABSTRACT

Aim: The aim was to study the visual results of laser blended vision (LBV), (LASIK with a nonlinear aspheric micromonovision protocol) for presbyopia correction.

Materials and Methods: Binocular and uniocular vision and postoperative outcome of 100 patients undergoing LBV were studied. The study included myopes (−0.25 to −7.25 DS), hypermetropes (+0.25 to +4 DS) and emmetropic presbyopes between ages 39 and 55 years (mean 47) with a minimum follow-up of 6 months.

Results: Binocular distance vision: 83% read 6/6 or better, 100% read 6/9 or better at 6 months. Near vision: 96% read near n6, remaining read n8. All patients had an intermediate vision (n6). An adaptation rate of more than 95% within first 3 months was noted without significant loss of visual acuity due to the procedure.

Conclusion: LBV may be a safe approach to presbyopic LASIK treatment with high adaptation rates. Long-term studies are needed to establish the stability of treatment results over time.

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Capsulorhexis in White Intumescent Cataracts: The Five Commandments to Follow

ABSTRACT

We describe a surgical technique for achieving a successful capsulorhexis in white intumescent cataracts. Raised intralenticular pressure is responsible for the high incidence of peripheral extension of the capsulorhexis (Argentinian Flag Sign) in intumescent cataract surgery. Swollen anterior and posterior sub-capsular cortex is responsible for the high intralenticular pressure. We present surgical strategies in the form of five commandments, which would ensure better success rates in achieving capsulorhexis in intumescent cataracts. These five commandments are based on the surgical principles of maintaining positive pressure in the anterior chamber and performing a two staged sequential active decompression of the swollen capsular bag and a two staged capsulorhexis. These strategies aim at gradual decompression of the swollen capsular bag, which will ensure a less tense anterior capsule and better control over the tearing anterior capsule.

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Systematic Transition to Phaco-Chop

ABSTRACT

Phaco surgeons initially train in a four quadrant divide and conquer technique. Subsequently, several surgeons transition to chopping techniques due to the perceived advantages of phaco-chop that include lower ultrasound energy and lesser zonular stress. Stop and chop has conventionally been the technique of choice for making this transition. However, the surgeon has to execute a full-fledged chop after the creation of two hemi-segments by the classical trenching and cracking skills already acquired in divide and conquer techniques. Here we describe a set of intermediate steps during four quadrant divide and conquer that breaks down the skills required for chopping and enables the surgeon to sequentially imbibe the required skill sets to make the transition to chop safer and smoother.

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Prospective Evaluation of the Clinical Profile, Treatment Outcomes and the Demand for Corneal Transplantation in Microbial Keratitis

ABSTRACT

Aim: The aim was to study the clinical profile, treatment outcomes, and the magnitude of corneal donor requirement secondary to corneal ulcers in our institute.

Materials and Methods: A prospective case series study was carried out on 134 eyes of 134 consecutive patients presenting with corneal ulcers from January 2010 to December 2013 at our tertiary eye care center. Information was recorded about the patient’s age and gender, risk factors, prior therapy, clinical presentation, microbiological work-up, management and its outcome.

Results: Majority of the corneal ulcers (46.2%) were seen in patients in the productive age-group (21 and 50 years), with 83% male preponderance. Ocular trauma (47%) with vegetative matter was the main predisposing factor. Of the corneal ulcers, 52.9% were of fungal, followed by viral, bacterial and neurotrophic etiology. At presentation, 11.1% were on topical steroid therapy. Only 41% had microbiological confirmation. About 47.7% healed with significant scarring, 41.7% with minimal scarring and 10.4% progressed to complications. Of the 10% eyes with complications, emergency keratoplasty was done in 4% and evisceration in 2%. 17% of eyes responded to antimicrobial therapy; 60% eyes needed therapeutic keratoplasty.

Conclusion: Despite an early and aggressive management, we found that 89% of ulcers healed with corneal scarring and poor visual outcome and 60% eyes needed keratoplasty for visual rehabilitation. Hence, combined public health initiatives, overall improvement in medical care and adopting successful eye bank development models is important to meet the increasing demand for keratoplasty.

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Ocular Perfusion Pressure and Pulsatile Ocular Blood Flow in Normal and Systemic Hypertensive Patients

ABSTRACT

Purpose: The purpose was to compare the ocular perfusion pressure (OPP) and the pulsatile ocular blood flow (POBF) in normal and systemic hypertensive patients.

Methods: Totally, 121 individuals (normal n = 60, systemic hypertension patients n = 61) were enrolled in this prospective age-matched comparative study. Intraocular pressure (IOP) and systemic arterial pressure were measured
in seated position with 2 min interval between the measurements using Goldmann applanation tonometer (GAT) and tycos sphygmomanometer, respectively. The OPP was calculated as 2/3 of mean arterial pressure (MAP) minus IOP. After 5 min in the seated position POBF measurements were taken with the ocular blood flow (OBF) tonograph.

Results: Mean age was 57.5 years (range 35-72 years) in the normal group and 59.6 years (range 36-78 years) in the hypertensive group; majority of the patients were female (68.5% and 71% respectively in each group). Measured
parameters in both the groups showed, systolic blood pressure (BP) (143.6 ± 20.5 mmHg vs. 121.9 ± 17.5 mmHg), diastolic BP (90.7 ± 13.5 mmHg vs. 80.1 ± 9.9 mmHg), MAP (108.4 ± 14.2 mmHg vs. 94.2 ± 11.2 mmHg), and OPP (57.6
± 14.6 vs. 48.7 ± 10.6 mmHg) were significantly greater (P = 0.001) in systemic hypertensive patients in comparison to normals. However, there was no difference in OBF tonograph values in both groups. The IOP measured by the OBF tonograph was higher than GAT in both groups, but the difference was not statistically significant (P = 0.41).

Conclusion: Systemic hypertensive patients have a higher OPP in comparison to normal patients, but they do not have higher POBF. More studies are required to evaluate the role of the OPP in different ocular pathologies affecting the POBF.

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Smartphone Indirect Ophthalmoscopy

ABSTRACT

Purpose: The purpose of this study is to describe in detail the procedure of performing indirect ophthalmoscopy using any smartphone along with instruments that are readily available in ophthalmic practice.

Methods: The procedure was performed with a smartphone and a 20D or 28D lens. Using the flashlight of the phone as a coaxial light source, the system works as an indirect ophthalmoscope where the camera creates a digital image of the ocular fundus on the phone screen through the condensing lens. High definition videos of the fundus were recorded using the inbuilt video recorder of the phone, and subsequently good quality fundus images were extracted from the video clips.

Results: With the described technique of smartphone indirect ophthalmoscopy, we were able to carry out basic screening of the ocular fundus without using a direct ophthalmoscope, slit lamp biomicroscopy or indirect ophthalmoscope. It also proved to be an excellent tool for documentation of fundus pathologies through good quality images.

Conclusion: The described technique is an easy and inexpensive way to photograph the fundus in patients using readily available portable instruments. Commercially available fundus cameras are outside the reach of many practitioners and institutes. Hence, the method seems to be a good tool for basic screening and documentation of fundus pathologies. With a small learning curve, it is relatively simple to master and takes advantage of the expanding mobile-telephone networks for telemedicine.

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Imaging the Intraoperative Macular Morphology Changes using a Handheld Spectral Domain Optical Coherence Tomography

ABSTRACT

Purpose: To study the intraoperative retinal macular morphology during macular surgery using handheld spectral domain optical coherence tomography (SDOCT). Design: Prospective, observational case series.

Methods: A handheld SDOCT device was used to characterize the preoperative and intraoperative OCT images in 10 eyes of 10 patients undergoing vitrectomy for macular hole (MH) and epiretinal membrane (ERM). I intraoperative imaging was repeated after removal of the internal limiting membrane or the ERM and the images were analyzed.

Results: Intraoperative SDOCT images from patients undergoing surgery (5 for full thickness MH including 2 previously failed surgeries and 5 for ERM were reviewed and quantitatively analyzed. In the 5 eyes undergoing surgery for MH, the minimum diameter of the hole showed a significant decrease (P = 0.031; the mean reduction 15.18%; range 6.14- 34.88%). Basal diameter increased in 2 eyes (mean change 9.96%), reduced in 2 (mean reduction 3.28%) while it remained unchanged in 1 case. The MH height decreased in 2 eyes (mean reduction 5.43%) and increased in 3 (mean change 20.04%). Intraoperative imaging in 5 eyes undergoing surgery for ERM revealed immediate decrease in retinal thickness in 3 eyes (mean change 5.00%), and increase in 2 eyes (mean change 17.76%). Comparison of the preincisional and intraoperative handheld SDOCT images demonstrated distinct changes in retinal macular morphology.

Conclusion: The intraoperative use of handheld SDOCT provides a novel method for visualizing and quantifying changes in retinal anatomy during macular surgery. Further study is warranted to determine whether intraoperative macular morphological changes could affect and prognosticate MH closure.

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Strabismus Following Scleral Buckling Surgery

ABSTRACT

Purpose: The purpose was to assess the incidence of strabismus, relationship of strabismus with type, and width of the scleral buckle (SB) after SB surgery for retinal detachment.

Methods: Retrospective analysis of 360 eyes of 344 patients, treated for rhegmatogenous retinal detachment with SB surgery between January 2008 and January 2013 was done.

Results: The mean age of patients was 38.45 ± 18.12 years (range: 7-89 years) was detected in 48 out of 344 (13.95%) patients at 6 weeks after SB surgery. Horizontal deviation was the most common type. Incidence of strabismus was higher after repeat SB surgery (4/9, 44.4%) compared to patients who had single SB surgery (44/335, 13.1%) (P = 0.02). Strabismus was observed in 18.5% of patients with implants, compared to 11.3% of patients who received explants (P = 0.02). Strabismus surgery was performed on 2 (4.1%) cases.

Conclusion: Horizontal strabismus is common after SB surgery for repair of retinal detachment. Repeat scleral buckling and use of implants resulted in a higher incidence of strabismus in the post-operative period. Majority of these cases resolve with conservative management.

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Change, the Only Constant!

Change is all around us. Over the past few decades, our profession, ophthalmology, as we know it, has undergone an ocean worth of change. Be it in the technology, we use to examine, image or treat our patients, be it in the knowledge of our trade or practice patterns, or be it in the wisdom of merging science and art in a way clinical research has never known before, change is the one thing that has been constant.

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