Ophthalmology and Allied Sciences

Introduction: Infectious keratitis is one of the leading cause of preventable blindness, proper and early diagnosis of infectious keratitis paves way for treatment and prevention of ocular morbidity. From corneal scrapings is considered to be the Gold standard in microbiological diagnosis of keratitis. Smear from impression technique can be used for laboratory diagnosis of keratitis. Purpose: This study was under taken to know the sensitivity and specificity of impression smear technique in diagnosis of infectious keratitis. Materials and Methods: Study was conducted at tertiary hospital, after taking all enrolled patients with infectious keratitis underwent clinical examination followed by smear examination by impression technique on filter paper and corneal scraping sent to lab for gram staining and KOH mount. Results: Out of 50 cases Male: Female ratio was 3: 1.1. Age group was 3070. Grams stain was positive in 70% patients with impression smear technique and in 64% patients with corneal scrapings. Sensitivity and Specificity of impression smear technique gram staining was 96.8% and 77.77% , positive and negative predictive value were 88.50% and 93.33%, accuracy of test was 90.0%. KOH mount was positive in 20% patients with impression smear technique and in 22% of patients with corneal scrapings. Sensitivity and Specificity of impression smear technique for KOH mount was 81.82% and 97.4%, positive an negative predictive value was 90.0% and 95.00%, accuracy of test was 92%. Specific therapy was started based on initial smear examination. Conclusion: Impression smear technique is safe simple and atraumatic procedure in lab diagnosis of infectious keratitis, with good sensitivity and specificity, it is also helpful in diagnosis of smaller lesions.

Keywords: Corneal Ulcer; Keratitis; Corneal Scraping. welcome

Introduction: Children are particularly vulnerable to infections, injuries, and deficiency disorders due to their poor nutritional status, lack of proper hygiene, and care. Majority of the cases of ophthalmianeonatorum and keratomalacia are seen in this class of people even though they are easily preventable by early intervention timely institution of proper remedial measures and effective methods of prophylaxis and treatment. Methodology: This was a cross sectional study carried out in schools for children aged 5 – 15 years to know the prevalence of refractive errors. The sample size was 1012 which included both boys and girls. Predesigned semi structured questionnaire was prepared as study tool Results: Out of 1012 students, 39 had refractive errors and among them 71.8% of students had myopia, 20.5% students had hypermetropia and 7.69% of students had astigmatism Conclusion: The type of refractive errors seen in both boys and girls in the decreasing order was found to be myopia, hypermetropia and astigmatism.

Keywords: Refractive Errors; School Screening; Myopia. 

Introduction: An association between various systemic conditions like diabetes mellitus, hypertension and glaucoma have been demonstrated. Likewise an association between thyroid orbitopathy and glaucoma have been described in various literatures. Methodology: Thyroid related orbitopathy was diagnosed on the basis of clinical history of thyroid dysfunction, eye symptoms and signs. Laboratory investigations – serum T3, T4 and TSH, which confirmed the thyroid status to be hyper, hypo or euthyroid and all patients, underwent ultrasonography and few computed tomography as required. Results: In our study minimum age was 18 years and the maximum was 69 years. The mean age was 46.17±10.06. One patient had family history of glaucoma and had normal intra ocular pressure, disc and fields.Family history of thyroid dysfunction was present in 7 patients (11.67%) and 8 patients (13.33%) were on medication for thyroid dysfunction. Conclusion: The labelling of thyroid related orbitopathy patients as ocular hypertensives should hence be made with care and these patients need careful follow up.

Keywords: Thyroid Related Orbitopathy; Glaucoma; Ophthalmopathy. 

Introduction: Conjunctivalautograft has become the most preferred standard for management of primary pterygium and double pterygium. Securing the autograft over the bed is an important part of surgery and eventually determines the outcome of surgery. Methodology: We reviewed the case records of 100 patients from January 2016 to 2017 who underwent pterygium excision with conjunctivalautograft at our institute. Surgery was performed by a single surgeon for primary or doubleheaded pterygium. Results: All cases were properly assessed and followed up at every visit. The average age of study population was 45 years (18 to 65). 75% of patients were less than 40 years of age. Male to female ratio was 1:1. All the patients had an uneventful surgery. The patients were followed up on 5th day, 15th day, 1month, 3months, and 6months. Conclusion: We strongly recommend the conjunctivallimbalautograft with autologous blood for ensuring low recurrence and safety.

Keywords: Pterygium; Conjunctivalautograft; Pterygium Excision. 

Introduction: No one can deny the fact that the eyes are the most important of our sense organs. Good eyesight plays a vital constructive role in the development of the faculties of the child. Most of our knowledge and skills are acquired by (Nit eyes which are said to be the windows to the world. Bad eyesight not only affects academic improvement, but in the long run causes untold damage to the psyche and selfconfidence of the child. Methodology: Screening was undertaken with the help and active cooperation of the school management. In each of these institutions the assistance of that particular classteacher and the physical instructor was made available. The class teacher was given the proformas and general aspects, like name, age, sex, class, address were filled up. Results: The majority of ocular disorders fall in the category of refractive errors (54.9’3%), conjunctival lesions (23.94%) and lesions of the Lids 414 (12.68%). These three put together account for 91.5%. Conclusion: The schools should condone the absence of the students for treatment especially surgical Procedures, where the child will have a short hospital stay and a longer recovery period.

Keywords: Screening; Ocular Morbidity; Refractive Errors. 

Purpose: The aim of this study is to find out the type of ocular trauma attending a tertiary care hospital in a semiurban population so that the patient can have the best visual outcome after treatment. Methods: This is a hospital based prospective study and sample size is of 100 consecutive patients attending emergency services from June 2015 to June 2017. Result: Majority of the ocular trauma attending the hospital were of closed globe injuries followed by chemical trauma. Injuries were more common in males. Conclusion: The visual outcome of the injured eye depends on the severity of the injury and the time lapse between injury and onset of treatment.

Keywords: Ocular Trauma; Semi Urban Population; Visual Outcome. 

Introduction: Patients with thyroid eye disease may have an elevated intra ocular pressure in primary position or on attempted upgaze, which is related to the restrictive myopathy and / or orbital congestion. Increased intra ocular pressure results from pressure of the inelastic muscle pulling the eye and is most commonly appreciated on attempted upgaze with a tethered inferior rectus muscle. Methodology: This prospective, observational study enrolled 30 consecutive patients, visiting to GRH Ophthalmology OPD with proven diagnosis of thyroid related orbitop. Thyroid related orbitopathy was diagnosed on the basis of clinical history of thyroid dysfunction, eye symptoms and signs. Laboratory investigations – serum T3, T4 and TSH, which confirmed the thyroid status to be hyper, hypo or euthyroid and all patients, underwent ultrasonography and few computed tomography as required. Results: The Paired sample test and statistics, revealed a significant increase in intraocular pressure, when the gaze is shifted from primary to up gaze (pvalue 0.0001). There was a mean difference of 4.57mm in intraocular pressure from primary to up gaze. Conclusion: The incidence of glaucoma was not higher than that in the normal general population, as only two patients had glaucoma.

Keywords: Intraocular Pressure; Glaucoma; Thyroid Related Orbitopathy. 

Introduction: Pseudoexfoliation cataract forms part of pseudoexfoliation syndrome. It is common in the older age group, with most cases occurring in late 60’s and early 70’s. The reported influence of sex is conflicting with one study showing a female preponderance and the other of males. No hereditary pattern has been established and studies have given conflicting results with regard to positive correlation with HLA typing. Methodology: Total numbers of 100 eyes with 100 patients were selected for the study who have presented with cataract and pseudo exfoliation. The present study was conducted in the Ophthalmology department and Patients attending ophthalmic OPD who had any evidence of any material deposit in the anterior segment during routine examination were further evaluated for PEX. Results: Majority of patients that is 88 of them had pseudo exfoliative material deposits on pupillary margin next to lens, 53 patients had deposits on iris surface, 42 had motheaten appearance, 12 had iris atrophy, and 15 had posterior synechiae and 5 had iridodonesis. Conclusion: The study included a total of 100 patients of cataract with PEX. The average age of the patients was 65.74 years with a slight male preponderance over females and with increased incidence of bilateral involvement.

Keywords: Senile Exfoliation; Capsularexfoliation; Fibrillopathia Epithelio Capsularis. 

Background: The prevalence of diabetes among the population is varied and different in different parts of the world. In India it has been reported form 428%. There is prevalence of 6.7% of retinopathy in patients of NIDDM at the initial diagnosis of diabetes. Methods: The present study was conducted at Narayana Medical College Hospital, Nellore for a period of two years. The cases included in the study were 50 diabetic patients with retinopathy changes of both sexes with different age groups. Those included were selected from the patients attending the department of medicine for the treatment of diabetic mellitus, and referred to department of ophthalmology for evaluation, known diabetic patients who attended the ophthalmology outpatient department directly for the ophthalmic evaluation were also included in the study. Result: The mean age of the study subjects was 55.65 years with standard deviation (SD) of 11.3 years. 30 right eyes (60%) showed non proliferative diabetic retinopathy (NPDR) whereas in 29 left eyes (58%) showed NPDR. The lesions noticed on FFA of the right and left eyes in patients under study are almost same for Microaneurysm, Microaneurysm with haemorrhages, Ischemic maculopathy except hard exudates, intra retinal microvascular abnormalities, venous beading and Neovascularization. Conclusion: From the present study, it was concluded that fundus fluorescein angiography is useful in differentiating the lesions and classifying the diabetic retinopathy. In addition this technique had a major contribution in establishing the cause of unexplained loss of visual acuity.

Keywords: Diabetic Retinopathy; Non Proliferative Diabetic Retinopathy; Proliferative Diabetic Retinopathy; Fundus Fluorescein Angiography. 

The orbital tumours coming to neurosurgical team are often those, which are referred by ophthalmological units when they consider it to be complex in nature that is retrobulbar tumours complicated by extraorbital and intracranial extensions. Methods: clinical records of 23 patients operated for retrobulbar orbital pathologies in department of neurosurgery, Bangalore medical college and research institute from 2011 to June 2016 were reviewed and analysed. Patient’s demographics, symptoms and signs at presentation, and histologic diagnosis were recorded. Results: Twenty three patients were operated, of which 12 were men and 11 women, and the age of patients ranged from 11 to 65 years and mean age was 43 years. Fourteen patients had primary intraorbital tumours, 8 patients had secondary orbital tumours extending from other adjacent contiguous bones or structures and 1 patient had metastatic tumour from ovarian neuroendocrine carcinoma. Conclusions: Orbit being a complex anatomical entity, management of complex tumours poses a challenging surgical problem. Although a significant percentage of these tumours are treated by the ophthalmologist alone, proficiency with a multitude of approaches and collaboration with a neurosurgeon is often required, especially for tumours that are located deep within the orbit, are large, or have an intracranial extension. Technical advances and modifications in surgical techniques along with involvement of plastic surgeons have decreased surgeryrelated morbidity and involvement of radiation oncologist to the team for adjuvant radiotherapy/chemotherapy would be beneficial for prolonged recurrence free and better quality of life.

Keywords: Orbital Tumours; Proptosis; Lateral Orbitotomies; Superior Orbitotomies; Craniofacial Excisions. 

Background and Objectives: Cataract surgery is the major cause of blindness in the world. For developing countries MSICShas come in as savior simple and effective. Surgical techniques are continually modified and improved upon to decrease postoperative astigmatism. Major factor responsible is site of the cataract incision. In old age majority of the patient will have against the rule astigmatism, which worsens if the incision is taken superiorly for MSICS. The same is reduced when incicion is taken temporally. Objective: of the present study is to (a) Compare the astigmatic outcome in superior V/s temporal incision in MSICS. (b) To know the visual outcome in MSICS with both superior and temporal incision. Methods: This study has been conducted on patients of senile mature and immarute cataract admitted to ophthalmology wards in Basaveshwar Teaching and General hospital attached to M.R Medical / College, Gulbarga from November 2007 toJune 2009. Results: Inthis study with temporal sclera incision had gross lower astigmatism when compared to the patients with superor incision. The final mean of astigmation in superior sclera was 0.99 +/0.58 SD and in temporal sclera group it was 0.66 +/0.43 SD. The difference in astigmatism was highly significant, zcalculated value 4.6>2.58 tabulated Z value. Conclusion: Superior incicsion shows ATR shift as compared to temporal sclera incision which induces WTR. SAI of <1.00 D was seen in 88% of patient with temporal incision as compared to 62% in superior incision group. Temporal incision procedure less as compared to 62% in superior incision group. Temporal incision procedure less astigmation and neutralizing the preexisting.

Keywords: Cantaract Surgery; Astigmatism; Superior Incision Group. 

Purpose: To evaluate the response ot the treatment of uncorrected latent hypermetropiain adults with chronic headaches. Methods: It’s a prospective descriptive study. 50 subjects of age group 1840 yrs with headache are evaluated using cycloplegic retinoscopy to estimate the latent hypermetropia .Other identifiable causes of headache are ruled out.With appropriate spectacle correction responses are evaluated at 1 month, 2 months,and 6 months on a 6 point patient satisfaction scale. Results: 55% were satisfied at 1 month, 75% at 2 month and 81% at 6 months. Among the age category 93.9% patients less than 30yrs were satisfied at the end of 6months and 74.6% were satisfied in more than 30 yrs age group. Conclusion: This study showed that age groups 1840 yrs who presented with recurrent headache with no secondary cause were benefitted with latent hypermetropia correction.Thus this stidy emphasis on the importance of cycloplegicretinoscopy and latent hypermetropia correction for young adults complaning of headache.

Keywords: Latent Hypermetropia; Manifesthypermetropia; Accommodation.

Aims: The present study was done to determine the clinical pattern and microbiological spectrum of pathogens implicated in causation of acute and chronic dacrocystitis, and their antibiotic susceptibility. Settings & Design: A prospective hospital based cross sectional study for a period of two years at a tertiary care hospital by the department of ophthalmology in association with department of Microbiology. Material & Methods: 350 patients above >20 years attending the OP of dept of ophthalmology with clinical signs and symptoms of dacrocystitis were enrolled. Demographic data, duration of illness, clinical signs and symptoms were noted. Specimens collected after lacrimal syringing or purulent material collected after applying pressure on the sac was transported to microbiology laboratory for processing and isolation of pathogens. The isolated pathogens were identified by standard biochemical tests and antibiogram interpreted by CLSI guidelines. Results: 350 cases were enrolled, with 196 acute and 154 chronic dacrocystitis. Females were predominant (54.3%) in the study and 3140 years was the predominant age group, with 39.4% having illness <1 week duration. 49.4% belong to low socioeconomic group and majority are house wives (22.9%) and farmers (32.3%). Epiphora was present in all cases of chronic dacrocystitis and pain and swelling was major complaint in acute dacrocystitis. Unilateral involvement in 89.4% of cases, right eye was most commonly involved in acute cases and left eye in chronic cases. Culture positivity was observed in 82% of cases, 297 total bacterial isolates and 14 cases were co infected with fungus Candida albicans. Staphylococcus aureus was the most common pathogen in the total study, Pseudomonas aeruginosa was the most common gram negative pathogen. Gram positive pathogens were predominant in acute cases and gram negative in chronic cases. All the isolates were sensitive to higher generation antibiotics. Conclusion: To conclude, our study clearly highlights changing trends of bacterial pathogens in causation of acute and chronic dacrocystitis. Tobramycin, Amikacin, netilmycin, imipenems are therapeutic options of choice in medical management of cases of dacrocystitis. The present study may help the ophthalmologist to choose appropriate rationale antibiotic which provides broader coverage of common ocular pathogens.

Keywords: Acute Dacrocystitis; Chronic Dacrocystitis; Epiphora; Staphylococcus Aureus; Pseudomonas Aeruginosa. 

Aim: To detect retinal changes in patients with type 2 Diabetes prior to vascular signs without diabetic retinopathy or with mild non proliferative diabetic retinopathy. Methods: A crosssectional study was performed in three groups: 1. Patients without diabetes (Group A), 2. Patients with type 2 diabetes without diabetic retinopathy (Group B), 3. Patients with diabetes with mild diabetic retinopathy (Group C). Analysis of retinal layers was performed using Topcon 3D OCT. Macular scans were analyzed with regard to: retinal nerve fiber layer thickness, central subfoveal retinal thickness and average macular thickness. Results: In total, 60 patients were included in this study, of which 16 (26.67%) were classified into control group (Group A), 28 (46.67%) classified as diabetic patients with no diabetic retinopathy (Group B) and 16 (26.67%) classified as mild diabetic retinopathy (Group C). Quantitative analysis with using Topcon 3D OCT showed that the mean retinal nerve fiber layer was thinner in diabetics without diabetic retinopathy group when compared to controls. Statistically significant reduction in average retinal thickness in mild diabetic retinopathy group compared to control. Also indicated reduction in retinal nerve fiber layer in diabetic without diabetic retinopathy and eyes with mild diabetic retinopathy, compared to controls. Both the results were statistically significant. Conclusions: Our study found reduction in thickness of retinal nerve fiber layer in patients with diabetes without diabetic retinopathy, which suggests neuroretinal changes before vascular signs of diabetic retinopathy.

Keywords: Diabetes Mellitus; Diabetic Retinopathy; OCT; Optical Coherence Tomography; Macula; Retina; Neuronal; Neurodegeneration. 

The present study included 200 cases. In this 6% in superior scleral incision showed up same level of astigmatism 82% patients showed astigmatism <1.00D in temporal group as compared to 48% in the superior sclearal group. In the temporal scleral group there was a Significant reduction of preoperative against the rule astigmatism from 71% to 65% pre operative with the rule astigmatism increased from 25% to 26% at 21st post operative day following. However decay of mean astigmatism in superior sclera incision showed a distinct increase in against the rule astigmatism from 55% to 86% at 21st postoperative day, and with the rule astigmatism decrased from 27% to 80% post operatively. Surgically induced astigmatism of<1.00D was found in 88% cases from temporal scleral group whereas 62% cases from superior scleral group had <1.00D SIA.

Keywords: Astigmatism; Temporal Scleral Group; Superior Scleral Incision. 

Background: Several challenges exists in rural areas, as most ophthalmologists are concentrated in urban areas, this leaves many people without access to regular eye exams or treatment, which is vital in preventing permanent vision loss in the setting of glaucoma. Therefore, the present study was undertaken to assess the Awareness and knowledge of Glaucoma among Households. Materials And Methods: This study included 200 households (100 rural;100 urban) aged above 20 years in rural and urban field practice areas. After the informed consent, every household was subjected to personal interview using a semistructured and pretested questionnaire Results: The awareness on glaucoma was significantly higher in the literates (p= 0.000) in urban and among rural area (p= 0.015) as compared to illiterates. There was a statistical difference in the awareness of glaucoma between the males and females (p=0.014) in urban area and in rural area (p=0.005). Conclusion: Awareness and knowledge of glaucoma is poor both in urban as well as rural population. This study highlights the need for health education to effectively prevent blindness due to glaucoma.

Keywords: Glaucoma; Awareness; Urban area; Rural Area. 

Objective: The study was aimed at assessing & creating awareness of those attending eye department of our tertiary care hospital to save the precious sight and take a step forward in preventing this avoidable blindness. Methods: All the participants aged 40 yrs. or older, attending the eye department of this hospital of central India included in this crosssectional survey conducted from March 2013 to February 2014, were subjected to a prestructured questionnaires. Data on demographics, and awareness collected and analyzed. Simultaneously a constant effort was made to create awareness among the selected group. Result: Randomly selected 924 patients attending the outpatient eye department participated in this study. The mean age of participants was 52±24.yrs. No significant difference in male/female participation. All patients belonged to urban and semiurban areas with almost similar ethnicity. Among the total participants, only 12.98% had heard of glaucoma and was found to have directly related to the level of literacy. Besides these, other disease groups like diabetes and hypertension also included in the study to find out the awareness of glaucoma in these high risk groups. Conclusions: Awareness of glaucoma in this part of country is very poor, more so the knowledge of the disease. Creating awareness through massmedia and community health education programmes will be very effective step in preventing this irreversible blindness.

Keywords: Awareness; Knowledge; Primary Glaucoma; Literacy. 

Objective: To evaluate the success and outcome of pterygium dissection and surface conjunctival autografting with sparing of the superior conjunctiva for the management of primary pterygium. Methods: Prospective non comparative interventionalcase seriesinvolving 30 eyes with primary pterygium who underwent pterygium dissection with surface conjunctival autografting in the cornea clinic of a medical college. Results: There were 22 (73.33%) males and 8 (27%) females included in the study. Mean age of the patients was 43.88 years (range 1966 years). Pterygium was Grade 1 in 9 (30%) eyes, grade 2 in 10 (33.3%) and Grade 3 in 11 (36, 6%) eyes. No significant intraoperative complications were encountered. Average surgical time was 12.8mins. Mean followup period was 48 weeks (ranged 24 weeks to 72 weeks). Graft adherence by the end of 4 weeks post operative period was seen in 29 (99.218%) eyes. Pterygium recurrence occurred in 1 (3.3%) eye. No vision threatening complications were encountered either intraoperatively or postoperatively. Conclusion: pterygium dissection with surface conjunctival grafting is an excellent option for treating primary pterygia and helps in maintaining a virgin superior bulbar conjunctiva which may be required for future glaucoma surgeries.

Keywords: Pterygium; Pterygium Surgery; Conjunctival Limbal Autograft. 

Aims: To study the various clinical presentations of mycotic keratitis based upon the type of fungi and predisposing factor. To study, the epidemiological features of confirmed culture proven cases of mycotic keratitis and to identify the etiological agents. Settings & Design: A prospective hospital based cross sectional study at a tertiary care hospital for a period of 3 years from October 2013 to September 2016. Material & Methods: 800 culture confirmed cases of mycotic keratitis were enrolled in the study and followed regularly. The demographic, epidemiological characters and clinical examination findings by slit lamp examination were noted. Corneal scrapings and swabs were sent to laboratory for cultivation and identification of fungi. Statistical Analysis: The collected data was entered in Microsoft excel spread sheet, verified and entered in MEDCALC software and analyzed for statistical significance. Results: Males were more common in the study (66.25%), 2130 years age group were more common(29.4%) and the incidence of mycotic keratitis was 38.28%. 78% were of rural background and 65.5% of cases were agricultural workers/farmers. Trauma was the common predisposing factor (78.75%) and traumatic agent was vegetative matter like husk, straw etc. Anterior chamber reaction was the commonest finding in slit lamp examination (91%).Fusarium sp was the common fungi (34.2%) followed by Aspergillus sp (32.5%). Candida sp accounted for 18.2% in the study. Pseudomonas aeruginosa was the commonest bacterial pathogen isolated (62.6%). Conclusion: our study highlights the demographic particulars of mycotic keratitis and epidemiological characters and clinical presentation in our geographic region. Early diagnosis of the condition is imperative for management either surgical or medical management. KOH wet mount is a simple microscopic diagnostic choice with more specificity which can be used in diagnosis of fungal keratitis.

Keywords: Mycotic Keratitis; Fusarium; Aspergillus SP; Pseudomonas Aeruginosa; KOH Wet Mount. 

Aim: To determine the prevalence of ocular changes in hypertensive disorders of pregnancy. Materials and Methods: This was a prospective observational study and it was conducted in period of 2years and it consisted of 100 subjects who fulfil the diagnostic criteria of hypertensive disorders of pregnancy. Results: Out of 100 patients, 61 patients had gestational hypertension, 23 had preeclampsia, and 15 had eclampsia, 2 had chronic hypertension and 1 had preeclampsia superimposed on chronic hypertension. Most of the fundus changes were seen in the 2225 age group. Fundus changes were observed in 21(21%) patients. Of these 21 patients with fundus changes, 19 patients had Grade I change, 1 patient had Grade II retinopathy change with retinal edema and macular edema and 1 patient had macular edema. Fundus changes were seen in 55.5% of preeclampsic and eclampsic patients. Out of 21 women who had preeclampsia, fundus changes were seen in 52.3% of them. Among 12 women who mild preeclampsia fundus changes were seen in 41.6%. Of 9 women with severe preeclampsia 66.6% had fundus changes. Out of 15 women who had eclampsia, fundus changes were seen 60% of them. Severe retinal changes like macular edema and Grade II retinopathy with retinal edema and macular edema were seen in eclampsic women. Visual disturbances were seen in 2 cases, out of these one patient had macular edema and the other had Grade II retinopathy change with retinal edema and macular edema. Most of the fundus changes (71.4%) were seen when the systolic blood pressure was 160 mm Hg. It was found that there was an increased incidence of retinal changes with an increase in systolic BP with a statically significant P value of 0.001. Fundus changes were seen only when the diastolic blood pressure was  100. It was found that there was an increased incidence of retinal changes with an increase in diastolic BP with a statistically significant P value of 0.0006. In this study out of 37 patients who had proteinuria, 19 patients had proteinuria of 1+ and retinal changes were seen in 5 (26.3%) of them, 14 patients had proteinuria of 2+ and retinal changes were seen in 11 (78.57%) of them and 4 patients had proteinuria of 3+ and retinal changes were seen in all (100%) of them. Conclusion: It can be concluded that fundus evaluation should be done in all patients with hypertensive disorders of pregnancy.

Keywords: Gestational Hypertension; Eclampsia; Macular Edema. 

Introduction: Dacryocystitis is the inflammation of lacrimal sac. It mostly results from blockage of nasolacrimal duct. Aim: The study was carried out for detection and identification of causative bacterial agents and their Sensitivity to different antibiotics. Materials and Methods: One year study was carried out from March 2015 to Feb. 2016. Samples were collected with the help of sterile swab and further processed in the department of Microbiology. Results: Out of 66 cases were studied, 64 (96.96%) were culture positive and only 2 (3.03%) were culture negative. Gram positive organisms were most commonly isolated than Gram negative organisms.The most common bacteria isolated were the Coagulase negative staphylococci 41 (64%), Staphylococcus aureus 12 (18.75%), Staphylococcus epidermis 3 (4.68%), Klebsiella pneumoniae 3 (4.68%), Pseudomonas aeruginosa 3 (4.68%) and Streptococcus pneumonia 2 (3.12%). Conclusion: Dacryocystitis is the most frequent disease of lacrimal system and one of the most important cause of ocular morbidity. As majority of our population live in rural areas, knowledge of causative organisms and the susceptibility of the bacteria towards antibiotics plays major role in the management of these disease.

Keywords: Dacryocystitis; Lacrimal Sac; Nasolacrimal Duct. 

Background: Normal visual functioning depends not only on patient’s visual acuity but also on many other parameters, such as the visual fields, perception of colour, contrast and visual skills. Clinically, objective measurements, such as those of acuity or the visual fields, provide an assessment of a patient’s visual status but do not reflect the degree of visual impairment that the patient experiences in his or her daily activities sufficiently. Impairment of vision affects the quality of life which is related to health, and affects the daily activities of life, including social activities. The efficacy of interventions should be validated by patient’s visual functions and by assessing visual or impact of visual impairment on daily activities. Aim: To evaluate visual functions and performance among children and young adults with refractive errors and to assess the effectiveness of ophthalmological interventions on visual functional improvement. Materials and Methods: The participants in this study comprised children and young adults with refractive errors, aged 530 years, attending the low Vision and paediatric ophthalmology department at Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirappalli. Data relating to distant visual acuity, near visual acuity, ocular examination, refraction after cycloplegia, near vision, contrast sensitivity; colour vision, field of vision and functional visual assessment were collected and reviewed after refractive correction. Results: The comparison of visual functions and functional skills in children and young adults with refractive errors showed that individuals in low vision groups had reduced visual functions even with best corrected visual acuity than the individuals in normal vision group. There was a statistically significant difference in uncorrected visual acuity, best corrected visual acuity, colour vision, contrast sensitivity, stereopsis, near point of accommodation, near point of convergence etc. between Group 1(patients with vision 6/18) and Group II(patients with vision<6/18). Functional skills like reading speed, writing speed and mobility were also reduced in low vision groups that shows statistically significant difference between Group 1 and II and also had significant difference among subgroups of Group 1 and II. None of the patients had age appropriate functional skills in Group 1 and Group II. After using interventions (like optical and nonoptical aids) for 6 months, there was a statistically significant improvement in BCDV, functional skills between first visit and followup visit and had significant differences among subgroups. But none of the individuals in Group 1and II had age appropriate functional skills. Conclusion: The present study had shown that in spite of improved clinical and functional vision with interventions, at short term followup, the visual skills required, were not age appropriate, both at initial and at also followup visit. Hence, functional vision parameters should be monitored as a criterion to determine the quality of vision in those with refractive errors especially in the paediatric age group.

Keywords: Refractive Error; Visual Function; Paediatric and Young Adults. 

Context: Corneal blindness is a major challenge faced today in the whole world; corneal ulcers being the most common cause. Bacterial corneal ulcers should be recognized and treated at the earliest as they can lead to permanent sight threatening complications. Aims: To study clinical course, antibiotic sensitivity pattern and treatment aspects of bacterial corneal ulcers. Settings and design: Prospective clinical study carried out at department of Ophthalmology, Karnataka Institute of Medical Sciences, Hubli. Methods and Material: A prospective clinical study was carried out. All patients attending ophthalmology out patient during the study period of November 2010 to May 2012 with definitive signs and symptoms of corneal ulcers were included in the study. Bacterial corneal ulcers were specifically studied in detail after microbiological evaluation. Statistical Analysis: Data was entered in Microsoft Excel worksheet and analyzed using proportions. Statistical test like chi square test was used wherever appropriate. P value of less than 0.05 was considered as statistically significant. Results: Majority of ulcers were caused by staphylococcus aureus (33.34%), followed by Pseudomonas (23.81%), Klebsiella (14.29%), Staphylococcus epidermidis (9.52%), alpha hemolytic streptococci (7.14%), beta hemolytic streptococci (4.76%), Streptococci pneumonia (4.76%), E. coli (2.38%). Fluorquinolone monotherapy was used in 64.39% cases. Surgical debridement was done in 76.2%. Most common complication was healed corneal scar in 69.05% of cases. Conclusion: Microbiological evaluation is the most important step in the management of bacterial corneal ulcer.

Keywords: Ulcer; Evaluation; Management; Intervention; Complications. 

Introduction: The study aims to study the mechanism, type, site, size, severity of injury and to see the final visual outcome after surgical repair at the end of 3 months. Material Methods: It is a single centric prospective study done at tertiary care centre over 1 and half year with 150 patients. Parameters taken were age, sex, profession of the patient, visual acuity and final vision at 3 months, anterior and posterior segment evaluation, imaging when required. Result: Males were affected more (3.8:1) involving unskilled labourers and farmers (30.6%) and students (28%). Majority of these were caused by sharp objects (93.33%), stick followed by stone. 80% patients were brought within 24 hours. In this study majority (58.66%) patients had vision worse than 2/60 at presentation. It was also observed in this study that corneal laceration (50%) is more common compared to scleral laceration (32%) while 18% had a corneoscleral laceration. Zone 3 injuries have the worst visual prognosis followed by zone 2 followed by zone 1. Conclusion: In our study factors associated ultimate with poor vision (<2/60) at 3 months were presenting visual acuity, extensive lid laceration (66.66%), relative afferent pupillary defect (96.14%), hyphaema (56.7%), vitreous loss (61.8%), retinal detachment (50%).

Keywords: Open Globe Injury; Ocular Trauma; Visual Outcome Post Trauma. 

Introduction: Thyroid associated ophthalmopathy is an autoimmune disorder affecting the orbital and periorbital tissues. Hyperthyroidism is commonly associated with thyroid associated ophthalmopathy, however in 5% to 10% of cases it is euthyroid. Genetic, environmental and endogenous factors play a role in the initiation of the thyroid ophthalmopathy. Materials and Methods: This is a prospective study conducted on total 40 patients according to inclusion criteria. All patients underwent a comprehensive ophthalmological examination and radiological examination. Results: In the present study, 5th decade was the most common age group observed with thyroid orbitopathy in 12 cases (30%). Female preponderance was seen with females twice more common than males. Hyper thryroidism (67.5%) is most common thyroid status observed. Uniocular presentation (75%) with right eye involved more frequently 40% than left eye. Sandy and Grittiness (60%) was the most common symptom, Proptosis (90%) was the most common sign and Lid retraction (85%) was the second most common sign observed. Inferior rectus most commonly involved muscle (62.5%) and least involved muscle was lateral recuts (22.5%). Corneal involvement with tear film abnormalities 10%, optic nerve compression 5% and ptosis 5% were observed less severe in our study. Conclusion: In present study we found that 5th decade 12 (30%) with female preponderance and most of the cases are with proptosis.

Keywords: Graves Ophthalmopathy; TAO; Hyperthyroid; Proptosis; Uniocular. 

Aim: To investigate the variation in average retinal thickness in macular region in otherwise normal young myopic subjects by using optical coherence tomography (OCT). Methods: One hundred and thirty ophthalmologically normal men 20 to 24 years of age with myopia (spherical equivalent, 0.25 to 14.25 D) underwent examination of one randomly selected eye. Tests performed were Visual acuity, BCVA with refraction, slit lamp examination, IOP by applanation tonometry, gonioscopy, Ascan ultrasound, fundus examination, visual field testing by HFA, and optic disc photography. Exclusion criteria were visual acuity better than 6/9, previous intraocular surgery, intraocular pressure >21 mm Hg or other ocular diseases. Three horizontal transfixation and three vertical transfixation OCT scans of 6 mm each were conducted on each eye by a single investigator. Neurosensory retinal thicknesses was measured, and the overall average, maximum, and minimum retinal thicknesses were analyzed. Results: The average retinal thickness of the macula does not vary with myopia. However, the parafovea was thinner and the fovea thicker with myopia.

Keywords: Myopia; OCT; Retina; Average Retinal Thickness; Elongated eye; Myopic Retina. 

Purpose: To determine the knowledge, attitude and practice towards strabismus among medical practitioners. Methods: A structured questionnaire was constructed with questions regarding awareness, knowledge of etiology, consequences, prevention and the treatment of strabismus. Questionnaire were randomly distributed among all doctors and answers obtained were tabulated. Total of 170 questionnaire sheets were distributed among them 150 completely answered sheets were collected. Results were calculated using proportions and percentages. Results: Only 54% of subjects included in the study knew about the aetiology and 70% of them knew that strabismus can be prevented. 95% prefer to refer strabismus patients to an ophthalmologists and 76% agree that every school going child to be screened for strabismus. 58% think that surgery is the only treatment and 59% knew strabismus can also be corrected optically. Conclusion: Although medical practitioners showed fair knowledge about the condition, still there is a need to create awareness regarding the etiological factors and varied treatment approaches is required.

Keywords: Strabismus; Quessionnaire; Medical Practitioners. 

Background: This study was undertaken to compare two types of incisionsstraight and inverted V ‘Chevron’ incisions in manual small incision cataract surgery (MSICS) with regards to surgically induced astigmatism. Methods: A prospective comparative study involving 100 eyes of 100 patients who underwent MSICS at Department of Ophthalmology, Gujarat Adani Institute of Medical Science, Bhuj, Kutch. All patients were subjected to a detailed ocular examination. Out of the 100 patients who underwent MSICS, 50 were randomized into Straight incision group and 50 into Inverted V shaped ‘Chevron’ incision group respectively. Results: No statistically significant difference noted in postoperative uncorrected and best corrected visual acuity. However, only 22% (n=11) of the patients who underwent MSICS with inverted chevron incision had SIA > 1.5 D, as compared to 48% (n=24) in the straight incision group, which was statistically significant. Conclusions: Inverted V shaped ‘chevron’ incision results in lesser postoperative astigmatism.

Keywords: Bhuj; Cataract Surgery; Incisions; Stigmatism. 

Introduction: Pregnancy Induced Hypertension (PIH) is an entity involving multiple systems; changes during pregnancy bring about many alterations in human body which are reversible. PIH in turn has got its effect on the visual system of the eye involving the retinal vasculature and producing myriad signs and symptoms. Purpose: This study was undertaken to bring out the various retinal changes in pregnancy and their post partum reversal time. Materials and Methods: This was a prospective study done on 100 patients with Pregnancy Induced Hypertension (PIH) who were referred to Department of Ophthalmology, KIMS, Narketpally, from October 2015 to September 2016. Detailed ocular examination including fundoscopy was done in all 100 patients and results were interpreted. Results: Out of 100 patients of pregnancyinduced hypertension (PIH) 16 were gestational hypertension patients, 60 were preeclamptic patients and 24 were eclamptic patients. Headache was the most common symptom encountered in 68% of cases Visual disturbances were seen in 16% of cases .percentage of patients developing retinopathy due to PIH increased as we moved from mild preeclampsia group to eclampsia group. The relationship between retinal changes and severity of PIH was statistically significant ( <0.0001) . Grade 4 retinopathy changes were seen in systolic blood pressure >180mm of Hg and diastolic blood pressure > 120 mm Hg. The percentage of patients developing severe retinopathy changes due to PIH was directly proportional to BP. Range of gestational age at which most of the patients developed PIH was from 3034 weeks.Pregnancy induced retinopathy changes were seen more in primigravidas. Reversal of signs and symptoms l occurred in all the cases by 10 weeks postpartum. Conclusion: We conclude that fundus changes in PIH are proportional to severity of PIH and BP, all signs and symptoms including visual acuity are reversible with proper control of PIH and periodic fundus examination and follow up is mandatory to prevnent complications.

Keywords: PIHPregnancy Induced Hypertension; PreEclamsia; Eclamsia; PostPartum; Visual Acuity. 

Aim: To determine and compare current levels of knowledge, attitude and practice patterns in known diabetics attending hospital and amongst diabetic patients in villages. Methods: Present Study was conducted at Department of Ophthalmology, Gujarat Adani Institute of Medical Science, Bhuj, and Kutch. 307 known diabetics coming to hospital for screening (group1) and 300 known diabetics in the villages (group 2) were evaluated and knowledgeattitudepractice regarding diabetic retinopathy was determined. Results: Majority 58.3% among hospital patients knew that diabetic retinopathy is a complication of diabetes as compared to only 18% of camp patients. Group 1 had better knowledge about diabetic retinopathy than group2. Attitude for eye checkup was poor both in group 1 and 2. Practices regarding need for eye checkup followed by patients in both groups were similar. Conclusion: The sex, literacy, occupational status, economic status and duration of diabetes mellitus were factors that were found to be significantly associated with knowledge, attitude and practices of the patients.

Keywords: Bhuj; NonProliferative Diabetic Retinopathy; Knowledge; Attitudes; Practice.

Aim: To determine the Occurrence of glaucoma and risk factors for primary openangle glaucoma among fishermen community of Naliya taluka of Kutch district. Material and Methods: A Observational Study was conducted to assess the prevalence of glaucoma among fishermen community of Naliya Taluka of Kutch district. All participants had a comprehensive eye examination at the base hospital, including visual acuity using logarithm of the minimum angle of resolution illiterate E charts and refraction, slitlamp biomicroscopy, gonioscopy, applanation tonometry, dilated fundus examinations, and automated central 242 fullthreshold perimetry. Results: The prevalence of any glaucoma was 2.5%, of POAG it was 1.6%, and if PACG it was 0.6% and secondary glaucoma excluding pseudoexfoliation was 0.2%. On multivariate analysis, increasing age, male gender, myopia greater than 1 diopter, and pseudoexfoliation were significantly associated with POAG. Conclusion: The prevalence of glaucoma in this population is not lower than that reported for other populations elsewhere. A large proportion of those with POAG had not been previously diagnosed. Early detection of glaucoma in this population will reduce the burden of blindness in India.

Keywords: Cross Sectional; Glaucoma; Fishermen; Naliya; Prevalence. 

Introduiction: Convergence Insufficiency (CI) is the leading cause of eyestrain, blurred vision, double vision (diplopia), and/or headaches. In the evaluation of patients with ocular asthenopia, convergence insufficiency should be suspected. Convergence insufficiency disorder interferes with a person’s ability to see, read, learn, and work at near.In studies that used standardized definitions of Convergence insufficiency, investigators have reported a prevalence of 4.2% to 6% in school and clinic settings. Objectives: To assess the incidence & associated symptoms of convergence insufficiency among general population. Materials & Methods: Patients visiting the ophthalmology OPD of SSIMS & RC were included for the study. patients were given CISS( convergence insufficiency symptoms survey) questionnaire & convergence insufficiency was tested was tested with RAF rule. Result: In group A total 68 patients (13.6%) out of 500 were diagnosed with convergence insufficiency. Most common associated symptom was headache (32.35%) [p value<0.04]. In group B 50 patients(10%) out of 500 had convergence insufficiency. Most common associated symptom was headache (17.64%). Conclusion: Convergence insufficiency is more common in Group A (<18 yrs. of age) & is one of the important causes for headache (32.35%). So all the patients with headache should be tested for convergence insufficiency.

Keywords: Convergence Insufficiency; Diplopia; Ocular asthenopia 

Aims: To explore the conjunctival impression cytology as a tool for the assessment of the cytological changes in type 2 DM & pterygium patients with normal tear film function tests. Materials & methods: This case control study was conducted in Navodaya Medical College Hospital & Research Centre in dept of Ophthalmology. Total 80 cases were examined i.e.20 patients with pterygium, 20 patients with type 2DM & 40 control group and conjunctival imprint smear cytology results were analysed. The presence of local tear film abnormalities was assessed by TBUT & Schirmer test. The changes in cytomorphology was studied using conjunctival imprint cytology. The data is entered on excel sheet & analysis is carried out by using SPSS 19.0 statistical software. Results: In our study inspite of normal tear film function tests, abnormal conjunctival impression cytology reports were found in 10 type 2DM cases & 11 cases of pterygium. Statistically significant difference was found between study & control group (p<0.001). Conclusion: Thus conjunctival impression cytology is a useful tool to assess the dry eye in pterygium & type 2 DM patients in presence of normal tear film function tests.

Keywords: Conjunctival impression cytology; Dry eye; Tear film; Pterygium; Type 2 DM.

Purpose: The aim of the study was to compare optic nerve head (ONH) and Retinal nerve fibre layer (RNFL) thickness tomographic parameters measured by Spectral Domain (SD) OCT and to identify which measurements are best able to differentiate between normal and glaucomatous eyes in Indian population. Design: Cross sectional prospective diagnostic study. Methods: Participants were recruited from a universitybased clinic. 30 age matched normal and 30 Open angle glaucomatous eyes who full filled the inclusion criteria were selected. All cases were subjected for optic nerve head (ONH) and Retinal nerve fibre layer (RNFL) thickness evaluation with the SD OCT (Carl Zeiss). All parameters were compared with normal eyes. The areas under the receiver operating curves AROC were calculated for each single parameter and then compared. Results: Comparative analysis of SDOCT parameters revealed statistically significant difference in all five RNFL parameters between both the groups. Most of the ONH parameters demonstrated statistically significant difference in glaucoma group when compared with control group. The inferior quadrant (0.976) and average RNFL thickness (0.970) obtained the highest AROC values in open angle glaucoma group. The rim area had the best diagnostic accuracy among the ONH parameters (AROC = 0.951). Conclusion: In the present study, RNFL parameters presented with better discriminatory abilities than ONH parameters in the normal and glaucomatous group. Out of all the RNFL and ONH parameters inferior quadrant RNFL thickness, average RNFL thickness and rim area had the best ability to discriminate between glaucomatous and normal eyes.

Keywords: Optical Coherence Tomography; Retinal Nerve Fiber Layer Thickness; Optic Nerve Head Analysis; Spectral Domain