Ophthalmology and Allied Sciences

Context: Glaucoma is the largest cause of bilateral blindness, second only to the cataract; however, the disability caused by glaucoma is irreversible. According to the World Health Organization model, based on the most recent available data, glaucoma accounted for 12.3% of blindness in 2002.

Aims: To find out the Prevalence of Primary open angle glaucoma in patients attending Ophthalmology OPD at KIMS Hubli and to study the various risk factors associated with Primary open angle glaucoma. Settings and design: Hospital based cross sectional study was carried out at Ophthalmology out patient department of KIMS, Hubballi.

Methods and material: Around 500 patients during the period of January 2016 to December 2016 satisfying the inclusion & exclusion criteria were enrolled into the study after valid consent. History, Visual acuity, slit lamp examination, CCT measurement, IOP measurement, Gonioscopy, Fundus evaluation, Visual field assessment was done on patients.

Statistical analysis: Proportions and appropriate statistical tests were used for statistical analysis. Results: Out of 1000 eyes of 500 patients included in the study, 83 eyes of 54 patients were diagnosed as cases of POAG.The overall prevalence of POAG were found to be 10.8 %. All 54 cases of diagnosed POAG were above 40 yrs of age. 18 pts were diabetic (33.33%), 22 had hypertension (40.74%). 6 patients had family history of glaucoma (11.11%).There were 11 smokers (20.37%) 5 myopic (9.2%) and 6 (11.11) patients had CCT < 555 µm in the study. Conclusion: We found high prevalence rate (10.8%) of POAG compared to population based studies. And the prevalence of POAG increases with age. Diabetes, hypertension, family history, smoking, myopic, and thinner CCT are risk factors associated with POAG. 

Keywords: Primary Open Angle Glaucoma; Age; Diabetic; Hypertension; Myopic.

 

Aims: To know the incidence and treatment outcome of various ocular manifestations of Allergic Fungal Pan Sinusitis.

Methodology: A prospective study was conducted in a medical college hospital in south India for
a period of 2 years which included all the cases of Allergic Fungal Pansinusitis presented to the hospital. The cases were diagnosed by Bent-Kuhn criteria. The cases with ophthalmologic involvement were included in the study. CT scan of PNS, brain, orbit were done and the disease extent was noted. Cases with eye involvement were planned for surgical debridement after an initial prednisolone oral 1mg/kg over 2 weeks. Surgical debridement was done endoscopically by a team of ENT surgeon, Oculoplastic surgeon and neurosurgeon. Histopathologic examination was done. Post-surgery the steroids were tapered over 2 weeks. Post-operative follow up was done
every day for first week followed by weekly once till a month and every 6 monthly once for a year in the form of clinical examination, CT scan was repeated after a week during post op period. In cases with suspected recurrence CT PNS was performed. Their outcomes were analyzed. Results: 6 cases (33%) had ocular involvement. Proptosis was the most common (28%) finding followed by epiphora(22.2%), ophthalmoparesis (22.2%), diplopia (22.2%), ophthalmoplegia (11.%), complete loss of vision (5%). Surgical intervention led to early recovery in proptosis followed by others except with PL -ve case.

Conclusion: Early treatment in AFPS prevents vision loss and has better outcomes. 

Keywords: Allergic Fungal Pan Sinusitis; Proptosis; Epiphora.

 

Aim/Background: Diabetic retinopathy is a medical condition in which damage occurs to the retina due to diabetes mellitus. The role of ‘longer term’ glucose stability in terms of HbA1c variability, and the occurrence and progression of diabetic complications among type 1 and type 2 diabetic patients remains elusive. This study aims to study the correlation of serum glycosylated haemoglobin (HbA1C) with severity of diabetic retinopathy in patients with type 1 and type 2 diabetes mellitus.

Patients and Methods: A descriptive correlative study was conducted with 200 patients and were investigated for diabetic retinopathy and HBA1c levels using laboratory investigations and detailed ocular examination.

Results: Diabetic retinopathy was the most commonly observed in >10 yrs of duration of diabetes (61.76% ) followed by 5 -10 yrs (27.45%) and < 5 years (10.78%). Diabetic retinopathy was most commonly observed in HBA1C levels of more than 10 gm (55.88%) followed by 7-10 gm (27.45%) and 7 gm (6.86%). There was statistically significant difference between duration of diabetes, HBA1C levels and diabetic retinopathy amongst study population (p value < 0.05).

Conclusion: Patients with Diabetic Retinopathy were found to have significantly raised serum glycosylated haemoglobin levels (HbA1c). The severity of Diabetic Retinopathy increased with raised levels of HbA1c noted mostly in patients with HbA1c levels more than 10 mg/dl. There was a significant correlation between Diabetic Retinopathy and duration of Diabetes Mellitus.

Keywords: Diabetes Mellitus; HbA1c Levels; Diabetic Retinopathy

 

Background and Aim: Cataract is the leading cause of visual impairment and blindness worldwide, accounting for more than 50% of the blindness cases. The objective of the present study was to determine the cause, presentations, types and over all social impact of cataract on children. The three main types of age-related cataracts are nuclear, cortical and posterior sub-capsular cataracts (PSCC).

Materials & Methods: The study was conducted in the ophthalmology department in the medical institute. The present study is the hospital based study conducted from the period of Jan to July 2017 that is 6 months. All the children diagnosed with cataract in the ophthalmology ward were included in the study.

Results: A total of 400 children were included in the study. All the children attended the opd of the ophthalmology department of the medical institute. 40 children were diagnosed with cataract. That shows the prevalence rate of 10%. The age range of presentation of cataract was found to be 3 – 10 years. The mean age was found to be 6.5 years.

Conclusion: The prevalence of cataract in children was found to be 10%, the mean age of patients was 6.5 years; corneal opacity and lens opacity were the most common symptoms and signs, respectively. Idiopathic cataract was the most common type and decreased vision was the most common complication. 

Keywords: Children; Cataract; Diabetes Mellitus; Etiology; Prevalence.

 

Aim: The aim of this study was to discuss the corneal endothelial cell characteristics, central corneal thickness and determine the relationship with age.

Methods: 200 eyes of 100 patients underwent specular microscopy. Corneal Endothelial Cell Density (CECD), Mean Cell Area (MCA), percentage of hexagonal cells, Coefficient of variation
(CV) and Central Corneal Thickness (CCT) were the parameters collected.

Results: Mean CECD was 2675.8±384.4 cells/mm2. MCA (Mean cell area) was 387.79 µm2±91.27 µm2, Coefficient of variation (CV) in cell size was 37.440 %±8.395% and percentage of regular hexagonal cells was 49.870%±7.921%. There was a statistically significant inverse correlation between age and CECD. A positive correlation was observed between CV, MCA and age.

Conclusion: CECD and CCT decreases with age. MCA and CV increase with age. Percentage of regular hexagonal cells is not dependent on age. 

Keywords: Central Corneal Thickness; Corneal Endothelial Cell; Specular Microscopy.

Aim: Present study was done with an aim to approximate the prevalence of Diabetic Retinopathy (DR) and to discover its relations with various variables amid type 2 Diabetes Mellitus (DM) patients.

Material and Methods: present cross-sectional research was performed in the Department of Ophthalmology for the period of one year. Overall 800 patients with type 2 DM present at outpatient Department of Ophthalmology were incorporated in the research. Visual acuity was assessed by Snellen chart. Qualitative analysis was compared with Chi square test ad quantitative analysis was compared with student‘t’ test. p <0.05 was considered statistically significant

Results: Overall 800 patients with DM were included in the study, out of this 18.1% had DR, in which males were more exaggerated (54.4%) than females (45.8%). Among 145 patients with DR, 121 had NPDR, showed 50.3% mild, 36.7% moderate and 4.9% severe NPDR, while 8.1% patients had PDR. Thirty three per cent were establish to be have DR over 80 years of age, trailed by 22% in the age group of 70-79 years.

Conclusion: Present study anticipated the prevalence of DR in a rural population with type 2 diabetic patients (18.1%).

Keywords: Cross-Sectional; Diabetes Mellitus; Prevalence; Retinopathy.

 

Introduction: Dacryocystorhinostomy (DCR) is an operation that creates a fistula between the lacrimal sac and nasal cavity to facilitate drainage of the tears in cases of nasolacrimal duct obstruction. Initially ‘DCR’ was performed by using an external approach for acquired nasolacrimal duct obstruction. Of lately endoscopic DCR is evolving as an equally effective alternative intervention.

Objective: The present study is to correlate the surgical outcome of external DCR and endonasal DCR regarding the patency rate and to assess the intraoperative and postoperative complications of both the interventions.

Materials and Method: This prospective clinical study was carried out in the Department of Ophthalmology and ENT, SIMS and RC, Bangalore, from 2016-2017. A total of 30 consecutive patients having complaints of watering with complete nasolacrimal duct obstruction diagnosed by
syringing; known cases were selected for DCR surgery. Dacryocystography was done in all the cases. Among 30 patients a total of 15 patients underwent external DCR and rest of the patients underwent endoscopic DCR. Revision cases were excluded from the study group. A detailed history, regarding symptoms was collected systematically. Data pertaining ocular examination, lacrimal syringing, intra-operative and postoperative complications and finally ultimate surgical outcome were collected. Data was analyzed by SPSS statistical software. ROC test was employed to draw the significant inference.

Results: The result showed that both surgical approaches had almost similar success rate ie. external DCR had 87% success rate with good specificity of 89.0% and sensitivity 79.99% and endoscopic DCR had 80% success rate with 83.22% specificity and sensitivity 71.88%. The complication rate was low in both the groups and no appreciable difference in complication rate was seen in both types of surgery p> 0.01.

Conclusion: Surgical outcome of both endoscopic and external DCR for Chronic Dacryocystitis was quite satisfactory p<0.001. The complication rate was low. Thus, these two different dacryocystorhinostomy techniques will be acceptable alternatives for the treatment of chronic dacryocystitis. With external DCR still the gold standard for chronic dacryocystitis, endoscopic DCR is a safe, minimally invasive effective alternative to external DCR, but it requires expertise and expensive equipment for endoscopy.

Keywords: Dacryocystorhinostomy; External; Endonasal; Endoscopic.

 

Purpose: To evaluate the postoperative outcome, cause of poor visual outcome and complication following cataract surgery in diabetic patients.

Methods: It is a comparative study conducted on 100 diabetic patients & 100 non diabetic patients undergoing planned manual SICS attending Ophthalmology Dept. in NMCH & RC, Raichur during Nov 2010-Apr 2012. Detailed clinical history and ocular examination was done. These patients were followed up post surgery on day 1, 1st, 3rd, 6th week, 3rd & 6th month. 

Results: Post operatively corneal edema was found in 21% of the diabetic & in 12% of non diabetic patients. Preoperatively 4% of patients had mild NPDR & 8% had moderate NPDR. At the end of 6 month, progression of retinopathy was seen in 6% of the patients. CME was seen in 2% of the patients & CSME occurred in 2% of the patients, P.C.O was observed in 24% of diabetic and 14% of non diabetic patients post operatively. Post operative visual acuity improved in both group, no statistically significant difference was obtained in visual acuity outcome in both the group at the end of 6 month follow up, with p=0.28 (>0.05).

Conclusion: To conclude diabetic patients with cataract have an overall good visual out come.
With adequate blood sugar control, careful preoperative planning, a traumatic surgical techniques, appropriate postoperative medicines & close postoperative supervision, diabetic patients can achieve excellent vision after cataract surgery just like our other cataract patients. 

Keywords: Diabetes Mellitus; Cataract; Post Operative Complication; Visual Acuity.

 

Background and Objective: To study the clinical profile of posterior capsular opacification (PCO) and outcome following Nd:YAG Laser capsulotomy. Methods: A total of 100 eyes presenting with PCO to Ophthalmology OPD, KBNIMS Kalaburagi who fulfils inclusion and exclusion criteria were taken for the study for the period from November 2015 to December 2016 as a time bound study. Nd: YAG Laser capsulotomy was done. The postoperative follow up was done 1hr, 4hr, 24hr, 1wk, 4wk, 6wk, after laser and observed for any complications.

Results: Among the 100 cases 43 were males and 57 were females. Majority of cases have pearls (80%) type of PCO. After the procedure 86% of patient got vision between 6/9 to 6/6 while 14% of patients had vision between 6/60 to 6/12. Complications like intraocular pressure spikes (10%), aqueous flare and floaters (4%), IOL pitting (3%), cystoid macular edema (1%) were seen.

Interpretations & Conclusion: Nd: YAG Laser capsulotomy is a safe and effective method to treat PCO.
Keywords: Posterior Capsular Opacification; Nd: Yag Laser Capsulotomy.

 

Aim: To evaluate and analyze the surgical outcome of sutureless, glueless conjunctival autograft (SLGL-CAG) fter pterygium excision. Prospective, interventional, hospital-based study. 

Methods: seventy eyes of seventy patients with primary pterygium were graded, and excision was performed by the single surgeon. To prevent recurrence, free CAG was taken from superotemporal or superior quadrant from the same eye and bare sclera was covered without the use of sutures or fibrin glue, allowing natural autologous coagulum of the recipient bed to act as a bioadhesive. The eye was patched for 24 h. postoperatively; patients were put on topical eye drops (gatifloxacin 0.3%, loteprednol etabonate 0.5%, and carboxymethyl cellulose 1%) for 4 weeks. The outcomes were assessed in terms of any recurrence, complication(s), and operative time at each follow-up visit on day 1, 7, 30, and 60.

Results: There were 52 females (74.2%) and 18 males (25.7%) with mean age (38.83±9.2 years and 38.88±6.5 years, respectively,  range 20–60 years. Cosmetic blemish was the chief indication of surgery (51 eyes, 72.8%). Graft-related complication took place in four eye (5.71%; graft dehiscence). Resurgery was required in the latter (5.71%). Granuloma was noted in 2 patients (2.85%). An average surgical time was 20±2 min.

Conclusion: The recurrence, complication rate, and the operative time of SLGL-CAG seem to be comparable with the current techniques in practice, without adding possible potential hazard of the surgical adjunct. 

Keywords: Pterygium; Recurrence; Suture-Less Glue-Less Conjunctival Autograft.

 

Aim: The present study is designed to understand the tear film abnormalities in patients with pseudoexfoliation syndrome. Method: The prospective non-randomized study of 50 eyes of 25 normal subjects and 50 eyes of 35 patients with PEX syndrome were undertaken. Tear film changes, schirmer’s 2 test and tear film break up time (TBUT) were performed. Result: The mean age was 56.4±4.2 years and 60.27±5.3 years in both PEX and control group respectively. 20 (57.1%) of the 35 patients in the study group had unilateral PEX and other 15 (42.85%) had bilateral presentation. The average mydriasis in eyes with PEX syndrome was 5.2 mm and in eyes without PEX syndrome was 6.5mm. Average Schirmer’s and TBUT in control group were 18.15±4.2 mm and 14.75±2.5s respectively. Whereas, the values were 7.21± 3.4 mm and 6.2±2.1s in PEX group and the differences were statistically significant (p< 0.05). Conclusion: Analysis of tear functions can help in the better management of PEX syndrome. 

Keywords: PEX Syndrome; Tear Film Break Up Time (Tbut); Schirmer’s 2 Test.

 

Aim: The purpose of this study was to study the frequency and types of complications of small incision cataract surgery (SICS) in patients with pseudoexfoliation [PEX]. Method: This cross-sectional descriptive study was carried out on 65 eyes of 65 patients with cataract and PEX who underwent SICS in a tertiary care hospital. Their perioperative and post-operative complications were documented. Results: The most common finding was Poor pupillary dilatation inspite of use of standard mydriatic drops and non-steroidal anti-inflammatory drugs. Spinchterotomy was done in 7 (10.7%) cases. Other problems encountered were accidental posterior capsule rupture, vitreous loss, retained cortical matter, decentered intraocular lens and zonular dialysis. Conclusion: Presence of associated PEX in cataract patients significantly increases the risk of vision threatening complications. Use of flexible iris hooks for small pupils and for capsular stability, capsular tension rings and high viscosity viscoelastics are useful modifications of surgical technique for good visual outcome. 

Keywords: Pseudoexfoliation; Zonular Weakness; Spinchterotomy; Pupillary Dilatation.