Spectrum of ocular firework injuries in children: A 5‑year retrospective study during a festive season in Southern India.

Purpose: Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them. Materials and Methods: A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days ‑ the day of Diwali, 1 day before, and 1 day after Diwali ‑ were included in this study. Results: Eighty‑four children presented with firework‑related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty‑four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval ‑ 2–13%). Conclusion: Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of protective eyewear should be considered.

Comparison between latanoprost and brimonidine efficacy and safety in Indian eyes.

PURPOSE: To compare the short-term efficacy and safety of topical latanoprost and brimonidine in Indian eyes. MATERIALS AND METHODS: Twenty-eight patients with ocular hypertension, primary open-angle, pseudoexfoliation or pigmentary glaucoma were enrolled. Following baseline measurements, latanoprost was applied topically once daily in the evening for 12-weeks. After a washout period, brimonidine was applied twice daily in all patients for 6 weeks; 16 patients continued for 12 weeks. Patients were examined at 2, 6 and 12 weeks. The primary outcome measure was the difference in mean intra ocular pressure (IOP) reduction at 6 and 12 weeks. The mean diurnal variation of IOP at baseline and at 12 weeks was also compared. RESULTS: Twenty-six of 28 enrolled patients completed the study. One randomly selected eye of each patient was used for analysis. At 6 weeks, the mean IOP reduction was 11.2 mm Hg (+/- 2.9 mmHg) with latanoprost and 6 mmHg (+/- 3.3 mmHg) with brimonidine. At 12 weeks this was 10.8 mmHg (+/- 2.8 mmHg) and 6.9 mmHg (+/- 3.1 mmHg) respectively. At 6 weeks 85.7% (24) eyes obtained more than 25% reduction in IOP with latanoprost compared to 13 (46.4%) with brimonidine. IOP reduction was maintained with both drugs throughout the study period. Two eyes did not show any response to brimonidine. Latanoprost reduced the diurnal variation of IOP from 5.10 to 2.90 mmHg; brimonidine reduced it from 4.70 to 3.90 mmHg. Conjunctival hyperaemia was present in one patient on latanoprost and three patients on brimonidine. Two patients experienced drowsiness with brimonidine. Neither drug produced side effects necessitating withdrawal from the study. CONCLUSION: In this short-term study, both latanoprost and brimonidine effectively reduced IOP and stabilised the diurnal curve in Indian eyes. Latanoprost was more effective than brimonidine.

Population-based screening versus case detection.

India has a large burden of blindness and population-based screening is a strategy commonly employed to detect disease and prevent morbidity. However, not all diseases are amenable to screening. This communication examines the issue of "population-based screening" versus "case detection" in the Indian scenario. Using the example of glaucoma, it demonstrates that given the poor infrastructure, for a "rare" disease, case detection is more effective than population-based screening.

Visual field defects in non-functioning pituitary adenomas.

PURPOSE: To report the prevalence and pattern of visual field loss in non-functioning pituitary adenomas and to study the relationship between the tumour size and severity of field defects. METHODS: Ninety-three patients with histologically confirmed pituitary adenomas, non-functional on hormonal assessment, underwent a complete ophthalmic assessment and automated perimetry using the HFA 30-2 programme. Defects with quadrantanopic or hemianopic characteristics, defined using criteria on the threshold/pattern deviation plots were considered typical. Typical defects were graded as mild, moderate and severe. All other defects were considered atypical. A neuroradiologist measured tumour size on a CT or MRI Scan. The Chi-square test for trend was used to test association of tumour volume with severity of typical defects. RESULTS: Eighty-eight (94.6%) of the 93 patients had a field defect. Typical field defects were seen in 69 (74.2%) patients and atypical in 19 (20.4%). A severe typical defect involving at least 3 quadrants in one or both eyes was the most common (24 patients or 25.80%). All 31 patients (33.3%) with a tumour size greater than 20 cc had field defects. Severity of field defect increased with tumour volume (Chi-square test for trends significant p = 0.0096). CONCLUSIONS: Field defects occurred in 95% of patients with non-functioning pituitary macroadenoma. A severe visual field loss involving at least 3 quadrants in one or both eyes was the most common. 20% of patients had atypical field defects. Severity of field defects increased with tumour volume.