Infectious keratitis – a review.

Infectious keratitis is an important problem in the Indian context, and epidemiological studies suggest a higher prevalence of disease as compared to the developed world. Various aspects of the problem, including the host defence, ocular and systemic risk factors and microbial mechanisms that enhance pathogenesis have been discussed. The clinical and microbiological approach to the infected eye and patient and the relevant tests have been outlined. The major classes of medications that are used the methods of delivery are specified. Finally, the approach to patients with non-responsive keratitis that requires surgical manoeuvres is also highlighted. Clinical experience is important in distinguishing an infective from an inflammatory corneal pathology. The role of an experienced microbiologist is inevitable, for good clinical outcome. Therapeutic keratoplasty has to be done at the right time for better clinical outcomes.

Intermediate uveitis – a review.

Intermediate Uveitis (IU) is an inflammatory disease, primarily involving the vitreous and peripheral retina. It accounts for around 8% of cases of uveitis and affects primarily children and young adults. The etiology is unknown but, found as an isolated and idiopathic condition or in association with systemic disorders such as multiple sclerosis and sarcoidosis and infectious diseases. Symptoms include painless blurring of vision, floaters and deterioration of vision. Clinical features seen are anterior segment affection with keratic precipitates and anterior chamber cells, vitritis, vasculitis in the peripheral retina, vitreal snow banks and cystoid macular edema (CME). CME was the major threat for deterioration of vision; other complications include vitreous haemorrhage, periphlebitis, cataract and glaucoma. Treatment of intermediate uveitis is based on periocular and oral corticosteroids. Cryotherapy or laser photocoagulations of the peripheral retina are options in patients when there is an insufficient response to periocular or systemic corticosteroids. Immunomodulatory therapy is used when other therapies fail. Pars plana vitrectomy (PPV) is indicated in patients with chronic significant inflammation, non-responsive cystoid macular edema, non-clearing vitreous haemorrhage, tractional retinal detachment and epiretinal membranes. IU is an intraocular inflammation involving the anterior vitreous, peripheral retina and pars plana. It usually affects patients from 5 to 30 years old, without gender or racial preferences. The etiology is unknown but there are several associated diseases. The long-term prognosis of intermediate uveitis is usually good, particularly with strict control of inflammation and with proper management of complications.

Conjuctivochalasis - a review.

Conjunctivochalasis is an ocular condition that is usually missed, unless specifically looked for. It is defined as a redundant loose non edematous inferior bulbar conjunctiva. Though generally asymptomatic, It may also present as dryness and foreign body sensation. Various grading systems like Mirmura ((based on Lid-parallel conjunctival folds), Mellers (based on lid-parallel conjunctival folds, punctual occlusion and conjunctival fold changes during down gaze and digital pressure) and Zhang’s based on conjunctival folds, dryness, foreign body sensations, epiphora symptoms, punctual occlusion, tear meniscus height, tear film break-up time (BUT), and conjunctival fold changes during down gaze) system has been outlined. Various etiological aspects like dissolution of the Tenon’s Capsule and role of expression of matrix metalloproteinase-1 (MMP-1) and matrix metalloproteinase-3 (MMP-3) has been dealt in detail. Different surgical approaches like pastepinch- cut conjunctivoplasty and their steps are specified. Conjunctivochalasis has to be understood in a wider depth and more research work is required to understand CCh in better detail so that preventive steps can be implemented with regard to secondary causes.

Dry eye - a review.

Of the myriad reasons for visits to an ophthalmologist, one of the most common maladies afflicting patients is Dry Eye Disease (DED), which can cause mild discomfort in the early stages and endstage ocular surface damage in its more severe forms. Dry eye is a problem of utmost importance, more in the developed rather than developing nations. Various aspects of the manifestation, including the tear osmolarity, ocular surface homeostasis and the role of ocular surface epithelial stem cells in maintaining the ocular surface homeostasis have been discussed. The objective tests to assess and grade dry eye have been noted. A systematic approach to the affected eye and the patient has also been outlined. The major categories of medications used along with the methods of delivery are specified in this review. A systematic approach in understanding the type and grade of Dry Eye Disease is mandatory for good clinical response. Along with clinical management the doctor should also stress on environmental changes that exaggerates dryness.

Correlation between macular thickness and volume with visual acuity in diabetic macular edema by using domain optical coherence tomography.

Introduction: To investigate the correlation between Macular thickness and Volume with Bestcorrected visual acuity (BCVA) in eyes with Diabetic macular edema and Type 2 diabetes. Materials and Methods: A retrospective study including 60 eyes of 60 patients evaluating Retinal thickness and macular volume measured with Spectral Domain Optical Coherence Tomography and best corrected visual acuity was measured with the Snellens Chart. Results: There is significant increase in the macular thickness and macular volume with decrease in the best corrected visual acuity. Conclusion: Diabetic macular edema causes decrease in visual acuity due increase in macular thickness and volume.

Effect of nepafenac 0.1% on macular thickness during immediate post operative period after phacoemulsification in patients with low risk for cystoid macular edema.

Introduction: To evaluate the effect of nepafenac 0.1% after routine phacoemulsification in patient at low risk for cystoids macular edema. Material and methods: This prospective hospital based study consists of 70 eyes of 70 subject with no risk factor for cystoid macular edema who underwent phacoemulsification by an experienced surgeon. All 70 subjects received preoperative nepafenac. 35 subjects received nepafenac post operatively (treatment). SD OCT (Spectral domain optical coherence tomography) and visual acuity measurement were taken pre op and post op (1 week, 1month). Final end point where comparison of macular thickness and visual acuity between two group. Result: All subjects in this study had excellent visual outcome post cataract extraction. There was small increase in macular thickness in both treatment and control group with no difference in visual acuity between first and second post op visits. Conclusion: There is an increase in macular thickness measured by OCT in low risk patients after phacoemulsification there was no clinical effect on final visual acuity.

Study on ageing changes of the optic nerve head in a group of normal subjects.

Introduction: Thickness of RNFL around the different quadrants of the optic disc margin progressively increases. Macular fibers occupying the lateral quadrant are the most resistant to glaucomatous damage and explain the retention of the central vision till end. This study was undertaken to determine the age related changes in the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in a group of normal subjects. Material and Methods: This prospective cross sectional hospital based study consisted of 150 healthy eyes of 75 subjects whom underwent ONH measurement using the Optovue optical coherence tomography (OCT) and examined the result of optic nerve head parameters and RNFL. Results- Mean cup disc ratio was found to be higher with increasing age. And the average RNFL thickness was found to decrease with increasing age. Conclusion: There are changes in optic disc parameters and RNFL with increasing age and the changes were measurable and significant.

Efficacy and safety of alcohol assisted epithelial delamination in recurrent corneal erosion syndrome.

Introduction: Recurrent Corneal Erosion Syndrome is a resistant condition to treat .Many modalities of treatment is available. Alcohol assisted epithelial delamination is relatively a new procedure and not widely practiced. This study evaluates the efficacy and safety of the procedure. Material & Methods: This is a retrospective study conducted in our hospital .We have enrolled 30 patients who underwent the procedure within last two years. Patients with RCE who remained symptomatic despite topical lubrication was included .Patients were followed up at 1 day, 4 days, 1 week, and 1 month. Success was defined as resolution of symptoms after 1 month of treatment. The preoperative and postoperative data were collected from EMR and analyzed. Results: Twenty nine patients were stable after the procedure. One patient required repeated treatment. There were no post operative complications. No patients lost any line of visual acuity. Conclusion: Alcohol assisted epithelial delamination is a safe and effective procedure for treating patients with recurrent corneal erosion syndrome.

Comparison of the surgical outcome and cost effectiveness of autologous blood with electrocautery pen and fibrin glue in the limbal conjunctival autografting for the treatment of primary pterygium.

Introduction: There are various techniques available for securing limbal conjunctival auto graft in the treatment of primary pterygium. purpose of this study to compare the surgical outcome and cost effectiveness of a new techniqueautologous blood with electrocautery pen and current standard of fibrin glue. Materials and methods: This retrospective study was carried out in 76 patients presented with primarypterygia who underwent pterygium surgery using autologous blood with ecp (36 eyes) and fibrin glue (40 eyes). all patients were followed up post operatively on 1stday, 7thdayand 6th month. during follow up,patients were assessed for graft displacement or loss and comfort. cost of the surgery was also compared. Results: No intraoperative complications occurred in either group. out of 36 patients, 4 graft dislodgements occurred in autologous blood with ecp group on the immediate post-operative day. while none in fibrin glue group. during the 6 months follow-up, 6 eyes in group i (16.7%) and 1 eye in group 2 (2.5%) developed recurrence. Conclusion: Autologous blood with ecp in conjunctival autografting is as effective as fibrin glue in terms of graft adherence and post-operative patient comfort. however, this method is 3 times cost effective than the commercially available fibrin glue.

Keratometric Changes after Corneal Collagen Cross linking for Keratoconus.

Background: Keratoconus is an asymmetric, non- inflammatory, and progressive ectasia of the cornea that is characterized by the thinning, steepening, and central scarring of the cornea. Corneal collagen cross linking with riboflavin and ultraviolet light is an accepted procedure to stabilize keratoconus. This study is aimed at finding out keratometric changes after corneal collagen cross linking. Methods: A total of 30 patients were enrolled, 15 males and 15 females. They were subjected to corneal topography, refraction, slit lamp examination, preoperatively and post operatively at 1 month 3rd moth and 6th month after corneal collagen cross linking. Results: Flattening of Keratometry values were noticed in 12 eyes (40%). The mean pre-operative K was 50.32 D. The mean post-operative K was 49.61 D. In 5 eyes (16.66%) the corneal curvature was unchanged and stable. Conclusion: There is significant decrease in mean keratometric values and flattening of cornea after corneal collagen cross linking.

Role of Ex-Press Glaucoma Shunt Implant in Glaucoma Filtering Surgery.

Glaucoma filtration surgery is a challenge for any glaucoma surgeon, because of its variable results and numerous complications. The Ex-PRESS glaucoma shunt, when used along with trabeculectomy gives a controlled drainage of aqueous and hence most of the complications due to over filtration like hypotony, choroidal detachment could be avoided. Tissue erosion and migration of device were initially noted, but later became rare due to modifications in techniques, like use under a sclera flap. The Ex-PRESS glaucoma shunt implant is a promising device in glaucoma filtration surgery, if used judiciously.