Central macular thickness change after uneventful small-incision cataract surgery - An observational study

Purpose: The purpose of this study was to diagnose CME with the help of optical coherence tomography (OCT) after uneventful cataract surgery to prevent visual deterioration. Methods: This study was conducted on 120 patients, who underwent manual small-incision cataract surgery with posterior chamber intra-ocular lens implantation. Follow-up was performed after the first week, sixth week, and 12th week post-operatively. Detailed examination was performed at each visit along with measurements of central macular thickness using OCT. Statistical analysis was performed using SPSS 22.0. Result: The mean age of the patients was 61.85 � 11.41 years having female preponderance. The pre-operative mean best corrected visual acuity (BCVA) was found to be 0.05 � 0.04, whereas the mean post-operative BCVA was found to be 0.65 � 0.17 at the first week, 0.66 � 0.17 at the sixth week, and 0.67 � 0.17 at the 12th week follow?up. The post-operative mean macular thicknesses at the first week, sixth week, and 12th week post?operatively were documented to be 221.66 � 8.49 ?m, 224.60 � 8.75 ?m, and 219.17 � 8.22 ?m, respectively. Conclusion: A sub-clinical increase in macular thickness occurs even after uncomplicated cataract surgery. The maximum increase was observed after 6 weeks of surgery, which returns to near normal values within 3 months. Comparison of central macular thicknesses pre-operatively and post-operatively at the first week, sixth week, and 12th week suggests a significant correlation

A rare case presentation of large mucinous ovarian cystadenocarcinoma in a young female

Here authors report a case of large ovarian mucinous cystadenocarcinoma in a young female complicating young pregnancy. Ovarian mucinous adenocarcinoma is a rare ovarian tumour that arises from the surface epithelium of the ovary. A 25-year young female, 9 days post-partum presented to the hospital with complain of abdominal distension. USG finding suggesting large solid cystic mass 36 × 14 cm arising from pelvis extending up to epigastrium. MRI pelvis evident of heterogenous hyperintense solid cystic mass lesion giving bunch of grapes appearance with size 24.5 × 25 × 11.5 cms seen in intra peritoneal space extending cranially up to epigastrium and caudally into pelvis giving anterior displacement of uterus.  And posterior displacement of bowel loops. A large part of lesion is cystic with solid component with multiple internal echoes.

A randomized, open-label, comparative study of oral tranexamic acid and tranexamic acid microinjections in patients with melasma

Background: Melasma poses a great challenge as its treatment modalities are unsatisfactory. Treatment using tranexamic acid is a novel concept. Aim: This study aimed to compare the therapeutic efficacy and safety of oral tranexamic acid and tranexamic acid microinjections in patients with melasma. Methods: This is a prospective, randomized, open-label study with a sample size of 64, 32 in each treatment arm. Thirty-two patients were administered localized microinjections (4 mg/ml) of tranexamic acid monthly in 1 arm, while in the other arm, 32 were given oral tranexamic acid 250 mg twice a day. Patients were followed up for 3 consecutive months. Clinical photographs were taken at each visit, and a modified melasma area and severity index scoring was performed at the beginning and end of treatment. Results: Improvement in melasma area and severity index score in the oral group was 57.5% as compared to 43.5% in the intralesional group. All 32 patients in the oral group (100%) showed >50% improvement, out of which 8 showed >75% improvement. In the intralesional group, 17 (53%) patients had >50% improvement, of which 3 had >75% improvement. The remaining 15 patients in this group had <50% improvement. Thus, the oral group showed a more significant response as compared to the intralesional group. No major adverse effects were observed in both the groups. At 6-month follow-up, two patients (6.2%) in the oral group had recurrence as compared to three patients (9.4%) in the intralesional group. Limitations: A small sample size was one of the limitations in this study. The dose of tranexamic acid in microinjections and the frequency of injections could have been increased. Conclusion: Tranexamic acid provides rapid and sustained improvement in the treatment of melasma. It is easily available and affordable. Oral route is undoubtedly efficacious, but the results of microinjections, while encouraging, can probably be enhanced by either increasing the frequency of injections or increasing the concentration of the preparation.

Evaluation of Lipid Profile Among Prehypertensive and Normotensive Patients: A Teaching Hospital based Study

Background: This study was designed to compare the lipid profile among prehypertensive and normotensive and its correlation between blood pressure and lipid profile in prehypertensive patients. Methods: This case-control study on forty prehypertensives and forty normotensive subjects. Blood pressures were recorded and serum lipid profiles were measured and compared using student t test. Correlation between blood pressure and serum lipid profile was done. Results: The mean SBPs of prehypertensives group and normotensives group were 132.43±6.25 mmHg versus 110.02±2.60 mmHg, respectively, and mean DBPs were 88.42±4.05 mmHg versus 74.21±3.72 mmHg, respectively. The mean SBP and DBP of prehypertensives group were higher than those of normotensives group. the serum lipid profile of recently, diagnosed prehypertensive patients was significantly altered as compared to normotensive subjects. Conclusion: The serum lipid profile of recently, diagnosed prehypertensive patients was significantly altered as compared to normotensive subjects.

High-Sensitive C–Reactive Protein with Lipid Profile Parameters in Dyslipidemic Patients: A Teaching Hospital Based Study

Background: Cardiovascular diseases, the leading causes of death in the world are rising rapidly in low- and middle-income countries. Our aim was to fine out the correlation between High-Sensitive C–reactive Protein with Lipid Profile Parameter. Methods: The strong and statistically significant positive correlation in between High-Sensitive C–reactive Protein (hsCRP) and Total Cholesterol with (p<0.016). Results: Statistically significant positive correlation between High-Sensitive C–reactive Protein and Triglycerides (p<0.001). LDL-C also showed a statistically significant positive correlation with High-Sensitive C–reactive Protein (p<0.03). HDL-C also showed a statistically not significant negative correlation with High-Sensitive C–reactive Protein (p<0.32). Conclusion: The patients with dyslipidemia for elevated blood hsCRP levels may be done to identify those patients with an increased risk stratification of atherosclerosis. Also this suggests that there may be a role for anti -inflammatory agents along with statins in treatment of dyslipidemia.

Evaluation Of Macular Thickness In Type-2 Diabetics On Pioglitazone

Thiazolidinediones are oral hypoglycemic drugs that have been recently used for patients of type 2 diabetes. Review of literature shows that their side effect of systemic fluid retention aggravates diabetic macular edema. This research work was designed to see the effect of Thiazolidinediones (Pioglitazone) on early diabetic retinopathy. Optical Coherence Tomography (OCT) was used to measure average and central foveal thickness. 122 consecutive eyes of metabolically stable Type 2 diabetes were taken up for study and followed for three months who fulfilled the exclusion criteria. Patients were divided in two groups. Group one included patients with no diabetic retinopathy. Group two included patient with mild / moderate retinopathy without macular edema. As group two was further randomized into two subgroups. First subgroup received standard systemic medical therapy for diabetes and second subgroup received 30mg Pioglitazone in addition to standard treatment. All subjects underwent complete ocular systemic examination including Optical Coherence Tomography (OCT) at baseline, 6 weeks and 3 months. In this study, there was increase in central foveal thickness and average cube thickness in both the subgroups on Pioglitazone. Pioglitazone therapy is related to statistically significant increase in macular thickness at three month follow up. Optical Coherence Tomography (OCT) is an important tool for picking up subclinical changes in macular thickness that do not reflect in visual acuity.

Phacoemulsification without preoperative topical mydriatics: Induction and sustainability of mydriasis with intracameral mydriatic solution.

Context: Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages. Aims: Evaluating the role of intracameral irrigating solution (0.5% lignocaine + 0.001% epinephrine) in initiating and maintaining the pupillary mydriasis during phacoemulsification. Secondary aims were to observe the effect of surgical time, nucleus density and ultrasound time on mydriasis during the procedure. Settings and Design: The study is a prospective interventional case series, conducted at tertiary care institution. Materials and Methods: Thirty patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. Pupillary diameter was measured serially during surgery and ultrasound time and total surgical time were noted. Statistical Analysis Used: Paired samples student–t test was done to compare means. Spearman correlation coefficient was used to study the effect of various parameters on mydriasis. Results: Thirty eyes completed the study. The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. Duration of surgery, grade of nucleus and ultrasound time had statistically insignificant effect on mydriasis. Conclusions: Intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provides rapid mydriasis which is adequate for safe phacoemulsification and is unaffected by other parameters.

Cataract surgery under topical anesthesia using 2% lignocaine jelly and intracameral lignocaine: Is manual small incision cataract surgery comparable to clear corneal phacoemulsification.

A prospective comparative study was undertaken to compare the patients’ pain experience, surgical outcome and surgeon’s experience in phacoemulsification and manual small incision cataract surgery (MSICS) under topical anesthesia supplemented with intracameral lignocaine (TASIL). In Group 1 (n=88) phacoemulsification was done and in Group 2 (n=92) MSICS was done. Pain scores were marked by the patients on a Visual analog scale (VAS) after the surgery. The surgical experience was noted on a questionnaire by the operating surgeon. Descriptive analysis and one-tailed Mann-Whitney test were used to draw results. The average VAS score in Group 1 was 0.65 (SD 1.31) and in Group 2 it was 0.90 (SD 1.22). This difference in the average was not statistically significant with P=0.09. The study demonstrates that MSICS and phacoemulsification both can be done safely under TASIL with acceptable patient comfort, and the pain experienced by the patients during the procedures is comparable.

Manual small incision cataract surgery under topical anesthesia with intracameral lignocaine: study on pain evaluation and surgical outcome.

The authors here describe manual small incision cataract surgery (MSICS) by using topical anesthesia with intracameral 0.5% lignocaine, which eliminates the hazards of local anesthesia, cuts down cost and time taken for the administration of local anesthesia. AIMS: To evaluate the patients' and surgeons' experience in MSICS using topical anesthesia with intracameral lignocaine in terms of pain, surgical complications, and outcome. SETTINGS AND DESIGN: Prospective interventional case series. MATERIALS AND METHODS: Ninety-six patients of senile cataract were operated by MSICS under topical anesthesia with intracameral lignocaine using "fish hook technique." The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience, and complications. STATISTICAL ANALYSIS USED: Statistical analysis software "Analyseit." RESULTS: There were 96 patients enrolled in the study. The mean pain score was 0.7 (SD +/- 0.97, range 0-5, median 0.0, and mode 0.0). Fifty-one patients (53%) had pain score of zero, that is, no pain. Ninety-one patients (approximately 95%) had a score of less than 3, that is, mild pain to none. All the surgeries were complication-free except one and the surgeon's experience was favorable in terms of patient's cooperation, anterior chamber stability, difficulty, and complications. The ocular movements were not affected, and hence, the eye patch could be removed immediately following the surgery. CONCLUSIONS: MSICS can be performed under topical anesthesia with intracameral lignocaine, which makes the surgery patient friendly, without compromising the outcome.

Illuminated curved 25-gauge vitrectomy probe for removal of subsclerotomy vitreous in vitreoretinal surgery.

Incarceration of vitreous in sclerotomy sites during pars plana vitrectomy can lead to wound-related complications similar to vitreous incarceration in cataract surgery. We describe an illuminated curved 25-gauge vitrectomy probe for removing vitreous from sclerotomy sites. Polyester tubing is used to secure a fiber optic endoilluminator (0.5 mm) with the curved 25-gauge vitrector (0.5 mm). The resultant illuminated curved vitrector (20 G) has a diameter of 1.0 mm. It facilitates complete removal of vitreous around the internal sclerotomies under direct visualization in both phakic and pseudophakic eyes. The same was confirmed with ultrasound biomicroscopy of the sclerotomy sites. Curved vitrector reduces postoperative complications related to incarcerated vitreous in phakic and pseudophakic eyes and other sclerotomy-related wound complications.