Limbus Sparing Limbal Incision - A New Modified Conjunctival Incision Technique in Strabismus Surgery

The aim of the study is to introduce a newer technique of conjunctival incision called ‘Limbus Sparing Limbal Incision (LSLI)’ for horizontal rectus muscle strabismus surgeries. Methods: 20 patients were randomly divided into two groups of 10 each. In group 1, the conventional limbal incision was given in the conjunctiva and in group 2, a modified limbal incision, Limbus Sparing Limbal Incision (LSLI) was given. Each patient was followed post operatively on 1st, 7th and end of six weeks. Symptoms like pain, discharge, FB sensation, conjunctival congestion, excessive watering and lid swelling were noted. A record was also made of the conjunctival hyperaemia/chemosis, gaping in conjunctival incision, conjunctival retraction/coiling, thickened conjunctival flap, suture granuloma, corneal abrasion, dellen formation, other signs of ocular surface disorders, need for suture removal and need for resuturing. Results: The mean pain score in group 1 was 1.30 ± 0.68 and 2.10 ± 0.57 in group 2 (p=0.010). Mean foreign body sensation score in group 1 was 1.10 ± 0.32, and 2.30 ± 0.68 in group 2 (p<0.001). In 20% of patients in group 2, re-suturing of the wound had to be done. Dellen formation was seen in 10% of patients in group 1 and none in group 2 (p=1.0). Conclusion: Though, the new modified conj incision spares the damage to perilimbal tissue and stem cells, the post op discomfort and delayed healing limited its use. However, large scale studies are needed which can compare the two techniques in terms of outcomes, complication rates, and patient satisfaction.

Potency dependent activity of homeopathic nanomedicine- classical and quantum electrodynamical approach

The effect of homeopathic medicine on biological and physical system is directly related to its potency [1]. However, from physico-chemical point of view it is difficult to explain this effect at such high dilution, as then the existence of even trace amount of particle is questionable. It has been reported that during the process of potentization, a large amount of mechanical energy gets transferred to the medium due to succussion [2]. This energy in all probability reduces the size of the drug aggregates. The drug then penetrates easily through the membrane barrier, and thereby gives rise to enhanced activity of the medicine. It has been experimentally proved by us and supported by others that indeed a reduction of size of the aggregates takes place with increase in potency [3]. Using five different homeopathic medicines, their sizes at three different potencies have been estimated and a general mathematical expression relating the size of the particle (Y) and the corresponding potency (X) has been derived as follows Y = a X -n. (AU)

Experimental study of oculocardiac reflex (OCR) with graded stimuli.

The present study was conducted to observe the effect of graded mechanical stimuli on occurrence of oculocardiac reflex (OCR). The experiments were carried out in twenty albino rabbits of either sex weighing between 1-2 kg. Changes in heart rate and/or cardiac rhythm (oculocardiac reflex) were studied by applying traction with progressively increasing weights to medial rectus muscle. Mean threshold value of square wave mechanical stimulus just sufficient to produce oculocardiac reflex was found to be 19 +/- 8.52 g. As the traction weights were progressively increased, more and more decrease in heart rate was observed. It was concluded that once the threshold value of stimulus was reached, the oculocardiac reflex showed a graded response with progressively increasing traction weights.

Profile of lower gastrointestinal bleeding in children from a tropical country.

Eighty five children were evaluated endoscopically for recurrent lower gastrointestinal (GI) bleeding. The male: female ratio was 2.4:1 with a mean age of 6 years (range 8 months to 2 years). After adequate bowel preparation endoscopic evaluation was done using olympus CF 101 colonoscope. Sedation was given only in two patients. Full length colonoscopy had been done in 16 cases only, to look for extent of disease in 8 cases and to ascertain site of bleeding when no lesion could be seen on sigmoidoscopy. Juvenile polyps were seen in 40 cases, amoebic ulcer in 20, solitary rectal ulcer in 4 and polyposis syndrome in 5 cases. Sigmoidoscopy alone could establish the diagnose in 76 cases. We conclude that flexible sigmoidoscopy alone is safe and adequate in ascertaining the cause of prolonged recurrent lower GI bleeding.

Management of foreign bodies of the upper gastrointestinal tract.

The use of flexible endoscopes had made removal of foreign bodies in the upper gastrointestinal tract easier and safer. We describe our experience of 49 cases of foreign bodies of the upper gastrointestinal tract. Majority (67%) of the patients were children and only 4 patients (8%) were above 45 years of age. The most common foreign bodies encountered were coins (25), fruit stones (4) and dentures (3). In 29 patients foreign bodies were lodged in the oesophagus and in 15 cases in the stomach. Forty one patients were considered for endoscopic removal of the foreign bodies and 40 could be managed successfully. There were no procedure related complications. We conclude that endoscopic removal of the foreign bodies of the upper gastrointestinal tract is a safe and effective technique.

A clinico-investigative profile in Graves' ophthalmopathy.

A clinico-investigative profile was studied in 30 patients with Graves' Ophthalmopathy (GO) (15 each with early and late). In accordance to the thyroid status 63.3% of patients were hyperthyroid and 36.7% euthyroid. There was slight female preponderence, with ratio being 1.5:1. Exophthalmometric readings were significantly high in GO patients as compared to controls. However, no significant diagnostic role of postural exophthalmometry was seen. Positional tonometery may have respectable place among the tests for early diagnosis of GO; however, it could not differentiate between hyperthyroid and euthyroid cases. Further the role of ultrasonography, if available could not be overemphasized.

Bilateral proptosis due to metastatic Ewing's sarcoma of the orbit: fine needle aspiration cytology (FNAC) and histopathology of a case.

Bilateral proptosis due to metastatic Ewing's sarcoma is an extremely rare presentation and thus merits reporting. The role of fine needle aspiration cytology in the diagnosis is highlighted.

Hospital epidemiology of dry eye.

One hundred consecutive cases of dry eye were studied to comment upon its epidemiological aspects. The incidence of dry eye amongst ophthalmic outpatients was 0.46% with a male:female ratio of 1:1.22. Fifty seven percent of the patients were above 50 years of age. The incidence was higher amongst outdoor workers and people from rural areas with poor socioeconomic status. The influence of hot and dry climate and nutritional status on dry eye incidence is discussed.

Ankle reflex photomotogram in thyroid dysfunctions.

The tap to half relaxation time of tendon achilles reflex was measured in thirty control subjects, forty-five thyrotoxic and sixty hypothyroid patients. The half relaxation time in the control males and females was 279.33 +/- 76.39 msec and 320.00 +/- 52.37 msec. respectively. In thyrotoxic males and females the half relaxation time was 256.67 +/- 31.62 msec (P less than 0.01) and 252.50 +/- 47.68 msec (P less than 0.01) respectively. Amongst the hypothyroid male and female patients the half relaxation time was 405.0 +/- 35.56 msec (P less than 0.01) and 422.5 +/- 115.36 (P less than 0.01) respectively. As all these values were statistically significant, we consider the photomotographic measurement of ankle reflex as an important aid to the diagnosis of thyroid hormone imbalances.

Tear film flow and stability in normal Indian subjects.

Tear film flow and stability studies were carried out in healthy population by Schirmer's test-1 and tear film break-up-time (BUT) measurements, respectively. The mean BUT observed was 13.87 +/- 4.79 seconds; however, in 22 percent of cases the values of BUT were even less than the lowest values laid down by various workers, from the Western countries. Maximum dry spots were located in the temporal quadrant.