Correlating Pregnancy Outcomes Between Early and Late Antenatal Bookings in Labasa Hospital – A Retrospective Cohort Study

Background@#Many benefits are associated with early antenatal booking which include but are not limited to accurate dating, early detection of medical and obstetrical disorders that could make the pregnancy a high-risk pregnancy and affect its outcome, and objective assessment of maternal baselines such as identifying pre-existing risk factors, taking weight, blood pressure, blood sugar level and urinalysis. If done early, it may provide a picture of the pre-pregnancy condition of the woman. @*Aim@#In the time period and setting looked at in this research, it was found that majority of the mothers booked late, however reasons for booking late were not sought as this was only a quantitative retrospective cohort study. From the outcomes measured, it was seen that anaemia was the most significant outcome associated with late bookers. PPH was also found to be significant amongst late bookers however other statistical analysis deemed it insignificant.@*Results@#The results of this study found that majority of the women (76,58%) booked late. Of these, women who booked late fell in the 15 to 25 age range, were of I-taukei ethnicity, were married, did domestic duties, attended secondary level of education and were multiparous. The most significant pregnancy outcome that was associated with late booking was found to be anaemia. The remaining outcomes were found to be insignificant.

Gonadotropin-secreting and thyrotropin-secreting pituitary adenomas: A single-center experience

ABSTRACT Objective: Data regarding rare FPAs from India, a resource limited setting, are limited. We describe a case series of rare FPAs from a single center in western India. Materials and methods: This was a retrospective case record review of patients diagnosed between January 2010 and July 2022. The diagnosis was based on biochemical (inappropriately elevated serum FSH/LH) and pathologic (positive immunostaining for FSH/LH) features in patients with FGA, and elevated serum thyroid hormones and normal/elevated TSH in patients with TSHomas. Results: We identified 11 patients with a total of six FGAs (median age 43.5 years, five men, one FGA cosecreting TSH, median largest dimension 40 mm, range 33-60 mm) and six TSHomas (median age 34.5 years, four women, two TSHomas cosecreting GH, median largest dimension 42.5 mm, range 13-60 mm). Symptoms of sellar mass effects led to pituitary imaging in most patients with FGA. Patients with TSHomas had symptoms of excess hormone secretion (GH/TSH) or sellar mass effects. The TSHomas that cosecreted GH/FSH were larger than those secreting only TSH. Transsphenoidal resection was the most common first-line therapy but significant residual disease was frequent (3 out of 6 FGAs and 4 out of 5 TSHomas). Conclusion: This is the first and second case series of FGAs and TSHomas, respectively, from India. In this study, TSHomas presented at younger age, were larger and had low surgical cure rates.

Mesenteric cystic lymphangioma in adults: a rare entity presenting as acute abdomen - a report of two cases

ABSTRACT Lymphangiomas are rare benign tumors that mainly involve the head and neck region in pediatric patients. Lymphangiomas of the small bowel mesentery in adults are rarer. We present two cases of mesenteric lymphangioma with acute abdominal pain on presentation. Case 1: A 38-year-old female presented with abdominal pain, vomiting, fever, and difficult evacuation. On abdominal examination, she had an ill-defined, tender lump, and radiological findings raised a possibility of perforation peritonitis. Thus, exploratory laparotomy was planned. Per-operatively, a mesenteric mass was found, which, on histopathological evaluation, was found to be a mesenteric lymphangioma involving the bowel. Case 2: A 27-year-old male presented with abdominal pain and difficult evacuation. Radiological evaluation revealed a multilobulated lesion involving the mesentery and with differential diagnoses of mesenteric fibromatoses and inflammatory pseudotumor. Histopathological assessment of the resected mass revealed a lymphangioma that was limited to the mesentery. Owing to their rarity and non-specific presentation, mesenteric lymphangiomas are often misdiagnosed on clinical examination and imaging. Thus, histopathological examination is the gold standard to reach a definitive diagnosis.

Frailty and chronic kidney disease: associations and implications / Fragilidade e doença renal crônica: associações e implicações

ABSTRACT Introduction: Frailty and its association with chronic kidney disease (CKD) has been established previously. The present study examined this association further by studying the distribution of frailty among groups defined by different stages of the disease. It also identified associated health deficits and explored their association with estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR). Methods: A cross-sectional survey was conducted on 90 non-dialysis dependent CKD Stage 1-4 patients, recruited in three stratified groups of 30 participants each based on the stage of disease. Frailty was assessed using Fried's frailty criteria and associated health deficits were recorded using a pre-determined list. Depression was screened using a 4-point depression scale. Results: 21.1% of the participants were frail and 43.3% were pre-frail. The proportion of frailty in CKD groups A (Stages 1 and 2), B (Stage 3a), and C (Stages 3b and 4) was 10%, 13.3%, and 40%, respectively. The association of health deficits including co-morbidities, physical parameters, mental status, daily activities, etc. with UACR, eGFR, and CKD stages was not statistically significant. Nearly one in two frail participants was depressed compared with 14% among non-frail participants. Conclusion: The skewed distribution of 21% frail subjects identified in our study indicates an association between frailty and advancing kidney disease. Frail individuals had a lower eGFR, higher UACR, were more likely to be depressed, and had higher count of health deficits and poorer performance on Barthel Index of Activities of Daily Living and WHOQOL. Early identification of depression would improve care in these patients.

RESUMO Introdução: Fragilidade e sua associação com DRC foram estabelecidas anteriormente. O presente estudo aprofundou esta associação, estudando distribuição da fragilidade entre grupos definidos por diferentes estágios da doença. Também identificou déficits de saúde associados e explorou sua associação com taxa de filtração glomerular estimada (TFGe) e relação albumina/creatinina urinária (RAC). Métodos: Realizou-se uma pesquisa transversal em 90 pacientes com DRC Estágios 1-4 não dependentes de diálise, recrutados em três grupos estratificados de 30 participantes cada, conforme estágio da doença. Avaliou-se fragilidade usando os critérios de fragilidade de Fried e registraram-se os déficits de saúde associados usando uma lista pré-determinada. A depressão foi verificada utilizando a escala de depressão de 4 pontos. Resultados: 21,1% dos participantes eram frágeis e 43,3% eram pré-frágeis. A proporção de fragilidade nos grupos de DRC A (Estágios 1 e 2), B (Estágio 3a), e C (Estágios 3b e 4) foi de 10%, 13,3%, 40% respectivamente. A associação de déficits de saúde, incluindo comorbidades, parâmetros físicos, estado mental, atividades diárias etc. com RAC, TFGe e estágios da DRC não foi estatisticamente significativa. Cerca de um em cada dois participantes frágeis estava depressivo comparados com 14% entre não frágeis. Conclusão: A distribuição enviesada de 21% dos indivíduos frágeis identificados em nosso estudo indica associação entre fragilidade e doença renal progressiva. Indivíduos frágeis apresentaram menor TFGe, maior RAC, eram mais propensos a depressão, tinham maior índice de déficits de saúde e desempenho inferior no Índice de Atividades da Vida Diária de Barthel e WHOQOL. A identificação precoce da depressão melhoraria o atendimento desses pacientes.

Perineural low dexamethasone dose as adjuvant in supraclavicular brachial plexus block for arteriovenous fistula creation in end stage renal disease: a randomized controlled trial

Abstract Background and aims: Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. Methods: Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. Results: All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). Conclusion: Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Abstract Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

Assessment of quality-of-life in cancer patients at tertiary care hospital in North India

Introduction: Cancer is a disease that emerges as a result of abnormal cell proliferation and their propensity to spread from one bodily region to another. There are over a hundred different types of cancer that impact individuals all over the world. It is difficult to identify in the early stages, but there are certain warning signals that the cells will turn malignant. Quality of life (QOL) is described by the World Health Organisation as "individuals' perception of life, values, objectives, standards, and interests within the cultural framework of the social environment in which they live and in relation to their goals, expectations, standards, and concerns." QOL assessment in health system is a multidimensional construct that can be measured by evaluating objective levels of health status filtered by the subjective perceptions and expectations of the individual. Aim and Objective: To assess socio-demographic factors and quality of life among cancer patients in tertiary care hospital. Materials and Methods: A hospital-based prospective observational study was conducted at Guru Gobind Singh Medical College and Hospital Faridkot district, Punjab (India). The study was conducted for a period of six months after getting approval from Institutional Ethical Committee (IEC). Generic instrument, SF-36 was used to assess the QOL. The study was analyzed on SPSS version 26.0 software. Descriptive and analytical analysis was used to describe the results. Results: Linear regression was conducted to see the relationship of physical functioning score with age and weight of the patients. The descriptive statistics shows the mean and standard deviation of the variable. The mean of physical functioning score was found to be (M = 27.82, SD = 15.635). The physical functioning score and age, weight of the patients in linear regression shows that the age and weight explain 17.5% Conclusion: Treatment revealed that severe and moderate activities restricted nearly half of the assessed patients, with body pain interfering with employment and routine activities. According to the findings of the current study, QOL deteriorates as the disease progresses. Cancer unquestionably has a detrimental influence on patients' quality of life, which is connected to the illness process itself, the therapy administered, and the length of the disease. (AU)

Audiological, Phonatory and Cardiac Correlates of Individuals Exposed to Low-Frequency Noise or at Risk of Vibroacoustic Disease

Abstract Introduction Low-frequency noise (LFN) is hazardous to hearing. Long-term exposure to LFN may lead to vibroacoustic disease (VAD), which not only affects a specific organ but the physiological function of entire systems, such as the auditory, phonatory, respiratory, and cardiac systems. Moreover, VAD may lead to many psychological problems and hence affect the quality of life. Objective To investigate the adverse effects of LFN on hearing, acoustic and perceptual correlates of the voice, blood pressure, cardiac rate, and anxiety level. Method A total of 20 subjects exposed to LFN and 20 not exposed to LFN were included, and a detailed case history was recorded. The patients were submitted to pure tone audiometry, otoscopic examination, acoustic and perceptual analyses of the voice, maximum phonation time, and an assessment of the s/z ratio. We also assessed blood pressure, and the results of a voice-related quality of life questionnaire and of the Hamilton anxiety rating scale. Results The results indicate that LFN had an adverse impact on the high-frequency threshold. The present study found a significant difference in shimmer and harmonics-to-noise ratio (HNR) values. Few subjects had high blood pressure and showed the sign of anxiety on the Hamilton anxiety rating scale. Conclusion Low-frequency noise has adverse effects on entire systems of the body and causes many psychological issues, which, in turn negatively affect quality of life.

Obstructive Sleep Apnea and Hearing Loss: Is There Any Correlation?

Abstract Introduction Obstructive sleep apnea (OSA) is a breathing disorder related to sleep that has a negative effect on the behavior and health of people around the globe. Chronic hypoxemia and variations in the concentration of oxygen in the blood noticed in OSA individuals may have adverse effects on the process of auditory transduction and transmission. Objective To assess the effect of OSA on hearing and to find out the parameters that have more influence on hearing recorded during polysomnography of patients with OSA. Methods The present is a hospital-based, observational, analytical, cross-sectional study conducted over a period of one year. After application of the exclusion criteria, the patients were then submitted to the application of the Berlin questionnaire, as well as polysomnography, impedance, and pure tone audiometry (PTA). Results A total of 58 individuals were studied. Age, gender, and height were comparable among cases and controls, while weight, body mass index (BMI), and neck circumference were significantly higher in cases in comparison to controls. The mean PTA was significantly higher at 10 kHz or higher frequencies in cases in comparison to controls. Conclusion We observed that there is evidence that the auditory mechanism is affected in OSA patients. We recommend early auditory screening of OSA patients for timely diagnosis and to raise awareness about its prevention.

Antibiotic prophylaxis for cataract surgery - Practice patterns amongst Indian Ophthalmologists

Purpose: To assess the current trends in use of perioperative antibiotic prophylaxis, especially intracameral antibiotics (ICAB), for cataract surgery in India. Methods: This was an E?survey using a previously validated questionnaire carried out by the All India Ophthalmological Society (AIOS) in August 2022. An E?mail invitation to complete an online 40?point survey was sent to all members of the AIOS using a digital E?mail service (Survey Monkey) and social media platforms. Results: Out of 1804 total respondents, 58% (n = 1022) reported using routine ICAB prophylaxis. Of those using ICAB, 89% (n = 909) reported using it for all cases, whereas the rest used it for specific indications such as post?PC rent (n = 43), one eyed patient (n = 19), and high?risk cases (n = 50). Commercially available moxifloxacin was by far the commonest agent used for ICAB (n = 686, 67%). Eighty respondents (8%) reported noticing occasional toxic reactions and nontoxic corneal edema (n = 64, 6%) with ICAB. Surgeons with >10 years� experience especially practicing in medical colleges used fewer ICAB (OR = 0.52, 95%CI = 0.38 � 0.72, P < 0,001) compared to younger surgeons (<5?year experience) in solo clinics. The commonest reason for nonadoption of IC antibiotics was 搖nconvinced of the need to use it in my setting� (n = 296, 52% of those who answered this question). Conclusion: IC antibiotic prophylaxis for cataract surgery has significantly increased in India from 40% in 2017 to 58% in 2022. Commercially available moxifloxacin was preferred by the majority users. Intraocular inflammation may occur occasionally and needs safer formulations to avoid this

Clinico-Hematological Profile and Management of Children With Non-Transfusion Dependent Thalassemia (NTDT) at a Pediatric Center in Northern India

Objective: To study the clinico-hematological profile, complications, and management of children with non-transfusion dependent thalassemia (NTDT) in northern India. Method: We retrieved and analyzed the data of 69 children with NTDT diagnosed between January, 2006 to December, 2018, aged under 18 years from our unit’s records. Result: The participants mean (SD) age was 4.4 (3.1) years, and they presented with anemia (29%), jaundice (13%), hemolytic facies (13%), splenomegaly (87%), thromboembolism (2.9%) and pathological short stature (28.5%). The most common cause of NTDT was ?-thalassemia (45%), followed by either compound-heterozygous or homozygous for E?-thalassemia mutation. The most frequent single genotype observed was compound heterozygous for IVS1-5 (G>C) and codon 26 (G>A). The mean (SD) follow-up duration was 3.5 (2.4) years. On follow-up, 27 children (%) remained transfusion free, and 30 (%) needed occasional transfusions. 63% of patients initially presenting with pathological short stature showed improvement in growth. Amongst children older than 10 years (n=20), subclinical hypothyroidism was detected in 6 children and impaired glucose tolerance test in 1 child. Conclusion: Eß-thalassemia was the commonest cause of NTDT in this population.

Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.

Study 3: Anterior segment optical coherence tomography-guided surgical approach in slipped medial rectus muscle

Purpose: To discuss the novel swept?source anterior segment optical coherence tomography (SS?ASOCT)?guided surgical approach in slipped medial rectus muscles. Methods: Prospectively (between February 2020 and July 2022), six patients with a clinical suspicion of slipped medial rectus muscle were recruited. After complete ophthalmic and orthoptic evaluation, the missing medial rectus muscle is screened using Anterior Segment Optical Coherence Tomography (ASOCT). In presence of a traceable muscle, its morphology, depth, and distance from a fixed anatomical landmarks were noted; in its absence, the status of other recti was noted. Intraoperatively, the features were confirmed and the intended intervention was performed. Results: The mean age of six patients was 25.66 ± 9.72 years, two with surgical trauma and four with penetrating trauma (66.66%). In five patients, the ASOCT traced the slipped medial rectus muscle successfully (83.33%); intraoperatively, the same was confirmed (within 1–2 millimeters) with favorable outcomes. ASOCT made a significant contribution in all subjects by reducing the number of interventions and muscle surgeries. Conclusions: In eyes with slipped medial rectus muscle, especially those which are within a finite distance from the angle can be traced using ASOCT. This approach impacts the outcomes in many ways

Cutting of sphincter in fistulectomy with primary closure in complex fistula-in-ano: is it feasible?

Introduction: Treatment of complex fistulas such as inter- or transsphincteric, recurrent, and high fistulae have high rate of recurrence or incontinence. Fistulectomy with primary sphincter reconstruction might represent an effective and safe alternative to reduce rate of recurrence and incontinence. The aim of this study is to assess incontinence and recurrence after fistulectomy with primary sphincter reconstruction for management of complex fistulas. Material and Methods: There were 60 patients with complex fistulae involving the sphincter, with 56 male and 4 female, mean age 40.6 years, operated by fistulectomy and primary sphincter repair over a period of 7 years. Patients were followed up for 6months for any complications, recurrence, and incontinence. Results: The majority of patients (50, 83.3%) had complete wound healing in 2 weeks, while 4 (6.6%) patients had hematoma and superficial wound dehiscence, which were managed conservatively and healed in 4 weeks. There was one recurrence. All patients had good continence postoperatively, except for mild fecal incontinence (FI, score 3), seen in 6 (10%) patients. However, all these patients regained continence within 6 weeks. Conclusions: Primary reconstruction of anal sphincter with fistulectomy is a safe option for complex fistula-in-ano. (AU)

Prevention and management of childhood progressive myopia: National consensus guidelines

Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.

Anthropometry of deep-set eyes with respect to difficulty in docking during femtosecond laser procedures

Purpose: To identify the facial anthropometric parameters that predict the difficulty during femtosecond (FS) laser. Methods: This was a single?center observational study was conducted on participants between the ages 18 and 30 years who were planned for FS?LASIK (femtosecond laser?assisted laser in situ keratomileusis) or SMILE (small incision lenticule extraction) at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. The front and side?facing images of the participants were analyzed using Image J software to measure different anthropometric parameters. The nasal bridge index, facial convexity, and other parameters were measured. The difficulty faced by the surgeon during docking was recorded for each subject. The data were analyzed on Stata 14. Results: A total of 97 subjects were included. The mean age was 24 (±7) years. Twenty?three (23.71%) subjects were females while the rest were males. Difficulty in docking was seen in 1 (4.34%) female and 14 (19%) males. The mean nasal bridge index was 92.58 (±4.01) in subjects with deep?set eyes and 89.72 (±4.30) in normal subjects. The mean total facial convexity was 129.28 (±4.24) in deep?set eyes, and 140.23 (±4.74) in normal subjects. Conclusion: Total facial convexity appeared as the most important feature, with the value being less than 133° in most subjects with unfavorable facial anthropometry

Optic nerve sheath fenestration: A second lease at sight

Purpose: To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies. Methods: Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed. Results: Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was ?1.9789 ± 1.46270, which improved to ?0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from ?1.3378 ± 1.50107 to ?1.0667 ± 1.33813 (p < 0.05). Conclusion: Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.

Occurrence and subsequent development of vertical deviations in patients treated surgically for infantile esotropia

Purpose: The purpose of this study was to evaluate the onset of dissociated vertical deviation (DVD) and inferior oblique overaction (IOOA), their subsequent development, and their correlation with pre and postoperative parameters. Methods: Medical records of patients with infantile esotropia who underwent surgery between 2005 and 2017 were retrospectively reviewed. DVD and IOOA were measured before and after surgery. Patients were divided into two groups based on horizontal and vertical deviation at the time of presentation: those with infantile esotropia only (group A) and patients with infantile esotropia who developed vertical deviation (group B). Results: Out of a total of 102 patients, DVD occurrence was seen in 53 patients (51.9%) and IOOA was seen in 50 patients (48.04%). DVD was seen in 22 patients at the time of initial examination and in 31 patients postoperatively. IOOA at presentation was seen in 45 patients (44.1%) and 5 patients (8.8%) postoperatively. No statistical difference was found in the age of surgery, angle of deviation, mean follow?up, and mean refractive error within both groups. The postoperative motor outcome was statistically comparable between the two groups (P = 0.29). Sensory outcomes of fusion (P = 0.048) and stereopsis (P?value = 0.00063) were better in group A. Conclusion: No correlation was found between the age of occurrence and development of vertical deviation with refractive error, angle of deviation, age, or type of surgery. We found that motor outcomes are not affected but sensory outcomes are affected in patients with vertical deviations. This indicates that DVD and IOOA are developed due to inherent disruption of fusion and stereopsis

Demographic profile and clinical characteristics of patients presenting with acute ocular burns

Purpose: To study and compare the demographic and clinical profile of acute ocular burns (AOB) in children and adults. Methods: This retrospective case series included 271 children (338 eyes) and 1300 adults (1809 eyes) who presented to two tertiary eye care centers within one month of sustaining AOB. Data regarding demographics, causative agents, severity of injury, visual acuity (VA), and treatment were collected and analyzed. Results: Males were more commonly affected particularly among adults (81% versus 64%, P < 0.00001). Among children, 79% sustained domestic injuries, whereas 59% of adults had work?place injuries (P < 0.0001). Most cases were due to alkali (38%) and acids (22%). Edible lime (chuna, 32%), superglue (14%), and firecrackers (12%) in children, and chuna (7%), insecticides, lye, superglue (6% each), toilet cleaner (4%) and battery acid (3%) in adults, were the main causative agents. The percentage of cases with Dua grade IV?VI was greater in children (16% versus 9%; P = 0.0001). Amniotic membrane grafting and/or tarsorrhaphy were needed in 36% and 14% of affected eyes in children and adults, respectively (P < 0.00001). The median presenting VA was logMAR 0.5 in children and logMAR 0.3 in adults (P = 0.0001), which improved significantly with treatment in both groups (P < 0.0001), but the final VA in eyes with Dua grade IV?VI burns was poorer in children (logMAR 1.3 versus logMAR 0.8, P = 0.04). Conclusion: The findings clearly delineate the at?risk groups, causative agents, clinical severity, and treatment outcomes of AOB. Increased awareness and data?driven targeted preventive strategies are needed to reduce the avoidable ocular morbidity in AOB