Cataract related blindness in India & its social implications.

The prevalence of blindness in India is 14.9 per 1000. Eighty per cent of this blindness is due to cataract alone. Most of the cataract blinds in the country are in the rural areas while the surgical service delivery network is concentrated in the urban areas. Thus a large proportion of patients in the rural areas continue to remain blind. This situation has many social implications. There is loss of productivity, breakdown of interpersonal relationships, depressive manifestations, loss of self esteem and most patients lead an isolated humiliating life. Patients lack information on the available services and continue to remain blind for years even after being diagnosed as operable. This is unfortunate because cataract surgery is one of the most cost effective health interventions known and most operated patients, irrespective of the surgical technique, are immensely satisfied with the level of visual rehabilitation after surgery.

Clinico-biochemical study of experimental complicated cataracts.

Clinically observed complicated cataracts, generally do not have a definite causal factor. We studied the effects of E. coli toxin injected suprachoroidally, to simulate the effect of toxins released by extraocular organisms on the lens. 79.2% of eyes had a definable cataract at the end of the 6th week of observation. The biochemical changes portrayed an increased oxidative activity in the lens, evidenced by a fall in glutathione concentration, and the consequent tertiary reorientation of proteins to increase insoluble proteins, forming a cataract.

Synergetic effects of U-V radiations and malnutrition of lens (experimental study).

The synergistic effects of protein deficiency and U-V radiation is cataractogenic as seen in our experimental model though individually these had no damaging effect on enzymatic profile and clinical appearance.

Management of secondary pupillary membrane in aphakia (YAG discission vs parsplana membranectomy).

Forty aphakic eyes, with secondary pupillary membranes, underwent pars plana membranectomy and YAG laser discission randomly. Visual improvement was similar in both the groups. IOP remained low for a week in pars-plana membranectomy while it transiently increased following YAG laser discission Complications like anterior chamber reaction, corneal edema and CME were more after pars plana membranectomy than in YAG laser discission. In membranes thicker than 1.2 mm, only pars plana membranectomy is recommended.

Cataract induced glaucoma--an insight into management.

The problem of phacomorphic glaucoma is a rather common entity in rural India owing to the delay in getting the cataract removed and the preponderance of cortical matter, compared with the Western world. The authors in India, South East Asia and Australia, have managed the problem differently leading to controversies. The pathogenesis has been investigated and is well understood. An aspect of phacomorphic glaucoma that remains quite unanswered, is of the relatively poor visual outcome and increased incidence of operative and post-operative complications. We endeavour to evaluate the management, intraoperative and post-operative complications of phacomorphic glaucoma (senile cataract induced). The effect of high intraocular pressure (I.O.P) and surgical trauma on the corneal endothelium is also assessed.

Corneal endothelial changes following pars plana lensectomy.

The corneal endothelial status was studied in 40 eyes of patients with congenital cataract before and 3 months after surgery. Twenty eyes of patients who underwent pars plana lensectomy revealed a mean endothelial cell loss of 8% (SD +/- .76) while the remaining 20 eyes which were operated by needling aspiration had a endothelial cell loss of 10% (SD +/- .89). The difference between the two groups was not statistically significant.

Visual acuity testing in cataract--an insight (cataract classification density based).

The senile cataracts have been graded on the basis of density objectively. The letter visual acuity, laser interferometric visual acuity and pin hole visual acuity were compared in various grades of cataracts and controls (phakic and aphakic) in 140 eyes. It was found that good correlation exists in all eyes except when cataract density is grade III or IV. The laser interferometry has good prognostic value when the predictability is assessed in early stages of cataract (Grade I & II).

Dermatoglyphic profile in congenital cataracts.

Forty-five children with congenital cataract cases were studied for patterns and compared with age sex matched controls. The patients showed marked differences in different dermatoglyphic traits. The intra uterine aetiological groups i.e. rubella, hereditary and undetected aetiology, showed variations in mainline terminations. Rubella group showed increased angle atd.

Sister chromatid exchanges in congenital cataracts.

A total of 25 patients with bilateral congenital cataracts, from three aetiological groups i.e. rubella (6 patients) hereditary (6 patients) and undetected aetiology (13 patients) were studied for sister chromatid exchanges (SCE). SCEs were markedly raised in the rubella groups as compared with age sex matched controls. The other two groups also showed raised SCE, more so in hereditary group.

Genetic appraisal of congenital cataract.

A total of 45 congenital cataract cases were studied for chromosomal aberrations and dermatoglyphic patterns. Whereas parents showed no marked differences, patients showed marked differences in different dermatoglyphic traits as compared to age-sex matched controls. Out of all the patients Rubella, hereditary and undetected actiology groups showed variations differently, SCE were seen in all cataracts irrespective of their aetiology as compared to controls.