Evaluation of post-operative dry eye in upper and lower eyelid reconstruction: A cross-sectional study

Purpose: In cases of eyelid malignancies requiring full thickness excisional biopsy followed by reconstruction of the created defect, the Meibomian glands are lost. Post?operative varying degrees of dry eye disease (DED) are expected in such patients. The aim was to evaluate the objective and subjective statuses of DED in cases of full thickness eyelid reconstruction following excisional biopsy because of malignancies. Methods: This was a cross?sectional pilot study. Objective and subjective dry eye parameters are assessed in cases of full thickness eyelid reconstruction following excisional biopsy because of malignancies in 37 eyes at 6 months post?operative follow?up. Analysis of variance and Chi square test were used for statistical analysis. Results: When compared with fellow eye, all the parameters were found to be statistically significant (P < 0.0). Subjective assessment of dry eye by ocular surface disease index (OSDI) scoring did not corroborate with the objective data (p 0.00). Lower eyelid reconstruction showed a minimum number of dry eye cases (P > 0.05). Conclusion: Prevalence of post?operative dry eye is more with increasing percentage of full thickness upper eyelid reconstruction. Disparity was found between objective and subjective parameters of dry eye in patients requiring varying percentages of upper eyelid reconstruction because of malignancies.

Prospective evaluation of wipe-out after glaucoma filtration surgery in eyes with split fixation

Purpose: To assess the incidence and cause of idiopathic, irreversible loss of vision (“wipe?out”) in the early post?operative period after glaucoma?filtration surgery in advanced glaucoma. Methods: It was a prospective, interventional cohort study. Patients with advanced glaucoma and macular split fixation underwent either only trabeculectomy (group A) or combined phaco?emulsification with trabeculectomy (group B). The incidence and cause of visual loss, changes in intra?ocular pressure, visual acuity, and visual field indices during 2 months post surgery were assessed. Results: Thirty patients (30 eyes) were divided in two groups. No significant difference was noted between the pre?operative and post?operative mean deviations in both groups (P = 0.41, P = 0.65). Two eyes in group A and one eye in group B had visual loss of two lines or more at the end of 2 months because of cataract and choroidal detachment. None of the eyes showed “wipe?out”. Conclusion: “Wipe?out” is a rare phenomenon after surgery in advanced glaucoma

Study of Retinal Nerve Fibre Layer Thickness in Type 2 Diabetes Mellitus by 3-Dimensional Optical Coherence Tomography from Eastern India.

Three dimensional optical coherence tomography (OCT) is a novel technique to diagnose retinal disorders. In diabetes, loss of retinal neurons is said to be an early event. We did a small pilot study from Eastern India to find the usefulness of OCT in detecting changes in retinal nerve fibre layer (RNFL) in diabetics. We selected adult type 2 diabetics without overt retinopathy. Patients aged more than 60 or with pre-existing problems like glaucoma or vasculitis were excluded. RNFL thickness was measured using HRA-OCT Spectralis analyser. A 12º area around optic nerve head was analysed and depth of each quadrant was separately measured. The patient values were compared with normative Indian data to detect aberrations. Also, the venous blood sugar levels were measured and correlation studies were done with the retinal thickness values. Standard statistical methods were used. We had 10 diabetic cases (20 eyes) and 11 controls (22 eyes). There was significant thinning of RNFL in 6 (60%) diabetic cases and none of the controls. Two of the diabetics had severe thinning around optic nerve head. 83% of the patients had thinning on temporal side and 50% on nasal side. Mean blood glucose levels were higher in those with RNFL thinning. Both FBS and PPBS showed significant negative correlation with retinal thickness measurements. This is probably the first study of its kind from India. 3-D OCT can be a valuable tool in screening diabetics for complications. However, more studies are needed to better elucidate the role of this novel technology.

Rabeto plus: a valuable drug for managing functional dyspepsia.

The aim of the study was to evaluate and document the efficacy and tolerability of rabeto plus (FDC of rabeprazole and itopride) in management of functional dyspepsia. It was an open, prospective, non-comparative, multidose study. The patients with functional dyspepsia (NERD or non-erosive reflux disease) attending OPD of a leading, tertiary care, teaching hospital in West Bengal (BS Medical College, Bankura) were inducted in the study. A total of 46 adult patients of either sex with functional dyspepsia and a clinical diagnosis of NERD were given 1 capsule of rabeto plus before breakfast, for up to 4 weeks. Primary efficacy variables were relief from symptoms of heartburn, nausea, vomiting, waterbrash and fullness. Secondary efficacy variables were global assessment of efficacy and toleration by patients and treating physicians. The tolerability was assessed on the basis of record of spontaneously reported adverse events with their nature, intensity and outcome. Out of 55 patients enrolled in the study, 46 completed the study as planned, while 9 patients were lost to follow-up (dropped). Most patients reported near total symptom relief by the end of study. Total symptom score showed remarkable and significant improvement from baseline to end of the study. Importantly, none of the patients reported any side-effect. All participants tolerated the drug well. Moreover, response to study drug was rated as excellent or good by over 93% patients and their treating physicians. This means that 9 out 10 patients receiving rabeto plus reported desired symptom relief from dyspepsia. Thus it was concluded that rabeto plus is a valuable drug for treatment of functional dyspepsia or NERD.

Vogt-Koyanagi-Harada syndrome in a 10-year-old child.

A 10-year-old female child attended outpatients department of Regional Institute of ophthalmology, Kolkata with the complaints of gradual dimness of vision of both eyes, recurrent pain, redness and photophobia. On examination, she was found to have bilateral anterior uveitis, poliosis and vitiligo. Laboratory tests were performed to rule out other causes of granulomatous uveitis. She was treated with topical and systemic steroids and topical cycloplegic. Then pars plana vitrectomy with lensectomy was carried out. The vision still remained poor.

Fine needle aspiration biopsy in the management of tumours in superolateral quadrant of orbit.

Forty-two cases of orbital lesions in superolateral quadrant were evaluated in our study by fine needle aspiration biopsy. Cases were histologically proven wherever possible. In 92.85% cases the diseases were correctly diagnosed. Females were mainly affected. Lymphomatous tumours were diagnosed on the basis of atypical lymphoid proliferation, correlated with clinical features and findings of computed tomographic scan and managed by radiotherapy. Pseudotumours, dermoid and epithelial tumours of lacrimal gland were diagnosed accurately except in one case of malignant mixed tumour where the malignant component was aspirated. Pseudotumours were treated by steroid, dermoid by excision. In case of adenocarcinoma and adenocystic carcinoma, tumour masses were removed by lateral orbitotomy and radiotherapy was applied when bony erosion was present. One case of eosinophilic granuloma was treated by radiotherapy and curettage. The suspected case of intra-osseous cavernous haemangioma did not turn up for treatment.

Unilateral loss of vision following snakebite.

A 14- year-old boy presented at the outpatients' department with the complaint of visual loss in the right eye of 1 1/2 months duration. He had the history of snakebite for which he was admitted to hospital. The diminution of vision started next day after snakebite. On examination, he had no perception of light in his right eye. USG B scan showed vitreous haemorrhage in his right eye. He was given IV methylpredinisolone. At follow-up after one month he still had no perception of light in his right eye with the haemorrhage in the vitreous subsided.

Evaluation of visual outcome following cataract surgery in a tertiary eye care hospital.

A retrospective study was conducted at the Regional Institute of Ophthalmology (RIO), Kolkata to assess the visual outcome in senile cataract after surgery in the age group of 45-65 years. A total number of 1837 operated eyes (1826 patients) were included in the study during the period of January, 2000 to December, 2000. Patients with low vision unrelated to cataract surgery were excluded. The mean age at cataract extraction was 56 +/- 9 years. Patients were followed for 6 months. Of 1837 operated eyes, 26 (1.4%) were blind (visual acuity < 3/60), 122 (6.6%) had low visual acuity (3/60-6/18) and 1689 eyes (92.2%) gained good vision (visual acuity > 6/18). Of 148 visually compromised eyes posterior capsular opacity (41.2%) was the commonest complication followed by corneal oedema (36.5%) and glaucoma (12.8%). Other posterior segment causes accounted for the remaining cases. The study emphasises the need for proper selection, good pre-operative check-up, skilled surgery and regular follow-up to improve the qualitative aspect of cataract surgery.

Ocular rhinosporidiosis.

Rhinosporidium seeberi, the causative organism causing rhinosporidiosis, also affects extranasal sites. A 1 5-year-old male presented with a conjunctival fleshy swelling near the inner canthus of the left eye. His visual acuity was within normal range. Conjunctival papilloma was the provisional diagnosis for which he was operated on. Histopathology proved to be a case of ocular rhinosporidiosis. Six months follow-up of the case showed no recurrence.

Vegetative intraocular foreign body of 25 years' duration.

Retained intraocular organic foreign bodies, particularly wooden bodies, are frequently encountered in ophthamlologic practice. We treated a patient with a retained intraocular foreign body--a single splinter from a broom--which had remained in the eye for 25 years.