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.

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.

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.

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.