Prescribing trends of anti glaucoma medication usage in treatment naive patients of primary open angle glaucoma in a tertiary care hospital in Eastern India

Background: Primary open angle glaucoma remains a high magnitude healthcare problem due to its prevalence and chronicity. The real world scenario of anti glaucoma medical therapy needs periodical auditing as far as drug prescriptions are concerned for formulation of treatment guidelines. Few studies from India have taken a longitudinal approach in this respect. This study was undertaken to identify such lacunae.Methods: This was an open label, prospective, observational study. Each treatment naive patient was followed up for a period of 6 months, where their prescriptions were scanned for the type of the anti glaucoma medications, total number of medications, route of administration, their duration of use and their frequency of dosage and change in medications if any, in each visits.Results: A gradual shift from monotherapy towards combination therapy was observed. Overall averages for prescriptions were topped by monotherapy at 44.25 followed by fixed dose combinations at 38.25, and then combination-polytherapy at 36 and the least number of prescriptions were for concurrent polytherapy at 17.5. Amongst all monotherapy agents, beta blockers were the most frequently prescribed drugs at baseline but their share of prescriptions was almost halved at the end of our study. The prostaglandin analogs on the other hand saw an upsurge in prescriptions from their baseline to the end of this study. Prostaglandin analogs andbeta blockers as fixed dose combination was a popular prescription over the entire study duration.Conclusions: Prescribing trends were remarkable for the shift from primary monotherapy towards fixed dose combinations as the study concluded. The decline in the number of beta blocker prescriptions and a rise in prostaglandin analog prescriptions is a testament to their better effectiveness and tolerability. The future of open angle glaucoma pharmacotherapy lies in prescribing more efficacious drugs either in monotherapy or in fixed combinations.

Visual impairment in urban school children of low-income families in Kolkata, India.

To evaluate pattern of visual impairment in school children from low-income families in Kolkata, India, an institutional cross-sectional study was conducted among 2570 children of 10 primary schools. Ocular examination including refraction was done and pattern of visual impairment and refractive error was studied. The age range was 6-14 years. Refractive error was seen in 14.7%. Only 4 children were already wearing correction. Myopia and hypermetropia was present in 307 (11.9%) and 65 (2.5%) children, respectively. Visual acuity of less than 6/12 in better eye was present in 109 (4.2%) and 5 (0.2%) children pre- and post-correction, respectively. Eighteen children had amblyopia. Although prevalence of refractive error in this group is less compared to school children of all income categories reported from other cities of India, it is more compared to school children of all income categories from the same city. Refractive error mostly remains uncorrected in this group.

A clinicopathological study of malignant melanoma with special reference to atypical presentation.

Malignant melanoma is a tumor of melanocytic origin. Lymphatic and hematogenous metastases are common in this condition. Retrospective analysis was performed in 16 consecutive cases diagnosed histopathologically as malignant melanoma at the pathology department of a medial college in eastern India. 75% of the patients were male; majority of them was in their sixth decade. All (100%) the lesions were pigmented. The primary site was known in all cases, except two (12.5%). Out of the 14 cases with known primary site 11 (78.57%) were cutaneous melanomas, including one arising in labia minora, two (14.29%) were ocular and one (7.14%) was vaginal in origin. Among cutaneous melanomas, superficial spreading type was the commonest variety and mixed population of epithelioid and spindle cell was the commonest histopathological pattern. The commonest grade of invasion was grade III (Clark's). The clinical presentation of the case of vaginal melanoma and the two cases of secondary melanomas, including the one with obscure primary tumor, were bewildering and hence are discussed separately.

Ophthalmic manifestations in people living with HIV attending a tertiary care centre of Eastern India.

A cross-sectional study was undertaken to evaluate ophthalmic lesions in human immunodeficiency virus-infected individuals in eastern part of India. One hundred and seventy-five Indian patients attending one tertiary care centre in Kolkata, were included in the study. Ophthalmic manifestations were found in 29.14%. Of them 64.70% had posterior segment lesion, 23.52% had neuro-ophthalmic lesion, 19.60% had anterior segment lesion, 15.69% had adnexal lesion. Human immunodeficiency virus retinopathy was the commonest ophthalmic lesion involving 23 eyes. Cytomegalovirus retinitis was found in only 10 eyes. Ophthalmic lesions were less common in this study than reported in earlier literature in India and abroad.

A cross-sectional study on aqueous humour lactate dehydrogenase level in retinoblastoma.

Lactate dehydrogenase enzyme is a non-specific marker found raised in different body fluids in various pathological conditions. This cross-sectional study was done in a medical college of Kolkata, India to find out lactate dehydrogenase level of aqueous humour in retinoblastoma cases. Aqueous humour lactate dehydrogenase level from 21 histology proved retinoblastoma cases and 21 controls was estimated and compared. Range of lactate dehydrogenase levels in retinoblastoma cases were 863-4819 IU/l; mean being 3396.9 IU/l; and in controls range was 48-146 IU/l; mean being 90.6 IU/l; 76.19% of retinoblastoma cases had value over 3000 IU/l. None of the controls had value above 150 IU/l. The difference between lactate dehydrogenase values of cases and controls was significant (p<0.001).

Posthepatitis aplastic anaemia presenting only with bilateral vision loss.

Aplastic anaemia is pancytopenia with marrow hypocellularity. Hepatitis-associated aplastic anaemia is a varient or aplastic anaemia that follows an acute attack of seronegative hepatitis. Here a case of hepatitis-associated aplastic anaemia presenting with sudden onset of severe simultaneous bilateral vision loss and without any other usual presenting signs is reported. Partial recovery of blood cell count occurred following immunosuppressive therapy. Posterior hyalodotmy helped rapid resolution of premacular subhyaloid haemorrhage. Although bilateral vision loss may rarely be the initial presentation of aplastic anaemia, no such report is known in hepatitis-associated aplastic anaemia. Posthepatitis vision loss needs careful investigation to exclude an underlying haematological disorder.

An observational study on retinoblastoma cases attending a medical college in Calcutta.

Excision of the eyeball was done in 23 cases with diagnosis of retinoblastoma in a medical college of Calcutta. Of them, 21 cases were histologically proved to be retinoblastoma. A clinicopathological study of these 21 cases was done. Retinoblastoma patients were between 5.5 and 71 months of age, 57.1% were females, in 90.4% cases there was unilateral involvement and left eye was affected in 68.4% patients. All the patients had negative family history. Majority of the patients (85.7%) presented with leucocoria. Multiple presenting features were present in 5 patients. Aqueous humour cytology revealed malignant cells in 9.5% patients. Imprint cytology of cut end of optic nerve stump was negative for malignant cells in all the cases. Histopathological study revealed presence of Flexner-Wintersteiner rosettes in 23.8%, pseudorosettes in 28.6%, anterior chamber involvement in 38%, choroid invasion in 42.8%, optic nerve involvement in 28.6%, necrosis in 28.6% and calcification in 9.5% cases. After one year of follow-up, none developed any metastasis except one patient who had developed intracranial metastasis.