Study Of The Surgical Outcome Of Sutureless Glueless Conjunctival Autograft In Pterygium Excision Surgery

Background: Pterygium is a hyperplastic elastoid wing shaped degenerative condition of the subconjunctival tissue which proliferates as vascularized granulation tissue infiltrating the cornea destroying the superficial layers of stroma and Bowman’s membrane causing corneal distortion and significant amount of astigmatism. Conjunctival autograft is a relatively new and effective surgical technique with good aesthetic results in the management of primary pterygium. Objective: To evaluate the surgical outcome in terms of recurrence and other complications of sutureless glueless conjunctival autograft in pterygium excision. Setting: Department of Ophthalmology, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh. Methods: Prospective interventional non randomized hospital based case series was carried out in 50 eyes with primary pterygium. Pterygium excision with limbal conjunctival autograft without glue or suture was performed in all patients. The patients were followed post operatively on day 1, day 7, 1 month and 6 months. Recurrence and other complications were noted at each visit. Results: Mean age of the study population was 36.96_x0001_11.39 years, 64% were males with maximum patients (72%) presenting in the age group of 20-40 years. The overall complication rate was 10%. Graft retraction was seen in 4%, Conjunctival Cyst in 2% and 1 case showed Graft Rejection. Recurrence rate was noted to be 2% at the end of 6 months. Conclusion: Sutureless glueless conjunctival autograft following pterygium excision is a simple, safe and economical procedure for the treatment of pterygium having excellent outcome.

A Prospective Study to Evaluate the Incidence of Open Angle Glaucoma Vs Primary Angle Closure Glaucoma in a Tertiary Care Centre

Background: Prevelance of Primary Open Angle Glaucoma Vs Primary Angle Closure Glaucoma. Methods: This study conducted in In this study between 20-60 year old patients included and diagnosed glaucoma. Results: In 680 patients , 484 (71.1%) showed PACG and 196 (28.8%) showed POAG (TABLE 3) & 127 (18.6%) patients severely affected with glaucoma, 491 (72.2%) patients moderately affected with glaucoma ,62 (9.1%)patient mildly affected with glaucoma. Conclusion: This study conclude that, Primary Angle Closure Glaucoma Is More Severe as Compare To Primary Angle Open Angle.

Evaluation of Non Surgical Management in Resolution of Congenital Blockage of Nasolacrimal Duct.

Background: Congenital Nasolacrimal Duct Obstruction (NLDO) affects 1% to 20% of infants. The non-surgical treatment includes lacrimal sac massage, whereas some cases need surgical intervention. The present study was conducted to prove that maximum number of cases resolve within six months of non-surgical management in infants aged new born to one year. Methods: This is a prospective and observational study in which 319 infants suffering from Congenital Nasolacrimal Duct Obstruction were treated with lacrimal sac massage and topical antibiotics. The symptoms of the patient were assessed after six months of treatment. Results: In infants new born to 8 months of age (233 eyes), more than 50% with NLDO will resolve within 6 months with non-surgical management. Conclusion: So the experience of rate of NLDO resolution in infancy without surgery will help clinician and parents effectively discuss treatment options.

Role of Topical Nepafenac and Topical Dexamethasone in Postoperative Inflammation after Cataract Surgery: A Comparative Study.

Background: To study the role of nonsteroidal anti-inflammatory Nepafenac 0.1% topically in comparison to topical steroid for controlling postoperative inflammation after cataract surgery. Methods: Prospective randomized controlled trials were given and double blind study was done. In both groups, similar baseline parameters were taken into consideration. Postoperative inflammation, intraocular pressure and visual acuity following routine small incision cataract surgery were assessed in both groups in first 21 days. Parameters were graded according to severity. Results: There was not much difference statistically in two groups in the treatment of any of the signs, including ciliary congestion, aqueous cells, flare, descemet’s folds, visual acuity and intraocular pressure (p 0.001) however, there was apparent improvement with corticosteroids when aqueous flare was considered but with Nepafenac there was no side effect and was well tolerated. Conclusion: Nepafenac is equally effective as topical steroid and can safely be used in routine postoperative inflammation after uncomplicated cataract surgery.

300,000 IU or 600,000 IU of Oral Vitamin D3 for Treatment of Nutritional Rickets: A Randomized Controlled Trial.

Objective: To evaluate the non-inferiority of a lower therapeutic dose (300,000 IU) in comparison to standard dose (600,000) IU of Vitamin D for increasing serum 25(OH) D levels and achieving radiological recovery in nutritional rickets. Design: Randomized, open-labeled, controlled trial. Setting: Tertiary care hospital. Participants: 76 children (median age 12 mo) with clinical and radiologically confirmed rickets. Intervention: Oral vitamin D3 as 300,000 IU (Group 1; n=38) or 600,000 IU (Group 2; n=38) in a single day. Outcome variables: Primary: Serum 25(OH)D, 12 weeks after administration of vitamin D3; Secondary: Radiological healing and serum parathormone at 12 weeks; and clinical and biochemical adverse effects. Results: Serum 25(OH)D levels [geometric mean (95% CI)] increased significantly from baseline to 12 weeks after therapy in both the groups [Group 1: 7.58 (5.50–10.44) to 16.06 (12.71– 20.29) ng/mL, P<0.001]; Group 2: 6.57 (4.66–9.25) to 17.60 (13.71–22.60, P<0.001]. The adjusted ratio of geometric mean serum 25(OH)D levels at 12 weeks between the groups (taking baseline value as co-variate) was 0.91 (95% CI: 0.65–1.29). Radiological healing occurred in all children by 12 weeks. Both groups demonstrated significant (P<0.05) and comparable fall in the serum parathormone and alkaline phosphatase levels at 12 weeks. Relative change [ratio of geometric mean (95% CI)] in serum PTH and alkaline phosphatase, 12 weeks after therapy, were 0.98 (0.7–1.47) and 0.92 (0.72–1.19), respectively. The serum 25(OH)D levels were deficient (<20 ng/mL) in 63% (38/60) children after 12 weeks of intervention [Group 1: 20/32 (62.5%); Group 2: 18/28 (64.3%)]. No major clinical adverse effects were noticed in any of the children. Hypercalcemia was documented in 2 children at 4 weeks (1 in each Group) and 3 children at 12 weeks (1 in Group 1 and 2 in Group 2). None of the participants had hypercalciuria or hypervitaminosis D. Conclusion: A dose of 300,000 IU of vitamin D3 is comparable to 600,000 IU, administered orally, over a single day, for treating rickets in under-five children although there is an unacceptably high risk of hypercalcemia in both groups. None of the regime is effective in normalization of vitamin D status in majority of patients, 3 months after administering the therapeutic dose.