Posterior capsular opacification and Nd:YAG capsulotomy rates in patients implanted with square-edged and non-square-edged intraocular lenses in manual small-incision cataract surgery: A randomized controlled study

Purpose: To study posterior capsular opacification (PCO) and neodymium?doped yttrium aluminum garnet (Nd:YAG) capsulotomy rates in patients implanted with square?edged and non?square?edged intraocular lenses (IOLs) in manual small?incision cataract surgery (MSICS). Setting: Tertiary eye care center. Design: Prospective, comparative, and randomized controlled study. Methods: This study included patients with senile cataracts scheduled for MSICS and IOL implantation. One eye of each patient was randomized to the implantation of square?edged (S group) or non?square?edged IOL (NSQ group). An independent observer analyzed PCO at 6, 12, 18, and 24 months under slit?lamp illumination. Results: A total of 104 eyes were included in this study. The mean age of the participants in the two groups was 63.2 (�2) years, and there were 65 (62.5%) men and 39 women (37.5%). The mean best?corrected visual acuity (BCVA) values at 6, 12, and 18 months were 0.157 (�10), 0.11 (�12), and 0.12 (�11), respectively, in the S group and 0.17 (�10), 0.17 (�12), and 0.20 (�17), respectively, in the NSQ group. At 12 (P = 0.03) and 18 months (P = 0.01) follow?up, the BCVA of the S group was significantly better than that of the NSQ group. Four eyes in the NSQ group and one eye in the S group required Nd:YAG. Conclusion: Evaluation of PCO and Nd:YAG capsulotomy rates showed that the 360� square of the posterior IOL edge plays a role in the prevention of PCO. Owing to the low cost of the material and the easy availability of IOLs manufactured from it, square?edged IOL has a definite role in the prevention of PCO in MSICS.

Study of the relationship between serum lipid levels and primary open-angle glaucoma

Purpose: To determine the association between serum lipid levels and primary open?angle glaucoma (POAG). Methods: In this case?control study, 50 patients with POAG documented by clinical tests using standard ophthalmologic equipment and 50 age?matched controls were investigated. Twelve?hour fasting serum lipid profiles, including total cholesterol, serum triglycerides, low?density lipoproteins (LDLs), and high?density lipoproteins (HDLs), were compared between the cases and controls. Results: The mean age of cases and controls was 62.84 ± 9.68 and 60.12 ± 8.65, respectively (P = 0.65). High total cholesterol levels (>200 mg/dl) were found in 23 cases (46%) and 8 controls (16%); high serum triglyceride levels (>150 mg/dl) were found in 24 cases (48%) and 7 controls (14%); high LDL levels (130 mg/dl) were found in 28 cases (56%) and 9 controls (18%); and low HDL levels (<40 mg/dl) were found in 38 cases (76%) and 30 controls (60%). The mean total cholesterol levels were 205.24 ± 36.90 mg/dl in cases and 177.68 ± 22.56 mg/dl in controls (P < 0.001); the mean serum triglyceride levels were 150.42 ± 49.55 mg/dl and 130.84 ± 23.16 mg/dl, respectively (P = 0.013); and the mean LDL levels were 139.50 ± 31.03 mg/dl and 114.96 ± 17.73 mg/dl, respectively (P < 0.001). The mean cholesterol, triglyceride, and LDL levels were significantly higher in cases than in controls (P < 0.05). Conclusion: The present study shows that higher proportion of POAG patients have dyslipidemia compared to age?matched controls. Though these findings need to be replicated by others. This study opens new vistas for further studies, such as lowering dyslipidemia, lowering the intra?ocular pressure and incidence of POAG, and whether the use of statins to reduce dyslipidemia affects the progression of POAG.

The complication rate following Neodymium-doped Yttrium Aluminum Garnet laser posterior capsulotomy for posterior capsular opacification in patients with and without comorbidities

Purpose: To study the complication rate following Nd: YAG posterior capsulotomy posterior capsular opacification (PCO) in patients with and without comorbid conditions. Methods: This was a prospective, interventional, comparative, and observational study. A total of 80 eyes, consisting of 40 eyes without ocular comorbidities (group A) and 40 eyes with ocular comorbidities (group B) that were being treated with Nd: YAG capsulotomy for PCO, were included. Visual outcome and complications of Nd: YAG capsulotomy were studied. Results: The mean age of group A patients was 61.65 ± 8.85 years and that of group B patients was 63 ± 10.46 years. Of the total, 38 (47.5%) were men and 42 (52.5%) were women. In group B, the ocular comorbidities were moderate nonproliferative diabetic retinopathy (NPDR) (n = 14 eyes; 14/40 = 35%), subluxated intraocular lens (IOL; <2 clock hours of subluxation; n = 6), age?related macular degeneration (ARMD; n = 6), post?uveitic eyes (having old signs of uveitis, no episode of uveitis since the last 1 year; n = 5), and operated cases of traumatic cataract (n = 4). The mean energy required in groups A and B was 46.95 ± 25.92 and 42.62 ± 21.85 mJ, respectively (P = 0.422). The average energy requirement in Grade 2, Grade 3, and Grade 4 PCO was 22.30, 41.62, and 79.52 mJ, respectively. An increase in intraocular pressure (IOP) of >5 mmHg from pre?YAG levels was observed in one patient in each group on day 1 postprocedure, for which medical treatment was given to both patients for 7 days. One patient in each group had IOL pitting. No patient had any other complications attributable to ND:YAG capsulotomy. Conclusion: Nd:YAG laser posterior capsulotomy is a safe procedure for PCO in patients with comorbidities. Visual outcomes were excellent after Nd:YAG posterior capsulotomy. Although a transient increase in IOP was noted, the response to treatment was good and a long?term increase in IOP was not observed

Comparative evaluation of an automated preloaded delivery system with a non-preloaded system

Purpose: To evaluate a single surgeon’s experience with an automated preloaded intraocular lens (IOL) delivery system and a nonpreloaded system. Methods: This was a prospective, observational case series. Phacoemulsification was performed under topical anesthesia by creating a temporal clear corneal incision. Patients were consecutively assigned to either the Clareon group (n = 50; the IOL was injected into the capsular bag by using an automated injector system) or the AcrySof group (n = 50; the IOL was injected into the capsular bag by using a conventional injector system). The main outcome measures were ease of implantation, intraoperative complications, postoperative centration, and visual acuity. Results: Additional manipulation in the anterior chamber was not required in 38 (74%) eyes in the Clareon group and 41 (82%) eyes in the AcrySof group. However, seven eyes in the Clareon group and one eye in the AcrySof group required trailing haptic dislodgement from the optic. Furthermore, two eyes in the Clareon group and five eyes in the AcrySof group required injector rotation (varying from 10° to 90°) in the wound. Moreover, in two eyes of the Clareon group, the silicon plunger of the injector system crossed over the optic. None of the patients developed iris trauma and PCR during IOL manipulation. All the IOLs were centered in the capsular bag. Conclusion: The automated IOL delivery system enables the controlled delivery of an IOL in the capsular bag. The effect of carbon footprints created by plastic generated from the delivery system and the implications of the CO2 cylinder on the environment should be addressed.

Evaluation of posterior capsular opacification and neodymium-doped yttrium aluminum garnet capsulotomy rates in patients with hydrophilic intraocular lens implantation with and without ocular viscoelastic device

Purpose: To study the effect of intraocular lens (IOL) implantation with and without ocular viscoelastic device (OVD) on posterior capsular opacification (PCO) in eyes with phacoemulsification. Methods: This prospective, comparative, and randomized case series included 70 patients (140 eyes) with senile cataracts scheduled for phacoemulsification and IOL implantation in a tertiary eye c are center. One eye of each patient was randomized to one of the two groups, namely, control and OVD. After phacoemulsification, the IOL was placed in the capsular bag under balanced salt solution (BSS) in the control group, whereas the IOL was placed under OVD in the OVD group. PCO was analyzed by an independent observer at 6, 12, and 18 months under slit?lamp illumination. Results: The mean age of the participants in the two groups was 61.2 (±9.9) years. Of the total participants, 68 (48.5%) were men and 72 (51.5%) were women. The mean keratometry (K1, K2) values of the OVD (44.26 ± 1.43, 44.93 ± 1.66) and control (44.51 ± 1.74, 44.69 ± 1.49) groups were similar. The mean IOL powers of the control and OVD groups were 21.25 (±1.94) and 21.53 (±1.86), respectively (P = 0.463). The mean best?corrected visual acuity (BCVA) of the control group at 6?, 12?, and 18?month follow?ups were 0.622 (±0.253), 0.315 (±0.203), and 0.063 (±0.163), respectively, whereas those of the OVD group were 0.592 (±0.253), 0.336 (±0.169), and 0.066 (±0.118), respectively (P = 0.922). None of the patients had postoperative raised intraocular pressure (IOP), uveitis, or endophthalmitis. Three and four eyes in the control and OVD groups, respectively, required neodymium?doped yttrium aluminum garnet (ND: YAG) capsulotomy at study termination (P = 0.999). Conclusion: The hydroimplantation technique of the placement of hydrophilic IOL did not reduce the PCO rate in the 18?month follow?up period. The ND: YAG capsulotomy rate did not differ between the groups

Berardinelli Seip Congenital Lipodystrophy Syndrome: 10 Year Follow-up

Lipodystrophy syndromes are extremely rare disorders ofdeficient body fat associated with potentially serious metaboliccomplications. Here, we describe a 10-year-old girl withgenetically proven Berardinelli Seip congenital generalizedlipodystrophy type 2, diagnosed at 10 months of age. Shedeveloped comorbidities like proteinuria, hypertension, diabetesmellitus, and liver fibrosis.

Phaco-emulsification in completely vitrectomized eyes: Intraoperative analysis of modified phaco sleeve.

Purpose: The purpose was to evaluate the results of modified sleeve in phacoemulsification of cataract in completely vitrectomised eyes, Materials and Methods: Twenty-five previously completely vitrectomized eyes of 23 patients having visually significant cataract were included. After through evaluation they underwent phaco-emulsification by phaco chop with a modified sleeve via temporal clear corneal incision. The modified sleeve was made by creating a small round port of approximate 1 × 1 mm size at the proximate end of the sleeve in line with the already existing ports. This port faced the posterior capsule while performing phacoemulsification. Patients were observed for any intraoperative complications. Result: The most common indication for pars plana vitrectomy in our study group was vitreous hemorrhage due to diabetic retinopathy [13 out of 25 eyes (52%)]. Intraoperative findings included miosis [seen in 3 (12%) eyes] and posterior capsular plaque [seen in 2(8%) eyes]. No other significant intraoperative complications (posterior capsular tear, dropped nucleus) were observed. Average effective phaco time was 33 sec. (±15.11). Conclusion: Though cataract surgery in postvitrectomized eyes is a challenging situation, modified sleeve prevents anterior chamber fluctuation and avoids complications arising out of it, making the surgery safe.

Determination of betulinic acid, oleanolic acid and ursolic acid from Achyranthes aspera L. using RP-UFLC-DAD analysis and evaluation of various parameters for their optimum yield.

Achyranthes aspera L. is a well known herb commonly used in traditional system of Indian medicine to treat various disorders, such as cough, dysentery, gonorrhea, piles, kidney stone, pneumonia, renal dropsy, skin eruptions, snake bite, etc. Here, we used RP-UFLC-DAD method for determining triterpenoids betulinic acid (BA), oleanolic acid (OA) and ursolic acid (UA) from A. aspera. Optimum yield of these compounds were studied and evaluated using parameters viz., method of extraction, time of extraction, age of plant and plant parts (leaves, stem and roots). Linear relationships in RP-UFLC-DAD analysis were obtained in the range 0.05-100 µg/mL with 0.035, 0.042 and 0.033 µg/mL LOD for BA, OA and UA, respectively. Of the variables tested, extraction method and parts used significantly affected content yield. Continuous shaking extraction (CSE) at ambient temperature gave better extraction efficiency than exposure to ultra sonic extraction (USE) or microwave assisted extraction (MAE) methods. The highest content of BA, OA and UA were determined individually in leaf, stem and root extracts with CSE. Collective yield of these triterpenoids were higher in leaf part exposed to 15 min USE method. To best of our knowledge, the study newly reports UA from A. aspera and the same was confirmed using ATR-FT-IR studies. This study explains the distribution pattern of these major triterpenoids and optimum extraction parameters in detail.

Monitoring seasonal variation of epicatechin and gallic acid in the bark of Saraca asoca using reverse phase high performance liquid chromatography (RP‑HPLC) method.

Background: Saraca asoca (Roxb.) Wilde (Fabaceae) is a high valued but vulnerable medicinal plant of Western Ghats region. This plant is mainly known for its use in various gynecological disorders. Objective: The objective of the present study was to investigate seasonal variation of the polyphenolic compounds viz., epicatechin and gallic acid in the bark of S. asoca by using Reverse Phase High Performance Liquid Chromatography‑Diode Array Detector (RP‑HPLC‑DAD) method. Materials and Methods: The bark was collected in six different Ritu (season) viz. Varsha (monsoon), Sharad (autumn), hemant (early winter), Shishir (winter), Vasanta (spring), and Grishma (summer) mentioned in Ayurveda. Results: The RP‑HPLC‑DAD analysis indicated that levels of epicatechin and gallic acid in the bark of S. asoca vary seasonally. The highest concentration of epicatechin was observed in Shishir Ritu (3315.19 ± 165.76 mg/100g) and gallic acid during Hemant Ritu (211.90 ± 10.60 mg/100 g). Conclusions: In present study, the ability to synthesize and accumulate both the compounds in bark of S. asoca varied greatly throughout the seasons. It was also observed that the compound epicatechin was present abundantly as compared to gallic acid throughout the seasons.

Clinical profile and mutation analysis of xeroderma pigmentosum in Indian patients.

Background: Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder characterized by cutaneous and ocular photosensitivity and an increased risk of developing cutaneous neoplasms. Progressive neurological abnormalities develop in a quarter of XP patients. Aim: To study the clinical profile and perform a mutation analysis in Indian patients with xeroderma pigmentosum. Methods: Ten families with 13 patients with XP were referred to our clinic over 2 years. The genes XPA, XPB and XPC were sequentially analyzed till a pathogenic mutation was identified. Results: Homozygous mutations in the XPA gene were seen in patients with moderate to severe mental retardation (6/10 families) but not in those without neurological features. Two unrelated families with a common family name and belonging to the same community from Maharashtra were found to have an identical mutation in the XPA gene, namely c.335_338delTTATinsCATAAGAAA (p.F112SfsX2). Testing of the XPC gene in two families with four affected children led to the identification of the novel mutations c.1243C>T or p.R415X and c.1677C>A or p.Y559X. In two families, mutations could not be identified in XPA, XPB and XPC genes. Limitation: The sample size is small. Conclusion: Indian patients who have neurological abnormalities associated with XP should be screened for mutations in the XPA gene.

Chemical composition and antimicrobial activity of the essential oil of Plectranthus mollis (Lamiaceae) from Western Ghats region, Karnataka, India / Composición química y actividad antimicrobiana del aceite esencial de Plectranthus mollis (Lamiaceae) de la región de los Ghats occidentales, Karnataka, India

Plectranthus is a large and widespread genus with a diversity of ethnobotanical uses. In traditional medicine P. mollis has been used against snakebites, respiratory stimulant and vasoconstrictor, cardiac depressant, cure for haemorrahage, treatment of mental retardation and rheumatism. P. mollis is reported to exhibit relaxant activity on smooth and skeletal muscles, and has cytotoxic and anti-tumour promoting activity, and can be used in the treatment of cancer. The aim of the present study was to identify chemical composition of the essential oil of P. mollis and to evaluate antimicrobial efficacy of the oil. The essential oil of the flowering aerial parts of P. mollis as obtained by hydro-distillation and analyzed by gas chromatography equipped with a flame ionization detector (GC-FID) and gas chromatography coupled with mass spectrometry (GC/MS). Twentyseven compounds were identified, which comprised 98.6% of the total constituents. The main compound was identified as fenchone (32.3%), followed by α-humulene (17.3%), piperitenone oxide (8.5%), cis-piperitone oxide (6.0%) and E-β-farnesene (5.9%). The oil was found rich in oxygenated monoterpenes type constituents (52.0%), followed by sesquiterpene hydrocarbons (40.2%), oxygenated sesquiterpenes (4.9%), and monoterpene hydrocarbons (1.5%). Antimicrobial activity of the essential oil of P. mollis was tested against six Gram-positive and eight Gram negative bacteria, and three fungi, by using the tube dilution method. The oil was active against the tested Gram-positive and Gram-negative bacteria, and fungi at a concentration range of 0.065±0.008-0.937±0.139mg/mL, 0.468±0.069-3.333±0.527 mg/mL and 0.117±0.0170.338±0.062mg/mL respectively. The present study revealed that the oil constituents somehow were qualitatively similar and quantitatively different than earlier reports from different parts of the world. The essential oil of P. mollis has found to be antimicrobial activity which can be usefulness in the treatment of various infectious diseases caused by bacteria and fungi.

Plectranthus es un género grande y extenso con una diversidad de usos etnobotánicos. En la medicina tradicional P.mollis se ha utilizado contra las mordeduras de serpiente, como estimulante respiratorio y vasoconstrictor, depresor cardiaco, cura para hemorragias, tratamiento del retraso mental y el reumatismo. Se informó que P. mollis presenta actividad relajante sobre los músculos lisos y esqueléticos, y tiene actividad promotora citotóxica y anti - tumoral, además puede ser utilizado en el tratamiento del cáncer. El objetivo del presente estudio fue identificar la composición química del aceite esencial de P. mollis para evaluar la eficacia antimicrobiana del aceite. El aceite esencial de las partes aéreas de las flores de P. mollis se obtuvo por hidro - destilación y se analizó por cromatografía de gases equipado con un detector de ionización de llama (GC-FID), y cromatografía de gases acoplada a espectrometría de masas (GC/MS). Se identificaron veintisiete compuestos, que comprenden el 98.6% de los constituyentes totales. El compuesto principal se identificó como fencona (32.3%), seguido de α-humuleno (17.3%), óxido de piperitenona (8.5 %), óxido de cis piperitona (6.0 %) y E-β-farneseno (5.9%). Se encontró que el aceite es rico en monoterpenos oxigenados de tipo constituyentes (52.0%), seguido de hidrocarburos de sesquiterpeno (40.2%), sesquiterpenos oxigenados (4.9%), e hidrocarburos monoterpenos (1.5 %). La actividad antimicrobiana del aceite esencial de P.mollis se ensayó frente a seis bacterias Gram-negativas y ocho Gram-positivas, y tres hongos, utilizando el método de dilución en tubo. El aceite fue activo contra las bacterias Gram-positivas y Gram-negativas y hongos ensayados, en un intervalo de concentración de 0.065±0.008 a 0.937±0.139mg/ml, 0.468±0.069 a 3.333±0.527mg/ml y 0.117±0.017 a 0.338±0.062mg/ml, respectivamente. El presente estudio reveló que los constituyentes del aceite de alguna manera fueron cualitativamente similares y cuantitativamente diferentes de los informes anteriores de diferentes partes del mundo. Se encontró que la actividad antimicrobiana del aceite esencial de P. mollis puede ser de utilidad en el tratamiento de diversas enfermedades infecciosas causadas por bacterias y hongos.

Phenotypic Variability in Congenital Lipoid Adrenal Hyperplasia.

Background: Congenital lipoid adrenal hyperplasia presents with adrenal insufficiency and sex reversal in 46XY genetic males. Case characteristics: Two patients (46 XY karyotype), one having ambiguous genitalia and other having female external genitalia, presented with adrenal crisis at 6 months and 4 weeks of age, respectively. Observation: Steroidogenic Acute Regulatory Protein gene sequencing revealed homozygous mutations in both patients. Outcome: Treatment with hydrocortisone and fludrocortisone resulted in marked improvement . Message: Congenital lipoid adrenal hyperplasia should be considered in infants having female or ambiguous genitalia, and presenting with adrenal insufficiency.

Endocrine abnormalities in children with Beta thalassaemia major.

Background: Endocrine complications in β-thalassaemia major patients in developing countries are likely to occur at younger ages due to suboptimal iron chelation. Objective: To assess the prevalence of endocrine abnormalities and correlate serum ferritin, degree of anaemia and liver dysfunction with endocrine dysfunction Method: A cross sectional study was carried out in B. J. Wadia Hospital, over a period of 2 years, on all children with β-thalassemia major over the age of 4 years receiving regular blood transfusions. Patients with transfusion dependent anaemia other than β-thalassemia major were excluded. Results: The total number of children over 4 years of age with β-thalassaemia major receiving regular blood transfusions during the study period was 135. Mean haemoglobin was 7.8 ± 0.6g/dl and the mean serum ferritin level 5295 ± 2736ng/ml. The most common endocrine abnormality was delayed puberty (68%). Seventy one (52.5%) patients had short stature with the height Z-score 2.8±0.8. Hypocalcaemia was observed in 40 (38%) patients. Ten (9.4%) patients had hypoparathyroidism while in 7 (6.6%) it was suspected based on hypocalcaemia, high phosphorus and normal alkaline phosphatase. Rickets was seen in 25 (23.5%) patients. Hypothyroidism was present in 22 (22%) patients of whom 14 had compensated hypothyroidism. Insulin resistance, impaired fasting glucose/impaired glucose tolerance (IFG/IGT) and diabetes mellitus were seen in 7.6%, 4.4% and 2.6% patients respectively. Mean age of patients with delayed puberty was 15.8±1, short stature 10.3±3.4, hypoparathyroidism 10.4±4.2, hypothyroidism 10.4±3, IFG/IGT 10.4±2 and diabetes mellitus 14.2±1.2 years. Bone mineral density was done in 48 patients older than 10 years. Eighteen (37.5%) patients had spinal osteoporosis. Five patients had more than one endocrine abnormality. Conclusions: There were no statistically significant differences between the patients with and without endocrine abnormalities with respect to serum ferritin, mean pre-transfusion haemoglobin and liver dysfunction except for ferritin in patients with hypoparathyroidism and diabetes mellitus.