Evaluation of changes in anterior segment morphology using Sirius Scheimpflug-Placido disk topographer following laser peripheral iridotomy in primary angle-closure disease

Purpose: To assess the morphological changes in the anterior segment following laser peripheral iridotomy (LPI) in primary angle?closure disease (PACD) using Sirius Scheimpflug?Placido disk corneal topographer. Methods: This was a prospective observational study. A total of 52 eyes of 27 patients with PACD who underwent LPI were analyzed for iridocorneal angle (ICA), anterior chamber depth (ACD), anterior chamber volume (ACV), horizontal visible iris diameter (HVID), corneal volume (CV), central corneal thickness (CCT), and horizontal anterior chamber diameter (HACD) 1 week following LPI, using Sirius Scheimpflug?Placido disk corneal topographer. Data analysis was done using Statistical Package for the Social Sciences (SPSS) software version 19.0, and paired t?test was used to assess the statistical significance. Results: Laser peripheral iridotomy was performed in 43 eyes with primary angle?closure suspect (PACS), six eyes with primary angle closure (PAC), and three eyes with primary angle?closure glaucoma (PACG). The analysis of the data showed statistically significant changes in anterior segment parameters of ICA, ACD, and ACV. Post?laser increase in ICA from 34.13° ± 2.64° to 34.75° ± 2.84° (P < 0.041), mean ACD increase from 2.21 ± 0.25 to 2.35 ± 0.27 mm (P = 0.01), and mean ACV increase from 98.19 ± 12.13 to 104.15 ± 11.16 mm3 (P = 0.001) were noted. Conclusion: Significantly quantifiable short?term changes in the anterior chamber parameters of ICA, ACD, and AC volume were seen after LPI in patients with PACD on Sirius Scheimpflug?Placido disc corneal topographer.

Safety and efficacy of Aurolab aqueous drainage implant in refractory glaucoma: A prospective study

Purpose: This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non?valved glaucoma drainage device (GDD) surgery in refractory glaucoma. Methods: This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM). Results: Thirty-four eyes were analyzed and the mean follow?up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively. Conclusion: AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long?term follow?up studies are needed to assess long?term IOP control and cost?effectiveness.

Study of anxiety in patients with glaucoma undergoing standard automated perimetry and optical coherence tomography - A prospective comparative study

Purpose: To compare the anxiety levels related to visual field testing and optical coherence tomography (OCT) in patients with glaucoma. Methods: This prospective, comparative study was conducted on patients with glaucoma. The participants’ anxiety traits were assessed using the State-Trait Anxiety Inventory [STAI]. Before visual field testing on Humphrey visual field analyzer (HVF) and retinal nerve fiber analysis on OCT, the participants completed Form Y1 to measure the current pretest level or ‘State’ anxiety [pretest anxiety]. Immediately after testing, participants were administered the Form Y1 questionnaire to assess the induced anxiety level during the testing [Intratest anxiety]. Results: A total of 228 patients were enrolled with 152 participants in the HVF group and 76 in the OCT group. The mean age of the participants in the HVF group was 57.2 ± 20.8 years and in the OCT group was 56.8 ± 20 years. There was no significant difference in trait and pretest anxiety between the HVF group and the OCT group (P = 0.971 and P = 0.716). Intratest test anxiety score was slightly higher in the HVF group (HVF: 42.13 ± 10.63, OCT: 40.71 ± 9.76; P = 0.33). The anxiety scores were higher when the experience of previous HVF tests was <2 and least when the number of tests exceeded five. Conclusion: Automated perimetry induces slightly more anxiety than OCT, which may affect test performance. The measured anxiety reduces as patients gain familiarity with the test with experience. This adds credence to the recommendation of more frequent visual field testing in newly diagnosed glaucoma patients

COVID-19-associated optic neuritis – A case series and review of literature

Neuroophthalmic manifestations are very rare in corona virus disease?19 (COVID?19) infection. Only few reports have been published till date describing COVID?19?associated neuroophthalmic manifestations. We, hereby, present a series of three cases who developed optic neuritis during the recovery period from COVID?19 infection. Among the three patients, demyelinating lesions were identified in two cases, while another case was associated with serum antibodies against myelin oligodendrocyte glycoprotein. All three patients received intravenous methylprednisolone followed by oral steroids according to the Optic Neuritis Treatment Trail ptotocol. Vision recovery was noted in all three patients, which was maintained at 2 months of the last follow up visit

Clinical profile, visual outcome and root cause analysis of post-operative cluster endophthalmitis due to Burkholderia cepacia complex

Purpose: To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram?negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc). Methods: Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day?care wards to localize the source. Results: Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48–60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia. Conclusion: Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow?up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection

Nonpseudomonal ecthyma gangrenosum of the upper lid treated with lid reconstruction.

Ecthyma gangrenosum (EG) is a cutaneous infection which usually occurs in immunocompromised patients. We report a case of EG of the eyelid treated with escharotomy and skin grafting, highlighting the importance of surgical management. A 2‑year‑old Asian Indian female presented to us with right upper lid edema with a large necrotic area. The child received intravenous cefotaxime for a week and the necrotic area turned to a well‑defined eschar. Escharotomy with wound debridement and skin grafting was done. The present case highlights the importance of surgical intervention to prevent the sequelae of scarring of upper lid.

Relationship between systemic hypertension, perfusion pressure and glaucoma: A comparative study in an adult Indian population.

Aims: To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives. Design: Cross‑sectional observational study. Materials and Methods: A total of 108 subjects with primary hypertension and 100 age‑matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey’s central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2. Statistical Analysis: Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect. Results: There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1½ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13–45%, P = 0.001) and glaucoma suspect (95% CI = 2–21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP. Conclusion: Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.

Isolated traumatic aniridia after trabeculectomy in a pseudophakic eye.

This is a single case report of an elderly patient who had blunt trauma in an eye that had phacoemulsification and two trabeculectomies. She had good vision with a well-functioning bleb before the trauma. She presented during her routine followup visit for glaucoma with isolated aniridia and an intact globe. The capsular bag, zonules, and the intraocular lens were intact. The cupping was 0.8, and the rest of the fundus and macula were normal. Pigments were seen over the sclera extending posteriorly upto the fornix. Gonioscopy revealed only faint pigments at the fistula. Following the trauma, the intraocular pressure had increased to 26 mm Hg. The mechanism and the management of the glaucoma are discussed.

Pseudoexfoliation on pseudophakos.

We report three patients with deposition of pseudoexfoliation (PXF) material on intraocular lens years after uneventful cataract surgery. PXF was not present before the cataract surgery. The PXF material was found on the anterior surface of the intraocular lens in the first patient and on the posterior surface as well in the other two patients. All the patients had a polymethylmethacrylate intraocular lens placed in the sulcus. The fellow eyes did not have PXF. All the patients had open angle glaucoma in both eyes.

Efficacy of intraoperative vancomycin in irrigating solutions on aqueous contamination during phacoemulsification.

PURPOSE: To study the efficacy of adding vancomycin in irrigating solutions, in comparison to topical antibiotic given preoperatively for a day, during phacoemulsification, in reducing the anterior chamber (AC) contamination. SETTINGS AND DESIGN: This was a prospective, interventional, hospital-based study. MATERIALS AND METHODS: This was a study involving 400 eyes of 400 paitens, undergoing routine phacoemulsification between January 2004 and June 2006. The patients were non-randomly assigned to two groups: Group 1 included 180 patients, who received topical ciprofloxacin eye-drops (four-hourly) for a day preoperatively and Group 2 included 220 patients, who underwent phacoemulsification with vancomycin (20 microg/ml) in the irrigating solution. Anterior chamber aspirate obtained at the end of the surgery was sent for microbial workup. The number of positive cultures in both the groups was determined. STATISTICAL ANALYSIS: This was performed using Chi-square test. Results: Aqueous samples showed microbial growth in 38 (21.1%) out of 180 eyes in Group 1 and in 17 (7.7%) out of 220 eyes in Group 2 ( P = 0.001). Coagulase-negative staphylococcus was the most common organism in both the groups. Aqueous samples from four eyes in group 1 showed multiple organisms, while none of the sample from group 2 showed more than one organism. None of the eyes in either group showed fungal contamination. One patient in Group 1 developed endophthalmitis, and the causative organism was Alcaligenes faecalis. All patients were followed up for a minimum of six months (range: 6 to 14 months and mean: 9.3 months). CONCLUSION: Addition of vancomycin in irrigating solutions is more efficacious in reducing AC contamination in comparison to topical antibiotic administered a day preoperatively.

Bilateral angle closure glaucoma following snake bite.

Snake venoms are complex heterogenous poisons with multiple effects. Ocular complications with snake bite are rare. This report describes two cases which developed bilateral acute angle closure glaucoma following snake bite. There was complete recovery in the two patients following timely diagnosis and treatment.