Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety

Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.

CLINICAL EVALUATION OF INTRAOCULAR PRESSURE MEASUREMENTS USING DIFFERENT TONOMETERS IN PATIENTS OF VARIOUS REFRACTIVE ERRORS

Background: Intraocular pressure (IOP)is an important ?rst indicator of probability and suspicion of Glaucoma. The virtual IOP status is grossly in?uenced by multiple factors including Refractive errors ,corneal biomechanics ,central corneal thickness(CCT) and Scleral rigidity. To compare relative IOP measurements and Aim: its variability in Emmetropes, myopic and hypermetropic patients using Schiotz, Goldmann Applanation(GAT)and I-Care Rebound tonometer to establish an equation between virtual and real time IOP. This observational Materials and Methods: prospective study comprised of 100 subjects above the age of 18 years inclusive37 Emmetropes , 31 Hypermetropes and remaining 32 belonged to myopia . Descriptive statistics were performed using SPSS for Windows Statistical Analysis : version 17.0 to calculate the demographic characteristics of the study cohort. The data were expressed as mean values including the standard deviation (SD) and the 95% con?dence interval (CI). Mean IOP measurements between Schiotz, I-Care and GAT were compared by One way ANOVA along with Individual pair wise comparison by applying Post Hoc Tukey Test for comparison of IOP measurements using a particular method of Tonometry in individuals of myopia, hypermetropia and emmetropia. The highest mean value of CCT 536.667 mum was in Hypermetropes whereas the lowest CCT value of Results: 507.031mum was in myopic eyes with statistically signi?cant (P<0.05). The mean value for IOP in Emmetropes was16.665 mm Hg for Schiotz , 15.027 Hg for GAT and 15.081 mm Hg for I –Care .Whereas Hypermetropes revealed mean value of 15.055 mm Hg for Schiotz , 14.323 mm Hg for GAT and 14.065 mm Hg for I –Care . The mean value for IOP in Myopic eyes was 16.875 mm Hg for Schiotz , 14.375 mm Hg for GAT and 14.688 mm Hg for I –Care . The study had revealed higher mean Conclusion : value of IOP in Myopic eyes as compare to Emetropic and Hypermetropic subjects.IOP measurements by the Schiotz tonometer were signi?cantly higher as compare to GAT and I-Care tonometer. Whereas recordings by GAT and I Care tonometers were almost in agreement .De?nitive correlation could not be established between pachymetry readings and adjusted IOP following GAT and I –Care tonometry .

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.

Modified small-incision cataract surgery for combined extraction � A comparative study of two techniques

Purpose: To explore straight incision technique in terms of efficacy for intraocular pressure (IOP) lowering by small-incision cataract surgery (SICS) trab versus modified 揻rown� incision with triangular scleral flap technique. Methods: This study was done at a tertiary health center. It included 44 eyes diagnosed with cataract and coexisting primary glaucoma that underwent SICS with trabeculectomy using modified 揻rown� incision with triangular scleral flap technique and straight incision in group A (n = 22) and B (n = 22), respectively. Postoperative evaluation was done at first postoperative day, then at the end of first week, third week, and 6 weeks; at the end of third month and finally at the end of sixth months. Data were entered and analyzed via Microsoft Excel sheet and SPSS software using Mann朩hitney U test for averages and Chi-square test for categorical values. Results: Mean preoperative IOP in groups A and B were 38.6 and 29.1 mm Hg respectively, by applanation tonometry. After 6-month follow-up, mean of difference in IOP (preoperative � postoperative) for group A was 20.8 � 8.3 mm Hg and that for group B was 17.2 � 13.5 mm Hg. Conclusion: Capacity of IOP reduction of both techniques was found to be comparable and did not show much difference up to the end of 6 months. Mastering technique of group A (modified 揻rown� incision with triangular scleral flap technique) requires more expertise; the simpler straight incision technique provided in group B may be effectively used by the novice and current era Ophthalmologists to combat glaucoma coexistant with cataract.

Outcomes of ab-interno irrigating goniectomy with trabectome in primary and secondary glaucoma from a single center in India

Purpose: This study was done to report intermediate?term outcomes of irrigating goniectomy with trabectome (trabectome) surgery among different types of glaucoma eyes from a single center in India using a cross?sectional, longitudinal, observational study design. Methods: Fifty?three patients (58 eyes) with glaucoma who underwent irrigating goniectomy with trabectome between January 2019 and February 2020 were included. Pre?operative data included age, gender, eye laterality, specific diagnosis, number of anti?glaucoma medications (AGMs), prior glaucoma surgeries, visual acuity, and intraocular pressure (IOP) on medical treatment. Post?operative data included IOP changes during the follow?up till 1?year, number of AGMs, any complications, or additional surgical intervention required. Success was defined as IOP ? 21 mmHg and ? 20% reduction of IOP from pre?operative IOP with no additional glaucoma surgery. Results: The cohort included 58 eyes (male 53.4% and female 46.6%) ranging from 0.6 to 81 years of age. The average baseline IOP was 23.4 ± 10.2 mmHg and reduced significantly with surgery to 14.1 ± 5.3 mmHg at 1?year follow?up. The AGMs reduced from 2.4 ± 1.4 pre?surgery to 1.6 ± 1.4 at 1?year follow?up. Four eyes required additional glaucoma surgeries for IOP control. The success rate of trabectome with phacoemulsification (88%) was discernibly higher than with trabectome alone (67%). Intra?operatively, significant blood reflux was noticed in 27 eyes, of which only one required tamponading with a viscoelastic agent. Conclusion: This study concludes that irrigating goniectomy with trabectome has good efficacy and safety in both pediatric and adult cases of glaucoma in terms of IOP control, reduction in AGMs, and low incidence of complications in the Indian population.

Assessment of Effect and Safety of Ripasudil (0.4%) in patients of Primary Open Angle Glaucoma / Ocular Hypertension

Background: The aim is to evaluate the intraocular pressure-lowering efficacy and tolerability of Ripasudil (0.4%) ophthalmic solution in patients of primary open-angle glaucoma/ocular hypertension.Material & Methods:In this prospective, interventional, single-arm, open-label study, 50 patients of POAG/ocular hypertension attending the Outpatient Department of Ophthalmology, Government Medical College, Patiala were included.Results:Mean value of numerical change in IOP at four weeks, at eight weeks, at twelve weeks in IOP were 3.61 � 2.05, 3.98 � 1.47, 4.44 � 1.53 respectively. Among side effects, conjunctival hyperemia, blepharitis, and allergic conjunctivitis were reported among 62%, 10%, and 8% of the subjects at four weeks. Final results after 12 weeks showed that only conjunctival hyperemia was reported as a side effect among 16% of the subjects. Conclusions:Our present study showed significant IOP-lowering effects and safety of ripasudil (0.4%) over 12 weeks in patients with primary open-angle glaucoma/ocular hypertension. For the treatment of glaucoma and OHT, ripasudil is regarded as a possible second-line choice in spite of the high occurrence of conjunctival hyperemia.

Secondary glaucoma after intravitreal dexamethasone implant (Ozurdex) injection in patients with retinal disorder: A retrospective study

Purpose: To investigate the rate of secondary glaucoma after intravitreal (IV) dexamethasone implant (ozurdex) 0.7 mg injection in a retinal disorder over a clinical treatment period of 2 years in a tertiary eye care center. Methods: Retrospective study based on the records of patients receiving IV ozurdex 0.7 mg implant for T/t of cystoid macular edema (CME), diabetic macular edema (DME), macular edema due to central retinal vein occlusion/branch retinal vein occlusion (CRVO/BRVO), and choroidal neovascular membrane (CNVM) at a tertiary eye care hospital for 2 years with 6 months of follow?up. The post?T/t intraocular pressure (IOP) and antiglaucoma medication (AGM) required was recorded at day 1, 1 week, 1, 2, 3, 4, and 6 months and analyzed for secondary IOP spike or ocular hypertension defined as IOP >21 mmHg at any point in time. The patients with pre?existing glaucoma and lost to follow?up were excluded. Results: A total of 102 eyes of 80 patients were included in the study. The mean baseline IOP was 14.40 + 2.97 mmHg, post?injection was 15.01 + 3.22 mmHg at day 1, 15.15 + 3.28 mmHg at 1 week, 15.96 + 3.62 mmHg at 1 month, 16.26 + 3.95 mmHg at 2 months, 15.41 + 3.33 mmHg at 3 months, 15.38 + 3.28 mmHg at 4 months, and 14.27 + 2.69 mmHg at 6 months. No significant difference was seen from baseline IOP at day 1 (P = 0.163), 1 week (P = 0.086), and 6 months (P = 0.748). Statistically significant difference was seen at 1 month (P = 0.0009), 2 months (P = 0.0001), 3 months (P = 0.023), and 4 months (P = 0.026). The mean IOP peak at 2 months recovered to baseline by 6 months subgroup IOP trend shows a similar variation and the results are consistent with the studies in the literature. About 19/102 (18.62%) eyes showed an IOP spike post?T/t. The maximum was seen at 2 months; 16 eyes showed a rise in the range 22–25 mmHg; 8 in the range 26–30 mmHg; and 1 eye had 34 mmHg and required multiple AGM—no surgical intervention was needed. Conclusion: A secondary IOP spike post?IV ozurdex 0.7 mg seen in 18.62% of the cases require AGM. The IOP monitoring should be meticulously performed for the variations and secondary IOP spike management to prevent irreversible damage to the optic nerve and visual field

Significance of non-intraocular pressure (IOP)-related factors particularly in normal tension glaucoma: Looking beyond IOP

Purpose: To study the relationship between intraocular pressure (IOP) and mean ocular perfusion pressure (MOPP) in patients with POAG and NTG. The secondary objective was to identify other contributory ischemic factors. Methods: This was an observational cross?sectional study from a tertiary eye hospital in patients who underwent full?day diurnal variation of tension (DVT). Blood pressure (BP) and IOP measurements were done every 3 h over 24 h. Mean arterial pressure (MAP) and MOPP were calculated. The nocturnal dip in BP was assessed; patients were classified as non?dippers, dippers, and over?dippers. The circadian MOPP fluctuation (CMF) was calculated using the Kruskal–Wallis test, and its relationship with type and severity of visual field was assessed. Results: In total, 149 patients were evaluated; 109 were classified as NTG, and 40 were classified as POAG. A nocturnal dip in BP was noted in 20% of NTG and 17.5% of POAG. The MAP was found to be lower in patients with NTG than POAG. In the NTG subgroup, we found that 20% of patients were over?dippers, 32% were dippers, and 48% were non?dippers. The CMF showed a greater fluctuation for over?dippers (P = 0.004 for the RE and 0.003 for the LE) than dippers and non?dippers. A weak positive correlation of CMF with the severity of fields was found. Conclusion: A 24?h monitoring of IOP, BP, MOPP, and assessment of systemic risk factors for primary glaucoma acts as an invaluable tool for the comprehensive management of NTG despite the limitations posed by DVT and BP recording

Correlation between choroidal thickness and intraocular pressure control in primary angle-closure glaucoma

Purpose: To study the correlation between choroidal thickness (CT) and IOP control in primary angle?closure glaucoma (PACG). Methods: In total, 61 patients (102 eyes) with PACG underwent subfoveal CT (SFCT) scanning using enhanced depth imaging–optical coherence tomography. The subjects with PACG were further grouped as controlled IOP (?21 mm Hg on maximal medical therapy) and uncontrolled IOP (>21 mm Hg on maximal medical therapy). The average CT of the PACG eyes was calculated and compared between both groups. A correlation analysis was done between CT and intereye difference in CT with the disease parameters. Results: The mean CT was 274.38 ± 42.10 ?m in 102 PACG eyes. SFCT was significantly increased in the uncontrolled IOP group as compared with the controlled IOP group. The mean SFCT was 245.57 ± 62.10 ?m in the controlled group and 294.46 ± 51.05 ?m in the uncontrolled group (P < 0.01). Factors associated with a thicker choroid were younger age, high IOP, and higher optic nerve head cupping (P < 0.001). Neither the visual field?mean deviation (VF?MD) nor pattern standard deviation (PSD) was found to be associated with overall CT. The intereye asymmetry between CT was significantly associated with poor VF?MD and PSD. Conclusion: PACG eyes with thicker choroid may be a risk factor for poor IOP control on medical anti?glaucoma therapy. Thicker choroid as compared to the fellow eye is a poor prognostic sign and these eyes should be monitored closely

Intraocular pressure fluctuation range and correction after small incision lenticule extraction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate changes in the normal intraocular pressure(IOP)fluctuation range after the small incision lenticule extraction(SMILE)in patients with low, moderate and high myopia and to explore new methods for postoperative IOP(IOP_post)correction.<p>METHODS: In this prospective case series study, 79 patients(158 eyes)who underwent SMILE at the Affiliated Hospital of Qingdao University from March 2018 to September 2019 were involved, and they were divided into low myopia(A), moderate myopia(B), and high myopia(C)groups. The 24-hour IOP was measured by the non-contact tonometer(NCT)and Goldmann applanation tonometer(GAT). Spherical equivalent(SE), central corneal thickness(CCT), the horizontal corneal diameter(WTW), corneal curvature, corneal volume(CV), ratio of the central 3-mm diameter CV(CCV_3mm)to the total CV, and the ratio of the cutting CV(ΔCV)to the CV were measured 3d preoperatively and 6mo postoperatively. The correlation between the postoperative NCT measurements(NCT_post)and various factors was statistically analysed, and the IOP_post expression model was established by phased multiple linear regression analysis.<p>RESULTS:The differences in IOP measured by NCT and GAT were not statistically significant(<i>P</i>>0.05), but the differences in IOP of the three groups were statistically significant(<i>P</i><0.05). The IOP_post range by NCT were 8-17 mmHg in group A, 7-16.3 mmHg in group B, and 7.7-14.3 mmHg in group C. The IOP_post range by GAT were 8-17 mmHg. The IOP_post fluctuation was <6 mmHg. The IOP_post difference between the right eye and left eye was 0-4 mmHg. A staged multivariate regression model was established: NCT_{post corrected(A)}= 0.349 × NCT_post + 4.137 × CCV_pre3mm - 1.533; NCT_{post corrected(B)}= 0.477 × NCT_post + 3.643 × CCV_post3mm -1.125; NCT_{post corrected(C)}= 0.638 × NCT_post + 3.426 × CCV_post3mm -0.716.<p>CONCLUSION:The IOP measured by NCT and GAT after SMILE was lower than that measured before surgery. For different patients, the greater the rate of change in CV before and after surgery, the lower the IOP_post. CCV_post3mm is an important index for evaluating IOP after SMILE and thus guide postoperative medication administration.

Knockdown of IOP1 Induces Premature Senescence in Primary HUVECs / 中国生物化学与分子生物学报

Iron-only hydrogenase-like protein 1 (IOP1) is a component of the cytosolic iron-sulfur protein assembly (CIA) machinery. IOP1 has been suggested to be a negative regulator of the hypoxia-inducible transcription factor 1(HIF-1). We previously reported that loss of one copy of NAR1 (the yeast homolog of IOP1) in diploid yeast cells leads to increased sensitivity to oxidative stress and decreased replicative lifespan‚ however‚ the underlying mechanism is still unclear. Recently‚ we found that the IOP1 protein was upregulated in late-passaged primary human umbilical vein endothelial cells (HUVECs) compared with that in early-passaged primary HUVECs‚ which indicated a potential association of IOP1 with cellular senescence. The aim of this study was to investigate the potential function of IOP1 in aging in mammalian cells. The primary HUVECs were transfected with IOP1-specific siRNA and subjected to premature senescence assays. We found that IOP1 knockdown leads to premature senescence and decreased cell proliferative ability (P < 0. 01) in primary HUVECs. Further studies revealed that downregulation of IOP1 resulted in upregulated ROS levels (P < 0. 01)‚ enhanced DNA damage (P<0. 05) and decreased mitochondrial respiration (P<0. 01) along with cell cycle arrest at the G

Relationship between ocular abnormalities and hematologic alterations in patients infected naturally by Ehrlichia canis / Alterações hematológicas e sua relação com anormalidades oculares em pacientes infectados naturalmente com Ehrlichia canis

ABSTRACT: To determine the association between ocular abnormalities and hematologic findings in Ehrlichia canis-infected dogs, 120 dogs suspected of canine ehrlichiosis were studied. All patients were subjected to rapid serologic diagnostic test for Ehrlichia canis, and the diagnosis was confirmed by quantitative PCR. PCR-positive patients underwent ophthalmologic examination and a hemogram and were grouped into patients with thrombocytopenia and anemia (G1), patients with thrombocytopenia (G2), and patients without hematologic disorders (G3). For ophthalmic evaluation, the patients were grouped into those having mild, severe, both mild and severe, and no ocular alterations. All patients presented with uveitis (100%). Severe ocular disorders predominated in G1 and G2 patients. Dogs with anemia and leukopenia showed severe ocular disorders. In dogs with a greater number of leukocytes and copies/µl of the TRAG gene, the intraocular pressure (IOP) tends to decrease and vice versa (r = −0.23, r = −0.26). In conclusion, uveitis is the earliest ocular alteration of canine ehrlichiosis. The severity of ocular abnormalities in patients with ehrlichiosis is associated with thrombocytopenia and may be aggravated by anemia and leukopenia. The hemogram and IOP are useful tools for predicting eye involvement in Ehrlichia canis-infected patients. In regions where Ehrlichia canis is endemic, the use of the tonometer should be routinely in dog general consultation.

RESUMO: Para determinar a associação entre anormalidades oculares e achados hematológicos em cães infectados com Ehrlichia canis, foram estudados 120 cães com suspeita de erliquiose canina. Todos os pacientes foram submetidos a um teste diagnóstico sorológico rápido para Ehrlichia canis, e o diagnóstico foi confirmado por PCR quantitativa. Os pacientes com PCR positivo foram submetidos a exame oftalmológico e hemograma completo e foram agrupados em pacientes com trombocitopenia e anemia (G1), pacientes com trombocitopenia (G2) e pacientes sem distúrbios hematológicos (G3). Para avaliação oftalmológica, os pacientes foram agrupados em pacientes com alterações leves ou graves, leves e graves e sem anormalidades oculares. Todos os pacientes apresentaram uveíte (100%). Os distúrbios oculares graves predominaram nos pacientes do G1 e G2. Cães com anemia e leucopenia apresentaram distúrbios oculares graves. Em cães com maior número de leucócitos e cópias/µl do gene TRAG, a pressão intra-ocular tendeu a diminuir e vice-versa (r = -0.23, r = -0.26). Em conclusão, a uveíte é o primeiro distúrbio ocular da erliquiose canina. A gravidade das anormalidades oculares em pacientes com erliquiose está associada à trombocitopenia e pode ser agravada por anemia e leucopenia. Hemograma e PIO são ferramentas úteis para prever o envolvimento ocular em pacientes infectados com Ehrlichia canis. Nas regiões em que o Ehrlichia canis é endêmico, o uso do tonômetro deve ser rotineiro nas consultas gerais de cães.

Outcome of Vitrectomy in Proliferative Diabetic Retinopathy Patients with Diabetic Nephropathy- A Retrospective Study at Tertiary Eye Centre, Telangana State, in South India.

The increase in prevalence of diabetes in India is one of the leading causes of blindness due to micro vascular and macro vascular complications. The complications in retina and kidney are due to damage of small vessels. Studies have shown significant association between diabetic retinopathy and diabetic nephropathy. In our study, we are discussing the complications during intra and post-operative period and also both anatomical and functional outcome in these patients after vitrectomy for proliferative diabetic retinopathy. Both eye and kidney share same vascular pattern. One pre-existing condition can be followed by the other condition due to similar microvascular damage. We wanted to evaluate the outcome of vitrectomy in proliferative diabetic retinopathy patients associated with chronic kidney disease.METHODSThis is a retrospective study done at Sarojini Devi Eye Hospital, Telangana State, South India, over a two-year period from June 2017 to June 2019. Data was collected from old medical records of our institute, from patients who presented to Retina Dept. with various complaints. They were examined in detail, documented and treated based on clinical presentation after clearance from physician. Patients presented with different ocular manifestations like non-resolving vitreous haemorrhage, focal tractional retinal detachment, multi focal tractional retinal detachment like broad based, table top, combined retinal detachment and tractional maculopathy. Patients underwent pars plana vitrectomy with or without silicone oil endotamponade.RESULTSPrognosis in these patients was good only in cases of non-resolving vitreous haemorrhage and focal tractional retinal detachment (47.61%) whereas in cases like multifocal retinal detachment cases outcome was favourable (42.82%) but patients with combined retinal detachment (9.52%) had poor anatomical and visual outcome.CONCLUSIONSManagement of these patients is very difficult when there is severe proliferative diabetic retinopathy with multiple broad vitreo retinal adhesions. Outcome is very poor particularly in patients of severe proliferative diabetic retinopathy associated with chronic kidney disease and coronary artery disease due to intra operative complications

Anti-Diabetic, Anti-Cancer Activity And Associated Toxicity Of Leucas Aspera Extract In Wistar Albino Rats

In regenerative medicine, nanotechnology plays a vital role in the diagnosis, the delivery of therapeutic drugs and the treatment of many diseases and disorders. Due to the growing need to develop environmentally friendly technologies in material synthesis, the biosynthesis of Iron Oxide Nanoparticles (IOP) has received considerable attention over the past decades. Therefore, the community is now looking back for traditional medicines for various diseases after the practice of allopathic drugs with tremendous side effects. There are an increasing number of biomedical applications for iron oxide nanoparticles; as such uses are essential for in-vitro characterisation and in-vivo to ensure the bio-safety of these particles. The main complication of diabetes due to frequent lipid peroxidation is liver damage and renal dysfunction, but treatment with Leucas aspera has a pronounced effect on these indicators, which protects the organs from further damage. The current research supports the traditional use of Leucas aspera against diabetes mellitus and cancer, as well as the safety, effectiveness and potency of Leucas aspera leaf extract's anti-diabetic and anti-cancer effect in the in-vivo model. The overall results reveal that Leucas aspera has the potential and can be a candidate of choice without side effect.

A community based study of scenario of glaucoma in Aligarh, India

Background: Glaucoma is the leading cause of irreversible blindness worldwide and is second only to cataracts as the most common cause of blindness overall. In the developing world, the prevalence of glaucoma is expected to rise even more dramatically as the population of adults has doubled within a span of few decades. So this study was done with an objective of finding out the prevalence of glaucoma among adults aged 40 years and above in the field practice area of the Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh.Methods: A cross-sectional study was carried out for the duration of one year. A total of 680 persons were interviewed and examined by a trained ophthalmologist for detailed eye examination including visual acuity, refraction and slit-lamp bio-microscopy, intraocular pressure (IOP) by Keeler Pulsair non-contact tonometer confirm by applanation tonometry, gonioscopy, and dilated fundus examination after ruling out the risk of angle closure. Anderson criteria were used to diagnose glaucomatous visual field defect.Results: In our study population, the IOP of the majority of population lied in 11-15 mm Hg with a mean IOP of 13.42±4.09 mmHg. In regard to optic disc examination, a cup to disc ratio of >0.6 was found in 35 eyes. According to the predefined criteria, a total of 31 subjects were diagnosed as glaucoma in either one or both eyes. The overall prevalence of glaucoma was found to be 4.6% (31/680), with the prevalence of primary open angle glaucoma, primary angle closure glaucoma, normotensive glaucoma and secondary glaucoma as 1.3%, 1.2%, 1.2% and 0.9% respectively.Conclusions: The prevalence of glaucoma is quite high in an elder population of Aligarh. This should warrant more intensive activities, focusing not only on early diagnosis and management of glaucoma but also include strengthening preventive ophthalmic care.

Effects of ND YAG Laser Capsulotomy on Intra ocular Pressure and Macular Thickness

AIM- This study was aimed to find the changes in macular thickness and intra-ocular pressure overtime after ND-YAG laser capsulotomy. Methods: 100 pts fulfilling the inclusion criteria were included in the study and underwent a detailed ophthalmic examination. Pts IOP and macular thickness was measured by goldmann applanation tonometery and ocular coherence tomography (OCT) respectively before performing the procedure. Each patient was called for follow up on day 1, 1 week, 4 weeks, 8 weeks and 12 weeks. During all the follow up visits complete eye examination, IOP measurement, and macular thickness measurement were noted. Results: For this study, a total of 100 eyes of 100 patients (54 males, 46 females) aged 18to 80 years (mean age 51.98±14.01 years) fulfilling the inclusion and exclusion criteria were enrolled in the study.IOP was significantly higher at all the follow-up intervals among those in whom >40 mJ energy was used as compared to those in whom <40 mJ energy was used Mean change in macular thickness was found to be significantly higher at day 1 and week 1 among those in whom >40 mJ energy was used as compared to those in whom <40mJ energy was used. However, at subsequent follow-up intervals, the difference was not significant statistically. Conclusion: Nd-YAG laser capsulotomy results in increased IOP and macular thickness which sustains upto a substantial period.Rise in IOP following Nd:YAG laser posterior capsulotomy is correlated with the amount of energy used.Change in macular thickness following Nd:YAG laser posterior capsulotomy is weakly/mildly correlated with the amount of energy used during the initial follow-up, however, subsequently it does not show a correlation with amount of energy used.

Effects of acupuncture, combined with phacoemulsification for cataract with glaucoma / 中国针灸

OBJECTIVE@#To observe the effects of acupuncture combined with phacoemulsification for cataract with glaucoma.@*METHODS@#Sixty-eight patients with cataract and angle-closure glaucoma were randomly divided into an observation group and a control group, 34 cases in each one. The patients in the control group were treated with phacoemulsification. Based on the treatment in the control group, the patients in the observation group were treated with and acupuncture at acupoints around eyes; the treatment was given once every other day, and 15-day treatment constituted a course, and 2 courses (60 days) were given. The intraocular pressure (IOP), visual acuity, pain severity, aqueous outflow (F value) and clinical symptoms were observed in the two groups before treatment and after 1 d, 7 d, 30 d and 60 d of treatment.@*RESULTS@#The IOP after 1 d, 7 d, 30 d and 60 d of treatment in the observation group was lower than that in the control group (all <0.05), while the visual acuity after 7 d, 30 d and 60 d of treatment in the observation group was higher than that in the control group (all <0.05). Compared before treatment, the IOP was significantly decreased after 1 d, 7 d, 30 d and 60 d of treatment in the two groups, and the visual acuity was significantly increased after 7 d, 30 d and 60 d of treatment in the two groups (all <0.05). The pain scores and F value after 7 d, 30 d and 60 d of treatment in the observation group were lower than those in the control group (all <0.05). Compared before treatment, the pain scores and F value after 7 d, 30 d and 60 d of treatment were significantly reduced in the two groups (all <0.05). After 60 d of treatment, the number of patients who presented general clinical symptoms in the observation group was significantly lower than that in the control group (<0.05).@*CONCLUSION@#Based on phacoemulsification, acupuncture and could significantly reduce the IOP and F value, relieve pain and improve visual acuity in patients with cataract and glaucoma.

Potential risk factors and treatment of high IOP elevation after operation in retinal detachment eyes of diabetic patients / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the intraocular pressure(IOP)fluctuation at the early stage of pars plana vitrectomy(PPV)and silicon oil tamponade in high myopia with rhegmatogenous retinal detachment(RRD)eyes in diabetic patients and analyze the potential risk factors and effective treatment.<p>METHODS: One hundred consecutive diabetic patients of rhegmatogenous retinal detachment in highly myopic eyes were retrospectively reviewed. Patients were divided into two groups: the experimental group, those who used Tobramycin Dexamethasone Eye Drops(TDED), and control group. Pre- and postoperative IOPs, retinal nerve fiber layer thickness(RNFL)and optic nerve head parameters were recorded before and after IOP elevation, and in the contralateral eye before the operation. Graphpad 7.01 was used for data analysis.<p>RESULTS: IOP elevation occurred in 42 eyes within 1wk after vitrectomy in all diabetic participants. Ocular hypertension(OHTN)was observed in 31 of 53 eyes in experimental group and 11 eyes of 47 eyes in control group at the early stage after operation. Significant differences were found between groups in 5d-1wk and 1mo after vitrectomy. In addition, IOP of 39 eyes had decreased by proper treatment and 3 eyes received glaucoma filtration surgery. Compared to the optic disc parameters before IOP elevation, the average and inferior RNFL thickness were thinner and rim area decreased as well as cup volume and vertical C/D radio increased after IOP elevation. The RNFL thickness of the opposite eyes in patients with IOP elevation was found thinner than the ones who never suffered ocular hypertension.<p>CONCLUSION: Continual use of glucocorticoid after vitrectomy is a potential risk factor of IOP elevation in high myopia with diabetes, and doubtful open angle glaucoma should be focused on its sensibility to glucocorticoid and IOP elevation.

Antiscarring effect of intraoperative bevacizumab in experimental glaucoma filtration surgery / Efeito antifibrótico do uso intraoperatório de bevacizumab em cirurgia filtrante experimental

ABSTRACT Purpose: To determine the effects of bevacizumab and mitomycin C alone and in combination on intraocular pressure and the scarring process after modified glaucoma filtration surgery in rabbits. Methods: The rabbits underwent modified glaucoma filtration surgery and were allocated into three groups to receive intraoperative treatment with subconjunctival bevacizumab (group A), mitomycin C and subconjunctival bevacizumab (group B), or mitomycin C (group C). Intraocular pressure was measured immediately preoperatively and on postoperative days 8, 14, 17, 21, 26, and 30. The scarring process was assessed 30 days after surgery by tissue section using hematoxylin and eosin, Masson's trichrome, and picrosirius. Expression of vascular endothelial growth factor (VEGF) was assessed by immunohistochemical analyses. All analyses were performed by a masked observer. Results: Animals in group A had higher intraocular pressure than those in groups B and C (p<0.01). Intraocular pressure did not differ significantly between groups B and C. The amount of fibrosis was similar with all stains used: group A had the highest level of fibrosis compared with groups B and C (p>0.05). There was less VEGF expression in group A than in groups B and C (p<0.01). Groups B and C did not differ in VEGF expression. Conclusion: Mean intraocular pressure and fibrosis were lower in animals receiving bevacizumab in combination with mitomycin C but did not differ from values in animals receiving mitomycin C alone. Inhibition of VEGF was greater when bevacizumab was used alone than when bevacizumab was combined with mitomycin C.

RESUMO Objetivo: Determinar os efeitos do bevacizumab, combinados ou não à mitomicina C (MMC), na pressão intraocular e processo cicatricial pós-cirurgia filtrante anti-glaucomatosa modificada em coelhos. Métodos: Os coelhos foram submetidos à cirurgia filtrante anti-glaucomatosa modificada e alocados em três grupos de acordo com o tratamento instituído - Grupo A: bevacizumab subconjuntival; Grupo B: bevacizumab subconjuntival e à mitomicina C ; Grupo C: à mitomicina C. A pressão intraocular foi aferida no período pré-operatório imediato e nos dias 8, 14, 17, 21, 26 e 30. O processo cicatricial foi avaliado no trigésimo dia de pós-operatório por meio de análise histopatológica utilizando-se hematoxilina eosina, tricrômio de Masson e picrosirius. A expressão do fator de crescimento do Endotélio Vascular (VEGF) foi avaliada por meio de análise imuno-histoquímica. Todas as análises foram feitas por um observador mascarado. Resultados: O Grupo A apresentou maior pressão intraocular que os grupos B e C (p<0.01). Não foram encontradas alterações significativas entre os grupos B e C. A quantidade de fibrose encontrada nos grupos foi similar com os 3 corantes utilizados: o Grupo A apresentou maior nível de fibrose em relação aos grupos B e C (p>0,05). Houve menor expressão de Fator de Crescimento do Endotélio Vascular no Grupo A em relação aos grupos B e C (p<0,01). Não houve diferença estatisticamente significante na expressão de Fator de Crescimento do Endotélio Vascular entre os grupos B e C. Conclusão: O bevacizumab associado à MMC apresentou pressões intraoculares mais baixas e menos fibrose, mas estes não foram estatisticamente significantes quando comparados ao uso da mitomicina C isolada. Uma maior inibição do fator de crescimento do endotélio vascular foi encontrada quando o bevacizumab foi usado isoladamente, em detrimento do seu uso associado à mitomicina C.

Study of Incidence of Peptic Ulcer Perforation in Young Adults: A Hospital Based Study

Background: Peptic ulcer formation affects about 2-10% of world population every year with higher incidence in younger individuals. Being a surgical emergency, it has higher mortality and morbidity. Thus, the aim of our study was to evaluate the incidence of peptic ulcer perforation based on gender, age and also to study its associated risk factors, clinical presentations, site along with surgical management and complications.  Materials & Methods: 75 patients diagnosed with perforated peptic ulcer were included and this study was conducted in the department of Surgery Government Bangur Hospital, Pali, Rajasthan, India. Structured performa was prepared to obtained details of patients and ethical clearance from the institute was also taken prior to the study. Results: 76% of patients in our study were males and 24% were females with male and female ratio 1:3.16. The prevalence of perforation was high in age group 20-30 years (30.7%). 62.7% of cases had positive family history and the incidence was in the patients who consumed non-vegetarian (84.8%), spicy (61.4%) and oily (69.5%) foods. Frequently observed clinical presentation were abdominal pain followed by tenderness and rigidity and gas under diaphragm. The common site of perforation was duodenum (62.7%) and most of the cases were treated by closure with omental patch (81.3%). The post-surgical complications frequently observed were wound infection (30.6%) and chest infection (28%). Conclusion: Peptic ulcer perforation is common disorder of gastrointestinal tract, now affecting younger adults with male preponderance. It is associated with unwanted health and economic issues. Therefore, earlier management is only the way to minimize complications and mortality.