Comparison of changes in blood pressure in phacoemulsification cataract surgery performed via topical and peribulbar anaesthesia: A cohort study.

Background: The purpose of study was to compare the changes in blood pressure in patients undergoing phacoemulsification cataract surgery under topical and peribulbar anaesthesia during preoperative, intraoperative and postoperative period. Methods: In this prospective cohort study, 240 patients undergoing phacoemulsification were divided into topical (Group 1) and peribulbar (Group 2) equally. Proparacaine 0.5% drops were used for topical anaesthesia, and Inj lignocaine with Inj bupivacaine were used to give peribulbar anaesthesia. Preoperative blood pressure was taken 30 min before surgery with automated sphygmomanometer. Intraoperative blood pressure was taken during phacoemulsification, and postoperative blood pressure was taken 1 h after surgery. Outcomes assessed were systolic, diastolic and mean blood pressure. Results: Systolic blood pressure in Group 1 was significantly increased in the intraoperative phase, whereas it was significantly decreased in Group 2 in the intraoperative phase. Diastolic and mean blood pressure in Group 1 showed no significant change, whereas in Group 2, both showed significant reduction in intraoperative and postoperative phases. Conclusion: The increase in intraoperative systolic blood pressure in topical group could be due to discomfort from microscope light, iris manipulation, irrigation and aspiration during surgery. The decrease in intraoperative systolic and diastolic blood pressure in peribulbar group could be due to systemic absorption of local anaesthetic. The mean preoperative systolic blood pressure was also higher in the topical group, which could be due to anxiety or stress under topical anaesthesia. The changes in blood pressure need to be observed so that timely intervention can be made to achieve favourable postoperative outcome.

Tear film abnormalities in pseudoexfoliation syndrome and normal healthy participants: A comparative analysis.

BACKGROUND: Pseudoexfoliative material is being implicated in causing tear film abnormalities, and the aim of the present study was to prove it and to compare with the normal healthy participants. METHODS: A total of 398 eyes of 200 participants were studied, and two groups were formed. The first, pseudoexfoliation syndrome (PEXS) group, included 198 eyes of 100 patients, and the second, age-matched control group, included 200 eyes of 100 participants. Tear film abnormalities were compared in the two groups by tear meniscus height (TMH), Schirmer test I, Schirmer test II and tear film break-up time (TBUT). RESULTS: On comparing the two groups using independent t-test, a significant difference was found in Schirmer test I, Schirmer test II, and TBUT between the PEXS group (Schirmer test I: 23.98 ± 10.68 mm, Schirmer test II: 17.11 ± 8.78 mm, and TBUT: 9.778 ± 5.54 s) and the age-matched control group (Schirmer test I: 27.08 ± 9.58 mm, Schirmer test II: 19.98 ± 8.48 mm, and TBUT: 13.495 ± 5.65 s) (p = 0.003 [Schirmer test I]; p = 0.001 [Schirmer test II]; and p < 0.001 [TBUT]). However, an insignificant difference was found in terms of TMH (p = 0.195) between the two groups. CONCLUSION: PEXS affects tear production and leads to unstable tear film.

Spectral domain optical coherence tomography-based prevalence of hydroxychloroquine maculopathy in Indian patients on hydroxychloroquine therapy: A utopia of underdiagnosis.

BACKGROUND: Spectral domain optical coherence tomography (SD-OCT) detects early structural damage to macula in patients on Hydroxychloroquine (HCQ) therapy. The current screening protocols emphasize concurrent use of both SD-OCT and Visual field analysis (VFA) which detects functional damage to detect Hydroxychloroquine maculopathy. However, VFA is a time-consuming and subjective test which is often neglected. This study gives the prevalence of Hydroxychloroquine maculopathy using SD-OCT alone which often fails to detect macular damage in peri-foveal and extra-foveal area of the retina. METHODS: Three hundred thirty four eyes of 167 patients taking systemic Hydroxychloroquine were studied with SD-OCT macular cube 512 x 128 to diagnose structural macular damage to detect prevalence of Hydroxychloroquine maculopathy. RESULTS: Out of 167 patients, only four patients showed features suggestive of Hydroxychloroquine maculopathy. One patient had ELM loss, two had para-foveal and one had peri-foveal IS-OS disruption. The SD-OCT gave prevalence as 2.4%. CONCLUSION: SD-OCT alone can underdiagnose burden of Hydroxychloroquine maculopathy (prevalence = 2.4%) when compared to studies which use both SD-OCT and Visual field analysis (prevalence = 7.5%).

Hyperglycaemia as a risk factor for the development of retinopathy of prematurity: A cohort study.

BACKGROUND: Retinopathy of prematurity (ROP) is a preventable cause of childhood blindness. Without treatment, over 45% of eyes can develop permanent visual loss. Hyperglycaemia has recently been described as a risk factor for the development of retinopathy of prematurity (ROP), a proliferative vascular disease of the retina that primarily affects premature infants. The characteristic neoproliferative growth of blood vessels in the retina is very well under stood with the clinical and experimental experiences with Diabetic retinopathy. The purpose of this study was to evaluate a possible relation between glucose levels in VLBW (Very Low Birth Weight) infants and development of ROP. METHOD: All at risk infants of a Neonatal Intensive Care Unit (NICU) of a tertiary care centre in western India were included in the study. The blood sugar values of the neonates were recorded at multiple times during their first week of life. On completion of 31 weeks of gestational age or 04 weeks of birth age, the neonates were subjected to ROP screening as per standard protocols. RESULT: A total of 103 neonates were included in the study and were subjected to ROP screening. A total of 32 neonates developed ROP at the end of the study. It was found with statistical significance that the neonates with higher average blood glucose values in the initial period of life had higher incidence of ROP at the time of screening with a Relative Risk of 2.506 (CI = 1.287, 4.882). CONCLUSION: A high average blood glucose level in neonates during the first week of life is an indicator for developing ROP at a later date. These neonates should be kept under close follow up in order to facilitate timely detection and prompt intervention.

Sheets glide-assisted versus Busin glide-assisted insertion techniques for descemet stripping endothelial keratoplasty (DSEK): A comparative analysis.

BACKGROUND: The donor lenticule insertion techniques play a crucial role in outcomes following descemet stripping endothelial keratoplasty (DSEK) and the current study is aimed to compare two of the commonly performed donor lenticule insertion techniques in DSEK. METHOD: Descemet stripping endothelial keratoplasty was performed in 48 eyes of 48 patients at two tertiary eye care centers from January 2014 to December 2016. At one center (Group 1), 26 patients had Sheets glide-assisted lenticule insertion whereas at other center (Group 2), 22 patients had Busin glide-assisted insertion of donor lenticule. Best corrected visual acuity (BCVA), manifest spherical equivalent, manifest cylinder, endothelial cell density (ECD) and percentage of endothelial cell loss (ECL) were compared between the two groups at 6 months after DSEK. In addition, intraopertaive and postoperative complications were also compared. RESULTS: At 6 months after DSEK, an insignificant difference was observed in BCVA [Group 1: 0.48 logarithm of the minimum angle of resolution (log MAR); Group 2: 0.50 log MAR (p = 0.74)], mean manifest spherical equivalent [Group 1: 0.64 diopter (D); Group 2: 0.59 D (p = 0.74)], mean manifest cylinder [Group 1: 1.35 D; Group 2: 1.32 D (p = 0.92)] and mean ECL [Group 1: 26.75%; Group 2: 28.76 (p = 0.44)] between the two groups. In addition, the rate of complications is similar between the two groups. CONCLUSIONS: Both Sheets glide-assisted and Busin glide-assisted donor lenticule insertion techniques are associated with similar surgical outcomes after DSEK.

Study of distribution of white-to-white corneal diameter and anterior chamber depth in study population obtained with optical biometry using intraocular lens (IOL) master.

BACKGROUND: This study was conducted to measure the distribution of white to white (WTW) corneal diameter and anterior chamber depth (ACD) in the study population by using optical biometry. METHODS: It was a cross-sectional observational study conducted at an Ophthalmology Out Patient Department of a Tertiary Care Centre. Optical biometry was performed in 650 eyes of the 325 patients using IOL Master and WTW and ACD were recorded. Differences in gender, and age-related alterations were analysed statistically. RESULTS: 195 (60%) subjects were males and 130 (40%) were females. Age of the study population ranged from 13 to 82 years and the mean age was 36.79 years. The mean WTW in the study population was 11.79 mm ± 0.05 mm and the mean ACD was 2.74 mm ± 0.03 mm. Mean WTW and ACD in male subjects was significantly greater than that of female subjects (p value < 0.001). No significant difference in WTW or ACD was seen between the various age groups. No correlation was seen between WTW and ACD in the study population. CONCLUSION: Mean WTW and ACD were smaller as compared to other population studies using intraocular lens (IOL) Master. This distribution has paved the way for a population based nomogram for our country which will help us plan surgeries in a better way.

A clinical study to describe the corneal topographic pattern and estimation of the prevalence of keratoconus among diagnosed cases of vernal keratoconjunctivitis.

BACKGROUND: Association of keratoconus with vernal keratoconjunctivitis is well known, but there are few topographic studies describing actual prevalence especially in India where it is a common condition. There is also scarce literature on the topographic patterns and subclinical topographic anomalies in cases of vernal catarrh and their relationship with various subtypes. This study was conducted to estimate the prevalence of subclinical keratoconus among Indian subjects with vernal keratoconjunctivitis and describe the various topographic abnormalities which can help in screening for these cases. METHODS: In the cross-sectional study conducted at a tertiary care center, 76 established cases of vernal keratoconjunctivitis were evaluated with placido disc-based videokeratography for topographic abnormalities and early keratoconus based on modified Rabinowitz-McDonnell criteria. RESULTS: Seventeen (11.2%) eyes satisfied both the modified Rabinowitz-McDonnell criteria of keratoconus. Corneal topographic pattern analysis showed asymmetric bowtie with inferior steepening in 17.11% of the patients. None of these patients had clinical evidence of keratoconus. CONCLUSIONS: The study showed 11.2% prevalence of keratoconus in patients suffering from vernal keratoconjunctivitis. The findings highlight the importance of using a simple placido disc-based corneal topography system for screening the patients with vernal keratoconjunctivitis for keratoconus. This can help in early detection and preventive intervention.

A clinical study to evaluate the results after toric intraocular lens implantation in cases of corneal astigmatism.

BACKGROUD: Modern day cataract surgery aims at a spectacle free vision which becomes difficult in cases with pre-operative astigmatism more than 1.5 D. Implantation of toric intra-ocular lenses (IOL) after phacoemulsification in such eyes is one of the ways to counteract this problem. METHODS: Thirty eyes with pre-operative astigmatism between 1.5 D and 4.5 D were implanted with toric IOLs following uneventful phaco-emulsification. The estimation of the axis of implantation of this toric IOL included calculating the surgically induced astigmatism (SIA) of the surgeon. RESULTS: Post-operatively, 20 (66.67%) patients had a visual acuity 6/9 or better and 17 (57%) had a visual acuity of 6/6 at 12 weeks. The mean postoperative uncorrected visual acuity (UCVA) was 0.12 ± 0.15 at 12 weeks. The difference between means of preoperative best corrected visual acuity (BCVA) LogMAR and postoperative UCVA at 12 wk LogMAR was found to be statistically significant at p = 0.001. Mean (SD) scores of pre-op astigmatism of study group was -2.20 (0.67) and residual astigmatism was -0.32 (0.44). CONCLUSIONS: The difference between means of pre-op astigmatism and residual astigmatism in the study group was significant at p = 0.001 with 95% CI -2.22 to -1.50. This significant difference was because of the toric IOL implantation.

Prevalence of corneal astigmatism before cataract surgery in Western Indian Population.

BACKGROUND: The prevalence and nature of corneal astigmatism among cataract surgery candidates has not been well-documented in Indian population. The purpose of the study is to analyse prevalence and presentation patterns of corneal astigmatism (CA) in cataract surgery candidates. METHODS: Keratometric values were measured in patients before cataract extraction. Descriptive statistics of CA were analysed including the assessment with age ranges. RESULTS: Mean CA of 223 eyes of 223 patients [mean age 61 ± 10 years (range, 29-90 years)] was 0.88 ± 0.61 (95% CI, 0.80-0.96) with 27.8%, 51.1% and 21.1% having with the rule (WTR), against the rule (ATR) and oblique astigmatism (OBL) respectively. Between 40 and 50 years, ATR exceeds WTR and reaches 100% by 80 years. A trend of less negative CA was seen up to 60 years and then increases up to 90 years. CA was below 0.25 dioptre (D) in 17.5% of eyes, between 0.25 and 1.25 D in 63.7% and ≥1.50 D in 18.8% of eyes. CONCLUSIONS: Considering CA < 1.25 D in majority of cataract surgery candidates, it is preferable to perform inexpensive keratorefractive procedures rather expensive toric IOLs, especially in developing world.

A clinical correlation of conjunctival microangiopathy with grades of retinopathy in type 2 diabetes mellitus.

BACKGROUND: Conjunctival microangiopathy has been described among diabetics similar to retinal vessel angiopathy. Correlation of these conjunctival microangiopathy changes with retinopathy may form the basis of screening by external examination without expert fundus evaluation. METHODS: Conjunctival vessels widths and tortuous segment length of conjunctival vessels of 96 patients with type 2 diabetes mellitus were photographed and measured by the Zeiss Fundus camera Visupac software. The measurements were correlated with retinopathy grade in those eyes. RESULTS: The mean conjunctival vessel width was 40.61 µ (SD 17.25) with a uniform increase from 34.4 µ (SD 8.70) in mild NPDR to 53.50 µ (SD 33.45) in the PDR group which was statistically significant (p < 0.01). The tortuous conjunctival vessel segment length increased from 711.51 µ (SD 83.90) in the mild NPDR group to 921.94 µ (SD 129.26) in those with PDR (p < 0.01). Vessel width greater than 80 µ was seen only in PDR and tortuosity values greater than 900 µ were seen in severe grades (severe NPDR and PDR). Both conjunctival vessel width and tortuosity showed a positive statistical correlation with increasing severity of retinopathy (r = 0.386, r2 = 0.149 and r = 0.645, r2 = 0.415). CONCLUSION: A positive correlation was seen between conjunctival vessel width and tortuosity with severity of retinopathy. Widths over 80 µ and tortuous segment length over 900 µ are suggestive of severe grades of retinopathy.

Corneal Endothelial Alterations in Chronic Renal Failure.

PURPOSE: To evaluate the corneal endothelial changes in patients with chronic renal failure. METHODS: A total of 128 corneas of 128 subjects were studied, and 3 groups were formed. The first, the dialyzed group, composed of 32 corneas of 32 patients; the second, the nondialyzed group, composed of 34 corneas of 34 patients; and the third, the age-matched control group, composed of 64 corneas of 64 healthy subjects were examined by a specular microscope and the endothelial parameters were compared. The dialyzed group (enhanced level of toxins in the blood) was further analyzed to assess the influence of blood urea, serum creatinine, serum calcium, and serum phosphorus including the duration of dialysis on corneal endothelium. RESULTS: On comparing the 3 groups using analysis of variance and posthoc tests, a significant difference was found in the central corneal thickness (CCT) and endothelial cell density (CD) between the control (CCT: 506 ± 29 µm, CD: 2760 ± 304 cells/mm) and dialyzed groups (CCT: 549 ± 30 µm, CD: 2337 ± 324 cells/mm) [P < 0.001 (CCT); P < 0.001 (CD)]; control and nondialyzed groups (CCT: 524 ± 27 µm, CD: 2574 ± 260 cells/mm) [P = 0.023 (CCT); P = 0.016 (CD)]; and dialyzed and nondialyzed groups [P = 0.002 (CCT); P = 0.007 (CD)]. Using the linear generalized model, a significant correlation was found between the endothelial parameters and blood urea only [P = 0.006 (CCT), 0.002 (coefficient of variation), 0.022 (CD), and 0.026 (percentage of hexagonality)], although the correlation was poorly positive for CCT but poorly negative for the remaining endothelial parameters. CONCLUSIONS: Corneal endothelial alteration is present in patients with chronic renal failure, more marked in patients undergoing hemodialysis and with raised blood urea level.

A prospective interventional study of effect of accelerated orthokeratology on the corneal curvature and refraction among young adults with myopia.

BACKGROUND: Orthokeratology with reverse geometry contact lens is a non-surgical alternative to conventional contact lenses for correction of myopia. However, the strength of evidence for its efficacy and safety is limited to retrospective studies and only a few prospective studies. This prospective study, the first on Indian subjects, evaluated the outcome of orthokeratology among young myopes. METHODS: Fifty eyes of 25 young myopes (age 19-29 years) with myopia of -1 to 5.0 diopter underwent accelerated orthokeratology using the reverse geometry ortho K - LK lenses for correction of myopia. They were followed up prospectively with weekly vision, refraction, corneal topography, and pachymetry to assess the correction of myopia. RESULTS: The mean Log MAR vision corrected from 0.748 ± 0.225 at base line to 0.025 ± 0.0630 at 12 weeks with 86% achieving 6/6 unaided day time vision. This was associated with significant central corneal flattening and thinning. The lenses were well tolerated with no significant complications. CONCLUSION: Overnight accelerated orthokeratology effectively corrects moderate degree of myopia and provide excellent spectacle free day time vision without any significant adverse effects in the short term.

A clinical study to evaluate the efficacy of intravitreal Anti-VEGF therapy in treating macular edema due to retinal venous occlusions.

BACKGROUND: A non-randomized, interventional study was carried out various types of retinal venous occlusions with significant macular edema who required an Anti-VEGF injection. METHOD: One hundred and one consecutive patients diagnosed as a case of CRVO/HCRVO/BRVO were enrolled in the study provided they had significant macular edema. Atleast three intra-vitreal injections of Anti-VEGFs were given and both the pre and post injections BCVA and CMT on OCT were observed and analyzed. RESULTS: 87 patients (86.14%) showed a significant improvement of vision of atleast two lines on the Snellen's and mean BCVA improved from log MAR +1.084 to log MAR +0.455. CMT on OCT showed reduction in thickness after Anti-VEGF therapy in 99 patients out of 101 and mean CMT decreased from 586.30 µ at baseline to 329.50 µ. Both of these findings were statistically very significant. CONCLUSIONS: Anti-VEGF therapy had a marked improvement in BCVA along with a dramatic reduction in CMT in the vast majority of RVOs patients with no serious ocular or systemic side effects.

Evaluation of Posterior Capsular Opacification following Phacoemulsification, Extracapsular and Small Incision Cataract Surgery.

BACKGROUND: Posterior capsular opacification is the most common complication of modern cataract surgery. METHODS: A prospective study was conducted on 150 patients (150 eyes) out of which 50 eyes each underwent cataract surgery by extracapsular cataract extraction, small incision cataract surgery and phacoemulsification technique. On postoperative follow up posterior capsular opacification and Neodymium: Yttrium Aluminium Garnet laser capsulotomy rate was evaluated. RESULT: Posterior capsular opacification rate was significantly less (p=0.03) in eyes which had undergone phacoemulsification as compared to extracapsular cataract extraction. However capsulotomy rate was not statistically significant after comparison of the three surgical techniques of cataract surgery. CONCLUSION: Posterior capsular opacification following cataract surgery can be minimized by the use of small incision cataract surgery and phacoemulsification.