Comparison of Keratometric Change Following Various Conjunctival Autografting Techniques in Pterygium Surgery.

Aim To compare the postoperative keratometric changes and duration of surgery for different techniques of conjunctival autografting in pterygium surgery. Methods Patients with primary pterygium attending the outpatient department and having appropriate indications for surgery were enrolled. Preoperative ophthalmic examination included visual acuity assessment, refraction, keratometry, slit lamp, and fundus evaluation. Pterygium excision surgery with conjunctival autografting was performed on all patients using one of the four different techniques, namely, sutures, fibrin glue, and the autologous blood and bridge techniques. Duration of surgery was recorded for all patients. Postoperatively, all patients were followed up on Day 1, Day 7, and Months 1, 3, and 6. Duration of surgery, keratometric changes, and recurrence rates were analyzed in all four groups. Results Sixty-eight eyes of 66 patients completed the study protocol. There was a significant reduction in astigmatism after the autologous blood graft technique (P value 0.0055) and the glue technique (P value < 0.0001). The success rate of the autologous and glue technique was 90%. The glue technique was found to be more time efficient (mean duration 20.40 minutes) than other techniques. Conclusion After pterygium excision, conjunctival auto grafting using either autologous blood or glue plays a significant role in reducing pterygium-induced astigmatism and recurrence rates with the added advantage of a shorter operative time.

Analysis of COVID-19-associated rhino-orbital-cerebral mucormycosis patients in a tertiary care center in Northern India.

Purpose: An unprecedented surge has been noted in rhino-orbital-Cerebral mucormycosis (ROCM) in times of current COVID-19 pandemic. The present prospective study aims to evaluate clinico-epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021. Methods: All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino-nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed. Results: A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID-19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino-nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality. Conclusion: Early suspicion and timely diagnosis of mucormycosis at rhino-orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.

The effect of smoking on ocular surface and tear film based on clinical examination and optical coherence tomography.

PURPOSE: Smoking is a global health problem with a high burden of smokers in India and the world as well. Smoking is a known eye irritant that may have a significant effect on the anterior ocular surface. Hence, the present study was aimed to investigate the effect of smoking on dry eye parameters, ocular surface, and central corneal thickness (CCT) and to compare the results with nonsmokers. METHODS: In this cross-sectional study, 40 (80 eyes) smokers and 40 (80 eyes) age-matched nonsmokers were included. The severity of ocular surface disease symptoms was assessed by the Ocular Surface Disease Index (OSDI) tool. All participants underwent a series of measurements, that is, the Schirmer's II test score and tear breakup time (TBUT). Tear meniscus height (TMH) and CCT were measured using anterior segment optical coherence tomography (OCT). RESULTS: The mean value of all dry eye parameters was statistically different among the group of smokers and nonsmokers. The mean score of symptomatic assessment (OSDI) was observed to be significantly higher in smokers than in nonsmokers (P < 0.0001), and dry eye parameters, that is, Schirmer's score (P = 0.0127), TMH (P < 0.0001), and TBUT (P < 0.0001) were significantly lower among smokers than nonsmokers. There was no significant difference in CCT between smokers and nonsmokers (P = 0.06). CONCLUSION: Cigarette smoking has deteriorating effects on the ocular surface. Exposure to smoking was found to be associated with dryness of the eye. Further studies are needed on a molecular basis.

Prevalence of Steroid-Induced Cataract and Glaucoma in Chronic Obstructive Pulmonary Disease Patients Attending a Tertiary Care Center in India.

PURPOSE: Exposure to corticosteroids is known to be associated with an increased risk of cataract and glaucoma. This study was undertaken to determine the prevalence of steroid-induced cataract and glaucoma in patients with chronic obstructive pulmonary disease (COPD) and to assess a dose-response relationship between them. DESIGN: This was a prospective observational study. METHODS: We identified all COPD patients aged 50 years or older, with minimum steroid exposure of 4 months and on inhaled corticosteroids from March 2014 to March 2015. Average daily dose of inhaled corticosteroids was defined as low (1-250 µg), medium (251-500 µg), and high (501-1000 µg) using fluticasone propionate equivalents. RESULTS: We screened 405 COPD patients, of which 48 were dropouts. We identified 58 cataract and 14 glaucoma patients with a prevalence of 16.24% and 3.92%, respectively. We also observed a dose-response relationship with the highest prevalence of cataract (39.6%) and glaucoma (42.8%) at daily doses of 501-1000 µg fluticasone propionate equivalents. CONCLUSIONS: It is evident that higher doses and longer duration of inhaled corticosteroid in COPD patients are associated with a higher prevalence of cataract and glaucoma.