Comparative Evaluation of Astigmatic Changes Induced by Superior and Temporal Corneal Incisions in Sutureless Phacoemulsification Surgery: A Case Series.

Background In cataract surgery, the effect of corneal incision astigmatism has been widely recognized for many years. The incision's size, shape, and location can all impact the patient's postoperative visual outcomes. Currently, phacoemulsification is considered the most preferred surgical technique for cataract extraction. However, there is still some debate about whether temporal incisions, which are smaller and considered nearly astigmatic neutral, result in more astigmatism than other incisions. As a result, it is important to continue studying the refractive changes induced by corneal incisions made at different sites during phacoemulsification surgery. Aim and objective To compare the incidence, extent, and course of postoperative astigmatic changes associated with superior versus temporal clear corneal incisions for sutureless phacoemulsification cataract surgery. Materials and method In this prospective study, 50 patients of the civil hospital in Gujrat with cataracts who underwent sutureless, small incision (2.8 mm) phacoemulsification surgery were included. The preoperative evaluation comprised visual acuity assessment, refraction, keratometry, fundus examination, and intraocular lens (IOL) power calculation. The superior incision was made in 25 patients, and the temporal incision was made in another 25 patients. Patients were examined preoperatively on day 1, at one week (day 7), after one month (day 30), and after two months (day 60). Result Postoperatively, two months (on day 60) postoperatively, in group A (superior approach), the mean surgically induced astigmatism (SIA) was 0.39±0.34 SD diopters, and in group B (temporal approach), it was 0.5±0.42 SD diopters. A significant statistical difference was not seen between these two groups. Conclusion Surgically induced astigmatism was minimal and comparable with both superior and temporal approaches to clear corneal incisions for phacoemulsification surgery.

Challenges and Motivators to Organ Donation: A Qualitative Exploratory Study in Gujarat, India.

Purpose: Despite the global efforts to improve organ donation, there is a demand-supply gap for organs in India. The only solution to meet this disparity is to improve deceased donor transplants in the country through victims of road accidents. The government has instituted several initiatives to achieve this goal. However, challenges and barriers continue to affect the organ donation process. The present study aims to document the motivating factors and obstacles in the decision of families to donate organs in Ahmedabad, Gujarat and their suggestions to improve the processes involved in organ donation. Patients and Methods: A qualitative exploratory study (in-depth interview) of ten relatives of deceased organ donors was conducted from Oct 2021 to Feb 2022. Interviews were audio recorded, and detailed notes were taken during the interview. Thematic analysis was done using ATLAS.ti version 8 software. Results: The significant motivators identified were family members' belief or conviction that it would help save the lives of others; a sense of moral obligation to do so as bodies of brain-dead persons can contribute to this noble goal, no use of the body after death, an extension of life, and being a role model for others. The challenges were mistrusting the organ donation process, fear of being responsible for any mishappening, and feeling of shock. The suggestions to improve organ donation included awareness creation, simplifying the legal process for accidental deaths, providing benefits to the donor family, and a system for identifying potential donors and their counselling. Conclusion: The present study reflects the need for a more comprehensive awareness campaign to generate awareness and remove the misconception about organ donation in India. The findings of the study can be helpful for policymakers to amend the current organ donation process in India and improve the disequilibrium of demand and supply of deceased donations in India.

Surgical Extraction of Traumatic Lodgment of a Pen Nib Between the Eye and Nasal Bridge of an Infant: A Case Report.

Unintentional eye injuries are common in small children. If left unobserved by parents or caretakers, it is challenging to assess as the kids are in distress and pain. Penetrating trauma in or near the eye requires urgent treatment as it can lead to infection and other complications. Early diagnosis and management help avoid further complications. An 11-month-old female was presented by her parents at a tertiary care clinic with inconsolable crying and swelling over the right eye's upper lid for one day. There was a history of possible trauma with a pen while the child was playing. During the examination, swelling in the right periorbital region between the eye and nasal bridge with the opening of the foreign body tract was noted. A skull X-ray with orbit showed a radiopaque nib of the pen in the right periorbital soft tissue. Emergency surgery was planned under general anesthesia. Surgery was performed and the pen was extracted from the right periorbital soft tissue lying between the eye and nasal bridge. Parents and health care providers, including pediatricians, should assess a crying child with a trauma history carefully even with no apparent clinical findings. Efforts must be done to correlate clinical findings with proper history and other needed investigations.

Effect of the COVID-19 Pandemic Lockdown on the Management of Diabetic Retinopathy: A Cross-Sectional Study.

Introduction Worldwide, diabetic retinopathy (DR) is one of the leading causes of vision loss. Early treatment and screening for DR have a major role in reducing the rate of the disease and the coronavirus disease 2019 (COVID-19) pandemic-related restrictions have altered real-world practice patterns in managing DR. Aims and objectives To evaluate the impact of the COVID-19 pandemic on the management of DR amongst patients presenting to a tertiary eye care center in Gujarat, India. Methods This is a cross-sectional study comparison of ophthalmic findings of 72 patients who presented to a tertiary care hospital with the manifestation of DR before and after the COVID-19 outbreak and subsequent lockdown. All the patients underwent detailed ophthalmic examinations, including optical coherence tomography (OCT) and fundus fluorescein angiography (FFA). Results The mean age of participants was 54.5 years, with the mean duration of diabetes being five years since first detected. Diabetes was present in 26 patients out of 72. The number of follow-up visits to an ophthalmologist before COVID-19 was at least every one to three months, which significantly decreased after the lockdown of COVID-19. We found a significant progression of DR and clinically significant macular edema (CSME) in patients with diabetes. Before COVID-19, there were two mild non-proliferative diabetic retinopathy (NPDR), seven moderate NPDR, 15 severe NPDR, and 15 very severe NPDR, which were increased post lockdown to three, nine, 27, and 21, respectively. The proliferative diabetic retinopathy (PDR) vitreous hemorrhage (VH) and tractional retinal detachment (TRD) were also increased to 12 after lockdown as compared to only six before the COVID-19 lockdown. The causes for progression are inability to attend regular check-ups, inability to take proper treatment of diabetes and DR, poor control of diabetes, episode of COVID-19, history of high dose of steroid use, poor kidney function, and not knowing that there is a progression of the disease. A common reason for not visiting an ophthalmologist was fear of the unknown due to COVID-19. Conclusions COVID-19 has severely impacted the routine follow-up of DR and, in the subsequent years, there might be an increased incidence of severe outcomes due to DR. The second wave of COVID-19 and its lockdown have had very significant effects on the visual outcome of untreated DR patients.

A Study on the Association Between Myopia and Elevated Intraocular Pressure Conducted at a Tertiary Care Teaching Hospital in Gujarat, India.

Introduction Glaucoma is characterized by the loss of retinal nerve fiber tissues and the loss of the neuroretinal rim of the optic nerve head is termed glaucomatous optic neuropathy (GON). The early diagnosis of glaucoma requires measurement of intraocular pressure (IOP) by tonometry. The gold standard method widely used in clinical settings to measure IOP is Goldmann applanation tonometry (GAT). Myopia is also considered a risk factor for glaucoma. Population-based and hospital-based evidence suggests that the prevalence of GON is higher in high myopic eyes than in emmetropic eyes. The present study aims to document the association between myopia and elevated IOP. Materials and methods A total of 400 medium and high myopic patients attending the ophthalmology outpatient department, in a tertiary care hospital, were measured for IOP using GAT and underwent a detailed clinical evaluation. All the patients also underwent slit lamp biomicroscopic examination and fundus examination. Other data included details on demographic, socio-economic, and occupational history. Results A detailed refractive error examination revealed that amongst 400 right eyes, 67.5% had medium myopia, while 66.75% of the left eye were medium myopic. Amongst the medium myopic eyes, the average IOP was 15.51±3.68 mm of Hg, while in high myopic, the average IOP was 16.19±3.33 mm of Hg. A difference of 0.68 mm of Hg with high myopic eyes having higher IOP values than medium myopic eyes was observed, and it was significant statistically with a p-value <0.05. Conclusion There is a statistically significant association between elevated IOP and the high myopic group. In comparison to IOP measured in medium myopic and high myopic patients, elevated IOP was observed in the high myopic group than in the medium myopic group.

Association of Serotonergic Pathway Gene Polymorphisms With Behavioral Parameters in Patients With Opioid Dependence.

Background and aims Opioid dependence is a chronic, relapsing substance use disorder with a multifactorial etiology, including a genetic component. Serotonin pathway gene polymorphisms have been an important focus of research for psychiatric disorders, including substance use disorders. This study aimed to identify the association of serotonin pathway gene polymorphisms with self-harm, depressive symptoms, impulsiveness, and aggression in patients with opioid dependence. Method The study group comprised 366 subjects with opioid dependence and 200 healthy volunteers. Patients were assessed for a history of self-harm, depressive symptoms, impulsiveness, and aggression using standard tools. Genomic DNA was used for genotyping of four polymorphisms - 5-HTTLPR, STin2 VNTR, TPH1 A218C, and TPH2 G703T. Results The short allele of 5-HTTLPR polymorphism showed a significant difference between cases (59.8%) and controls (40.1%) (p=0.001) and revealed an association with age at opioid dependence (p=0.033). There was a borderline significance of the short allele of 5-HTTLPR with the duration of opioid use (p=0.061) and non-plan impulsivity (p=0.076), suggesting a role of 5-HTTLPR in the susceptibility of opioid dependence. The other markers did not differ between cases and controls. However, the STin2A polymorphism revealed a significant association with anger scores, which may indicate its role in aggressive behavior. Conclusions The present study, the first of its kind, suggests an association of 5-HTTLPR polymorphism with opioid dependence and STin2A polymorphism with aggressive behavior among opioid-dependence patients, signifying the role of these markers in our patient population.

Evaluation of Coronal Leakage Following Different Obturation Techniques and in-vitro Evalution Using Methylene Blue Dye Preparation.

INTRODUCTION: Coronal and apical leakage still remains one of the most important cause for endodontic failure in spite of the presence of advanced endodontic materials. The cause may attribute to different filling techniques, physical and chemical properties of sealers and presence or absence of smear layer assessment of coronal or apical leakage is used as a research method to compare the sealing ability of different techniques and endodontic materials. AIM: To compare the coronal bacterial leakage using methylene blue in four different obturation techniques after protaper hand instrumentation. MATERIALS AND METHODS: Ninety extracted single-rooted teeth were instrumented to an apical preparation size F3 Protaper hand files. Twenty teeth were randomly obturated with lateral compaction, 20 with vertical compaction, 20 with combination of vertical and lateral compaction and 20 with Thermafil. Ten teeth were used for positive and negative controls (five teeth in each group). Teeth were kept in 100% humidity for 90 days, and then subjected coronally to Proteus vulgaris for 21 days to assess bacterial leakage. After bacterial challenge, methylene blue was placed coronally for another 21 days, and then scoring was done according to depth of dye leakage. Chi-square test was done for statistical analysis. RESULTS: Leakage as observed with combination of vertical and lateral compaction was significantly less than vertical compaction, lateral compaction and thermafil carriers during bacterial challenge. However, when dye was used it also showed statistically significant results with thermafil carriers showing the least leakage in comparison to vertical condensation, lateral condensation and combined groups. CONCLUSION: The study concludes that two different methods i.e. bacterial and dye leakage revealed considerable variation on the same substrate Thus, due to the presence of variability among the results obtained by two different analytical methods used in the present study, the study emphasizes the need for standardization of methods as the lack of standardization hinders the comparison of different endodontic filling techniques.

Unusually large submandibular epidermoid cyst: A case report, differential diagnosis and therapy.

Epidermoid cysts are rare, slow-growing, benign, and developmental cysts that are derived from abnormally situated ectodermal tissue. Epidermoid cysts may grow anywhere on the body and about 7% of them are located in the head and neck. These cysts arise from traumatic implantation of epithelium or entrapment of epithelial remnants during embryonic fusion. Histopathologically, they are lined by stratified squamous epithelium and lumen without any skin appendages. Here, we present a case of large epidermoid cyst occurring in submandibular region.

Use of topical brimonidine to prevent intraocular pressure elevations following Nd: YAG-laser posterior capsulotomy.

OBJECTIVE: To study the effect of brimonidine on intraocular pressure (IOP) following capsulotomy among Indian subjects. MATERIALS AND METHODS: The study was a nonrandomized trial with open label. RESULTS: 80% of the subjects showed a decrease in IOP after instilling 0.2% brimonidine (1 hour pre capsulotomy). No such decrease was observed in control. After 1 and 4 h post capsulotomy a statistically significant decrease in IOP ranging between 1-10 mmHg was found in 73.3% of the treatment group. CONCLUSIONS: In the present study 0.2% brimonidine has been proven effective to counteract the increase in IOP following Nd-YAG laser capsulotomy in Indian setting.