Clinical and Antibacterial Efficacy and Safety of Besifloxacin Ophthalmic Suspension Compared With Moxifloxacin Ophthalmic Solution.

PURPOSE: To evaluate the efficacy of besifloxacin ophthalmic suspension 0.6% compared with moxifloxacin ophthalmic solution 0.5% in the treatment of bacterial conjunctivitis in an Indian population. DESIGN: Multicenter, randomized, double-masked, active-controlled, parallel-group, clinical trial, including 6 clinical sites in India. METHODS: Patients were randomized to receive 1 drop of besifloxacin or moxifloxacin in the infected eye(s), 3 times daily, for 5 days. Primary efficacy end points included clinical resolution and bacterial eradication at day 5. Secondary efficacy end points included clinical resolution and bacterial eradication at day 8, ocular discharge, bulbar conjunctival injection, investigator's global assessment, and bacterial eradication by species. Efficacy was analyzed using the Cochran-Mantel-Haenszel and Pearson χ2 tests. Safety was assessed by the incidence of ocular and nonocular treatment-emergent adverse events (AEs), changes in visual acuity, and biomicroscopy and ophthalmoscopy findings. Data presented are that for the subset of patients from India. RESULTS: Of the 123 patients randomized at clinical sites in India, 96.7% completed the study. Day 5 differences in microbial eradication (100% besifloxacin vs 96.3% moxifloxacin) and in clinical resolution (78.9% besifloxacin vs 71.4% moxifloxacin) were not statistically significant. No statistically significant between-group differences were observed for secondary end points. All ocular AEs in both groups were mild or moderate in severity. There were no drug-related ocular AEs with besifloxacin. CONCLUSIONS: Treatment of bacterial conjunctivitis with besifloxacin 0.6% produces similar antibacterial and clinical efficacy as that with moxifloxacin 0.5% in an Indian population, with no clinically meaningful safety concerns.

Temporal retinal thickness in eyes with glaucomatous visual field defects using optical coherence tomography.

PURPOSE: To evaluate the temporal macular retinal thickness in normal, early, and advanced glaucomatous eyes using optical coherence tomography 3 (OCT-3) and correlate the superior-to-inferior retinal thickness (S/I RT) ratio with corresponding field defects in early and advanced glaucoma patients. PATIENTS AND METHODS: Forty normal eyes, 40 eyes with early glaucomatous visual field defects, and 33 eyes with advanced visual field defects were included. All participants underwent complete ocular and visual field examinations and OCT-3 imaging on the same day. A 3×3 mm area temporal to the foveal reflex was scanned with the OCT-3 using 6 horizontal, equally spaced raster lines. Retinal thickness was evaluated at points 500 µm apart for each line and S/I RT ratio computed between similar points above and below the fovea for each patient. One-way ANOVA was used to compare S/I RT ratio between the normal, early, and advanced glaucoma eyes. RESULTS: Average retinal thickness increased progressively, as points temporal to the fovea were scanned. There was a statistically significant difference between the average superior and inferior retinal thickness at points 1500, 2000, and 2500 µm temporal to the fovea in both early and advanced glaucoma eyes (P<0.05) with corresponding significant differences in the S/I RT ratios, when compared with the normal participants (P<0.017). CONCLUSIONS: OCT-3-generated S/I RT ratios were successfully able to reproduce the structural damage in eyes with early and advanced glaucoma field defects and can complement optic disc scanning protocols in diagnosing glaucoma at an early stage.

Evaluation of optical coherence tomography and heidelberg retinal tomography parameters in detecting early and moderate glaucoma.

PURPOSE: To evaluate the relationship between optic nerve head (ONH) and peripapillary retinal nerve fiber layer (RNFL) parameters by optical coherence tomography (OCT) and confocal scanning laser ophthalmoscopy (Heidelberg retinal tomography; HRT; Heidelberg Engineering, Heidelberg, Germany) in early and moderate glaucoma and to compare several OCT-based automated classifiers with those inbuilt in HRT for detection of glaucomatous damage. METHODS: This cross-sectional study included 60 eyes of 60 patients with glaucoma (30 early and 30 moderate visual field defects) and 60 eyes of 60 healthy subjects. All patients underwent Fast Optic Disc and Fast Peripapillary RNFL scans on the OCT and then HRT evaluation of the ONH during the same visit. Glaucoma variables obtained from OCT and HRT analyses were compared among the groups. Receiver operator characteristic (ROC) curves generated by performing linear discriminant analysis (LDA), artificial neural networks (ANNs), and classification and regression trees (CART) on OCT-based parameters were compared with the Moorfield regression analysis (MRA), R Bathija (RB), and FS Mickelberg (FSM) functions in the HRT, to classify eyes as either glaucomatous or normal. RESULTS: No statistically significant difference was found in the disc area measured by the OCT and HRT analyses within each study group (P > 0.05). The areas under ROC curves were 0.9822 (LDF), 0.9791 (CART), and 0.9383 (ANN) as compared with 0.859 (FSM), 0.842 (RB) and 0.767 (MRA). CONCLUSIONS: OCT-based automated classifiers performed better than HRT classifiers in distinguishing glaucomatous from healthy eyes. Such parameters should be integrated in the OCT to improve its diagnostic abilities.

Classifying patterns of localized glaucomatous visual field defects on automated perimetry.

AIM: To classify the classic patterns of glaucomatous visual field defects on automated perimetry and to study their proximity to fixation. STUDY DESIGN: Cross-sectional observational study. MATERIALS AND METHODS: About 1120 full threshold 30-2 reliable visual fields of glaucoma patients were analyzed by 2 glaucomatologists. Classically described patterns of visual field defects were identified on the pattern deviation plot and definitions proposed. Interreader agreement between 3 independent (not involved in the classification) readers was determined. Proximity to fixation of the different patterns was assessed. RESULTS: Interreader agreement with 3 readers was found to be 93% or more between any 2 readers using the present system of classification. Central fixation was seen to be involved in 45% of the glaucomatous visual field defects studied overall. CONCLUSIONS: The proposed definitions of topographical glaucomatous field defects based on the pattern deviation probability plot are simple to use in clinical practice with good interreader agreement.

Inter-instrument agreement and influence of central corneal thickness on measurements with Goldmann, pneumotonometer and noncontact tonometer in glaucomatous eyes.

PURPOSE: This study was conducted to compare the intraocular pressure (IOP) measurements by the Goldman applanation tonometer (GAT), non contact tonometer (NCT) and the ocular blood flow (OBF) pneumotonometer in different IOP ranges in glaucomatous eyes. The effect of central corneal thickness (CCT) on IOP measurement in chronic glaucomatous eyes using the three different tonometers was also evaluated. MATERIALS AND METHODS: IOP measurements of 130 eyes of primary glaucoma patients were performed using GAT by an ophthalmologist while NCT and OBF-pneumotonometer measurements were performed by an experienced optometrist. The IOP values were compared amongst the three instruments in the three different IOP ranges (0-18 mmHg, > 18 to 25 mmHg, > 25 mmHg). CCT was also measured in all patients. RESULTS: The mean of paired difference between GAT and NCT was 0.9 +/- 3.1 mmHg while that between GAT and OBF-pneumotonometer was 0.3 +/- 3.4 mmHg. The OBF-pneumotonometer and NCT were more affected by corneal thickness (0.41 mmHg and 0.4 mmHg / 10 micro corneal thickness respectively) while GAT was the least affected by corneal thickness (0.3 mmHg / 10 micro corneal thickness) though the difference was not statistically significant ( P =0.42). CONCLUSION: With appropriate correction for corneal thickness the NCT and OBF-pneumotonometer can be used as reliably as GAT in following up glaucomatous patients.

Optical coherence tomography findings in commotio retina.

A 16-year-old boy presented with diminished visual acuity of 6/60 following blunt trauma to his right eye with a cricket ball. Fundus examination showed commotio retinae. Optical coherence tomography (OCT) demonstrated increased reflectivity with small optically clear spaces in the area corresponding to the photoreceptor outer segment. At 2-month follow up the visual acuity improved to 6/6. A small area of retinal opacification persisted nasally, and OCT of the corresponding area continued to show increased reflectivity in the area of photoreceptor outer segment. Increased reflectivity on OCT in eyes with commotio retinae probably denotes photoreceptor outer segment disruption and seems to be reversible to a variable extent.

Effect of laser in situ keratomileusis and laser-assisted subepithelial keratectomy on retinal nerve fiber layer thickness.

PURPOSE: To evaluate and compare the influence of laser in situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASEK) on the peripapillary retinal nerve fiber layer (RNFL) thickness. SETTING: Observational case series. METHODS: Twenty nonglaucomatous patients with mild to moderate myopia were included. One eye in each patient was randomly selected to have LASIK (Group 1, n = 20), and LASEK was performed in the fellow eye (Group 2, n = 20). The RNFL thickness measurements were performed using optical coherence tomography (OCT) preoperatively and 1 day and 1 month postoperatively. The RNFL thickness parameters were compared using repeated-measures 1-way analysis of variance (ANOVA) followed by multiple comparison tests in both groups. The main outcome parameter was RNFL thickness as determined by OCT before and after LASIK and LASEK. RESULTS: The mean age of the patients was 21 years +/- 3.2 (SD). The mean preoperative spherical equivalent was -4.23 +/- 1.71 diopters (D) in Group 1 and -4.16 +/- 1.68 D in Group 2. The mean ablation depth was 73.35 +/- 27.85 microm and 66.35 +/- 23.64 microm in groups 1 and 2, respectively. In Group 1, the mean average RNFL thickness, inferior average, superior average, temporal average, and nasal average were 98.2 +/- 5.6 microm, 128.6 +/- 11.9 microm, 120.38 +/- 10.2 microm, 65. 8+/- 7.1 microm, and 80.5 +/- 18.8 microm, respectively. None of the RNFL thickness parameters or RNFL ratios were found to have a significant change after surgery. In Group 2, the average RNFL thickness, inferior average, superior average, temporal average, and nasal average were 98.47 +/- 5.9 microm, 128.38 +/- 14.3 microm, 125.1 +/- 8.8 microm, 66.4 +/- 8.2 microm, 73.6 +/- 15.8 microm, respectively. No significant change was observed in any of the parameters following surgery. No significant alterations were noted in the RNFL parameters following LASIK or LASEK. CONCLUSIONS: Laser in situ keratomileusis and LASEK did not significantly affect the RNFL thickness parameters postoperatively.

Diagnostic capability of optical coherence tomography in evaluating the degree of glaucomatous retinal nerve fiber damage.

PURPOSE: To evaluate the role and ability of optical coherence tomography (OCT) to detect differences in peripapillary retinal nerve fiber layer (RNFL) thickness between normal and glaucomatous eyes and also between different severities of glaucoma. METHOD: This cross-sectional observational study included 160 eyes of 160 healthy subjects and 134 eyes of 134 patients with primary open-angle glaucoma (POAG). Peripapillary RNFL thickness was measured on OCT using the fast RNFL thickness protocol. The RNFL thickness parameters used for evaluation included average RNFL thickness and inferior, superior, nasal, and temporal RNFL thickness. The glaucomatous eyes were subdivided into three subgroups on the basis of visual field defects and a fourth subgroup of eyes blinded by glaucoma. RNFL thickness parameters were compared among the normal eyes and the glaucoma subgroups. Correlation of global visual field indices with RNFL thickness parameters was also performed. RESULTS: The average RNFL in control subjects, early glaucoma, moderate glaucoma, severe glaucoma, and blind glaucoma were 102.30 +/- 10.34, 77.68 +/- 15.7, 66.07 +/- 15.5, 53.65 +/- 14.2, and 44.93 +/- 4.95 microm, respectively. There was a significant difference in all RNFL thickness parameters between normal and all glaucoma subgroups (P < 0.001). Average and inferior RNFL thicknesses showed the highest area under the receiver operating characteristic curve, with 0.905 and 0.862 for normal versus early glaucoma, 0.705 and 0.722 for early versus moderate glaucoma, 0.737 and 0.717 for moderate versus severe glaucoma, and 0.635 and 0.584 for severe versus blind glaucoma. Both mean deviation (MD) and corrected pattern standard deviation (CPSD) showed a significant correlation with all the RNFL thickness parameters in eyes with glaucoma (P < 0.001). CONCLUSIONS: RNFL thickness measured on OCT may serve as useful adjuncts in accurately and more objectively distinguishing normal from glaucomatous eyes, even in the early stages of glaucoma and may help to differentiate various severities of glaucoma. Average and inferior RNFL thicknesses are among the most efficient parameters for distinguishing such a differentiation. RNFL thicknesses in eyes blinded by glaucoma provide an estimate of the component of the RNFL thickness, which is not related to visual function.

Inadvertent sclerostomy with encysted bleb following trans-scleral contact diode laser cyclophotocoagulation.

A 22-year-old woman underwent 360 degrees trans-scleral contact diode laser cyclophotocoagulation for refractory glaucoma. Conjunctival burns and scleral thinning were noticed inferonasally at the last laser application. Intraocular pressure in the first week was normal. Six months later the patient presented with encysted filtering bleb and high intraocular pressure. Ultrasound biomicroscopy revealed a full thickness sclerostomy. This report suggests that inadvertent sclerostomy may present with encysted bleb months after trans-scleral contact diode laser cyclophotocoagulation.

Limbal patch graft in surgically induced scleral necrosis.

BACKGROUND: Surgically induced scleral necrosis (SINS) is a rare consequence of ocular surgery. Various graft materials have been recommended for the repair of scleral necrosis. We report use of fresh cadaveric limbal graft for the same purpose. METHOD: A 42-year-old female presented with severe pain and buckle extrusion following external segmental buckling surgery for inferior retinal detachment. Buckle removal performed under general anesthesia revealed an area of scleral necrosis with uveal prolapse. Due to non-availability of other donor material a fresh cadaveric limbal graft remnant after keratoplasty was used for the repair after obtaining informed consent. RESULTS: Successful uptake of graft was observed and the globe integrity was restored. CONCLUSION: The case suggests that a fresh limbal graft may provide adequate tectonic support in eyes with SINS and can serve as an option for donor graft tissue in emergency situations.

Atypical presentations of orbital cysticercosis.

We describe three patients with orbital cysticercosis who presented with atypical clinical or radiologic features previously unreported. All three patients had a cyst with a scolex on imaging studies. After 6 weeks of treatment, all three had almost complete resolution of their features.

Indications of penetrating keratoplasty in northern India.

PURPOSE: To identify the indications for penetrating keratoplasty in northern India. METHODS: All the eye bank records of penetrating keratoplasties performed during the period from June 1997 to November 2003 at Rajendra Prasad Center for Ophthalmic Sciences were reviewed. RESULTS: During this period, 2022 penetrating keratoplasties were performed. The leading indications for penetrating keratoplasty were corneal scarring (38.03%) followed by acute infectious keratitis (28.38%), regrafting (11.5%), aphakic bullous keratopathy (7.27%), pseudophakic bullous keratopathy (6.18%), and corneal dystrophy (3.85%). Healed infectious keratitis (19.83%) was the most common subcategory among the eyes with corneal scarring followed by traumatic corneal scars (16.71%). Healed (19.83%) and active keratitis (28.38%) together accounted for the majority of keratoplasties (48.21%). In cataract-related corneal edema (13.45%), aphakic bullous keratopathy (7.27%) was almost as frequent as compared with pseudophakic bullous keratopathy (6.18%). CONCLUSIONS: Corneal infections either active or healed are the most common indication for keratoplasty in northern India.