Long term effects of anti-VEGF agents: patho-physiological perspectives.

Monoclonal antibodies directed against different targets have become a new tool for the treatment of various disorders. More than 20 monoclonal antibody-based therapies have been approved in the USA and hundreds more are in development. Some of these therapies are finding applications in ocular disorders. The role of anti-VEGF in the treatment of wet ARMD is now well known. Anti-VEGF, which were initially discovered to treat carcinomas like bevacizumab in metastatic colorectal carcinoma, have now found place in ophthalmology to treat disorders where neovascularization/angiogenesis leads to blindnes.

A rare case of collodion baby with ophthalmic involvement.

BACKGROUND: Ichthyosis is an infrequent clinical entity worldwide (1:300,000 births). When diagnosed in a newborn, two forms can be identified: collodion baby and its most severe form, harlequin fetus or maligna keratoma. In both cases, clinical manifestations are thick and hard skin with deep splits. The splits are more prominent in the flexion areas. CASE: We report a case of a 4- day-old baby who was referred to JNMC Eye OPD by the Pediatric Department of the JNMC. He was having severe bilateral ectropion of the upper lids and chemosis of conjuntiva, without corneal involvement. There was distortion of the pinna and peeling of the skin, more over the chest around the neck region and over the flexor aspect of limbs. CONCLUSION: Management of collodion baby requires a multi-disciplinary approach.

Presbyopia and its anatomical and physiological variants.

AIM: To study the various ocular anatomical and physiological parameters in presbyopia. MATERIALS AND METHODS: We studied the various ocular anatomical and physiological parameters like corneal curvature (keratometry readings: K1 and K2), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT) and axial length (AL) in 100 presbyopic patients between 35 - 55 years of age. The patients were divided into two age groups: I (35 ± 44 years) and II (45-55 yrs). ACD, AL and LT were measured using an Ascan. CCT was measured with ultrasonic pachymetry. RESULTS: The CCT decreased (BE), LT increased and ACD decreased (RE) significantly with increasing age (p less than 0.05). There was no significant difference in males and females. Nearly 3/4th of the total increase in lens thickness was responsible for the decrease in the anterior chamber depth and the rest, 1/4th , goes posteriorly. Corneal curvature and AL showed no significant change with age. CONCLUSIONS: The mean of CCT decreased significantly with advancing age. As age increased, the mean value of lens thickness increased and anterior chamber depth decreased. Nearly 3/4th of total increase in LT was anteriorly, decreasing the ACD. Corneal curvature and AL has no relation with age.

Accommodation: its relation to refractive errors, amblyopia and biometric parameters.

AIM: To study accommodation in relation to different refractive errors, amblyopia and to measure the anatomical changes in the accommodating eye MATERIALS AND METHODS: We studied the amplitude of accommodation (AA) in 150 patients in the age group 11 ± 30 years which included emmetropes, myopes, hypermetropes and hypermetropic amblyopes using the Royal Air Force (RAF) rule. The anterior chamber depth (ACD), axial length (AxL) and lens thickness (LT) changes during accommodation were measured using an A-scan. Myopes and hypermetropes were further divided based on the amount of refractive error : less than 2D, 2 -4D and greater than 4D. RESULTS: Corrected low myopes had the highest accommodation amplitude (p less than 0.05) followed by emmetropes. Corrected hypermetropes were found to have the lowest amplitude of accommodation (p less than 0.05). The amblyopic eye had a significantly low AA compared to the non-amblyopic eye (p less than 0.05). ACD decreased (p less than 0.05) and LT increased (p less than 0.05) during accommodation. The AxL increase was maximum in myopes (p less than 0.05) followed by hypermetropes but the change was not significant in hypermetropes (p greater than 0.05). CONCLUSION: The amblyopic eye has low amplitudes of accommodation proving the benefit of near adds in amblyopic patients. Prolonged near work might induce myopia in susceptible eyes by increasing the axial length.

School eye survey in rural population in UP, India.

OBJECTIVE: To find out the prevalence of refractive errors and pattern of ocular morbidity amongst the school children of a rural village. MATERIALS AND METHODS: A cross sectional study was carried out in children of age group 3 - 12 years in a rural village of Hathras, Uttar Pradesh, India. All the children were examined including visual acuity measurement using Snellen's E chart, retinoscopy and refraction under cycloplegia. Examination of the anterior segment, media, and fundii was also done. Myopia was defined as spherical/cylindrical equivalent refractive error of at least -0.50 D and hypermetropia as +0.50 D or more (Dandona et al 2002). RESULTS: In the survey 220 eyes of 110 children were examined, majority of them were in 5-10 year age group. The prevalence of uncorrected visual acuity of 6/6 was 85.40%. Refractive error was the cause in 6.81% of eyes with vision impairment, out of which myopia and hypermetropia were present in 26.67% of eyes. Blepharo-conjunctivitis was present in 15.45% of children and Bitot's spots were present in 0.90% of them. Colour blindness was found in one child. CONCLUSION: The prevalence of refractive error in rural school is 6.81 %. Blepharitis is the commonest cause of ocular morbidity.

A report on a rare case of Kearns Sayre-like syndrome.

PURPOSE: To report the presentation of a rare case of Kearns-Sayre-like syndrome (KSS) CASE: A 14-year-old boy presented with progressive drooping of both upper eyelids for 10 years. Past history of right sided hemi-plegia and left facial nerve palsy was present. Examination (OU) showed total external ophthalmoplegia, ptosis and pigmentary retinopathy. The patient also had a short stature (height 121.9 cm) for his age.