A Novel Multi-Ingredient Supplement Reduces Inflammation of the Eye and Improves Production and Quality of Tears in Humans.

INTRODUCTION: Dry eye is a multifactorial condition of the eye caused by insufficient tear production and imbalance in tear composition leading to faster evaporation of tear fluid. It is also associated with inflammation that often leads to ocular surface damage. Symptoms of dry eyes include itchiness, soreness, red eyes, a burning sensation, eye fatigue and blurred vision. The objective of this study was to evaluate the efficacy and safety of our multi-ingredient supplement in subjects with dry eye syndrome (DES). METHODS: We recruited 60 subjects with mild to moderate DES who were randomized in a 1:1 ratio in a single-center study to receive LCD (lutein 20 mg, zeaxanthin 4 mg, curcumin 200 mg curcuminoids, vitamin D3 600 IU) or placebo (soybean oil) capsules for 8 weeks. The primary outcomes evaluated were changes in tear volume by Schirmer's test and ocular symptoms by the Ocular Surface Disease Index (OSDI); secondary outcomes included evaluation of changes in Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear film break-up time (TBUT), corneal and conjunctival staining, tear osmolarity, matrix metalloproteinase-9 (MMP-9), artificial tear use and safety assessments. The outcomes were compared between the LCD and placebo groups at baseline and day 56 of supplementation. RESULTS: Fifty-nine subjects, 30 from LCD and 29 from placebo group, completed the study. The LCD group showed significant improvements (P < 0.0001) for Schirmer's test, OSDI, TBUT, SPEED, ocular staining scores, tear osmolarity (P = 0.0005), MMP-9 (P = 0.0017) and reduced artificial tear use (P = 0.0004) and its frequency of use (P < 0.0001) in subjects compared to placebo from baseline to day 56. No safety issues were observed in the study. CONCLUSION: The LCD supplement showed significant improvements in the production, stability and quality of tears by reducing ocular surface damage and tear inflammation and can be used as an adjuvant to artificial tears in subjects with DES. TRIAL REGISTRATION: Clinical Trials Registry of India (http://ctri.nic.in/) identifier: CTRI/2021/01/030493.

Serum Malondialdehyde as a Biomarker of Oxidative Stress in Patients with Primary Ocular Carcinoma: Impact on Response to Chemotherapy.

PURPOSE: To study the level of serum malondialdehyde (MDA), a biomarker of oxidative stress before and after chemotherapy in various ocular malignancies and to correlate its significance with clinicopathological parameters. METHODS: Thirty two histopathologically confirmed cases of primary ocular malignancies were included in this longitudinal cohort study. Detailed clinicopathological assessment was done. Analysis of serum MDA level in the patient before and after chemotherapy was measured and its prognostic significance was analyzed. RESULTS: Maximum cases were of eyelid malignancy (n=18, 56.2%) followed by retinoblastoma (18.8%) and OSSN (6, 18.8%). About 43.75% patients were in the advanced-stage. The tumor was histopathologically well-differentiated in 20 (62.5%) cases. Most common malignancy was sebaceous gland carcinoma of the eyelid (n=10,31.25%). Serum MDA level in patients were significantly higher than controls [5.5712±0.32779 vs 2.5531±0.08056 nmol/mL, p<0.001]. Level was significantly reduced after chemotherapy (4.5146±0.23209 nmol/mL). Serum MDA was maximum in cases of rhabdomyosarcoma (5.9450±0.23335 nmol/mL) and retinoblastoma (5.7433±0.14334 nmol/mL). It was minimum in basal cell carcinoma (5.3775±0.17746 nmol/mL). Pre chemotherapy serum MDA level was significantly higher in patients having larger tumor (>20mm, p< 0.001) and having lymph node metastasis than those without lymph node metastasis [5.8350±0.17113 vs 5.4833± 0.32193 nmol/mL, p<0.006]. No significant difference was observed in post chemotherapy serum MDA level as for as size of tumor (p=0.947) and histopathological differentiation (p=0.109) was concerned. CONCLUSION: The serum MDA level is a potential biomarker in primary ocular carcinoma to assess oxidative stress and its impact on response to chemotherapy.

Tuberculous encephalopathy without meningitis: A rare manifestation of disseminated tuberculosis.

Tuberculous (TB) encephalopathy is a rare presentation of the central nervous system tuberculosis. Its pathophysiology is believed to have an immune mechanism without any direct invasion by the tubercular bacilli. The clinical presentation is highly variable from mild illness to a potentially fatal one. The characteristic signs of meningitis and cerebrospinal fluid findings are mild or absent. Diffuse white matter edema and demyelination have been noted. This clinical entity has been reported mainly from the pediatric population. In the adult population, it has been reported only in very few case reports. We report here a rare case of TB encephalopathy in a 21-year-old female with disseminated tuberculosis, without meningitis, responding to antitubercular therapy.

Urinary Versus Recombinant Gonadotropins for Ovarian Stimulation in Women Undergoing Treatment with Assisted Reproductive Technology.

Globally, about 10%-15% couples are affected by infertility, with major role being played by the couple's lifestyle. Several gonadotropin preparations (urinary, purified urinary, recombinant, and biosimilars) are available for use. Purified urinary formulations offer numerous advantages over their predecessor, including lesser injection dose required, ability to be administered subcutaneously, less batch-to-batch variability, better efficacy, ability to individualize protocols as per patient's need, better control of developing follicles, less risk of multiple pregnancies, and hyperstimulation. Published results of Cochrane reviews and meta-analysis show no difference in efficacy or safety between urinary and recombinant gonadotropins. In the absence of any significant difference, cost plays an important role in deciding choice of gonadotropins. In this article, we have reviewed the results of comparative clinical trials, Cochrane analysis, and meta-analysis to derive consensus statements regarding efficacy, safety, and cost implications of urinary versus recombinant gonadotropin preparations.

Selective laser trabeculoplasty for primary open-angle glaucoma patients younger than 40 years.

OBJECTIVE: To evaluate the efficacy of selective laser trabeculoplasty (SLT) among patients with juvenile-onset primary open-angle glaucoma (JOAG). METHODS: Patients diagnosed with JOAG who were not controlled on medical therapy were offered a trial of SLT. The patients were followed up prospectively for 1, 3, 6, and 12 months postlaser to evaluate the efficacy of SLT as second-line therapy. Success was defined as an intraocular pressure (IOP) reduction of ≥20% at 12 months without the need for further medication, laser, or surgery. Factors associated with success/failure, prelaser IOP, age, and angle dysgenesis on gonioscopy were analysed. RESULTS: The average prelaser IOP in these JOAG eyes (n = 30) was 25.3 ± 6.5 mm Hg, which reduced to 17.3 ± 5.8 mm Hg at 12 months (p = 0.01). All patients were of Indian ethnicity. Out of 30 eyes, at 12 months post-SLT, 13 (43%) eyes had at least a 20% reduction in IOP. In the eyes that achieved success, the average reduction of IOP was 37.6%. There was no difference in the prelaser IOP between those with success (25.5 ± 5.6 mm Hg) and those that failed (25.1 ± 8 mm Hg; p = 0.8), nor was there a difference in the mean age between successful cases (34.4 ± 9.4 years) and failures (31.6 ± 8.9 years; p = 0.4). However, those without angle dysgenesis were 4 times (CI 1.1-15.2) more likely to succeed with SLT than those with angle dysgenesis (p = 0.03). CONCLUSIONS: A significant proportion of patients with JOAG can benefit from an IOP reduction after SLT. Those with gonioscopically normal-appearing angles are more likely to respond to SLT.

Arteriovenous Malformation of Face.

Arteriovenous malformations (AVMs) are rare congenital vascular malformations accounting only 1.5% of all vascular anomalies with 50% occurrence in the oral and maxillofacial region. It usually results from birth defects of the vasculature. A literature search revealed only few case reports of AVMs in the facial region. Lack of meticulous diagnosis, scarcity of knowledge, and paucity of literature can result in their exsanguinations leading to fatal hemorrhagic incidents after various dental procedures such as tooth extraction, surgical intervention, puncture wound, or blunt injury in involved area. The present case describes the accidental diagnosis of asymptomatic high-flow AVMs in the facial region of pediatric patient reported primarily for the treatment of periapical abscess. This case report is unique because although there was no history of bleeding episodes, thorough examination and investigations diagnosed it as high-flow vascular malformation. It is important for the dental practitioner to be aware of AVM which may be present in the head and neck region that can produce fatal bleeding episodes during various dental procedures. Proper diagnosis of AVMs through complete history, precise clinical examination, and advanced imaging modalities can help in preventing serious life-threatening complications.

Prognosis of different glaucomas seen at a tertiary center: A 10-year overview.

AIM: This study aims to determine treatment patterns, long-term intraocular pressure (IOP) and perimetric control in different glaucomas seen at a tertiary eye center. SETTINGS AND DESIGN: Hospital-based, cross-sectional chart review of patients routinely following up at an outpatient glaucoma service. METHODS: Patients with a follow-up of at least 10 years were evaluated. Their mean IOP, visual field (VF) status, and medications/surgery required at final assessment were noted. STATISTICAL ANALYSIS: Descriptive statistics (mean, standard deviation, and range) were used for all parameters. RESULTS: A total of 230 patients met our inclusion and exclusion criteria, 79 having ocular hypertension with open angles or primary angle closure (PAC), 35 primary open angle glaucoma (POAG), 50 PAC glaucoma (PACG), 20 primary congenital glaucoma (PCG), 46 secondary glaucoma patients. Ocular hypertensives with open angles showed progression to POAG in 3.7%, those with PAC in 5.2%, at a mean IOP of 17.3 ± 3.37 mmHg and 17.13 ± 4.41 mmHg, respectively. A progression on Humphrey Field Analyzer was seen in 11% of POAG and PACG eyes at a mean IOP of 13.50 ± 5.07 and 13.09 ± 3.95 mmHg, respectively. Fifteen percent of primary congenital glaucomas (PCGs) showed a glaucomatous VF defect after 10 years. In secondary glaucoma eyes, the mean IOP at last follow-up visit was 12.38 ± 3.74 mmHg, with progression noted in 7.69% of eyes. CONCLUSION: This study provides evidence that routine delivery of care can provide well controlled IOP in glaucomas, both primary and secondary, and the VF stabilized in about 90% of patients over a period of 10 years, with the currently available glaucoma medications and trabeculectomy.

Unilateral Macular Star in a Case of Hypertension and Retinitis Pigmentosa.

PURPOSE: To describe a case of hypertension and retinitis pigmentosa presenting with a unilateral macular star. METHODS: Case report. RESULTS: A 17-year-old female with chronic kidney disease and hypertension presented with a mild blurring of vision in the left eye. There was a history of night blindness. Both eyes had optic disc pallor, arteriolar attenuation, and peripheral bony spicules suggestive of the triad of retinitis pigmentosa. Macular star was seen in the left eye alone. We ascribe the macular star to hypertension as the patient had only a mild decrease in vision, no relative afferent pupillary defect, and similar visual evoked response amplitude and latency in both eyes. CONCLUSION: Unilateral macular star may be seen in hypertension and may simulate neuroretinitis in the clinical setting.

Age estimation based on Kvaal's technique using digital panoramic radiographs.

INTRODUCTION: Age estimation is important for administrative and ethical reasons and also because of legal consequences. Dental pulp undergoes regression in size with increasing age due to secondary dentin deposition and can be used as a parameter of age estimation even beyond 25 years of age. Kvaal et al. developed a method for chronological age estimation based on the pulp size using periapical dental radiographs. There is a need for testing this method of age estimation in the Indian population using simple tools like digital imaging on living individuals not requiring extraction of teeth. AIMS AND OBJECTIVES: Estimation of the chronological age of subjects by Kvaal's method using digital panoramic radiographs and also testing the validity of regression equations as given by Kvaal et al. MATERIALS AND METHODS: The study sample included a total of 152 subjects in the age group of 14-60 years. Measurements were performed on the standardized digital panoramic radiographs based on Kvaal's method. Different regression formulae were derived and the age was assessed. The assessed age was then correlated to the actual age of the patient using Student's t-test. RESULTS: No significant difference between the mean of the chronological age and the estimated age was observed. However, the values of the mean age estimated by using regression equations as given previously in the study of Kvaal et al. significantly underestimated the chronological age in the present study sample. CONCLUSION: The results of the study give an inference for the feasibility of this technique by calculation of regression equations on digital panoramic radiographs. However, it negates the applicability of same regression equations as given by Kvaal et al. on the study population.

Ipsilateral maxillo-mandibular ossifying fibroma.

Ossifying fibroma is a benign fibro-osseous lesion which occurs at various locations in maxillofacial region. A synchronous presentation of this lesion in both, the maxilla and the mandible is a rare occurrence. The present article reports a case of ossifying fibroma in a 45-year-old woman who manifested lesions in the right maxilla and mandible. The clinico-radiologic and histopathologic modalities of diagnosing this entity are evaluated and discussed.

A solitary crateriform ulcer of the lower lip: a case report with review of literature.

Keratoacanthoma (KA) is a relatively common skin lesion. We report a case of KA-mimicking squamous cell carcinoma in a 40-year old smoker, who was also having speckeled leukoplakia on the buccal mucosa. The present case highlights the importance of histopathological diagnosis, as the treatment in latter case is aggressive, which is unnecessary if attempted with KA. Moreover, the present report provides an overview of such lesions, which could be encountered in clinical situations for which definitive diagnosis is of paramount importance before the starting of treatment plan.

Evaluation of retinal nerve fiber layer thickness measurement following laser in situ keratomileusis using scanning laser polarimetry.

AIM: To evaluate the effect of laser-assisted in situ keratomileusis (LASIK) on the measurement of retinal nerve fiber layer thickness by scanning laser polarimetry using customized corneal compensation in myopes. MATERIALS AND METHODS: Scanning laser polarimetry was performed on 54 eyes of 54 healthy patients with myopia using the glaucoma diagnostics variable corneal compensation (GDx VCC) instrument (Laser Diagnostic Technologies, San Diego, California) before and a week after LASIK. The various parameters were compared using the Student's t test. RESULTS: No statistically significant change was observed in any of the retinal nerve fiber layer parameters before and after LASIK. CONCLUSIONS: While the measurement of retinal nerve fiber layer thickness by scanning laser polarimetry is affected by anterior segment birefringent properties and LASIK would be expected to produce changes in the same, customized corneal compensation using the GDx VCC seems to adequately compensate for these changes.

Tuberculous osteomyelitis of the mandible: a case report in a 4-year-old child.

The incidence of tuberculosis is increasing worldwide. The disease has a variable mode of presentation and therefore diagnosis is not easy. Although a rare occurrence, the differential diagnosis of tuberculous osteomyelitis must always lurk in the deepest recesses of the dental clinician's mind when routine therapy fails to bring about an improvement in lesions of the jaw. We present an unusual case of tuberculous osteomyelitis in a 4-year-old boy in whom pulmonary tuberculosis was detected only subsequently and emphasize the role of history taking, diagnostic techniques, and management.