Extent of glaucomatous damage on the first presentation.

AIM: The aim is to determine the magnitude of glaucomatous damage in the asymptomatic subjects identified with primary glaucoma for the first time and thus to evaluate the significance and efficacy of screening measures for glaucoma. MATERIALS AND METHODS: An observational retrospective cohort study of 100 asymptomatic patients of age more than 40 years, diagnosed with and under treatment for primary glaucoma was performed. Patients were categorized into having early, moderate, and severe glaucoma, according to standard automated perimetry (SAP) mean deviation (MD) in the worse eye (<-6, -6 to -12 and >-12 dB, respectively). Risk factors were correlated with the severity of glaucoma at presentation and statistically analyzed. RESULTS: About 32%, 33%, and 35% of patients were found to have early, moderate, and severe stages of glaucoma with average MD of -3.51 ±1.53, -8.65 ±1.64, -17.15 ± 5.13 on SAP, respectively. The association of risk factors such as age (P = 0.006) and glaucoma awareness (P = 0.044) with the severity of glaucoma was statistically significant. There was no direct statistical correlation found between gender, history of diabetes mellitus, family history of glaucoma, intraocular pressure, central corneal thickness, the angle width, and the severity of glaucoma in our study. CONCLUSION: Majority of cases with primary glaucoma show no symptoms until advanced irreversible stages. Early screening and proper treatment are the only ways to halt its progression. In spite of available facilities, 68% of patients in our study were found to have moderate-to-severe stages of glaucoma. This indicates that our screening measures should reach the masses at the primary level, with a focus on awareness programs.

Corneal ulcer secondary to ectropion in lamellar Ichthyosis: A rare congenital disorder.

We present a rare case of Lamellar Ichthyosis with bilateral ectropion with left sided corneal ulcer with descemetocele in a four-month-old female child, the youngest ever reported. Ichthyosis is a group of skin disorders characterized by the presence of fish-like scales all over the body (Mushriff, 2016; Turgut et al., 2009). Lamellar Ichthyosis is a rare congenital condition with incidence of 1 in 100,000 (Conditions), affecting males and females equally. Inheritance is Autosomal Recessive (Conditions). It involves generalized body as a collodion baby at birth; once the membrane sheds, patient develops large, thick, brown, pasted scales associated with ectropion, eclabium, scarring alopecia, plantar and palmar hyperkeratosis (Mushriff, 2016). Mild cases are managed with hydration, lubrication and keratolytic-agents (Mushriff, 2016). Severe cases are treated with Oral Retinoid. Proper lubrication and patching of eyes with timely management of ectropion to prevent the exposure keraopathy and related complications are needed in such cases. Secondary infections can lead to vision threatening complications, so child with ichthyosis should be under Ophthalmic observation for early needed interventions.

Effect of anterior capsular polishing on the rate of posterior capsule opacification: A retrospective analytical study.

AIM: To determine whether anterior capsule polishing during cataract surgery done by phacoemulsification has any effect on the rate of posterior capsule opacification. MATERIALS AND METHODS: We conducted a 3 year retrospective analytical study at our hospital. The medical records of patients who underwent cataract extraction by phacoemulsification with foldable square edge hydrophilic PCIOL between April 2007 and March 2010 were reviewed. The study included 1009 eyes of 950 patients who underwent phacoemulsification with foldable square edge hydrophilic IOL in the bag implantation with anterior capsular polishing. The control group included 981 eyes of 957 patients in whom anterior capsular polishing was not done. Patients in the age group of 45-65 years with well dilating pupils were included in the study. They were evaluated at 1 week, 1 month and 1 year post-operatively. Exclusion criteria included glaucoma, shallow anterior chamber, uveitis, high myopia, pseudoexfoliation, diabetes mellitus, traumatic cataracts, posterior polar cataract, subluxated cataracts, previous ocular surgeries, patients allergic to dilating drops, and steroid intake. Intraoperatively, the exclusion criteria were not achieving the total anterior capsule cover on the IOL optic, sulcus fixated IOL, and any intraoperative complications like posterior capsule rupture. After bimanual irrigation/aspiration, all enrolled patients were randomly assigned to receive either 360 degree anterior capsular polishing or No anterior capsular polishing and results were studied. RESULTS: The rate of posterior capsule opacification in the study group and in the control group was not statistically significant. CONCLUSION: Though it was thought that anterior capsular polishing will lead to reduced rate of PCO formation, our study showed that there was no significant difference in PCO formation between the two groups. However, it was seen that the rate of anterior capsule opacification and capsular phimosis showed a significant reduction in cases in which anterior capsular polishing was done.

Loa loa macrofilariasis in the eyelid: case report of the first periocular subcutaneous manifestation in India.

We report a case of periocular subcutaneous macrofilariasis as an initial sign of a systemic Loa loa infection. Thorough history, eye examination, surgical intervention and parasitological analysis. A periocular adult Loa loa worm was extracted from the left upper eyelid of an Indian lady living in Mumbai after presenting to our department with sensation of worm crawling under the left upper eyelid skin. Patient was admitted and was treated with diethylcarbamazine, oral steroids and albendazole with steroid cover under observation. In an era of increasing global travel, this case highlights the importance of direct questioning of previous travel as signs may be nonspecific and transitory. With clinical suspicion of Loa loa infestation, initiation of systemic investigation should not be prolonged and early treatment should be started under observation.

Bilateral multiple primary iridociliary cysts - A rare case report.

UNLABELLED: Iridociliary cysts are often found in patients as an incidental finding during a routine ophthalmic evaluation and if asymptomatic do not require any treatment per se. However, these are often mistaken as iris melanoma and the patient is managed accordingly causing a great deal of inconvenience to the patient as well as the doctor. CASE PRESENTATION: A 69 year old male presented to the ophthalmic out-patients department for routine ophthalmic evaluation. On examination, he is best corrected visual acuity was 6/9, N6 in both eyes. Post-mydriasis evaluation showed a Grade II nuclear cataract in both eyes. There was a smooth, pigmented mass with a rounded surface projecting from behind the iris resembling an iris melanoma. On further evaluation, he was found to have multiple ciliary body cysts. CONCLUSION: Ultrasound biomicroscopy is a valuable technique in diagnosing iridociliary cysts.