Effect of donor and host factors on corneal graft transparency

Objective: To study the correlation between donor factors and recipients' factors on graft clarity.Materials and methods: The study comprised 30 cases of Keratoplasty surgery with a follow up of6 months. All donor corneas were evaluated by Konan specular microscope for endothelial cellcount; details of the donor like age, cause of death were noted. The patients were divided into twogroups, Group 1 had graft failure, and Group 2 had clear corneas. Observation and Result: Therewere 12 patients in group 1 and 18 patients in group 2 with six months of follow up. The meanendothelial cell count in group 1 was 1942.3/mm2, and group 2 was 2334.8/mm2. There is asignificant difference in the mean endothelial cell count between the two groups. On analysing theindication for Keratoplasty in two groups, the outcome was best for the corneal opacity group duringworst for the graft failure group. Conclusion: Donor endothelial cell count significantly influencedgraft outcome; rest donor factors (age, death enucleation interval, enucleation surgery interval)don't affect graft survival. Indication for Keratoplasty is a significant predictor of graft survival.

Clinical patterns of Uveitis in a Regional Eye Institute of North India

Background: Uveitis encompasses many conditions, all characterized by inflammation of the uvealtract either directly or indirectly. It can occur at any age but predominantly affects patients in theworking-age group. Objective: To report the clinical pattern of Uveitis in North India. Settings andDesign: A prospective study in a regional eye institute. Methods: After taking informed consent,100 patients with Uveitis aged 20–60 years were recruited from eye OPD between 2012- 2014.Detailed history, complete ophthalmic examination, standard diagnostic laboratory tests andradiographic studies wherever required were made. Statistical analysis used: Descriptive.Results: The mean age being 41.55 years. There were 57% males and 43% females with 32%acute uveitis and 68% chronic uveitis cases. Anterior Uveitis was seen in 83% of patients, followedby posterior Uveitis (7%), pan-uveitis (6%) and intermediate Uveitis (4%). A definite associationwith the systemic disease was determined in 27% of cases. The most frequently observed systemicdiseases were ankylosing spondylitis, Tuberculosis and herpes zoster ophthalmicus (6% cases each).This was followed by HIV (3%), sarcoidosis (3%), ulcerative colitis (2%) and endophthalmitis (1%).No specific aetiology or association with systemic diseases could be established in 73% of cases. Inmost cases, the systemic disease was not suspected before eye involvement and was recognizedonly after the subsequent diagnostic procedures. Conclusion: The etiological diagnosis of Uveitis isoften challenging as there are marked variations in ocular and systemic signs and symptoms. Asignificant number of cases may unfold with the evolution of advanced techniques.

Sleep-disordered breathing a neglected risk factor in primary open-angle glaucoma

Background: Sleep-disordered breathing (SDB) is accompanied by large swings in blood pressureand the repetitive hypoxic period during sleep, which may accelerate anoxic optic nerve damageseen in glaucoma. There are many associated risk factors in primary open-angle glaucoma (POAG),but recently, SDB, though a neglected one, is coming up as a risk factor. However, various studieshave reported controversial findings. Objective: To evaluate the relationship between SDB andPOAG. Design: A hospital-based case-control study. Methods: A total of 400 patients between 30–70 years were recruited from eye OPD between 2008- 2010. They were divided into two groups, 200cases with established POAG and 200 age and sex-matched healthy subjects with normal IOP in thecontrol group. Detailed history, complete ophthalmic and ENT examination was made along withBMI, blood pressure and neck girth measurement. Both groups were interviewed with aquestionnaire regarding SDB and were recorded on the Epworth sleepiness scale (ESS). Results:The mean age being 55.02 ± 8.66 in the POAG group and male predominance noted both in POAGand SDB patients with ESS> 10 was statistically significant (p < 0.05). Also, patients in the POAGgroup with ESS > 10 had more IOP and BMI, greater neck girth, high BP and more ENT problemswith p-value < 0,001, which is highly significant, thus showing the relationship between SDB andPOAG. Conclusions: Increased community awareness and earlier detection of glaucoma and itscorrelation with SDB results in decreased morbidity.

A retrospective study to analyse the ocular morbidity in the slum-dwelling population of central India.

Background: The study aimed to evaluate the prevalence of different ocular pathologies in theslum-dwelling population of central India and to find its correlations with socio-demographic factors.Methodology: The study was conducted as a cross-sectional study in 84 slum areas across Bhopal,Jabalpur and areas in the vicinity using a camp-based approach during the study period of 3 years.A total of 15478 participants attended the camp, and of them, 6177 patients had variousophthalmological conditions. A detailed history was obtained, and participants were subjected to acomplete ophthalmological examination. Based upon their diagnosis, they were prescribedtreatment. Referral to the tertiary care centre was done when needed. Results: The prevalence ofocular morbidities was 39.9%. The most common ocular morbidity documented in our study wasrefractive errors (22.7%). Proportions of lid pathologies were significantly higher in patientsbelonging to less than ten years of age (36.4%). In contrast, refractive errors were observed inhigher proportions of patients belonging to more than ten years of age (p<0.05). Pterygium ratiowas significantly higher in males, whereas ocular malignancies were higher in females (p<0.05).Proportions of almost all the ocular morbidities were substantially higher in patients with lowsocioeconomic status (p<0.05). Conclusion: The overall prevalence of ocular morbidities in theslum population is high. The most common ocular morbidity includes refractive error and allergicconjunctivitis. These morbidities correlated with age, gender and socioeconomic status. Werecommend periodic screening of the slum population across all age range to prevent long termcomplications and disabilities.

Comparison of conjunctival free autograft and Rotational flap technique in primary pterygium surgery: Visual changes and safety profiles

Aims and objectives: To evaluate the postoperative symptomatic comfort, visual changes,complication and rate of recurrence in free conjunctival autograft and rotational flap technique inprimary pterygium surgery. Materials & Methods: This prospective study was conducted in 60 eyesof 60 patients, presented with primary progressive nasal pterygium larger than 1mm causingsymptomatic discomfort, astigmatism and cosmetic disfigurement. Patients were divided into twogroups randomly. In group A, patients with pterygium excision with free conjunctival autograft andgroup B, pterygium excision with rotation flap technique were included. Post-operative day 1symptomatic comfort (symptoms and signs), graft stability, corneal clarity and any complicationwere noted. Visual acuity (VA), auto-refracto keratometer measurements and detailedbiomicroscopic examinations, were performed preoperatively and postoperatively at 1month and 3months. Results: Most of the patients in our study were in the middle age group of 40-49 years(41.6%). Out of 60 patients, 35 were males (58.4%) and 25 were females (41.6%). Patients withoutdoor activities had a higher prevalence of pterygium (78.4%). The incidence of pterygium wasmore in the right eye (60%) than left eye (40%). Of the 60 patients, Grade I, II and III pterygiumwas 20%, 56.7% and 23.3% in group A and 16.7%, 63.3% and 20% in group B respectively. Themean symptomatic score was statistically significantly higher for group A for each factor (P<0.05).In the 3rd month, the overall patient’s satisfaction score was significantly higher in group B(P<0.05). Conclusion: Both surgical techniques were equally effective in terms of visual acuity,astigmatism and recurrence. The patient’s satisfaction score was significantly higher in the rotationflap technique group.

Ocular Manifestations Of Carotid Cavernous Fistula and Clinical Outcome After Management

Aim: The purpose of the study is to report the ocular manifestations of Carotid cavernous fistula. Toconfirm the diagnosis by radiological investigations and to evaluate the clinical outcome aftermanagement. Materials and Methods: Patients who presented to the ophthalmology departmentwith signs and symptoms of carotid-cavernous fistula were evaluated by clinical examinationfollowed by radiological investigations like ultrasound, Doppler, CT scan and MRI. They laterunderwent DSA ( Digital Subtraction Angiography) for confirmation followed by definitive treatment.Results: Out of four patients who had direct CCF, three cases were managed by endovascularembolization of the parent artery. The remaining one case was conservatively managed by carotidmassage as it was a low flow fistula and the patient also had Parkinson’s disease. Four cases thathad indirect CCF were managed by carotid massage. Complete closure of the fistula is seen in allcases. Patients were followed up for 1 month, 3 months and 6 months and clinical outcome wasevaluated. Conclusion: CCF should be suspected in the presence of arteriolised conjunctivalvessels, proptosis and audible bruit. Diagnosis is by radiological tests like ultrasonography, Doppler,CT scan and MRI. The confirmatory test is digital subtraction angiography (DSA). Direct CCF iseffectively treated with endovascular therapy by coiling the fistula and indirect CCF is managed bymanual compression. Early diagnosis and treatment can prevent sight-threatening complications.

Brown’y points for guessing!- A case report of an unusual pigmented corneal plaque.

A 54-year-old female presented with complaints of blurring in the right eye since 2 years. A grade 3nuclear sclerosis and a peculiar band-shaped subepithelial brown corneal patch, within the inter-palpebral area was noted. The overlying epithelium was scraped for smears and cultures which cameback negative. The patient underwent uneventful cataract surgery, but returned 2 weeks later withcomplaints of watering and grittiness. Surprisingly a dendritic ulcer was noted within the pigmentedpatch, which responded to topical antivirals and tear substitutes. History of a similar episode, 3years back was elicited upon questioning the patient.

Prevalence Of Refractive Errors In School Going Children In Rural And Urban Areas -A Cross-Sectional Study

Introduction: Visual impairment affects students’ routine schoolwork and day-to-day activities.Hence, the aim is to study the prevalence of various refractive errors and their comparison amongschool children of 5-15 years in rural and urban areas. Methods: This cross-sectional studyexamined 998 students from both rural and urban schools. After obtaining ethical clearance andinformed consent, students were examined for refractive errors. The students with the refractiveerror were given a socio-demographic questionnaire and questionnaire regarding their usage oftelevision, computer, and family history of refractive errors. A Chi-square test was used to test thestatistical significance of proportions. P-value < 0.05 was considered statistically significant, anddata were analyzed by using coGuide software, V.1.03 Results: The prevalence of refractive errorwas found to be 6.41 %, with a prevalence of 7.61% in urban and 5.21% in rural areas. Thedifference in the type of refractive error between the study groups was found to be insignificant,with P= 0.897. Conclusion: Prevalence of refractive errors was more in urban school children thanrural. Refractive error was more prevalent in 13-15 years age group in both rural and urban schoolchildren. The most common refractive error was myopia, followed by astigmatism andhypermetropia.

Correlation between type 2 diabetes mellitus and central corneal thickness: A cross-sectional study

Background and Aim: Diabetes has emerged as an important global health concern because of itsvarious adverse effects on the ocular tissue. The present study was done to study the correlationbetween type 2 diabetes mellitus and central corneal thickness in patients coming to the tertiarycare institute of Gujarat, India. Material and Methods: The present study was conducted over 1year at the tertiary care institute of Gujarat, India.50 patients with type 2 diabetes mellituspreviously diagnosed by a physician on treatment and 50 age-matched controls who are non-diabetics on history and blood sugar levels were enrolled. The central corneal thickness wasmeasured using an ultrasound pachymeter using multiple reading single point modes by a singleperson. Results: The mean central corneal thickness in diabetics was 565 ± 21 micrometres and innon-diabetics was 517 ± 20 micrometres. The central corneal thickness was found to be higher inpatients with type 2 diabetes mellitus when compared to non-diabetics. Conclusion: Patients withtype 2 diabetes mellitus were found to have thicker corneas as compared to non-diabetics. Thisshould take into consideration while interpreting intraocular pressure and before any refractivesurgeries in diabetics.

Comparison of the efficacy between Ginkgo Biloba and Caroverine in the management of Idiopathic Tinnitus.

Aim: This Study of Tinnitus management conducted to compare the efficacy of two drugs namelycaroverine and gingko Biloba in Mahavir institute of medical sciences, Vikarabad over one year.Objective: To describe the results found in a group of people who have undergone treatment withcarvoverine, gingko Biloba,placebo. Method: Using Tchqs Score 90 adult subjects with the complaintof tinnitus and associated symptoms were analyzed with Proper History, Clinical Examination andPure Tone Audiometry and Thcq’s to determine the Degree of Annoyance of the Tinnitus and toAssess Tinnitus Impact on the Quality of Life before and after Treatment. Results: There was asignificant reduction in the degree of annoyance caused by Tinnitus, there was a significantreduction of tinnitus and there was a significant improvement in hearing thresholds, consequently,on the Quality of Life of the respondents after using the caroverine, gingko Biloba. Conclusion: Thisstudy allowed the Verification that the use of Caroverine, gingko bilobaand placebo for the Treatmentof Tinnitus and their Effect.