Conjunctival choristoma in an adolescent

Conjunctival choristoma presents as a painless epibulbar mass comprising epidermal and dermal tissues. Histopathological evidence helps to establish the diagnosis. The tumor manifests in childhood, nonetheless, it may also be seen in adolescents.

Traditional eye medicine associated keratitis- Current trends and practices

To study the prevalence, types and demographic profile of traditional eye medicine (TEM) use among corneal ulcer patients presenting to a tertiary eye care centre in South India.A cross-sectional study conducted on 432 new corneal ulcer patients at a tertiary eye care centre in South India from September 2018 to July 2019. Data collected included demographic profile such as name, age, sex, occupation, income, rural/urban residence, type of TEM use. Of the 432 new corneal ulcer cases, 32 used TEM. Most TEM users belonged to the age group 40- 60 years (n= 20; 62.5%). There was no difference in sex distribution. Majority of TEM users in our study resided in rural areas (n= 30; 93.75%), were involved in agriculture as occupation (n=28, 87.5%) and belonged to the lower socioeconomic status n=31(96.88%) as per Kuppuswamy classification. Profile of TEM used ranged from plant extract (n= 14; 43.75%), tongue cleaning (n= 5; 15.63%), oil (n= 7; 21.87%), breast milk (n= 4; 12.5%) and ash (n= 2; 6.25%). Use of traditional medicine is a prevalent practice in the study population. These findings offer a better understanding of health seeking behaviour of the study population which will lead to better planning, implementation and targeting of preventive and promotive eye services and awareness programmes.

To study visual and neurological outcome after treatment according to ONTT protocol

To evaluate the visual and neurological outcomes of Optic Neuritis Treatment Trial (ONTT). 40 Patients presenting with optic neuritis were enrolled in this study to analyze the Visual and Neurological outcomes after treatment according to ONTT Protocol, with emphasis on signs of anaemia, protein calorie malnutrition, vitamin deficiency, generalized lymphadenopathy, sinusitis, septic foci. Patients were followed up for three subsequent visits to assess the rate of visual recovery.Maximum patient 35(87.5) treated according to ONTT protocol while 5 (12.5%) treated with oral steroids alone. Maximum 33 eyes (70.2%) attain BCVA > 6/36 after 1st follow-up (with in 1 month) while 10(21.3%) eyes attain BCVA of 6/6 after 1st follow-up. 11 eyes (25.6%) attain BCVA 6/6 after II follow-up. General prognosis for recovery of vision was good and was slightly worse in more severely affected cases in the present series. Pallor of the optic disc and defect of vision did not always correspond–3 eyes which showed temporal of the disc at the end of follow up had a final vision of 6/9 or better in each eye.

Clinical profile of anterior uveitis in tertiary health centre of central India

To study the clinical profile of anterior uveitis in patients attending the Ophthalmology department of tertiary health centre of central India A cross-sectional, observational study was done in the department of Ophthalmology of tertiary health centre from January 2017 to July 2019. A total of 199 cases of anterior uveitis were studied to assess their clinical presentation and etiology. After thorough history taking, demographic data and clinical pattern were documented. Comprehensive ophthalmic evaluation, necessary laboratory investigations and radiological imaging were performed to establish the etiology. The maximum number (n=79; 39.7%) of patients were in the age group of 21-40 years and the mean age of the study subjects was 36.9+21.8 years. The male to female ratio was 1:1.42 (117 females, 82 males). Uniocular disease was found in 91.95% cases and majority (n=175; 87.93%) of the patients had acute presentation with 95.47% cases having non granulomatous uveitis. A specific diagnosis could not be made in 62.8% cases. Trauma (21.7%) was the most common cause in patients with a specific diagnosis. Persistent posterior synechiae was the most frequently seen complication (21.08%) although majority of the patients (66.8%) did not reveal any major complications.Patients with anterior uveitis most commonly had acute presentation. The disease was rarely bilateral and was mostly non-granulomatous in presentation. It was mostly idiopathic and among the known etiological factors, trauma was the most common cause.

Assessment of knowledge, attitude and practice of diabetic eye care among non-ophthalmic speciality doctors at a tertiary institute in India

Aim of this study was to assess the knowledge, attitude and practices (KAP) in eye care of diabetics by non-ophthalmic doctors of different specialization. The was a cross-sectional questionnaire based KAP survey among 108 non-ophthalmic diabetes mellitus treating faculties of various departments at our institute. The level of Knowledge was considered excellent if the overall average score was > 75%, similarly questionnaire focusing on attitude was considered positive if the average score was > 50% and excellent practice constituted an average score > 75%. The findings will be noted in percentages with 95% confidence interval limit. Out of the 108 subjects, 75.57% {95%CI(61%-78%)} of participants had excellent knowledge, while >87.6% {95%CI(73%-88%)} of participants had a positive attitude towards diabetic eye care, whereas there were glaring deficits in diabetic eye care practices accounting to only 45.5%{95%CI(32.8%-51.4%)} which was considered poor. Knowledge and attitude regarding diabetic eye care was excellent, there was glaring deficits in the practice of diabetic eye care by non-ophthalmic treating doctors. The deficit was probably due to busy schedule of some doctors, due to lack of uniform eye care protocols of diabetic patients, and lack of updated timely education of eye care practices among non-ophthalmic medical professionals. Hence based on the findings of our study we aim to train and educate our non-ophthalmic medical faculty regularly for adequate and better management of spectrum of diabetic eye disease.

Comparison of efficacy of topical alcaftadine (0.25%) versus olopatadine (0.1%) in allergic conjunctivitis

The most common atopic ocular condition in clinical practice is allergic conjunctivitis. One of the preferred treatment options for allergic Conjunctivitis is anti histamines eye drops. The study purpose is to compare the clinical efficacy between topical alcaftadine 0.25% and olopatadine hydrochloride 0.1% in allergic conjunctivitis patients.A prospective, randomized, open label, parallel group, comparative study was conducted on 60 Patients with bilateral allergic conjunctivitis (30 in each group) after taking an informed written consentand was evaluated from May 2018 to November 2018. Patients were randomized into 2 groups of 30 each, group A received topical Alcaftadine 0.25% twice daily and patients in Group B received topical olopatadine hydrochloride 0.1% twice daily for 2 weeks. The patients were evaluated on first visit (baseline) followed by 7 and 14 day after starting the treatment. At each visit signs and symptoms were evaluated and rated using a scale from 0-3(0-Absent, 1- mild, 2 moderate and 3- severe). The change from baseline in the mean scores of itching, hyperemia, photophobia and tearing on day 14 is the primary outcome variable.: The signs and symptoms of allergic conjunctivitis were reduced by 2 weeks from baseline after using both the drugs. Relative significant efficacy was achieved in alcaftadine group for Itching, hyperemia and photophobia, but not for tearing (p=0.3). When compared to 0.1% olopatadine hydrochloride, 0.25% alcaftadine is more effective in reducing the symptoms of all types of allergic conjunctivitis except those mentioned in exclusion criteria.

A study to assess the efficacy of topical cyclosporine A 0.05% in the management of dry eye with meibomiam gland dysfunction

: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. Meibomian Gland Dysfunction (MGD) is an abnormality of the meibomian gland that blocks the secretion of lipids. Without sufficient lipid production, tears evaporate quickly causing Dry Eye.MGD is associated with multiple pathological mechanisms including inflammation, microbial factors and lipid deficiencies. Topical Cyclosporine A (CsA) 0.05% is a calcineurin inhibitor that reduces inflammation by specifically inhibiting T‑cell activity, which reduces ocular surface inflammation and improves tear film dynamics. This was a prospective observational study done on 100 patients at the Department of Ophthalmology Basaveshwar teaching and general hospital, on patients of dry eyes due to meibomian gland dysfunction. Patients who were diagnosed with dry eyes due to meibomian gland dysfunction were invited to take part in the study. Patients were divided randomly into two groups of 50 patients each. This study, was explained in detail to them. An informed consent was obtained. Patients fulfilling the inclusion criteria were listed.All OSDI scores (symptom intensity, frequency and aggravation) revealed decreasing patterns throughout the observation period in both the groups. In single analysis, the cyclosporine A 0.05% group showed a significant improvement for each score at 3 months (p < 0.01, p = 0.01, p = 0.02, respectively). The mean TBUT after treatment in the group A (cyclosporine A group) increased to 12.36± 3.58(p<0.001) seconds, and in the group B (Control group) the TBUT score increased to 11.01±3.06 seconds. After 3 Months, there was statistically significant improvement in the mean Schirmer’s scores in both the treatment groups, however improvement was significantly greater in Cyclosporine A group. Prior to the treatment in group A (Cyclosporine A) mean Lissamine staining score was 2.73±0.15 and post treatment it reduced to 1.32±0.15 which was statistically significant (P<0.001). In group B (Control group) score before treatment was 2.46±0.15 and after treatment it reduced to 2.39±0.27 (p=0.11), not much difference was seen. : Findings from our study showed that there were significant improvements in the dry eye conditions due to defect in meibomian gland by treatment of topical Cyclosporine A 0.05% and sodium hyaluronate 0.1%.

Triad of rubric assessment, constructive feedback and video recorded surgeries key assessment for competent ophthalmic surgeon

Ophthalmic surgery involves very precise surgical skill, which is difficult to teach and even more cumbersome in assessment of resident’s surgical skill. Hence it’s a need of time to adopt newer tool for transferring as well as assessing surgical skill. With this concept in mind International Council of Ophthalmology (ICO) has developed various tools for assessing surgical skills. If we use this tool not only as learning tool but also to give constructive feedback on the surgical skills of resident doctors it will help in creating a competent ophthalmic surgeon and eventually help society in general. 1To develop more standardized surgical training; 2. To assess efficacy and feasibility of new tool in improving surgical skills of Post Graduate(PG) student; 3. To know the effect of constructive feedback on surgical performance. Small incision cataract surgery training is done by Rubric designed by ICO- OSCAR. The same tool was used to assess video recorded cataract surgery of residents by different faculties and assess their surgical skill. The assessor simply circled the observed performance description at each step of the procedure. The ICO-OSCAR score was completed. At the end of the case assessor immediately discussed operated case with student to provide timely, structured, specific performance feedback. Oscar score was recorded and analysed with inter rater agreement. OSCAR TOOL has very good inter rater agreement i.e.(0.96). Analysis of student & Observer feedback infers that OSCAR Tool is best tool for learning as well as assessment tool and is easy to use. Recorded surgeries & constructive feedback from assessor helped Post Graduate students to improve surgically. This resulted in best outcome for patient in terms of good visual acuity post operatively. The formative assessment of surgical skills becomes an integral part of our formal residency, training framework, it would be in the interest of our trainees and trainers that we should adopt the OSCAR tools to train and assess. These tools can add immense value to our residency as well fellowship surgical training and possibly help create a generation of competent trainee.Formative Assessment and constructive feedback in surgical training will improve the competency of new ophthalmic surgeons.Structured surgical training will be relatively easy to observe and perform, as trainee learns what is required to be competent.This will ultimately improve the overall quality of patient care.

Accuracy and predictability of novel MS Excel-based surgically induced astigmatism calculator

Study of steepening, flattening, clockwise, and counter-clockwise torque effect is indispensable to understand and design surgical induced astigmatism calculator. Hence, in this study by constructing a novel Microsoft Office Excel 2007 based astigmatic calculator following cataract surgery, analysis on the accuracy and predictability evaluated for the performance. Post-cataract surgery patients from May 2019 to January 2020 at a tertiary medical institution recruited for this present study. Based on Pythagoras principle, MS Excel calculator designed and the law of cousins for calculating the vector magnitude and axis respectively. Manual keratometry measurements for pre and postoperative horizontal (Kh) and vertical (Kv) curvatures established, and statistical analysis for the resultant SIA magnitude and axis deduced with Medcalc software comparing with the existing SIA 2.1 version calculator. A total of 29 eyes of 25 patients studied with a mean age of 62.55 (±8.08) years, males contributing to 14 (56%), and right laterally in 17 (58%) eyes. MS Excel and SIA 2.1 versions calculated a mean SIA magnitude of 0.66 (±0.47) D and 0.64 (±0.55) D respectively. Pearson coefficient correlation (r=-0.16, p=0.40), paired-two sample test (t value= 0.11, p= 0.91) and ROC curve analysis (AUC = 0.75, p= 0.34, 95% CI= 0.25 to 0.99) calculated. Regression equation (y = 0.75 + -0.14 x) and limits of agreements (95% CI -0.29 to 0.31) analyzed, and, 95% of data points distributed within ±1.96 SD of the line of equality on Bland-Altman difference plots.The present calculator proclaimed an acceptable accuracy and agreement with a prediction of 0.61 Diopter for every unit change in the magnitude of SIA 2.1 software in addition to consideration of interchangeability.