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.

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.

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.

Slit lamp photography for objective assessment of topical eye disorders

Evidence based scientific studies has weightage, when they are presented with quantitative data analysis. Documentation and parametric analysis has become an integral part of present day research. Any publications or write-ups without explanation through standard parameters are not appreciated by the research society. In Ophthalmology assessment of various parameters through photography is a debatable issue. Affordability for higher end diagnostic / OPD instruments may not be feasible for all. In such a scenario, here is an attempt made to standardize the slit lamp photography with a smart phone and its scientific analysis for evaluating clinical conditions like sub-conjunctival hemorrhage, etc. This technique can become a tool for assessment and response of the therapies as well as an important tool to seek help from higher centers. Various add-on benefits in research, limitation and scope for further evaluation also being discussed.

To determine functional visual improvement after cataract surgery in eyes with age related macular degeneration

To determine whether patients with Age related macular degeneration (ARMD) benefit from cataract surgery in terms of best corrected visual acuity (BCVA) and to assess impact of surgery on progression of ARMD.: A prospective study was carried out of patients with and without ARMD undergoing cataract surgery at our department. Patients were divided into two groups- Group A (cases) with ARMD and Group B (controls) without ARMD and other retinal pathology. BCVA of cases was recorded on day 1, day 14, 1 month and 1/month and compared to that of controls.: BCVA significantly improved but markedly less than that experienced by control eyes. No increased incidence in progression to wet form of ARMD. Cataract surgery is safe in ARMD patients with no evidence of increased complications or rates of disease advancement.

Changes in macular thickness post uncomplicated MSICS & phacoemulsification surgery

To evaluate changes in macular thickness via-a-vis visual acuity post uncomplicated manual small incision cataract surgery (MSICS) & phacoemulsification surgery Prospective clinical study on 160 patients of uncomplicated immature senile cataract, aged 40-70yrs, patients were randomised into two groups, MSICS & phacoemulsification, by simple 1:1 randomization, who underwent uncomplicated cataract surgery with posterior chamber intraocular lens (PCIOL). Post-operatively, the patients were evaluated for best corrected visual acuity (BCVA) and changes in macular thickness by optical coherence tomography (OCT) at post-op Day 1, 7, 21, 48, and 12 weeks. Paired t-test was used for comparison across follow up. : At 12 weeks post-operative, mean logMAR BCVA was 0.01±0.02 for MSICS group and 0±0.02 for Phacoemulsification group. Macular thickness was not statistically significant (p=0.342) between MSICS group (219.19±17.88µm) and Phacoemlusification group (215.61±16.21µm), at the end of 12 weeks post-operative. Clinically significant macular oedema was not diagnosed in any of the patients at the follow-ups.: Both procedures achieved good post-operative Best Corrected visual acuity without significant differences in BCVA between both the groups at the end of 12 weeks.