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Formative assessment using direct observation of single-patient encounters in ophthalmology residency
Kavita Bhatnagar, OK Radhakrishnan, Abhay Lune, K Sandhya
July-December 2014, 6(2):49-53
Background: There has been a growing concern that trainees are infrequently observed, assessed, and given feedback during their workplace-based education. This has led to an increasing interest in a variety of formative assessment methods that require observation and offer the opportunity for feed. Mini-clinical evaluation exercise (mini-CEX) is an observation tool that facilitates the assessment of skills that are essential for good clinical care and provision of immediate feedback. The aim of this article is to sensitize academician-clinician in developing countries to mini-CEX. Materials and Methods: This observational study was conducted on 10 postgraduate students who were assessed on clinical skills, communication skills, professionalism and ethics in different clinical settings using a validated mini-CEX global rating scale. Data analysis was done. Student's scores in the first encounter and last encounter were compared to see an improvement in their performance. Results: A total of 216 encounters was observed and rated on a nine-point Likert scale. Mean score and maximum improvement were seen for Humanistic qualities/professionalism. About 100% residents found mini-CEX exercise useful. Faculty feedback was more useful than multiple encounters being observed. Over 90% patients were highly satisfied with resident behavior. The mean score for faculty satisfaction with mini-CEX was 5.33, and for the students, it was 5.48. Conclusion: Mini-CEX is an examination tool which permits evaluation based on a much broader set of clinical settings and patients. It also gives an opportunity to observe and communicate with the students in real life settings. It can be used as a tool to identify and highlight deficient areas in individual performance for further improvement.
  5,466 924 -
Retinal cryotherapy in diabetic vitreous hemorrhage
Ahmad Ahmadzadeh Amiri, Mohammad Riazi Esfahani
January-June 2013, 5(1):28-33
Background: To evaluate the role of cryotherapy of anterior retina in preventing vitreous hemorrhage in patients with proliferative diabetic retinopathy (PDR). Materials and Methods: The patients were divided into two groups: (1) retinal cryotherapy without sufficient retinal laser treatment and (2) anterior peripheral retinal cryotherapy (ARC) in addition to sufficient panretinal laser treatment. The history and management of vitreous hemorrhage were recorded. Ocular examination and fluorescein angiographic findings for recovery of vision and presence of recurrent vitreous hemorrhage and neovascularization in the two groups were compared to determine the effectiveness of adjunct cryotherapy in PDR. Results:The rate of clearance of vitreous hemorrhage in groups 1 and 2 was 11 out of 13 (85%) and 15 out of 17 (88%), respectively (P = 0.717). In patients with cleared vitreous, the complete regression rate of neovacularization in groups 1 and 2 was 2 out of 11 (18%) and 8 out of 15 (53%), respectively (P < 0.05). Frequencies of the neovascular categories at different ocular sites in each group were similar, and no statistically significant difference was found (group 1, P = 0.884; group 2, P = 0.43). Comparison of corrected visual acuity on the last follow-up to corrected visual acuity before ARC gave the following results: 19 eyes had improved visual acuity of at least two lines, and visual recovery had similar distributions (group 1, P = 0.05; group 2, P = 0.085). Conclusions:It seems that ARC combined with photocoagulation might be a helpful adjunct procedure in PDR and to prevent recurrent vitreous hemorrhage.
  5,758 246 -
A rare case of duane retraction syndrome type 1 with exotropia and nystagmus
Sandhya R Kruthiventi, Akash P Shah, Abhay A Lune, Renu M Magdum
July-December 2013, 5(2):85-86
Duane retraction syndrome is a congenital miswiring of the medial and lateral rectus muscle. We reported a case of 12-year-old female child having left eye abduction limitation with normal adduction, widening of interpalpebral fissure of left eye on attempting abduction. She has 5 ∆ exotropia for distance and orthophoria for near in primary gaze. She has pendular nystagmus also.
  5,310 222 -
Evaluation and comparison of surgically induced astigmatism between phacoemulsification and small incision cataract surgery
Pallavi Patil, Abhay Lune, OK Radhakrishnan, Renu Magdum, Neha Rajappa
July-December 2013, 5(2):67-72
Background: Surgically induced astigmatism is the cause of poor postoperative vision even after uneventful cataract surgery. Aim: The aim of study was to compare the incidence, amount, type, and course of surgically induced astigmatism and visual acuity in temporal 5.5-mm clear corneal phacoemulsification and 6-mm superior scleral incision in Small incision cataract surgery (SICS). Materials and Methods: A total of 200 eyes of 200 patients with a mean age of 62 years were included in the study. Cases were randomly divided into two groups. Group A had undergone 5.5-mm temporal clear corneal phacoemulsification and group B had undergone 6-mm superior scleral SICS. Surgically induced astigmatism was analyzed by SIA software. Results: Mean age in group A was 61 (±8) years and in group B was 63 (±10) years. Mean surgically induced astigmatism in group A was 1.05 (±0.58) D, 1.13 (±0.52) D, 1.13 (±0.56) D, and 1.08 (±0.52) D on 1 st , 7 th , 21 st , and 45 th postoperative days, respectively. The change from 1 st to 45 th day was not significant. The same in group B was 0.75 (±0.58) D, 0.81 (±0.54) D, 0.88 (±0.49) D, and 0.91 (±0.47) D on 1 st , 7 th , 21 st , and 45 th postoperative days, respectively. Surgically induced astigmatism was comparable on all days between the groups. We found significant with the rule and against the rule type of astigmatism post-operatively in the temporal clear corneal incision in phacoemulsification group and in superior scleral incision in small incision cataract surgery group respectively. Conclusion: Surgically induced astigmatism was higher in the 5.5-mm temporal clear corneal group than in the superior scleral group. Clinical outcome of both surgeries was same, as there was no significant difference in the uncorrected postoperative visual acuity in between the groups.
  4,759 550 -
Ocular problems in diabetes mellitus
Galal Mohamed Ismail
July-December 2014, 6(2):43-48
Diabetes Mellitus (DM) is an important health problem affecting wide population band globally. According to the World Health Organization (WHO) considerable numbers of individuals were diagnosed with DM, however, notable numbers are still undiagnosed due to diverse reasons. All diabetics are at risk of developing pathological complications in particular ocular complications seemed to appear early and might lead to blindness at late stages. The screening and routine medical eye care programs helped in detecting early the ocular problems allowing best possible remedy. Monitoring of such ocular problems has significant role in reducing advance stages that might lead to blindness. In an attempt of listing possible ocular problems due to DM, the author reviewed what would be most seen in practice across the ocular and visual components structurally and functionally. Assuming the article might be used as a quick reference by the clinicians involved in seeing diabetic patients.
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Current role of international non-governmental organizations in prevention of blindness in Sudan
Kamal Hashim Binnawi
July-December 2013, 5(2):37-38
  1,751 2,753 -
Genetics and diabetic microangiopathy
Amir Ahmadzadeh-Amiri, Ahmad Ahmadzadeh Amiri
July-December 2015, 7(2):27-34
Human vital organ systems may be affected by diabetic microvascular complications (DMC), lead to public health difficulty. Recent evidence shows genetic factors provide to the genetic and structural variants, and/or variability in disease severity play important roles in the development of DMC among the patients with similar risk factors. Several genetic loci have discovered that figure the risk of DMC as detected by genetic linkage studies. Genetic variants demonstrate for susceptibility to DMC as detected by genetic association studies. Copy number variation and interactions of gene Χ environment have been discovered by compelling analysis of structural variants. Mitochondrial DNA also acts a definite role in the development of DMC. Sequencing technologies have light important horizon on detecting rare and common genetic loci. This review focuses on the common science of the genetic context of DMC. Finally, recognition of genes or genetic loci and structural variants providing to risk of or guarding from DMC will help intuition the underlying mechanism of DMC, with conclusive suggestions for the evolvement of new medicine for diabetes mellitus complications.
  1,766 2,690 -
Case series of Cyclogyl-induced delirium in elderly
Kalpana Sharma, Tarun Sood, Mandeep Tomar, Anuj Sharma
July-December 2016, 8(2):39-41
Cyclopentolate is an anticholinergic, antimuscarinic tertiary amine which has been widely used as a topical cycloplegic and mydriatic agent by ophthalmologists. Systemic absorption of the drug can occur transconjunctivally or through nasolacrimal duct through highly vascular nasal mucosa. This can lead to central anticholinergic syndrome which includes restlessness, hallucination, psychosis, hyperactivity, seizures, incoherent speech, and ataxia. We report a case series of three patients developing central nervous system toxicity following instillation of cyclopentolate. This article lays stress on the judicious use of this drug and outlines the steps that can be taken to reduce systemic absorption and toxicity include using the lowest available concentration of the drug.
  1,487 2,408 -
Labial mucus membrane graft for alkali injury
Vipul Bhandari, Jagdeesh Kumar Reddy, Rahul Mahajan
July-December 2013, 5(2):87-89
The case report of a 60-year-old man has been presented to report the treatment of alkali injury with labial mucus membrane graft. The patient presented with fall of cement in the right eye. He had perilimbal ischemia and corneal epithelial defect and his cornea was hazy. A diagnosis of severe alkali injury was made. The cement particles were removed. He was started on topical antibiotics, steroids, cycloplegic and lubricants. Later, he developed symblepharon and perilimbal ischemia, and the corneal epithelial defect was still present. A labial mucus membrane grafting was performed. An amniotic membrane was placed over the ocular surface and a conformer was placed and topical steroids, antibiotics and lubricants were continued. At follow-up, it was noted that the graft was taken up well and her best corrected visual acuity improved to 6/18.
  3,517 199 -
Prevalence of dry eye among patients with red eye
Atif Mohammed, Omer Mussa, Abdullah Salim Obied
July-December 2013, 5(2):39-42
Aim: To investigate the dry eye syndrome (DES) among patients with red eye. Materials and Methods: This is hospital-based, cross-sectional, case control study. We selected about 100 patients with red eye and 100 patients without red eye (control group) from the same area. A complete eye examination was performed including Schirmer's test and fluorescein staining. Results: The study showed that symptoms and signs in the DES patients with red eye is greatly higher than in patients without red eye (P = 0.001). The prevalence of dry eye in patients with red eye is 32% and in patients without red eye is 40%. Conclusion: Red DES is an advanced stage of DES and it reflects the severity of the DES. Schirmer's test and fluorescein staining are important diagnostic tests for dry eye and hence, they should be included in the routine examination especially in red eye patients.
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Eyelid gangrene and endophthalmitis after Chalazion surgery: About a case
Pepin Williams Atipo-Tsiba, Edith Sophie Kombo Bayonne
July-December 2015, 7(2):64-66
A chalazion is caused by an obstruction of excretion channel of the meibomian gland due to the accumulation of its own secretions. It can be ovoid, lobed, but most often it is a round nodule, variable in size, usually painless. Conservative treatment is the rule. When this fails, surgery is the only alternative, especially for nodules located far from the inner canthus due to the risk of seeing the section of lacrimal organs. This surgery is simple, with local anesthesia in adults and sometimes general anesthesia in children. It is exceptionally the cause of complications that can compromise the visual and/or vital prognosis. We have only found three cases in the literature, one apex orbital syndrome, an eyelid necrosis and one severe orbital bleeding. This observation reports a case of an eyelid gangrene associated with endophthalmitis due to Pseudomonas aeruginosa, which occurred after surgery for Chalazion in a healthy patient.
  3,319 117 -
Biometry for IOL power calculation, which technology is better optical or acoustic?
Mehul Shah, Shreya Shah, Kaivan Shah, Payal Patel
January-June 2014, 6(1):6-9
Objective: The aim of this study is to investigate the accuracy of prediction of different biometric methods for the calculation of intraocular lenses. Materials and Methods: We examined consecutive cataractous eyes with the IOL-Master-500 as well as with the acoustic biometry and keratometry. In all eyes, the intraocular lens to be implanted was chosen by means of the SRK/T formula, based on the measurements conducted with our standard method. The achieved postoperative refraction is obtained, at least 4 weeks after surgery, by the treating ophthalmologists. The results were compared and analyzed statistically using SPSS17. Results: We examined 156 out of which 72 female and 84 were male. Comparison of eye lengths as well as of the keratometric measurements showed good correspondence between the obtained measurements by both methods, acoustic biometry yielding significantly (P < 0.001) different axial lengths than the IOL Master, and the B and L yielding significantly (P < 0.001) different mean corneal refraction power than the IOL Master. The accuracy of the refraction obtained postoperatively compared to the preoperative aim was better with IOL Master compared to acoustic method. Conclusions: The predicted systemic differences in measurement results could be verified. Significant improvement in accuracy of our postoperative refraction prediction was achieved using IOL master. The other advantages of the IOL Master are the substantial gain in time, as well as the fact that performance of the measurements may be delegated. Only shortcoming was the use of IOL master in mature cataract.
  3,018 326 -
A clinico-bateriological study of chronic dacryocystitis
Khevna Patel, Renu Magdum, Sarika Sethia, Abhay Lune, Atreyee Pradhan, RN Misra
January-June 2014, 6(1):1-5
Aim: This hospital-based study was conducted to identify common bacterial organisms and the antibiotic susceptibility of these organisms and to study the demographic profiles of patients with chronic dacryocystitis. Materials and Methods: A total of 100 patients above the age of 40 years were examined. Patients complaining of epiphora and nasolacrimal duct block on syringing were selected. Demographic factors such as age, sex, occupation and social status were recorded. Samples were collected by applying pressure over the lacrimal sac and allowing the purulent material to reflux through the lacrimal punctum, or by irrigating the lacrimal drainage system with sterile saline and collecting the refluxing material. Samples were sent for microbiological investigation and antibiotic sensitivity pattern. Results: One hundred patients were included in the study, of which the majority of patients were in the age group of 50-60 years (43%); female (52%) were more commonly affected. Majority of the patients belong to low socioeconomic status (64%) and majority were housewives (39%), and the left eye was more commonly involved (56%). All patients presented with epiphora (100%), and majority of them had mucopurulent regurgitant (71%) on sac-syringing. Of 100 clinical samples, 83% were culture positive and the remaining were reported as having no growth (17%). Among the Gram-positive organisms isolated, Staphylococcus aureus (41%) was the most common organism (1%). Most of the isolates of S. aureus were sensitive to ciprofloxacin (82.9%). Conclusion: It is important to know about microbial organisms responsible for chronic dacryocystitis as it is one of the important predisposing factors for postoperative endophthalmitis, especially due to the large volume of cataract surgery performed nowadays. Knowledge of common bacteria causing chronic dacryocystitis and their antibiotic sensitivity may help in deciding the appropriate antibiotic coverage for ocular surgery.
  2,918 347 -
Incidence of increased intraocular pressure and factors associated with it after optical penetrating keratoplasty at secondary care centre, India
Kamal R Dodia, Nirzari M Shah, Rajesh K Chudasama
January-June 2014, 6(1):14-18
Background: An increase in intraocular pressure (IOP/glaucoma) any time after penetrating keratoplasty (PK) leads to a significant endothelial cell loss with dire consequences. The present study was conducted to know the incidence of increased IOP and factors associated with it following optical PK. Materials and Methods: A prospective study was conducted at Ophthalmology Department of PDU Medical College and Civil Hospital Rajkot, a secondary level center for 2 years from May 2010 to April 2012. A total of 50 patients admitted for optical PK during the study period were enrolled. Detailed history was elicited regarding ocular problem and any treatment taken for the same. Results: Nearly 30% of the patients reported an increase in IOP in the present study. Majority (58.0%) patients were above the age of 55 years. Based on preoperative diagnosis, increase in IOP was reported among patients with aphakic bullous keratopathy (100.0%), adherent leucoma (50.0%), graft failure (44.4%) and pseudophakic bullous keratopathy (25.0%). After 1 month of optical PK, 18.0% patients reported an increase in IOP, 28.0% after 2 months and 26.0% after 3 months. Out of 15 patients who reported an increase in IOP, 14 (93.3%) were given medical treatment and 1 (6.7%) patient required surgical treatment. Conclusion: Age above 55 years, preoperative diagnosis of adherent leucoma, aphakic eyes were major risk factors for the post-operative increase in IOP in the present study. Peak rise in IOP was reported following 2 months post keratoplasty. Post PK glaucoma in the majority of patients responded to medical treatment.
  2,819 212 -
Color vision deficit in diabetes mellitus in presence of no or minimal diabetic retinopathy
Galal Mohamed Ismail
July-December 2013, 5(2):43-48
Introduction: Color vision examination is of great clinical interest in diabetes mellitus, since changes in color vision can be accepted as an indication of pathological condition. Color vision as a psychophysical measurement was performed with a view to providing an assessment of early neural functional integrity in the presence of no or minimal diabetic retinopathy. Materials and Methods: The investigation was carried out on a healthy visual system control group and a number of age and sex-matched non-insulin dependent diabetic groups with different levels of diabetic retinopathy. The psychophysical test used was the Farnsworth Munsell 100-Hue test. Results: The results were considered in terms of the presence of functional changes relative to the severity of retinopathy and the duration of diabetes. The color vision test differentiated between normal and those with diabetes but without retinopathy. Clearly the color vision score error mean is increased in the diabetic groups compared with the normal subjects and the level of the score error mean increases with the severity of retinopathy, but not to duration. Conclusion : C0 hanges in color vision are not strongly related to the duration of diabetes, but more to the severity of the retinopathy.
  2,543 326 -
Wooden sticks as objects of ocular injury: Are they really bad?
Mehul Shah, Shreya Shah, Sandip Vora, Dilip Batra, Ritu Pandya
July-December 2013, 5(2):62-66
Background: To compare the incidence of infection and damage caused by wooden stick with that caused by other objects and evaluate other objects causing ocular injury. Setting: Tertiary care hospital in rural part of central western India. Materials and Methods: This was a prospective observational cohort study designed in 2002. Patients with all open-globe injuries in either eye, diagnosed and managed between January 2003 and December 2009, were enrolled in our study. The injuries were grouped as those caused by wooden stick and injuries by other objects. Data were collected in International Society of Ocular Trauma initial and follow-up report form and were analyzed. Results: In our study, there were 687 cases of which 496 were open-globe cases. Wooden stick is one of the most common objects of injury in a rural setting. Wooden stick associated with any infection, the final visual outcome was significantly better than that of the injury caused by other objects. (P = 0.002). The outcome measures were final visual acuity and complications. Conclusion: Despite the wooden stick being a common object of injury, it is an important predictive factor for better visual recovery and is not associated with any infection.
  2,679 187 -
Ocular manifestations of head injury: A clinical study
Anu Malik, Alka Gupta, Neha Luthra, Vivek Gupta
July-December 2016, 8(2):46-50
Purpose: To clinically correlate the various ocular findings with the neurological status in cases of closed head injury and between ocular involvement and mortality rate. Study Design: Prospective study. Methods: In 189 patients with closed head injury, the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) were applied to grade the severity. A detailed ophthalmological examination was carried out within 12 h of sustaining injury. Ocular neurological signs, GCS and RTS were then used to prognosticate the outcome. Apart from suturing of laceration, patients were managed by a multidisciplinary approach. Conclusion: Ocular complications occurred in 129 of 189 (68.3%) head-injured individuals with 172 cases, (91%) male and 17 cases (9%) female in the age range 3-75 years with a mean of 28.68 years. Young adult males (16-30 years) were more vulnerable to head injury. Road traffic accident was the most common cause of head injury in 130 cases (68.8%) leading to soft-tissue injuries to the globe and adnexae in maximum no. of patients. The most frequently encountered neuro-ophthalmic manifestation was pupillary involvement, followed by papilloedema and optic nerve trauma. The association between ocular signs and the outcome was significant (P = 0.003). All the patients that died had ocular signs of neurological significance. There was a significant co-relation of the GCS, neurodeficit and the ocular signs with the outcome. Pupillary abnormalities, papilloedema and lateral rectus palsy pointed towards a poorer outcome. The GCS, neurodeficit and ocular signs contribute significantly to the prediction of outcome.
  2,533 315 -
Visual evoked potential: Head size, sex, and BMI
Jayesh D Solanki, Naisargi H Naisargi, Hemant B Mehta, Chinmay J Shah
July-December 2013, 5(2):79-81
Background: Visual evoked potential (VEP) is a useful noninvasive neurological diagnostic tool affected by certain physical and physiological parameters, age being the major of all. However, only few baseline studies have been conducted in India and none in Gujarat. Materials and Methods: Monocular pattern reversal VEP (PRVEP) was carried out using a standard protocol in medical students of same age group. Latencies of various waveforms were calculated and effects of gender, body mass index (BMI), and head size were studied. Results: Observations revealed normative VEP latencies in line with other studies. Difference observed for only N70 wave, head size were statistical significant and that for BMI, gender, and between eyes were not. Conclusion: Normative VEP data of age, BMI-matched healthy medical students showed no ethnic variation; disproved gender influence on VEP latencies and slight sex difference observed is due to head size.
  2,491 346 1
Serum Na + and K + as risk factors in age-related cataract: An Indian perspective
Adeeb A Khan, Syed Wajahat A Rizvi, Abadan K Amitava, Shagufta Moin, Ziya Siddiqui, Faraz Yusuf
January-June 2014, 6(1):10-13
Background: Recent reports suggest an association between deranged metabolism and age-related cataracts (ARC). Aim: This study was planned and carried out to evaluate some biochemical variables as possible risk factors for the different morphological types of ARC. Materials and Methods: We compared serum Na + and K + in 100 cases of ARC and 100 age- and gender-matched controls. The ARC patients were sub-grouped according to the WHO cataract grading system into posterior sub-capsular (PSC), nuclear (NC), cortical (CC) and mixed cataracts (MC). Statistical analysis was done using t-test, ANOVA, and post-hoc (Tukey) test. The 95% CI are reported; significance was set at P ≤ 0.05. Results: Although within normal range, the overall mean serum levels of Na + were significantly higher (P < 0.001; 95% CI for difference: 2.95 to 8.56) in the cases (145.39 (±3.04) mEq/L) as compared to controls (139.63 (±13.91) mEq/L). Except for the PSC group, sub-group analyses showed significantly higher Na + levels than controls (P < 0.05). There was no significant difference in serum K + levels. Importantly, serum Na + and K + levels were within the normal reference range in all the subjects. Conclusion: This study suggests that there is a tendency to have higher Na + levels in ARC as compared to non-ARC subjects, although within normal reference values.
  2,477 270 -
Prevalence and causes of blindness: Results from the rapid assessment of avoidable blindness survey in gezira state, sudan
Kamal Hashim Binnawi, Awad Hassan Mohamed, Balgis Alkhair Alshafae, Zainab Abdalla, Mazin Alsanosi, Mamoun Mirghani Ahmed, Fadwa Hashim Binnawi
January-June 2013, 5(1):17-22
Objectives: To estimate the prevalence of avoidable blindness in people aged 50 years and older in Gezira state, Sudan, using the Rapid Assessment for Avoidable Blindness methodology. Design: Cross-sectional, population-based survey. Participants: Forty-three clusters of 50 people aged 50 years or older were selected by probability proportionate to size sampling of clusters. Households within clusters were selected through compact segment sampling. A total of 2150 eligible persons were selected, of whom 2103 (97.8%) persons were examined. Materials and Methods: Participants underwent a comprehensive ophthalmic examination in their homes by specially trained ophthalmic teams, including measurement of visual acuity (VA) with a tumbling-E chart and the diagnosis of the principal cause of visual impairment. Results: The prevalence of bilateral blindness (presenting VA <3/60) was 9.37% (95% confidence interval [CI] ±1.95) and the prevalence of bilateral visual impairment (VA of <6/18-6/60) was 3.9% (95% CI ±1.10) in the sample. Definite avoidable causes of blindness (i.e., cataract, refractive error, trachoma and corneal scarring) were responsible for 74.6% of bilateral blindness. Cataract was the major cause of blindness (57.4%), followed by glaucoma (17.3%). Conclusions: The prevalence of blindness in people aged 50 years and older in Gezira state was slightly higher than that expected. Than main cause of blindness was cataract, followed by glaucoma. Three quarters of blindness was due to avoidable causes.
  2,413 277 -
Clinical presentations and outcomes following ocular injury with intraocular foreign bodies
Mansukhani Sasha Anil, Nicholson Anjali Daraius, Murade Sujit Mardansingh, Hussain Faraaz Syed
July-December 2015, 7(2):35-40
Context: Globally, of 55 million ocular trauma cases occurring per year, 1.6 million are rendered blind. Intraocular foreign bodies (IOFBs) form a major subset (40%) of the penetrating eye injuries. Aims: To study the clinical presentations, visual outcomes, and the prognostic factors in penetrating eye injuries with IOFB. Settings and Design: This is a prospective cohort study conducted at a tertiary care center. Thirty-three eyes of 33 consecutive patients presenting to our center between March and December 2012 with IOFB injury were included in the study. Materials and Methods: After obtaining informed consent, detailed history and examination findings were noted at presentation. Computed tomography scanning was done in all patients. The details of the IOFB extraction procedure were noted and the patients were followed up for 3 months following the surgery. Statistical Analysis Used: All statistical calculations were performed in Stata (12.1) using the t-test. Results: Fifty-three percent were males between 15 and 30 years of age. Seventy-three percent had foreign body located in the posterior segment, whereas 27% were located in the anterior segment. The incidence of endophthalmitis was 16.67%. The final best corrected visual acuity appeared to be worse with poorer vision at presentation, larger foreign body size, scleral entry wound, and foreign body removal during a secondary surgery. Conclusions: Penetrating eye injuries with IOFB usually occurred in young males at work places. Factors leading to poor visual outcome were poor vision at presentation and larger foreign body size.
  1,719 966 -
Evaluation of corneal endothelium before and after neodymium : Yttrium-aluminium-garnet laser capsulotomy in posterior capsular opacification
Neha Rajappa, Abhay Lune, OK Radhakrishnan, Renu Magdum, Pallavi Patil, Rahul Mehta
July-December 2013, 5(2):73-78
Aim: The aim of this study is to evaluate the corneal endothelial changes before and after neodymium:yttrium-aluminium-garnet (Nd:YAG) laser posterior capsulotomy in patients with posterior capsular opacification (PCO) among adults. Materials and Methods: This prospective non-comparative study was carried out in 200 eyes of 200 adult patients with clinically diagnosed PCO. Eyes were later subjected to Nd:YAG laser capsulotomy and followed up at 1-12 weeks to evaluate the damage caused by laser on the corneal endothelium. Computerized morphometry was used to evaluate the central corneal thickness, size, shape and cellular density, coefficient of variation and hexagonality of the endothelial cells using non-contact specular microscopy before and after laser capsulotomy. Data was analyzed using Chi-square and t-test and P < 0.05 were considered significant. Results: Endothelial cell density (ECD) varied from 1659 to 2792 cells/mm 2 with a mean of 2298.7 cells/mm 2 before laser treatment. At 1 week, the mean ECD was 2178.1 cells/mm 2 (P < 0.0001) and 12 weeks was 2121.3 cells/mm 2 (P < 0.0001). The difference between pre-laser ECD and ECD at 1-12 week was 120.6 cells/mm 2 and 177.4 cells/mm 2 (7.78%) respectively which was found to be highly significant. Hexagonality of corneal cells varied from 49% to 84% with a mean of 72.22% pre-laser. At 1 week, hexagonality was 71.42% (P < 0.005) and at 12 weeks was 70.22% (P < 0.0001). The difference was clinically significant. 90% patients had two or more than two Snellen's line visual improvement. Conclusion: In our study, although there was a dramatic improvement in visual acuity after laser capsulotomy, we found a significant reduction of ECD. Although Nd:YAG laser capsulotomy presents the advantage of being non-invasive and effective method to treat PCO, the corneal endothelium may be damaged by laser radiation.
  2,352 257 -
Rapid assessment of avoidable blindness in amran and lahj governorates of Yemen
Tawfik Kaid Al-Khatib, Adnan Ali Ahmed, Aziz Shaher Hameed
January-June 2013, 5(1):9-16
Objectives: To determine the magnitude and causes of avoidable blindness in 50 years and older population of Amran and Lahj governorates, Yemen. Materials and Methods: Using the RAAB manual, 78 clusters were randomly selected, 50 people aged of 50 ≥50 years were examined in each cluster. Visual acuity (VA) was measured with a tumbling "E" chart. Ophthalmologists examined people with <6/18 in either eye. A software program for RAAB was used for data collection and analysis. Results: In Amran and Lahj, 1789 (91.8%) and 1836 (94.3%) people were examined, respectively. The prevalence of blindness (VA < 3/60 in better eye, with available correction) in Amran was 9.33%, while in Lahj it was 10.84%. The principal cause of blindness was unoperated cataract in both governorates. The three main barriers to cataract surgery were unaware of treatment, destiny /God's will and cannot afford in both Amran and Lahj governorates. Conclusion: The prevalence of blindness, severe visual impairment and visual impairment in people aged ≥50 years in Amran and Lahj governorates were relatively higher than WHO's estimate in the sub region and the principal cause of blindness was untreated cataract in both governorates.
  2,349 222 2
Progress in blindness prevention in North Sudan (2003-2010)
Kamal Hashim Binnawi
January-June 2013, 5(1):3-6
Objectives: (1) To review progress in the prevention of blindness in Sudan compared to Vision 2020 targets. (2) To show gaps and shortfalls. Materials and Methods: Reports of national Vision 2020 program covering the period 2003-2010 are reviewed, including data generated from six RAAB surveys conducted in 2009-2010. Results: Prevalence of blindness is 1% compared to 1.5% in 2003. Cataract surgical out-put, cataract surgical rate (CSR), and IOL implantation rate increased steadily. It is estimated that 70% of the population are covered with refractive errors services. Low vision services are provided by four centers. Trachoma mapping completed for Northern Sudan except Darfur. SAFE strategy is implemented. Prevalence of childhood blindness is not known. Two centers provide specialized pediatric eye services. There is community-directed treatment with Ivermectin (CDTI) in 3 out the 4 onchocerciasis foci. Ophthalmologists tripled in number. Optometists exceeded 1000, compared to less than 500 in 2003. Secondary and tertiary level facilities increased in major cities. There is no primary eye-care program. Conclusion: Northern Sudan shows good progress in most of the components of Vision 2020, namely cataract, trachoma, onchocerciasis, refractive errors, and low vision. However, scaling up and attention to diabetic retinopathy and glaucoma are still needed to reach all the targets by the year 2020.
  2,262 266 1
Pediatric Cataract: How important is the age of intervention?
Mehul A Shah, Shreya M Shah, Krunal D Patel, Rukhsana M Rehman
July-December 2013, 5(2):54-61
Purpose: To study the effect of age of intervention on visual outcome following treatment of pediatric patients with cataract. Materials and Methods: This is a Prospective cohort study. We studied a consecutive series of pediatric patients with congenital, developing, or traumatic cataracts who underwent surgery between January, 1999 and April, 2012 at our center. Patient demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded. Results: In total, 1305 eyes of 815 children were included: Unilateral cataracts were present in 786 (60.2%) eyes. There were 610 (46.7%) traumatic and 695 (53.3%) non-traumatic cases. Ages at surgery ranged from 1 to 215 months. Eyes were grouped by the age of surgical intervention performed: Group 1, </= 5 years including 286 (21.9%) eyes, and Group 2, >5 years, including 1019 (78.1%) eyes either by anterior or pars plana route ΁ IOL placement. The mean follow-up time was 117 days. Ultimately, 173 (13.3%) Group 1 and 442 (33.9%) Group 2 patients achieved a visual acuity better than 6/24 (P < 0.001). Age at intervention was significantly related (all P < 0.001) to visual outcome. Conclusions: Age of intervention affects visual outcome significantly (P < 0.001).
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