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   2013| July-December  | Volume 5 | Issue 2  
    Online since January 10, 2014

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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.
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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.
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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
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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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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.
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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.
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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.
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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.
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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.
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Nd:YAG laser hyaloidotomy as treatment for premacular subhyaloid hemorrhage
Mehul A Shah, Shreya M Shah, Parul Agrawal
July-December 2013, 5(2):82-84
Patients with premacular subhyaloid hemorrhage presented with sudden loss of vision. [1] Nd:YAG laser creates posterior hyaloidotomy, enabling rapid diffusion of subhyaloid hemorrhage into the vitreous gel. This case study was performed to assess the results of Nd:YAG laser hyaloidotomy. A 40-year-old diabetic male presented with painless, sudden diminution of vision in the right eye. His visual acuity (VA) for distance in Right Eye (OD) was finger counting (FC) at 1 m. Anterior segment examination was normal except for posterior cortical cataract. Oncyclopegic examination revealed premacular subhyaloid hemorrhage with fluid level. A Nd:YAG laser posterior hyaloidotomy was performed, and it allowed clear visualization of the posterior pole with improvement of visual acuity to 6/9 at 1-week follow-up. Nd:YAG laser hyaloidotomy an is effective procedure for the treatment of recent premacular subhyaloid hemorrhage, producing rapid dispersion of blood with restoration of visual function.
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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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Visual field deficit in diabetes mellitus in presence of no or minimal diabetic retinopathy
Galal Mohamed Ismail
July-December 2013, 5(2):49-53
Introduction: Central visual field examination is a great clinical interest in diabetes mellitus, since changes in the visual field would be accepted as an indication of pathological condition. Hence, it is reflecting structural abnormalities in the ocular and the neural mechanisms of vision. The central visual field was examined in this study to investigate possible early changes in the macular area 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 Oculus Tubingen perimeter. 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 visual fields test differentiated between normals and those with diabetes but with retinopathy. The test failed to differentiate between normals and diabetics without retinopathy. Conclusion: Visual filed defects are not strongly related to the duration of diabetes, but more to the severity of the retinopathy. They can be correlated to areas of capillary non-perfusion.
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Von Hippel Lindau disease with exudative retinal detachment and retinal hemangioma
Renu M Magdum, Akash P Shah, Pallavi P Patil, Kunal Patel
July-December 2013, 5(2):90-92
Von Hippel Lindau (VHL) disease is a rare multisystem autosomal dominant disease characterized by retinal, cerebellum and spinal cord hemangioblastomas, renal cell carcinomas, adrenal pheochromocytomas, angiomatous or cystic lesions of the kidneys and pancreas. Early detection and treatment of VHL disease may prevent loss of vision and loss of life. We report a case of VHL disease in a 34-year-old male who presented to us with a massive exudative retinal detachment with multiple hemangiomas in right eye and peripheral angioma with regressed papillomacular bundle angioma in left eye. Vision in the right eye was already lost. He had mass in head region of pancreas, cholelithiasis and right renal cortical cyst. Patient had undergone bilateral adrenalectomy for pheochromocytoma, craniotomy for cerebellar hemangioma and photodynamic therapy in left eye for papillomacular bundle angioma.
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