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   2014| January-June  | Volume 6 | Issue 1  
    Online since August 16, 2014

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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.
  4,313 479 -
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.
  4,255 459 -
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.
  3,736 392 -
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.
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Childhood proptosis: A case of missed diagnosis
Snehal R Thakre, Jyotika P Mishrikotkar, Sheetal U Wankhede, Supriya A Deshpande
January-June 2014, 6(1):33-35
Proptosis in childhood can be a diagnostic dilemma. We present a child who came with subacute onset, bilateral and asymmetric proptosis. He was diagnosed to have pseudotumor on the basis of imaging studies and started on systemic steroids. He responded partially, only to have a recurrence few weeks later. Baseline blood investigations showed a substantial drop in hemoglobin. Peripheral blood smear (PBS) showed atypical cells suggestive of leukemia. A bone marrow biopsy confirmed acute myeloid leukemia. The case illustrates an extra-ocular, systemic cause of proptosis, which was missed on initial presentation. The clue to the diagnosis was clinched on simple baseline tests such as hemoglobin and PBS. An extra-ocular cause, though uncommon, should always be considered in evaluation for every childhood proptosis to prevent delayed diagnosis.
  3,430 283 -
Keratomalacia in a neonate secondary to maternal Vitamin A deficiency
Renu Magdum, Sampada Tambolkar
January-June 2014, 6(1):36-39
Vitamin A deficiency (VAD) is a leading cause of childhood blindness, morbidity and mortality, especially in developing countries like India. The universal Vitamin A supplementation program is mainly aimed at the age group from 6 months to 5 years. However, malnourished pregnant women with VAD and their infants, who are entirely dependent on breast milk, constitute another highly susceptible group to the blinding effects of vitamin A deficiency. We need to develop strategies aimed at safe vitamin supplementation in this vulnerable group. The aim of reporting blinding keratomalacia in a 20-day-old neonate was to emphasize on the need to revise health care strategies.
  3,144 210 -
Visual evoked potential in diabetes mellitus
Galal Mohamed Ismail
January-June 2014, 6(1):24-29
Introduction: The visual evoked potential is suggested to be a sensitive indicator of functional changes in the visual processing pathway. Visually evoked potentials have previously been reported to be affected in diabetes. Materials and Methods: The equipment consisted of a Nicolet 1000 clinical averager, Nicolet HGA 200A amplifier and Nicolet N/C 1015 visual stimulator. The pattern check sizes used were 10 and 40 minute arc with contrast of 80 and 40% for each check size. The non-insulin dependent diabetes (NIDD) patients were recruited from the University of Bradford Diabetic Retinopathy Screening Programme. The non-diabetic control group was recruited from patients, partners and members of the University in departments other than Optometry. The age and duration of diabetes for all subject groups were normally distributed. Results: Correlation coefficients between the duration of diabetes and VEP latencies of the three diabetic groups individually and the diabetics as a group all failed to reach significance, reflecting the large variance within the data. Similarly, correlation coefficients between the duration of diabetes and VEP amplitudes of the three diabetic groups individually and the diabetics as a group all failed to reach significance, reflecting the large variance within the data. Conclusion: The visual evoked potential latency and amplitude seemed to be poor indicators of the duration and severity of diabetic retinopathy in diabetes.
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Finding children with blindness and visual impairment in five local government areas of Sokoto state using the key informant method
Nasiru Muhammad, Zainab Mohammed Ali
January-June 2014, 6(1):19-23
Background: Pilot inclusive education program that provide education to blind children in routine schools have been implemented in 1 local government area (LGA) of Sokoto state in 2009. Encouraged by the success recorded in the initiative, the Sokoto state Ministry of Education through the State Universal Basic Education Board (SUBEB) decided to expand the programme to other LGAs across the three senatorial districts. This study was conducted to trace blind/visually-impaired children in 5 LGAs of the state in order to link them with clinical, educational or rehabilitative services. Materials and Methods: Primary health care workers (PHCWs) and volunteers were used as key informants over a 10-day period to trace visually impaired/blind and bring them to an examination venue. This followed mobilization and sensitization of the community leaders. A team of an ophthalmologist, optometrist and ophthalmic nurse conducted the eye examination in each LGA on a fixed date including refraction. Results: A total of 107 children were reviewed as children having eye problems. Girls constituted 45% of the children. Twenty-seven children (25%) were found blind using a VA of <3/60 or failure to fixate a penlight in the better eye; and 19 (18%) were visually impaired. Eleven children needed glasses while 18 others were referred for refraction at base hospital. Eighteen children needed cataract surgery. Twenty-five percent of the children were not enrolled in any school, only one child was enrolled in School for the multiple handicapped and 31% need to be enrolled in formal school. Sixteen children need enrolment into an inclusive education school, as they were irreversible blind. Conclusion: The major causes of childhood blindness in Sokoto state are either preventable or curable.
  2,325 255 -
Proptosis because of nasal inverted papilloma masquerading as cholesterol granuloma
Shivcharan Lal Chandravanshi, Malay Verma, Nirmala Subramanian
January-June 2014, 6(1):30-32
Inverted papilloma is a relatively uncommon neoplasia of the nasal cavity and paranasal sinuses. We report a case of a 52-year-old patient having sinonasal inverted papilloma masquerading as orbital cholesterol granuloma. The cholesterol granuloma was removed by combined superior orbitotomy approach and nasal endoscopic route under general anesthesia. The diagnosis was confirmed by histopathological examination. Postoperative nasal endoscopic examination and CT scan revealed no residual tumor, with no recurrence over twelve months.
  2,336 201 -