Indian Journal of Ophthalmology最新文献

Purpose: This study aimed to determine the effect of intense pulsed light (IPL) treatment on meibomian gland disease.

Settings and design: This is a prospective interventional study.

Methods: Seventy eyes of patients with dry eye disease undergoing three sessions of IPL therapy, 15 days apart, were included. Each patient completed the dry eye questionnaire (SPEED) for symptomatic assessment. Dry eye evaluation tests were performed, including Schirmer's 1 test, meiboscopy, noninvasive tear break-up time (NIBUT) and interferometry. These tests were repeated before each IPL session.

Statistical analysis used: Data analysis was performed using IBM SPSS Statistics software (Version 20, Inc., Chicago, Illinois, USA). To Kolmogorov-Smirnov test was used to assess the normality of the variables. The Chi-square test was applied for statistical analysis. Level of significance was set at p ≤ 0.05.

Results: The mean symptom score from the dry eye questionnaire (SPEED) showed a significant reduction of 24.5% ( p < 0.001) in symptoms. Schirmer's 1 test showed an improvement of 16.43% on day 15 and 40.13% on day 45. Meiboscopy grade improved by 13.54% on day 45. NIBUT improved from 53.29% on day 15 to 135.53% on day 45. Interferometry showed an improvement of 58.91% on day 45.

Conclusions: The various investigative tests demonstrated both qualitative and quantitative improvements in dry eye disease, and patients reported symptomatic relief. The effects of IPL therapy, in terms of symptomatic relief, continued to improve with each session. The quality of the tear film also improved progressively. IPL therapy is a potential therapeutic option for MGD.

Purpose: To analyze the clinical profile of vernal keratoconjunctivitis (VKC) and its response to treatment in human immunodeficiency virus (HIV) patients and its relation with CD4 counts.

Methods: This study is a retrospective observational case series of patients with HIV and VKC.

Results: Thirteen patients presented with HIV and VKC, with 69.2% having a severe-grade VKC. Median age of onset of VKC was 5 years in children and 31.5 years in adults. Seventy percent had a drop in CD4 counts at the onset of VKC. The duration between diagnosis of HIV and onset of VKC was statistically less in adults than in children. Eleven were on highly active antiretroviral therapy at presentation, and three patients were changed to second line of therapy, two of whom showed worsening of VKC just before shifting.

Conclusion: The study thus highlights the correlation between worsening of VKC and decrease in CD4 counts, and thus there is a need for aggressive management of HIV to prevent VKC-related complications.

Allergy is one of the most common diagnoses in an ocular surface clinic, and its treatment can range from a simple lubricant to the most complex combinations of medications belonging to several diverse classes. Antiallergics are the most commonly used medication overall in all forms of allergy. Several options are available, and it is important to understand how to start, select, and continue their use. Understanding the nature and severity of allergy is key to understand the effectiveness and limitations of this class of drugs in each patient. The article provides a brief overview of antiallergics in the for the busy practitioner.

Purpose: To study the outcome of tenonplasty in eyes with perilimbal ischemia in acute ocular surface burns.

Methods: This was a single-center retrospective study that included all patients presenting between May 2012 and December 2022 with acute ocular surface burn (within 6 weeks from injury) with perilimbal scleral ischemia, without perforation or previous surgical intervention for the same. All these patients underwent single-stage tenonplasty with amniotic membrane transplantation and medical management. Successful outcome was defined as globe preservation at 6 months.

Results: Twenty-three eyes of 20 patients were included in our study. Out of these, alkali was the most common offending agent (10 eyes of 8 patients). The extent of scleral ischemia was <90° in seven eyes, 90°-180° in six eyes, and >180° in 10 eyes. The mean interval between the injury and tenonplasty was 16.5 days. Globe integrity in 20 of the 23 eyes was maintained 6 months post injury. Three eyes that developed hypotony at the end of 6 months had more than 180° of perilimbal scleral ischemia at presentation. The extent of scleral ischemia correlated with the development of phthisis bulbi, but the values were not statistically significant ( P = 0.081).

Conclusion: Tenonplasty in the acute stage acts as a globe-salvaging procedure in acute chemical burns with perilimbal scleral ischemia. Extensive scleral ischemia in an acute chemical burn remains a poor prognostic factor for globe integrity in the long term.

Purpose: To study the techniques, clinical outcomes, and complications of autologous Tenon's patch grafting in patients with non-infectious corneal melt.

Methods: This retrospective analysis included 15 eyes from 15 patients with non-infective corneal melt who underwent autologous Tenon's patch grafting between January 2021 and December 2023 at our tertiary care institute. The age of the patients ranged from 16 to 79 years (mean: 46.64 ± 17.20 years), and there were eight males and seven females. Tenon's tissue was harvested from the same eye in all patients, placed on the perforation site, and tucked in and secured with 10-0 nylon sutures in 14 eyes and with additional cyanoacrylate glue in one eye. The follow-ups ranged from 1 month to 2 years (mean: 9.17 ± 6.83 months).

Results: The graft healed with scarring and vascularization in 10 eyes (66.67%), and loss of Tenon's patch graft was seen in two eyes (13%). Three (20%) patients were lost to follow-up, and five (33%) achieved a vision of >20/200.

Conclusion: In active immune corneal melt, Tenon's patch graft restores cornea and globe integrity, delaying the need for keratoplasty in an inflammatory condition.

The immunology of the ocular surface has an important role in maintaining homeostasis and in the etiopathogenesis of a number of diseases when dysregulated. This can result in damage to the cornea and ocular surface and loss of clarity and vision. As the entire ocular surface is linked via its epithelium, vascular supply, and innervation, changes across one aspect have tangible effects on the other. Immune cells residing on the ocular surface and those that traffic across the ocular surface interact with the structural tissues to release molecular factors and result in tissue response and disease. Studies in animal models and in vitro experiments along with in vivo studies on the human ocular surface have given newer insights with closer representation of actual health and disease. Some of the diseases which have been found to have a strong immunological basis include dry eye disease (DED) and Sjogren's syndrome, keratoconus, corneal graft rejection, autoimmune conditions such as peripheral ulcerative keratitis, and Stevens-Johnson syndrome. The ocular surface immunology has unique patterns and signatures across different diseases. These give us an opportunity to understand the diseases better find newer targets for therapy and an opportunity to reduce visual morbidity. Clinically, we envisage a shift from steroids and broad action immunomodulators toward target specific drugs making personalized medicine and customized therapy the way forward.

Purpose: This study aimed to analyze the clinical presentation, treatment outcomes, and histopathology features of ocular surface squamous neoplasia (OSSN) in a South Indian population and correlate the area of lesions to the histopathological grade/severity of carcinoma in situ (CIN) and squamous cell carcinoma (SqCC) invasive and noninvasive tumors.

Methods: The study was a retrospective cross-sectional study. The study reviewed electronic medical records (EMRs) of 99 eyes of 99 South Indian patients who underwent en bloc excision and biopsy for tumors in the corneal and conjunctival epithelium with suspicion of OSSN over 1 year from January 2019 to December 2019. Postoperatively, patients were treated with three cycles of topical 0.04% mitomycin C eye drops. Sixty-three had requisite EMR data with a follow-up period of 1 year.

Results: Patients had equal gender distribution with an age range of 28-83 years. The most common clinical variant was leukoplakic lesion, and the area of the lesion was the only predicting factor for SqCC and CIN.

Conclusion: Bigger (T2) lesions should be strongly suspected for OSSN and promptly excised. Histopathologic analysis should be performed, and post-op topical mitomycin C or interferon alpha 2b is administered to avoid recurrence. In this study, by correlating the area of the lesion, we introduce a new variable that may aid in clinical prognostication alongside the AJCC classification.

To review the perioperative considerations, surgical techniques, and outcomes of amniotic membrane grafting for acute ocular manifestations in Stevens-Johnson syndrome (SJS) and discuss a novel amniotic membrane grafting method. An online literature search of published articles on amniotic membrane grafting in acute SJS was performed using appropriate keywords on March 1, 2024. The relevant articles were included and analyzed. The review summarizes the relevance of amniotic membrane grafting in the current scenario. It also compares different techniques of amniotic membrane grafting and the ocular surface coverage each procedure provides. A novel technique of amniotic membrane grafting has been discussed with a schematic explanation. It also summarizes the complications of amniotic membrane grafting and their management, and the long-term outcomes of amniotic membrane grafting in preventing chronic sequelae. One should have a lower threshold for doing amniotic membrane grafting in cases with ocular involvement. This prevents the development of long-term sequelae and subsequent corneal blindness.

The cornea is the most densely sensory innervated tissue in the body. Sensory corneal nerves are essential to maintain ocular surface homeostasis and are involved in the blink reflex, tear production, and the release of trophic factors that are key in the wound healing process. Compromise of corneal sensory nerves leads to neurotrophic keratopathy (NK), an uncommon degenerative disorder that may lead to corneal epithelial breakdown, ulceration, corneal opacification, and even perforation. Management of this condition is difficult and visual disability often ensues in affected patients. While treatment has been traditionally focused in promoting epithelial healing, the past decade has seen a breakthrough in new medical and surgical therapies geared toward promoting corneal reinnervation. This review presents a comprehensive update on NK, focusing on current as well as potential new strategies for its diagnosis and management.