Indian Journal of Ophthalmology最新文献

Purpose: To present a simple transconjunctival technique for the excision of intraconal orbital hydatid cysts.

Methods: This retrospective, non-comparative, clinical intervention case study was conducted between April 2018 and October 2023. The study included five patients presented to the Orbital unit of Assiut University Hospital with an intraconal orbital cyst, which histologically proved to be a hydatid cyst. In all cases, a conjunctival incision near the fornix was made depending on the cyst location as revealed by computed tomography (CT) or magnetic resonance imaging (MRI). A traction suture was applied to the two relevant recti muscles to guide the globe toward the desired direction. Blunt orbital dissection was made toward the cyst until exposing its anterior surface. A 20-gauge needle was introduced into the cyst and followed by aspiration of its content. The collapsed cyst was then removed by non-toothed forceps and followed by copious irrigation of the field. The follow-up period ranged from 11 to 58 months.

Results: The age of patients ranged from 11 to 44 years. Three were males and two were females. The cyst was iso-dense to the vitreous on CT and iso-intense to the vitreous on MRI. In all cases after aspiration of the content, the collapsed cyst was easily removed. None of the five patients developed recurrence during the follow-up period.

Conclusion: The removal of the collapsed orbital hydatid cyst in the intraconal space after the aspiration of its content via transconjunctival anterior orbitotomy is a simple, fast technique with early recovery and maximum cosmesis.

Cicatricial entropion can be challenging to manage, and surgery may lead to anterior lamellar and focal lash loss or tarsal scarring. We describe a surgical technique to address focal cicatricial entropion that avoids conjunctival incisions and minimizes changes to the aesthetic contour of the eyelid. Four patients underwent surgery with a square portion of the posterior row of eyelash follicles being excised anterior to the tarsus. A buccal mucous membrane graft was then harvested and inserted between the lamella. The plug served to recreate a mucosal membrane at the posterior reflection of the eyelid and separate the anterior and posterior lamella mechanically. With a mean follow-up of 5.16 months, no patients experienced regrowth of lashes at the graft site, and corneal irritation from aberrant eyelashes was abated. The buccal plug technique provides an aesthetically minded, less invasive approach to surgical management of localized entropion with trichiasis.

Purpose: To evaluate the lacrimal punctal changes in different age groups using anterior segment optical coherence tomography (AS-OCT).

Methods: A cross-sectional observational study was conducted between January 2023 and January 2024 including healthy subjects between 20 and 80 years. The selected eyes from healthy patients were divided into four age groups (21-35 years, 36-50 years, 51-65 years, 66-80 years), and lower lacrimal puncta were analyzed using AS-OCT. Outcome measures included external punctal diameter (EPD, distance between the highest points of the punctal papilla), internal punctal diameter (IPD), vertical canalicular depth (VCD), fluid seen within the punctum, and presence of ampulla.

Results: 128 eyes of 64 patients were included with 32 eyes in each group. The mean EPD ranges from 441.5 ± 74.9 μm to 638 ± 138.8 μm among different age groups. The mean IPD varies between 251 ± 22.2 μm and 335 ± 21.6 μm. The mean VCD ranges from 424.2 ± 127.2 μm to 925 ± 144.1 μm among different age groups. The fluid within the punctum in the age group 21-65 years was 85-91%, which decreased notably to 40% in the 66-80 years age group. Ampulla was present in 11 (8.5%) out of 128 eyes. All the punctal parameters were the highest in the premenopausal age group (≤50 years) compared to the postmenopausal age group (P < 0.001). The values of all punctal parameters were higher in males compared to females.

Conclusion: AS-OCT is a useful tool to evaluate lacrimal punctal structure in vivo. Age-related correlations were found in the punctal quantitative parameters.

Objective: This study investigates the practice patterns related to paediatric myopia among Paediatric Ophthalmologists in India, based on a 2023 survey conducted via Google Forms.

Methods: The survey aimed to gather insights into physicians' perceptions and experiences concerning the clinical and treatment aspects of myopia in children.

Results: The survey reveals several key insights into current practice patterns among Paediatric Ophthalmologists in India regarding paediatric myopia management. The recommended mean age for a child's first eye checkup is 3 years, underscoring the importance of early detection. Refractive error thresholds for prescribing spectacles are set at 3.0 D for infants, 2.0 D for preschool children, and 1.0 D for school-going children older than 3 years. There is a growing trend in using 0.01% Atropine eye drops for myopia management, with a mean prescription age of 4.83 years. Notably, 80.11% of respondents prioritize documenting myopia progression regardless of the child's age. Orthokeratology and Peripheral Defocus spectacle lenses are gaining recognition, and lifestyle modifications such as increasing outdoor activities and reducing near activities are widely acknowledged as effective. While most respondents do not use progressive lenses for myopia, there is significant emphasis on axial length measurements and considering the lag of accommodation. Additionally, under-correction of myopia is favored by a notable proportion of practitioners. These findings indicate a shift towards early intervention and evidence-based strategies in myopia control.

Conclusions: The survey highlights a shift towards early intervention and evidence-based myopia control strategies among practitioners. There is, however, room for improvement in standardizing approaches and considering additional factors like axial length and lag of accommodation. Collaborative efforts among policymakers, health regulatory bodies, and industry stakeholders are essential to enhance the accessibility and affordability of myopia control treatments and address the growing health burden associated with paediatric myopia.

Purpose: To compare the functional outcome and quality of life (QOL) index following non-endoscopic endonasal dacryocystorhinostomy (NEN-DCR) and external dacryocystorhinostomy (EXT-DCR).

Methods: Patients were prospectively allocated to two groups. All adult patients presenting with primary nasolacrimal duct obstruction (PANDO) undergoing EXT-DCR and NEN-DCR at a tertiary eye care center were included. Patients in one group underwent EXT-DCR and others NEN-DCR. Functional outcomes were measured by Munk Score and fluorescein dye disappearance test (FDDT). A validated quality of life questionnaire (EQ-5D-3L) in the local language (Odiya) was used to measure health status (social impact score) before and 1 day, 2 weeks, 6 weeks, and 3 months after surgery. The primary outcome measure was the functional outcome-Munk Score and secondary outcome measures included the QOL index and the FDDT.

Results: A total of 110 patients were recruited and equally distributed ( n = 55) in both groups. The mean age of the population was 47.6 years (SD = 14.02; range 20-79 years). The majority (71%, 79/110) were female. When longitudinally followed over time, functional outcome and QOL index showed reasonably rapid and marked improvement in both groups after surgery compared to baseline scores. The Munk score ( P = 0.037) and QOL index ( P = 0.007) were marginally better on the first postoperative day for the NEN-DCR group compared to EXT-DCR but comparable at all subsequent visits. At a median follow-up of 9 weeks (range: 0.5-24 weeks), the anatomical outcome was comparable between both groups.

Conclusion: Our results demonstrate that functional outcome and QOL index show rapid and marked improvement in both NEN-DCR and EXT-DCR after surgery. NEN-DCR outcomes were marginally better on the first postoperative day but comparable to EXT-DCR thereafter.

Purpose: In clinical ophthalmology, prisms, commonly made of glass, are labeled based on the prism diopter (PD) value measured in the anterior Prentice position. However, they are often used in the posterior parallel position for practicality, causing a discrepancy between labeled and effective PD. This study proposes a conversion tool to address this issue.

Methods: Geometric optical analysis was employed to calculate the effective PD of glass prisms in the posterior parallel position. A lookup table was created to convert the labeled PD of the anterior Prentice position to the effective PD when the prism is used in the posterior parallel position. Clinical data from 162 patients with horizontal strabismus were collected to validate the method. Glass prism measurements, converted to effective PD, were compared with acrylic prism results.

Results: The variations were significant in glass prism PD with rotation in the anterior Prentice position but stability in the posterior parallel position. Clinical deviations were larger with glass prisms, especially exceeding 30 PD, compared with acrylic prisms. Converted PD from glass prisms correlated well with acrylic prisms (R 2 = 0.94, P = 0.002). The half-width of the 95% limit of agreement was ±12.32 PD.

Conclusion: The proposed conversion table is valid, facilitating consistency between clinical and literature-based prism use in different positions and materials.