Indian Journal of Ophthalmology最新文献

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.

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.

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: There are no universally established guidelines for material selection in orbital wall fracture reconstruction. With an increasing preference for permanent implants, this study aimed to compare the long-term clinical outcomes of three different non-resorbable materials in reconstructing isolated orbital floor fractures.

Design: A retrospective, interventional comparative study.

Methods: The medical records of patients with unilateral pure orbital floor fractures who underwent orbital reconstruction using non-resorbable alloplastic implants at two tertiary referral centers between January 2017 to December 2021 were reviewed. Cases with non-pure orbital floor blowout fractures and/or <2 years of follow-up were excluded. Patients were separated into three groups according to the implant material type: porous polyethylene (PPE) sheet, polypropylene (PP) mesh, and titanium (Ti) mesh. These groups were then retrospectively analyzed for clinical outcomes, implant-related complications, and patient's satisfaction.

Results: Sixty-six patients met the inclusion criteria. Twenty-four patients (36.36%) received PPE sheets, 20 patients (30.3%) had PP mesh, and 22 patients (33.33%) received Ti mesh. At the 6-month postoperative visit, nine patients (40.9%) in the Ti mesh group experienced postoperative diplopia compared to six patients (30.0%) in the PP group and one patient (4.2%) in the PPE group (P < 0.047). Following the initial 6-month postoperative period, the PP group had more frequent postoperative enophthalmos compared to the other 2 groups. The total ocular motility restriction score was significantly lower in the Ti mesh group compared to the other 2 groups at all follow-up visits. Patient's satisfaction was significantly higher in the PPE group (median = 10, IQR = 1) compared to the PP (median = 8.5, IQR = 3) and Ti groups (median = 8, IQR = 3), P < 0.001. Reoperation was needed in seven patients (31.8%) in the Ti group, two patients (10%) in the PP group, and none in the PPE group.

Conclusions: The use of PPE orbital implants for the repair of isolated orbital floor fracture provides better long-term clinical outcomes compared to PP or Ti mesh and reduces the need for reoperation across all fracture sizes. Ti mesh has been associated with a higher frequency of unfavorable clinical outcomes and implant removal.

Purpose: To investigate the effect of S-100 absorbable hemostatic patch coverage on anastomotic mucosa in endonasal endoscopic dacryocystorhinostomy (En-DCR).

Methods: Two hundred and twenty-six patients with unilateral chronic dacryocystitis (CD) were randomly divided into two groups in a randomized controlled trial: the S-100 absorbable hemostatic patch group (group A) and the control group (group B). All patients underwent En-DCR. Group A received an S-100 absorbable hemostatic patch covering the wound approximately 2 mm around the ostium at the end of the En-DCR, whereas group B received no treatment. The patients were followed up for 12 months, and the mucosal epithelialization of the wound, granulation formation, bleeding, and success rate of ostial patency were compared between the two groups.

Results: Our study included 106 patients in group A and 102 patients in group B. After 2 weeks, the intact mucosal epithelium lining the ostia was 96 in group A and 77 in group B. At 12 months follow-up, there were five patients with scars (4.7%) and seven patients with granulomas (6.6%) in group A, compared with 17 patients with scars (16.7%) and 18 patients with granulomas (17.6%) in group B. There were significant differences in scar formation and granuloma formation between the two groups (P = 0.007 and 0.007, respectively). The success rate of anastomotic patency was 92.5% (98/106) in group A and 78.4% (80/102) in group B (P < 0.05). Postoperative bleeding was more substantial in group B than in group A (P < 0.05).

Conclusion: S-100 absorbable hemostatic patch cover can reduce the risk of postoperative bleeding and improve the success rate of EN-DCR treatment of CD by promoting healing of the anastomotic mucosa and preventing wound scar and granuloma formation after EN-DCR.

Purpose: The primary objective of this study was to investigate the possible role and assess the potential relationship of speculum use during phacoemulsification surgery in the occurrence of blepharoptosis.

Methods: Our study is a prospective observational design to analyze patients who underwent phacoemulsification surgery under topical anesthesia between October 2017 and May 2018 at a tertiary eye hospital in South India. All patients had their Margin Reflex Distance 1 (MRD1), levator palpebrae superioris (LPS) function, and lid crease distance (LCD) measured before and after surgery on day one, one month, three months, and six months to evaluate the extent of ptosis at each time point that was recorded clinically and photographic documentation for accurate evaluation.

Results: Out of the 221 patients who participated in the study, a total of 250 eyes were examined. On postoperative day one, 34 patients (15.8% with a rigid speculum and 11.4% with a non-rigid speculum) developed ptosis. At the one-month follow-up, ptosis persisted in four patients, with one patient having undergone surgery using a rigid speculum and the rest of three patients with a non-rigid speculum. However, further follow-ups at three and six months revealed a complete resolution of ptosis in all cases, indicating that the ptosis was transient and resolved spontaneously.

Conclusion: Speculum use cannot be considered as the sole causative factor for postoperative ptosis, as a multitude of other modifiable factors, such as superior rectus bridle suturing, anesthetic approach, prolonged patching, and duration of surgery, may have an additive effect alongside speculum used in the development of postoperative ptosis.

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.