Indian Journal of Ophthalmology最新文献

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: To explore whether a low-cost ophthalmoscope (Arclight) can be used by naive nonophthalmic examiners to effectively screen for pediatric eye disease.

Methods: Fifty-four children (108 eyes) were examined by five medical students using an Arclight. Gold standard examination was performed by an ophthalmologist using a slit lamp and indirect ophthalmoscope. Examinations performed included ophthalmoscopy of the optic disc, estimation of the cup-to-disc ratio (CDR), corneal light reflex test (CRT), Bruckner's reflex test (BRT), and evaluation of refractive error. We determined the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the nonophthalmologist's Arclight exam compared to the gold standard findings of comprehensive evaluation by pediatric ophthalmologists.

Results: Using the Arclight, the optic nerve exam was successfully completed in 65% of patients. CDRs above and below 0.5 could be determined with 66.7% sensitivity and 84.4% specificity. Arclight CRT measurements were significant ( P < .00001) predictors of strabismus, with 80% sensitivity, 95.1%, specificity, 80% PPV, and 95.1% NPV. BRT was not a significant predictor of amblyopia, with a 34.6% sensitivity, 85.7% specificity, 69.2% PPV, and 58.5% NPV. Refractive error was estimated with a success rate of 81% for emmetropia, 38% for myopia, and 21% for hyperopia. The Arclight ease-of-use was rated on average as 4.4 (SD = 0.9) on a scale of 1 to 5, with 1 being the hardest and 5 being the easiest.

Conclusions: Our study shows the Arclight as an affordable and effective alternative to the traditional ophthalmoscope for assessing eye disease in children. This device can improve eye health services in under-resourced regions.

Purpose: To compare the efficacy, safety, and tolerability of lifitegrast 5% versus carboxymethylcellulose (CMC) 0.5% in adult patients with dry eye disease (DED).

Methods: A total of 370 eligible patients with DED were randomized equally to receive twice-daily doses of a single drop in each eye of either lifitegrast 5% or CMC 0.5% for 12 weeks. Follow-up at weeks 2, 6, and 12 evaluated changes from baseline in primary [eye dryness score (EDS), ocular discomfort score (ODS), ocular surface disease index (OSDI), and tear film break-up time (TFBUT)] and secondary [Schirmer tear test (STT) score and corneal fluorescein staining (CFS) score] endpoints. Global improvement, safety, and tolerability were also assessed.

Results: At week 2, values of ocular discomfort score, OSDI, and conjunctival redness were significantly more favorable in patients treated with lifitegrast compared to CMC. At week 6, values of all study variables were better in patients treated with lifitegrast compared to CMC; differences between the groups were statistically significant for all except photophobia. This trend was also maintained at week 12. Global improvement and tolerability were found to be better with lifitegrast than with CMC. No serious safety concerns were reported in any treatment group.

Conclusion: To our knowledge, this is the first active-controlled trial informing on the efficacy, safety, and tolerability of lifitegrast 5%. Significantly more favorable values for EDS (except photophobia), ODS, OSDI, TFBUT, STT score, CFS score, and conjunctival redness score were achieved at week 12 with lifitegrast 5% compared to CMC 0.5%.

Collagen cross-linking (CXL) is considered as a successful therapeutic approach for corneal conditions like keratoconus and corneal ectasia. Despite its efficacy in stabilizing these conditions, the occurrence of post-CXL scars remains a concern. Keratoconus and other corneal ectasias are characterized by structural weaknesses in the cornea. This weakness contributes to the vulnerability of corneal scar formation. In addition, corneal biomechanics and tissue properties play a significant role in scar development. Procedural factors during CXL, including duration and intensity of ultraviolet light exposure, the concentration and type of riboflavin, and the precise application of treatment, have been identified as potential causes of scar formation. Individual patient factors such as variations in healing response and genetic predispositions, associated ocular allergy, and chronic contact lens wear can also impact scar development post-CXL. Understanding these variables is essential for risk stratification and personalized treatment approaches, ultimately optimizing patient outcomes. In addition, regular follow-up visits and patient education are essential to ensure optimal healing and minimize scar related complications. We have tried to explain the numerous reasons of scarring following epithelium-off CXL by conducting a thorough Medline search and reviewing our clinical images. This review serves as a concise overview of the causes and risk factors associated with scar formation after epithelium-off CXL.

Purpose: To study the association of retinopathy with vision-related quality of life in patients with blood dyscrasias.

Settings and design: A cross-sectional observational study was conducted at a university-based hospital.

Methods: Two hundred patients with blood dyscrasias underwent comprehensive ocular examination, including dilated fundus examination. Vision-related quality of life was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25).

Results: Retinopathy was observed in 99 out of 200 patients (49.50%) with blood dyscrasias. The most common retinal findings were venous tortuosity with dilation (31.70%), intraretinal hemorrhages (27.88%), soft exudates (12.50%), white-centered hemorrhages (12.50%), and arteriolar attenuation (12.50%). A significant association was found between retinopathy in blood dyscrasias and NEI-VFQ subscales of general vision ( P value: 0.01**), near activities ( P value: 0.04*), distance activities ( P value: 0.01**), mental health ( P value: 0.01**), color vision ( P value: 0.01**), peripheral vision ( P value: 0.01**), role difficulties ( P value: 0.01**), and social functioning ( P value: 0.01**).

Conclusion: The study highlights the prevalence of retinopathy in blood dyscrasia patients and its detrimental impact on vision-related quality of life. Regular fundus examinations are imperative for early detection and management of retinopathy to prevent significant visual impairment. Further research is warranted to elucidate underlying mechanisms and improve clinical management strategies.

The Schirmer strip measures tear volume in millimeters. A major limitation of the Schirmer strip is that it does not measure tear volume in a volumetric unit. Furthermore, the linearity range, lower limit of detection (LLOD), and lower limit of quantification (LLOQ) are not established. In this context, we developed a new filter paper based tear volume strip, which measures tear volume in microlitres (a volumetric unit), with a defined linearity range, LLOD, LLOQ, as well as inter-day and intra-day variability. We used standard Whatman filter paper no. 41, measuring 40 × 5 mm. Balanced salt solution (BSS) was used as a tear surrogate. By placing a specific volume of BSS at one marked end of the paper, we measured the distance travelled by the BSS after one minute. Different volumes of BSS (0.5, 1, 2, 4, 8, and 16 μl) were used, and the distance travelled by the BSS drop was recorded. Linearity was evaluated, and the LLOQ and LLOD were determined. Scale data were generated within the linearity range (10 replicates for each). Percentage recovery was calculated, and inter-day and intra-day variation as well as intra examiner and inter examiner coefficients of variation (CV%) were evaluated. High linearity (r2 = 0.976) was observed across all the tested volumes (0.5-16 μl), However, linearity improved within the tested volume range of 1-8 μl (r2 = 0.996). With an LLOD of 0.538 μl and an LLOQ of 1.63 μl, data for the scale were generated from 2-8 μl. Overall, volumetric recovery ranged from 97.34%-104%. The intra-day CV% ranged from 4.576% (for 2 μl) to 1.911% (for 5 μl) and 1.71% (for 7 μl). The inter-day CV% ranged from 1.715 (7 μl) to 4.36% (for 2 μl). The intra examiner CV% ranged from 0.422% (for 7 μl) to 2.66% (for 2 μl). The inter examiner CV% ranged from 1.93% (7 μl) to 3.69% (for 2 μl). This new tear volume measuring tool (named SI tear strip) represents a valuable tool for the measurement of tear volume (in μl) per unit time. This tool may be very helpful for the quantitative evaluation of dry eye patients and functional assessment of lacrimal glands.

Purpose: To evaluate the clinical profile of retinal artery occlusion (RAO) and impact of presentation on visual outcomes.

Design: A retrospective analysis of case files of 3070 patients with RAO was performed using electronic medical records.

Methods: Demographic data were analyzed using descriptive statistics. The differential distribution of risk factors of RAO with age was studied. Time to presentation and treatment effects were assessed using multivariate regression. Interaction plots were drawn to assess the impact of risk factors on outcomes.

Results: Central RAO was the most common type (n = 2443, 77.11%), followed by branch RAO (n = 500, 15.78%), while combined retinal vascular occlusion and cilio-RAO were rare. Most of the patients (71.40%) were male and had unilateral (96.81%) affliction. Almost half presented within the fifth (24.85%) and sixth (21.4%) decades of life. Hyperhomocysteinemia had a higher association (1.95, P = 0.0019) with younger patients (<40 years), while hypertension (3.64, P < 0.001), diabetes mellitus (DM; 4.18, P < 0.001), and coronary artery disease (CAD) (4.26, P = 0.002) were significantly commoner in older patients. CAD (5.1%) and cerebrovascular disease (0.6%) were detected after ocular presentation in some patients. Embolus, though detected rarely (1%), was associated (60%) with serious systemic disorders. Early presentation (<6 h) was associated with better visual outcomes (mean log of minimum angle of resolution 1.8 ± 1.3 vs. 2.1 ± 1.3, P = 0.032). Neovascular glaucoma (2.14% overall) was twice more common in DM (P < 0.0004) and led to further vision loss. Visual improvement occurred in 10% of patients over follow-up.

Conclusion: RAO occurs slightly earlier compared to coronary and cerebrovascular disorders and can precede their detection. Associated risk factors vary with the age of presentation. Presentation within 6 h needs facilitation for better outcomes and management.

Purpose: To characterize visual outcomes in Zone I and II open globe injuries with lens involvement.

Setting: Level 1 Trauma Center Hospital, Seattle WA.

Design: Retrospective case series.

Methods: Zone I and II open globe injuries between May 2009 and May 2018 were reviewed for lens involvement, demographic data, injury characteristics, associated ocular comorbidities, surgical details, and visual outcomes. Eyes with nontraumatic or surgical injuries, prior penetrating keratoplasty, or a history of cataract extraction were excluded. Visual outcomes were compared using the Kruskal-Wallis and Fisher's exact tests.

Results: A total of 145 Zone I and II globe injuries (63 without lens injury and 82 with lens injury) with at least 6 months of follow-up were included. Endophthalmitis was not identified in any patients without lens involvement, while 9 patients with lens injury (11%) developed endophthalmitis. Patients with lens injury demonstrated a more severe ocular trauma score (P = 0.003). Best-corrected visual acuity (BCVA) was significantly better (P = 0.03) in patients without lens injury compared to those with lens injury. The median (interquartile range) BCVA in the no-lens injury group was 20/40 (20/25 - 20/400), while in the lens injury group it was 20/80 (20/40-20/300). The location of intraocular lens (IOL) placement did not influence final visual acuity outcomes (P = 0.76). However, eyes left aphakic had worse BCVA compared to those that received a secondary IOL (P = 0.005).

Conclusions: Open globe injuries with lens involvement are associated with worse visual prognosis. An increased rate of endophthalmitis may contribute to this difference. In eyes requiring secondary IOL placement, the location of the IOL did not affect final BCVA.