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Medicine and Dentistry >
Indian Journal of Clinical and Experimental Ophthalmology
Editor in chief: Dr. Rajendra Prakash Maurya
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Factors Influencing Healing Of Fungal Keratitis Under Treatment: A Clinical Study
Author:Ramyash Singh Yadav, Brij Mohan Rao, Praveen Kumar, Akash Srivastva
Volume: 2 | Issue no: 3-2016 | Pagination: 278-284
Purpose: To study the local and general factors influencing healing of fungal keratitis. To evaluate the effects of various antimycotic treatment regimens of fungal keratitis. Method: The patients were taken up from those attending the out-patient department of ophthalmology of Nehru hospital attached to B.R.D Medical College Gorakhpur from June 2006 to October 2007. All cases of corneal ulcer with clinical features of fungal keratitis and cases of corneal ulcer with positive 10% potassium hydroxide mount1,2 were selected, detailed history taken and examination done under (a) general examination, (b) systemic examination and detailed ocular examination along with blood investigations and 10% potassium hydroxide mount1,2 preparation. Treatment evaluation and follow up was done regularly for the period of one month, progression and treatment response noted and parameters were recorded .the ulcer was taken: Healed: If the epithelial defect had healed with negative fluorescein staining and there was no progressive stromal infiltration. Delayed healing: If the size of ulcer decreased but not fully healed and still require further active treatment and Failed: If the size of ulcer remained same or increased or ulcer got perforated requiring active surgical intervention. Result: 47 pts were included in study, 5 patients did not turn up. 18 patients (42.86%) leave the study with successful healing of corneal ulcer, 9 patients (21.43%) required further treatment due to delayed healing response and treatment failure occurred in 15 patients(35.71%) requiring active surgical treatment in form of conjunctival hooding, Amniotic membrane graft, evisceration etc. Conclusion: From the observation of this study it can be concluded that fungal keratitis is a suppurative, ulcerative disease of cornea, with a poor visual outcome even with the best efforts due to inability of highly sensitive and specific tools. Disease is more common in patients with reduced immunity, trauma with vegetative matter, low socio-economic status and injudicious use of steroids. There is also big lack of specific and effective fungicidal drugs. All available anti-fungal drugs are very slow acting and prevent the growth of fungus only, without killing it. At present the most effective drug is topical 5% Natamycin, which is also fungi-static and slow acting.
Nd-Yag Laser Posterior Capsulotomy And Visual Outcome
Author:Pankaj Soni, Akash Srivastava, Deepti Yadav
Volume: 2 | Issue no: 3-2016 | Pagination: 271-277
Introduction: Posterior capsular opacification is the most common delayed complication of cataract surgery with IOL implantation. This results due to proliferation and migration of reminant epithelial cells that form clump and fibrosis on the posterior lens capsule leading to posterior capsular opacification(PCO). Method: The cases for Nd-Yag laser posterior capsulotomy were collected from amongst those attending the ophthalmology OPD of Nehru chikitsalay, Gorakhpur in period of one year (May 2015 to June 2016). Patients were selected on the basis of inclusion criteria according to study requirement and observations were made for outcomes. Observations: The observations made on the basis of our study are as follows: - Maximum eyes (52%) were in the age group 50-60 years. - Male (61.7%) outnumbered female(38.3%) in ratio of 3:2. - Maximum number of cases need YAG laser capsulotomy between the period of 36 months -60 months. - Thick white opacification type of PCO required maximum energy and maximum shots. - Post-YAG Laser capsulotomy visual improvement is 87.3% in 6/12 to 6/6. - 5.1% cases shows no change. - Most frequent complications is rise of intra ocular pressure. Conclusion: - Depending upon the thickness/density of PCO three types of PCO?s were encountered. - Most frequent complication is rise of IOP, which is mainly seen in eyes exposed to total laser energy level of >40mJ or above, this rise of IOP respond well to timolol 0.5%. - When the energy levels are raise, the complications also raises, thus to minimize this number of settings should be increased. - It is safe and readily acceptable to patients.
A Clinical Study Of Corneal Complications Of Manual Small Incision Cataract Surgery
Author:Anitha S. Maiya, Akshatha M. Dharmesh, R. Jayaram
Volume: 2 | Issue no: 3-2016 | Pagination: 266-270
Aims and objectives: To study: (i) the various postoperative corneal complications of manual small incision cataract surgery,(ii) the preoperative and intraoperative risk factors contributing to such complications, and (iii) the final visual outcome in the patients with corneal complications. Design: It is a prospective, hospital based observational study. Materials and methods: We studied 60 eyes of 60 consecutive patients with visually significant cataract who underwent manual small incision cataract surgery with implantation of posterior chamber intraocular lens. The postoperative corneal complications and best corrected visual acuity of these patients were studied on postoperative day 1, 7, 15, 30 and 45. The preoperative risk factors if any and intraoperative complications were noted. Results: 60 eyes of 60 consecutive patients who underwent manual small incision cataract surgery were studied. Corneal complications were seen in 7 patients(11.67%); of these striate keratopathy was seen in 5 patients (8.3%), 1 patient (1.67%) had a Descemet?s membrane detachment and 1 patient (1.67%) had microcystic corneal edema. Corneal complications were seen in patients with preoperative risk factors and in patients with intraoperative difficulties during surgery. At the end of 6 weeks postop, 95% of the patients achieved a best corrected visual acuity of 6/9 or better. Conclusions: Corneal complications after Manual small incision cataract surgery should be anticipated in patients with preoperative risk factors and prolonged and difficult surgeries. With timely and appropriate treatment, most of the corneal complications resolve by the 2nd postoperative week. Careful preoperative planning and meticulous surgery can prevent most of these complications.
Rate Of Microbiological Contamination Of Multi-Use Vials Of Bevacizumab And Risk Of Endopthalmitis
Author:Abhishek Agarwal, Nikhil Dixti, Neeti Garg, Rohini Godara
Volume: 2 | Issue no: 3-2016 | Pagination: 263-265
Introduction: To determine the rate of microbiological contamination in multi-use vials of bevacizumab used for multiple intravitreal injections and to determine the rate of endophthalmitis in patients who received intravitreal injections from these vials. Methods: Eighteen 100-mg (4 mL) vials of bevacizumab (Avastin; F. Hoffmann-La Roche Ltd. Switzerland) were used for 327 intravitreal injections in period of 18 months. These vials were stored in refrigerator at 2 ? 8 oC for 30 days. From each vial, two samples of 0.05ml of avastin was withdrawn with the help of 1ml syringe at 7 and 30 days after the opening the vial. These samples were send for bacterial and fungal staining and culture. 327 patients who received intravitreal injections were monitored for signs and symptoms of inflammation or endopthalmitis. Results: No evidence of microbiological contamination was detected in 18 vials sent for microbiological staining and culture. 327 patients who received intravitreal injections from these vials did not showed any signs or symptoms of inflammation or endopthalmitis. Conclusions: Using the muti-use vials of bevacizumab for intravitreal injections which are stored for up to 30 days in refrigerator at 2?8 oC is safe.
Assessment Of Dry Eye In Rural Hospital Setting, B.G. Nagara, Karnataka
Author:Sundip Shenoy, Reagan Madan
Volume: 2 | Issue no: 3-2016 | Pagination: 257-262
Background: Dry eye is a common condition that is often under diagnosed. Normal vision requires moist healthy ocular surface. A sufficient quality of tears, normal composition of tears film, lid closure to maintain healthy ocular surface. Due to lack of uniformity in definition and inability of any single diagnostic test or set of diagnostic test to confirm or rule out the condition. There has been a shift towards symptom based assessment as a key component in clinical diagnosis with grading of severity of dry eye. Use of symptom based validated questionnaire might be beneficial as it allows grading of symptoms and is repeatable for comparative purpose before, during and after treatment. Recent advances in treatment suggests the use of lubricants, antiinflammatory drugs, plugs to augment the tear film. Objectives: A prospective study was conducted to assess the dry eye in rural hospital setting at B.G. Nagara Karnataka with the objective to study the frequency of occurrence of dry eye and identify risk factors, correlate dry eye status with clinical tests, demographic and disease profile and devise appropriate therapy. Methods: A total of 63 cases were chosen from the outpatient department of Sri Adichunchanagiri Institute Of Medical Sciences and assessment of dry eye were made by tests like Tear breakup time, Schirmer?s, Rose Bengal dye test with prior administered Ocular surface disease index (OSDI) questionnaire for subjective grading of dry eye. Results: In our study majority 31.7% patients were in the group 41-50 years. Prevalence of overall dry eye in our study was 85.7%. Prevalence was more in females as compared to males. Risk factors associated with dry eye were identified with diabetes mellitus type II being more prevalent among them. In the study Osdi questionnaire had a good reliability and consistency (p<0.001). Pearson correlation with r value among various test like Tear breakup time, Schirmer?s, Rose Bengal dye test and OSDI score showed a good correlation. Conclusion: Dry eye is a chronic disease and increase in prevalence of dry eye increases with age. Subjective tests like OSDI correlated well with objective tests in our study. Grading of dry eye helps in better management of dry eye and its complications.
The Prospective Study Of Clinico-Etiological Analysis On Patients Of Papilloedema
Author:Chetan P. Saoji, Surendra P. Wadgaonkar, Preeti A. Patil, Bhimrao S. Kamble
Volume: 2 | Issue no: 3-2016 | Pagination: 253-256
Background: As the etiologies of papilloedema are important from prognostic point of view, early recognition of its cause & prompt treatment is required for better visual outcome. Objective: To study the etiology of the papilloedema in concerned patient and to study the optic disc changes by using ophthalmoscope and classify papilloedema. Materials and Methods: This prospective study was based on patients presenting to our tertiary care hospital. 45 cases were selected amongst the patients attending our hospital during the study duration from July 2012 to July 2014. 45 patients were registered and informed consent was taken prior to study, those patients not giving consent for study were excluded. These participants were interrogated their demographic, investigative and management data were recorded and documented on predesigned and pretested proforma, and analyzed by using SPSS version 17. Results: Papilloedema occur in a wide range of age group but are more common in the age group of 31-40 years. Overall, males were affected more than females. All the patients had bilateral papilloedema. The common etiological factor for papilloedema was intracranial space occupying lesion. According to stages of papilloedema, early papilloedema was most commonly seen. 57.2% of the patients had normal visual acuity (unaided) in papilloedema and all the patients had normal color vision pattern. Conclusion: A careful history, general and complete ophthalmological work-up with necessary investigations like CT, MRI/MRV are mandatory to diagnose patients with papilloedema.
Pattern Of Refractive Errors Among The Patients Presenting To Eye Department Of District Hospital Of Uttarakhand
Author:Manu Bhardwaj, Lokesh Kumar Singh, Alka Gupta, Bhaskar Dutt
Volume: 2 | Issue no: 3-2016 | Pagination: 248-252
Introduction: Refractive errors are the most common eye disorder encountered in eye OPD of any region worldwide. Global estimates indicate that more than 2.3 billion people in the world suffer from poor vision due to refractive error (RE), this study was conducted to see the pattern of refractive errors in patients of district hospital, which serves most of the population of hilly region of Garhwal, Uttarakand. Material and Methods: The present hospital based prospective study was conducted in the department of ophthalmology, district hospital Dehradun. All patients from the age of 5 and above attending the eye OPD were taken for the study for the period of 2 months from 25 April?16 to 24 June?16. They were referred for refraction after proper anterior and posterior segment evaluation. Presbyopia was not analysed in our study. Results: During the study period 1986patients attended the eye OPD. Out of which 259(13.04%) had refractive error. Out of which 98 were male(37.84%) and 161 were female(62.16%), age of the patients varied from 5 to 65 years with a mean age of 31.89 years. Among them 93(35.91%) had myopia, 73 (28.19%) had hypermetropia, 49(18.92%) had ATR astigmatism, 25(9.65%) had with the rule astigmatism, 19(7.33%) had oblique astigmatism. Discussion: Refractive errors are important cause of visual impairment in developing countries, specially in remote areas, it is very difficult to provide efficient refraction services. Among the refractive errors, myopia was the commonest, constituting 35.91% of all refractive errors. Followed by hypermetropia 28.19%, ATR astigmatism 18.92%, WTR astigmatism 9.64%, oblique astigmatism 7.34%. It was seen that prevalence of myopia is more in younger age group of 15 to 24 years as compared to hypermetropia, which is increasing with age, with peak at 46 to 55 years. It was seen that hypermetropia was also more common among women(p<0.05). According to a study by Prema et al, which was conducted in Tamil Nadu, Hyperopia was commoner among women than men (p = 0.001); was positively associated with diabetes mellitus (p = 0.008) in the rural population. In our study it was seen that ATR astigmatism was found more common than WTR astigmatism(p=0.00262). WTR astigmatism was more in 5-15 years age group. ATR astigmatism was more seen in 26-45 years of age group. Conclusion: Refractive errors are common eye conditions, which can be easily corrected with appropriate spectacles. Myopia is more common in younger population while hypermetropia is more common in older age groups.
Ocular Manifestations Of Rheumatic Diseases: A Hospital Based Study
Author:Kamran M Hassan, Manish S, R. Ravikumar, Syed Asghar Hussain
Volume: 2 | Issue no: 3-2016 | Pagination: 242-247
Background: Changes in the organ of sight in rheumatic diseases may result from the inflammatory process because of immunemediated ocular inflammation which causes severe debilitation and visual loss. Therefore by understanding the various ocular presentations of these systemic inflammatory diseases is vital so as to arrive expeditiously at the correct diagnosis and treatment plan with the goal of preserving visual function. Methods: A cross sectional study was done on patients over a period from November 2014 to September 2015. A total of 102 patients with rheumatic disease were investigated for any ocular manifestations after obtaining informed written consent. ACR(American College of Rheumatology) criteria was used for the diagnosis of Rheumatic Diseases. Ocular investigation for dry eye included Schirmer?s test, Tear film break up time test (TBUT) and 1% Rose Bengal test. Positivity for Immunological factors and their association to ocular manifestations statistically analyzed. Results: The overall incidence of ocular manifestations of the rheumatic disease process in the study was 63.7% (65 cases). Uveitis incidence was 34.3%(35 cases) being the commonest ocular abnormality detected followed by KCS of 19.6%(20cases). The total number of cases with ANA positivity in Rheumatic disease is 22 as in Table 4, those with ocular manifestations and ANA positivity is 16 out of 20 (80%) as in Table 5. Six (50%) of the twelve patients with Keratoconjunctivitis sicca had high Rheumatoid factor titer values by slide agglutination (> 1:128). Conversely of the seven patients with high Rheumatoid factor titer values (> 1:128), six (85.7%) had Keratoconjunctivitis sicca. Conclusion: Therefore, following a multidisciplinary approach by ophthalmologists, rheumatologists, physicians and pediatrician would help for an early intervention to preserve vision where possible.
A Study To Evaluate The Cause Of Blindness/ Low Vision Among Certified Visually Disabled Individuals In Mandya District Of Karnataka
Author:Srinivas Siddegowda, Pradeep Addagadde Venkataramana, Manjula Thambuswamy Ramamurthy, Prathibha Shiv
Volume: 2 | Issue no: 3-2016 | Pagination: 238-241
Aim: To identify the demographic characteristics, degree and cause of visual disability among certified visually disabled individuals in Mandya district, Karnataka, India in patients attending Ophthalmology OPD. Materials and Methods: Retrospective record based observational study was carried out in teaching Hospital of Mandya district. Data was collected from visual disability certificates of patients who attended our OPD during the period May 2013 to May 2016. The cause of the visual loss was ascertained. Information from the history, clinical examination and investigations was compiled. Results: In our study, a total of 152 patients were enrolled out of 170 cases. Children and young adults up to age of 30 years constituted around (48, 31.57%) of cases. Among certified visually disabled individuals there were more males (105, 69.08%) compared to females (47, 30.92%). Amount of visual disability percentage of 100%, 75% and 40% was seen in 102(67.10%), 36(23.68%) and 14(9.21%) people respectively. Congenital ocular malformations (32, 21.05%), Retinitis pigmentosa (27, 17.76%) and Optic atrophy (21, 13.81%) were responsible for more than 50% of the cases. Conclusion: Children and young adults constitute around one third of disabled individuals. Men are more common beneficiaries when compared to women showing gender bias. Congenital ocular malformation and Retinitis pigmentosa were the most common causes of certified visual disability.
Prevalence Of Ocular Pseudo Exfoliative Syndrome In Rural Population: A Study From South India
Author:Sujani Narendra Bairy, Pravenya Praveen Kemidi
Volume: 2 | Issue no: 3-2016 | Pagination: 231-237
Introduction: Pseudo-exfoliation is a complex age related disorder of production and accumulation of fibrillar material in the anterior segment of eye.It is more common as the age advances. It is also associated with serious ocular problems such as cataract and glaucoma. Aims: To find out the prevalence and pattern of clinical presentation in pseudo-exfoliative syndrome in patients visiting ophthalmology out- patient department in a rural area. Materials and Methods: This was a prospective study carried out over a period of one year in the department of Ophthalmology, Mamata Medical College and associated General Hospital, Khammam. In this study 2000 individuals, (1111 male and 889 female) above the age of 40 years, were selected randomly and complete ocular examination was done in these subjects. Results: Ninety (4.5%) out of 2000 individuals screened showed varying degree of pseudo-exfoliation syndrome in one or both eyes. The prevalence rate increased with advancing age. It was 4.5%, at 40 years and above, 5.35 %, 6.35 % and 6.89 % at 50, 60, and 70 years and above respectively. In males the prevalence rate was 5.67% and in females 3.03%. Mean age at which this syndrome was detected is 67.32 SDą8.81 years. In males, it was 68.84 (SDą8.26) years and in females 63.96(SDą9.20) years. Bilateral involvement of the eyes was more common. Frequency of signs of pseudo- exfoliation syndrome increased with advancing age and the common signs were pseudoexfoliation material over pupillary border, over anterior capsule of lens, peripheral band, pupillary ruff defects, pigment deposition over trabecular- meshwork and over endothelial surface of cornea, and on anterior surface of lens capsule. Conclusion: Pseudo-exfoliation syndrome is common in hospital visiting population especially in the elderly population in rural South India. Thorough ophthalmologic examination helps to pick up this syndrome. Early detection helps to prevent associated complications such as cataract, glaucoma capsulare and phacodonesis.
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