Acute corneal hydrops in keratoconus

Acute corneal hydrops is a condition characterized by stromal edema due to leakage of aqueous through a tear in descemet membrane. The patient presents with sudden onset decrease in vision, photophobia, and pain. Corneal thinning and ectasias combined with trivial trauma to the eye mostly by eye rubbing is considered as the underlying cause. With conservative approach self-resolution takes around 2 to 3 months. Surgical intervention is required in cases of non-resolution of corneal edema to avoid complications and for early visual rehabilitation. Intracameral injection of air or gas such as perflouropropane is the most common surgical procedure done. Recent investigative modality such as anterior segment optical coherence tomography is an extremely useful tool for diagnosis, surgical planning, and postoperative follow up. Resolution of hydrops may improve the contact lens tolerance and visual acuity but most cases require keratoplasty for visual rehabilitation

Awareness and Referral Patterns of Diabetic Retinopathy: A Hospital Based Study

Introduction: Diabetic Retinopathy (DR) has emerged as an important cause of ocular morbidity and blindness in past 20 years. About one fifth of known diabetics are projected to have DR in their lifetime. Thus awareness about DR is an important determinant in reducing the burden of blindness due to DR. Aim: To identify the factors that accounts for poor awareness about DR among patients with Diabetes Mellitus (DM). Materials and Methods: Three hundred thirty cases of DM who were undergoing screening for the first time were subjected to questionnaire to assess their awareness about DR. On the basis of awareness about visual blurring caused by diabetes the cases were divided into two groups, Group I included aware cases and Group II unaware cases. Various factors were then compared between these two groups like demographic profile, literacy level, Socioeconomic Class (SEC), family history, type and duration of DM. All cases were under treatment for DM and majority was on oral hypoglycaemic agents. Results: The study included 330 cases undergoing retinal screening for the first time. The mean age of the study group was 52.8±11.3 years with 54.5% male and 45.5% female cases. Overall, 226 cases (68.5%) were aware that DM could lead to visual impairment (Group I) and 104 (31.5%) cases were unaware of the condition (Group II). Awareness was more in male patients (54.5%), with positive family history (23%), with higher educational qualification (70%) and those belonging to a high SEC (55.8%). The rate of referral by the first contact physician for routine DR screening was 21.2%. The source of information for most of the cases was print media. Conclusion: Literacy and SEC are important factors for awareness of DR. Practice pattern among primary care physician also affects the awareness of DR

Comparison of biomechanical properties between post penetrating keratoplasty and deep anterior lamellar keratoplasty in keratoconus patients using ocular response analyser

Introduction: Corneal biomechanics have been studied over recent years. The Ocular Response Analyser (ORA) is the first simple device able to measure the biomechanical properties of the cornea. Deep anterior lamellar keratoplasty (DALK) is considered an alternative procedure to penetrating keratoplasty (PK) in advanced keratoconus patients that leaves the host corneal endothelium and Descemet’s membrane intact. This provides thea dvantage of an absence of potential corneal endothelial rejection. The aim of the study was to compare the biomechanics between the two keratoplasty techniques. Method: This prospective comparative study included 150 eyes of150 patients. Patients were divided into 3 groups. 50 eyes with no previous surgery (Group1), 50 eyes of post PK (Group2) and 50 eyes of post DALK (Group 3) in advanced keratoconus patients were included in the study. Corneal Hysteresis (CH), corneal resistance factor (CRF), Goldmann- correlated intraocular pressure (IOPg) and corneal compensated intraocular pressure (IOPcc) was measured using Reichert ocular response analyser at 1 year follow up. Results: Mean age of the patients in PK group was 24.2±6.83 years and 20.95±6.49 yrs in DALK group ( p value < 0.126 , statistically insignificant). Mean CH in control group (10.9±1.42) and DALK group (10.5±3.79) was significantly higher than PK group(9.1±2.36)( p value < 0.01). Mean CRF in control group (10.6±2.56) and DALK group (10.1±3.2) was significantly higher than PK group (8.87±2.68) ( p value <0.01). However in these groups no statistically significant difference was seen in IOPcc and IOPg. Conclusions: Corneal biomechanical properties in post penetrating keratoplasty and lamellar procedures differ significantly

Ocular allergy and keratoconus

Keratoconus is the most common corneal ectatic disorder, the cause of which is largely unknown. Many factors have been implicated, and the ocular allergy is being one of them. The commonly proposed pathogenesis includes the release of inflammatory mediators due to eye rubbing which may alter the corneal collagen and lead to corneal ectasias. The onset of keratoconus is often early in cases associated with allergy and routine corneal topography may detect subtle forms of keratoconus. These cases may require early keratoplasty and are at an increased risk of having acute corneal hydrops. Surgical outcomes are similar to primary keratoconus cases. However, post-operative epithelial breakdown may be a problem in these cases. Control of allergy and eye rubbing is the best measure to prevent corneal ectasias in cases of ocular allergy

Ocular manifestations in Kindler syndrome

We aimed describe the chronic ocular sequelae of Kindler syndrome. All cases of Kindler syndrome with ocular involvement that presented to a tertiary eye care center were included. Three cases of Kindler syndrome with ocular changes were reviewed. Case 1 (10 years, female) had recurrent epithelial breakdown with severe dry eye and corneal opacity secondary to keratitis. Case 2 (28 years, male) had symblepharon , ocular surface keratinization , and severe dry eye. Case 3 (16 years , female ) had partial limbal stem cell deficiency with dry eye. All cases were treated with topical lubricants, short course of low-potency steroids and immuno-modulators. Attention must be paid to the eye in addition to the oro-an-genital mucosa to avoid longterm ocular sequelae

All India Ophthalmological Society members survey results: Cataract surgery antibiotic prophylaxis current practice pattern 2017

Purpose: The purpose of this article is to document the current practice pattern of Indian ophthalmologists for antibiotic prophylaxis in cataract surgery to prevent endophthalmitis. Methods: Fifteen structured questions were sent online to all ophthalmologists registered with the All India Ophthalmological Society. The questionnaire was divided into three main categories of prophylaxis – preoperative, intraoperative, and postoperative. A web-based anonymous survey was conducted, and a unique response link allowed completing the survey only once. We compared the results with a similar 2014 survey among the members of the American Society of Cataract and Refractive Surgeons (ASCRS). Results: The response was received from 30.2% (n = 4292/14,170) ophthalmologists. The results were as follows: all respondents do not prepare the eye with 5% povidone-iodine (83% of them use povidone iodine), majority (90%) use topical antibiotic both pre- and post-operatively, 46% use subconjunctival antibiotic at the end of surgery, and 40% use intracameral antibiotic (46% of them in high-risk patients only). Moxifloxacin was the preferred antibiotic for topical and intracameral use. Comparison with the 2014 ASCRS survey results showed a similarity in decision for pre- and post-operative antibiotics and intracameral antibiotic but dissimilarity in the choice of intracameral antibiotic and decision for subconjunctival antibiotic. Conclusion: The antibiotic prophylaxis practice by the Indian ophthalmologists is not too dissimilar from the practice in North American Ophthalmologists (ASCRS) though all ophthalmologists in India must be nudged to preoperative preparation of the eye with povidone-iodine and discontinue the practice of postoperative subconjunctival and systemic antibiotic

Recent advances in diagnosis and management of Mycotic Keratitis

Mycotic keratitis is a major cause of corneal blindness, especially in tropical and subtropical countries. The prognosis is markedly worse compared to bacterial keratitis. Delayed diagnosis and scarcity of effective antifungal agents are the major factors for poor outcome. Over the last decade, considerable progress has been made to rapidly diagnose cases with mycotic keratitis and increase the efficacy of treatment. This review article discusses the recent advances in diagnosis and management of mycotic keratitis with a brief discussion on rare and emerging organisms. A MEDLINE search was carried out for articles in English language, with the keywords, mycotic keratitis, fungal keratitis, emerging or atypical fungal pathogens in mycotic keratitis, investigations in mycotic keratitis, polymerase chain reaction in mycotic keratitis, confocal microscopy, treatment of mycotic keratitis, newer therapy for mycotic keratitis. All relevant articles were included in this review. Considering the limited studies available on newer diagnostic and therapeutic modalities in mycotic keratitis, case series as well as case reports were also included if felt important