Clinico-epidemiological profiles of patients sustaining ocular trauma due to firecrackers during the festive season of Diwali

Background: Considerable number of cases of firecracker injuries is reported during the festive season of Diwali in India. The purpose of this study is to identify the clinico-epidemiological patterns of ocular injuries caused by firecrackers during this period.Methods: This was a prospective case series of patients attending eye OPD with ocular trauma sustained by Firecrackers during the festive season of Diwali, 2016 in a Tertiary Care Centre in Surat. Demographic data of all the patients and type of firecracker causing injury were noted. Ocular examination of all patients was performed at the time of presentation and on follow-up. Treatment received by the patients was noted.Results: Out of total 20 patients, 85% were male (17 out of 20). Mean age of the patients was 12.15 years and majority of patients (45%) were of 6 to 10 years’ age group. Most patients (85%) sustained injury by Single shot crackers like Bijili crackers and Timing bombs. The injuries reported ranged from Eyelid burns, conjunctival or corneal burns to partial thickness corneal tear and macular scar formation with interventions ranging from ocular wash with saline to repair of partial thickness corneal tear. Many of the injuries were caused because of negligence. Corneal epithelial defect was the most frequent injury (affecting 96% of the total no. of eyes affected) followed by Eyelid burns (affecting 56% of the total no. of eyes affected). Cases having visual impairment or blindness had corneal and/or retinal involvement.Conclusions: Ocular trauma resulting from firecrackers can lead to significant ocular morbidity and permanent blindness and is a preventable cause. All steps must be taken through public awareness and legislation to ensure that firecrackers are used in a safe manner during Diwali celebrations. The medical professionals should be adequately trained to give primary emergency care which has a key role in the visual outcome

Subluxation of lens alarms to homocystinuria

Homocystinuria is a disorder of methionine metabolism. The term Homocystinuria refers as abnormally large amounts of homocystine are excreted in the urine. The condition was caused by impaired functioning of the cystionin B-synthetase (CBS) enzyme. Homocystinuria is an autosomal recessively inherited defect in the trans-sulfuration pathway (homocystinuria I) or methylation pathway (homocystinuria II and III). The most common form of homocystinuria is characterized by near sightedness, dislocation of the lens at the front of the eye, an increased risk of abnormal blood clotting, and brittle bones that are prone to fracture or other skeletal abnormalities. Some affected individuals also have developmental delay and learning problems. Homocystinuria has a current cumulative detection rate of 1 in 344,000. A high concentration of homocysteine makes fibrillin unstable. Fibrillin is responsible to form the structures which hold the lens of the eye in place. We report a case of 28 year old male with unilateral Subluxation of lens following trauma coincidentally diagnosed to have Homocystinuria and bilateral Subluxation of lens. On account of case we would like to emphasize homocystinuria should be considered as differential diagnosis in Subluxation of lens

An observational comparative study of intraocular pressure changes in post-operative cataract patients treated with dexamethasone and difluprednate

Background: Cataract is the leading cause of blindness worldwide. Treatment of cataract is surgical. Topical corticosteroids are routinely used in the treatment of post-operative inflammation following cataract surgery. This study aims to compare the intraocular pressure changes caused by topical steroids (dexamethasone and difluprednate) and to detect adverse effects.Methods: All patients operated by phacoemulsification in ophthalmology Department of SMIMER Surat were taken as subjects. Depending on topical steroids prescribed after surgery, subjects were separated into 2 groups, group 1 - difluprednate and group 2 - dexamethasone. Changes in intra-ocular pressure (IOP) of patients were collected from the data available pre-operative, 1st ,2nd ,3rd ,4th week after surgery and were analyzed. Other parameters whose data were collected are-adverse effects and compliance of patients.Results: In group 1 preoperative mean IOP was 15.5. At the end of 1st week, the mean IOP was significantly increased to 15.8. There was equal rise in IOP during 3rd week and 4th week which means that after 3rd week IOP remains stable. In group 2 preoperative mean IOP was 15.4. At the end of 1st, 2nd, 3rd and 4th there was significant increase in IOP as compared to preoperative mean IOP. Adverse effects were reported more in group 2.Conclusions: In group 1 there was a rise in IOP up to three weeks but after 3rd week IOP remained stable. In group 2 rise in IOP was seen throughout 4 weeks of treatment. Adverse effects seen more in group 2. Compliance of patients was better in group 1

A case report on bilateral neuromyelitis optica

Neuromyelitis optica (NMO, Devic disease) is an autoimmune inflammatory disorder of the central nervous system (CNS) in which the autoimmune system attacks myelin of the neurons located at the optic nerve and spinal cord, thus producing a simultaneously or sequential longitudinally extensive inflammation of the optic nerve (optic Neuritis) and spinal cord (myelitis). Early discrimination between NMO and multiple sclerosis is important because the two diseases have different natural histories and treatment regimens. Seropositivity for NMO-IgG and longitudinally extensive spinal cord lesions are characteristic of NMO. Despite the absence of a definitive therapeutic strategy for NMO syndrome, methylprednisolone pulse therapy is recommended in the acute phase. Treatment strategies in relapse phases are aimed at preventing relapses, and increasing evidence shows a better clinical response of immunosuppressive therapy than immuno-modulating therapy (a standard multiple sclerosis-modulating therapy). We have described a 32 years old girl who had visual loss due to acute optic neuritis before 15 days in right eye and followed by complete visual loss in left eye. NMO was diagnosed because of its characteristic longitudinal myelitis and positive NMO-IgG. After combine therapy with prednisolone and an immunosuppressant, the patient’s medical condition was stable and no relapse symptoms were observed

An observational comparative study of intraocular pressure changes in post-operative cataract patients treated with dexamethasone, difluprednate and prednisolone in a tertiary care centre

Background: Cataract is opacity of lens which is treated surgically. Topical corticosteroids are routinely used in the treatment of post-operative inflammation following cataract surgery. This study aims to compare the intraocular pressure changes caused by various topical steroids (prednisolone, dexamethasone and difluprednate) in post cataract patients. To compare compliance and to detect any significant adverse effects.Methods: Patients admitted in ophthalmology department for cataract surgery operated by phacoemulsification were taken as subjects. Total number of patients enrolled in the study were 354. Subjects were separated into 3 groups depending on topical steroids which were prescribed after surgery: group 1 - difluprednate, group 2 -dexamethasone and group 3 - prednisolone. Changes in intraocular pressure (IOP) of patients were measured by ophthalmology department preoperatively and postoperatively after 1st, 2nd, 3rd, 4th week of surgery. These data were collected and analysed. Adverse effects, Compliance of patients and number of bottles of drug used after surgery were also noted.Results: On comparing IOP, there was significant variation (p<0.027) between 3 drugs after one week of drug administration. When group 1 was compared with group 2 or group 3 there was no significant difference Average cost of difluprednate is about 3 times higher than the cost of dexamethasone or prednisolone.Conclusions: All the three topical steroids cause a rise in intraocular pressure in post cataract patients. But in group 1 (difluprednate) there was a rise in IOP up to three weeks after surgery but after 3rd week IOP remained stable. Adverse effects were seen more in group 2 and group 3.

VITRECTOMY IS SUCCESSFUL IN RESTORING EYE SIGHT: AN INTERVENTIONAL STUDY IN TERTIARY CARE HOSPITAL

Introduction: Pars planavitrectomy is the final step in management of many disease. Taking into consideration usefulness and necessity of Pars planavitrectomy in today’s world we would like to do this study to evaluate the surgical outcome of 20 gauge pars planavitreoretinal surgery. Methodology: A hospital-based prospective interventional study of series of 46 patients was carried out in retina clinic of SMIMER, Surat, Gujarat, From July 2012 to November 2014 who underwent vitreoretina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed. Results: Of 46 patients, preoperatively, 89 % had visual acuity of 2/60 to perception of light .The main indication for TPPV was nuclear drop, in 50 %.The visual acuity improved to better than 6/60 in 57% patients , whereas, overall, in 86.9 % of the subjects, it improved by 1 lines postoperatively. The commonest intra-operative complications was bleeding intraocularly(4.35%). Conclusion: Useful vision can be restored by pars planavitrectomy in the majority of the patients (p value <0.01). Timing of vitrectomy did not have influence on visual outcome in patients of nuclear drop. Progression of cataract is the commonest complication of TPPV(10.87%). Indications of vitrectomy does not have statistically significant influence on visual outcome after vitrectomy

A case report on bilateral neuromyelitis optica

Neuromyelitis optica (NMO, Devic disease) is an autoimmune inflammatory disorder of the central nervous system (CNS) in which the autoimmune system attacks myelin of the neurons located at the optic nerve and spinal cord, thus producing a simultaneously or sequential longitudinally extensive inflammation of the optic nerve (optic Neuritis) and spinal cord (myelitis). Early discrimination between NMO and multiple sclerosis is important because the two diseases have different natural histories and treatment regimens. Seropositivity for NMO-IgG and longitudinally extensive spinal cord lesions are characteristic of NMO. Despite the absence of a definitive therapeutic strategy for NMO syndrome, methylprednisolone pulse therapy is recommended in the acute phase. Treatment strategies in relapse phases are aimed at preventing relapses, and increasing evidence shows a better clinical response of immunosuppressive therapy than immuno-modulating therapy (a standard multiple sclerosis-modulating therapy). We have described a 32 years old girl who had visual loss due to acute optic neuritis before 15 days in right eye and followed by complete visual loss in left eye. NMO was diagnosed because of its characteristic longitudinal myelitis and positive NMO-IgG. After combine therapy with prednisolone and an immunosuppressant, the patient’s medical condition was stable and no relapse symptoms were observed

Subluxation of lens alarms to homocystinuria

Homocystinuria is a disorder of methionine metabolism. The term Homocystinuria refers as abnormally large amounts of homocystine are excreted in the urine. The condition was caused by impaired functioning of the cystionin B-synthetase (CBS) enzyme. Homocystinuria is an autosomal recessively inherited defect in the trans-sulfuration pathway (homocystinuria I) or methylation pathway (homocystinuria II and III). The most common form of homocystinuria is characterized by near sightedness, dislocation of the lens at the front of the eye, an increased risk of abnormal blood clotting, and brittle bones that are prone to fracture or other skeletal abnormalities. Some affected individuals also have developmental delay and learning problems. Homocystinuria has a current cumulative detection rate of 1 in 344,000. A high concentration of homocysteine makes fibrillin unstable. Fibrillin is responsible to form the structures which hold the lens of the eye in place. We report a case of 28 year old male with unilateral Subluxation of lens following trauma coincidentally diagnosed to have Homocystinuria and bilateral Subluxation of lens. On account of case we would like to emphasize homocystinuria should be considered as differential diagnosis in Subluxation of lens

Clinical Characterization and Genomic Analysis of Samples from COVID-19 Breakthrough Infections during the Second Wave among the Various States of India

From March to June 2021, India experienced a deadly second wave of COVID-19, with an increased number of post-vaccination breakthrough infections reported across the country. To understand the possible reason for these breakthroughs, we collected 677 clinical samples (throat swab/nasal swabs) of individuals from 17 states/Union Territories of the country who had received two doses (n = 592) and one dose (n = 85) of vaccines and tested positive for COVID-19. These cases were telephonically interviewed and clinical data were analyzed. A total of 511 SARS-CoV-2 genomes were recovered with genome coverage of higher than 98% from both groups. Analysis of both groups determined that 86.69% (n = 443) of them belonged to the Delta variant, along with Alpha, Kappa, Delta AY.1, and Delta AY.2. The Delta variant clustered into four distinct sub-lineages. Sub-lineage I had mutations in ORF1ab A1306S, P2046L, P2287S, V2930L, T3255I, T3446A, G5063S, P5401L, and A6319V, and in N G215C; Sub-lineage II had mutations in ORF1ab P309L, A3209V, V3718A, G5063S, P5401L, and ORF7a L116F; Sub-lineage III had mutations in ORF1ab A3209V, V3718A, T3750I, G5063S, and P5401L and in spike A222V; Sub-lineage IV had mutations in ORF1ab P309L, D2980N, and F3138S and spike K77T. This study indicates that majority of the breakthrough COVID-19 clinical cases were infected with the Delta variant, and only 9.8% cases required hospitalization, while fatality was observed in only 0.4% cases. This clearly suggests that the vaccination does provide reduction in hospital admission and mortality