Bilateral cortical blindness secondary to tuberculous meningitis in a young Indian female

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Association of cataract and sun exposure in geographically diverse populations of India: The CASE study. First Report of the ICMR-EYE SEE Study Group.

PURPOSE: To determine the prevalence of cataract and its association with sun exposure and other environmental risk factors in three different geographically diverse populations of India. DESIGN: Population based cross sectional study during 2010-2016. PARTICIPANTS: People aged ≥ 40 years residing in randomly sampled villages were enumerated (12021) and 9735 (81%) underwent ophthalmic evaluation from plains, hilly and coastal regions (3595, 3231, 2909 respectively). METHODS: A detailed questionnaire-based interview about outdoor activity in present, past and remote past, usage of sun protective measures, exposure to smoke, and detailed ophthalmic examination including assessment of uncorrected and best corrected visual acuity, measurement of intraocular pressure, slit lamp examination, lens opacities categorization using LOCS III and posterior segment evaluation was done. Lifetime effective sun exposure was calculated using Melbourne formula and expressed as quintiles. These were supplemented with physical environmental measurements. MAIN OUTCOME MEASURES: Lifetime sun exposure hours, smoking, indoor kitchen smoke exposure and their association with cataract and subtypes. Prevalence of cataract calculated based on lens opacities or evidence of cataract surgery. RESULTS: Cataract was identified in 3231 (33.3%) participants. Prevalence of cataract in males (32.3%) and females (34.1%) was similar. Nuclear cataract was the commonest sub-type identified in 94.7% of affected eyes. Sun exposure had a significant association with cataract with odds ratio (OR) increasing from 1.6 (95% Confidence Intervals [CI]: 1.4, 1.9) in 3rd quintile, to 2.6 (CI: 2.2, 3.1) in 4th quintile and 9.4 (CI: 7.9, 11.2) in 5th quintile (p<0.0001). Cataract also showed a significant association with smoking (OR: 1.4, CI: 1.2, 1.6) and indoor kitchen smoke exposure (OR: 1.2, CI: 1.0-1.4). Nuclear cataract showed a positive association with increasing sun exposure in 3rd (β coefficient 0.5, CI:0.2-0.7), 4th (β: 0.9, CI: 0.7-1.1) and 5th (β: 2.1, CI:1.8-2.4) quintiles of sun exposure, smoking (β: 0.4, CI: 0.2-0.6) and indoor kitchen smoke exposure (β: 0.3, CI: 01-0.5) while cortical cataract showed a positive association with sun exposure only in 5th quintile (β: 2.6, CI:1.0-4.2). Posterior subcapsular cataract was not associated with any of the risk factors. CONCLUSION: Cataract is associated with increasing level of sun exposure, smoking and exposure to indoor kitchen smoke

Clinical picture, diagnosis and management of diabetic retinopathy for primary care physician

Diabetes is a major public health problem in our country and diabetic retinopathy is one of the important complications of diabetes. It is emerging as an important cause of visual impairment. The diagnosis and treatment facilities for diabetic retinopathy are currently limited to the tertiary level hospitals and are grossly insufficient to meet the need of population. Early detection of diabetic retinopathy and its treatment remains a major challenge for the health care providers. The current article provides information about clinical picture, screening and diagnostic criteria for diabetic retinopathy for the physicians and general practitioners working at primary level. This will be helpful in creating awareness among them about the health condition. These practitioners will be able to participate in screening of diabetic patients and their referral for diabetic retinopathy to the higher centres. Their involvement is expected to achieve prevention of visual impairment and blindness due to diabetic retinopathy

Giant congenital facial melanocytic nevus

Giant Congenital Melanocytic Nevus (GCMNs) is mostly reported in area of trunk followed by limbs and head. Their incidence is <1:20,000 newborns It derives attention due to its association with malignant melanoma.The risk of developing malignant melanoma is between 5 to 10%.We report a case of twelve year old boy with hyperpigmented lesion on face

Long-term effect of panretinal photocoagulation on optic nerve head parameters in diabetic retinopathy using Heidelberg retinal tomography III

PURPOSE: The aim of this study was to evaluate the effect of panretinal photocoagulation (PRP) in diabetic retinopathy patients using Heidelberg retinal tomography III (HRT). SUBJECTS AND METHODS: A total of 90 eyes of 90 consecutive newly diagnosed patients with diabetic retinopathy (nonproliferative diabetic retinopathy, NPDR, Group I and proliferative, PDR, Group II) were recruited for the study. The eyes with PDR were subjected to PRP. The effect of PRP was measured on optic nerve head (ONH) parameters using HRT. RESULTS: Follow-up up to 4 years in both groups indicated that in Group II proliferative diabetic retinopathy (PDR) participants undergoing PRP, the ONH parameters showed a significant difference in cup area (P = 0.023), cup volume (P = 0.001), mean cup depth (P = 0.015), maximum cup depth (P < 0.001), mean retinal nerve fiber layer (RNFL) thickness (P < 0.001) at 1 year of follow-up, and remained significant in all at 4 years of follow-up, whereas there was no significant difference in any of the optic disc parameters in the participants of Group I belonging to NPDR group as compared to PDR group after 4 years. CONCLUSION: PRP affected the ONH morphology in the PDR group and the effect of this change should be interpreted with caution. This may require setting a new baseline for RNFL measurements using the HRT when documenting RNFL loss or glaucoma progression in patients who have undergone PRP

Conjunctivitis in the newborn- A comparative study

Background: Conjunctivitis of the newborn is defined as hyperemia and eye discharge in the neonates and is a common infection occurring in the neonates in the first month of life. In the United States, the incidence of neonatal conjunctivitis ranges from 1-2%, in India, the prevalence is 0.5-33% and varies in the world from 0.9-21% depending on the socioeconomic status. Aim: To study the organisms causing conjunctivitis of the newborn and to correlate the etiology with the mode of delivery. Design: Single center, prospective, observational study. Materials and Methods: A total of 300 mothers and their newborns, born over a period of one year, were included in the study. Of these 200 newborns were delivered through vaginal route (Group A) and 100 (Group B) delivered by lower segment caesarean section (LSCS). At the time of labour, high vaginal swabs were taken from the mothers. Two conjunctival swabs each from both eyes of the newborn were collected at birth and transported to Microbiology department in a candle jar immediately. Results: Eight babies in Group A, developed conjunctivitis at birth. None of the babies in Group B developed conjunctivitis, this difference was statistically highly significant (P<0.000). The organisms found in the conjunctiva of the newborns in Group A were Coagulase negative Staphylococcus, α hemolytic Streptococcus, Escherichia coli and Pseudomonas spps. However, the commonest organism leading to conjunctivitis in the newborn in this study was Coagulase negative Staphylococcus. It was observed that the mothers of 5 out of 8 babies (60%) developing conjunctivitis gave history of midwife interference and premature rupture of membranes so the presence of risk factors contribute to the occurrence of conjunctivitis in the newborn. Conclusions: It is inferred that the mode of delivery and the presence of risk factors is responsible for conjunctivitis in the newborn

Treatment before macular grid in patients of diabetic macular edema

AIM: The aim of this study is to compare the efficacy of intravitreal bevacizumab and posterior subtenons triamcinolone acetate in the management of diffuse diabetic macular edema (DME) and to evaluate their efficacy as an adjunct to modified grid laser in management of DME. DESIGN: This was a prospective, randomized clinical trial of 30 patients. MATERIALS AND METHODS: A total of 30 patients attending the medical ophthalmology clinic at a tertiary care hospital were included in the study. These 30 patients were divided into two groups. Group I (15 eyes) received intravitreal bevacizumab followed by modified grid photocoagulation 2 weeks after injection. Group II (15 eyes) received posterior subtenons triamcinolone followed by modified grid photocoagulation 2 weeks after injection. Each patient in our study was followed up at 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after the initial injection to record the central macular thickness (CMT) and best-corrected visual acuity (BCVA). RESULTS: Both the combination therapies have efficacy to reduce the CMT (P = 0.001). The percentage fall in CMT was greater in bevacizumab + laser group, and there was a significant difference in the CMT values at the end of the study in the bevacizumab group (P = 0.013). The mean BCVA improved in both the groups and this difference was statistically significant compared to the baseline (P = 0.005). However, there was no statistically significant difference in BCVA between the two groups at the end of the study. CONCLUSION: Both intravitreal bevacizumab and posterior subtenons triamcinolone given as an adjuvant therapy along with modified grid laser are equally efficacious in the reduction of the CMT; however, the percentage fall in the CMT was greater in bevacizumab + laser group, and there was a significant difference in the fall in CMT at all the visits as compared to a plateau in the fall of CMT in posterior subtenons triamcinolone group

Diurnal versus office-hour intraocular pressure fluctuation in primary adult onset glaucoma

Purpose: To evaluates the role of measuring intraocular pressure (IOP) outside office-hour in primary adult onset glaucoma. Methods: This retrospective study included 100 cases of primary adult onset glaucoma. IOP readings obtained with Goldmann applanation tonometry between 7 am and 10 pm were compared to office-hour readings. Results: One hundred patients were enrolled (mean age: 58.64 ± 10.98 years) in the study. Overall, mean diurnal IOP was significantly higher than mean office IOP (p < 0.05). Two-thirds of the patients had peak IOP measurements outside office-hour. Mean diurnal IOP fluctuation (7.03 ± 2.69 mm Hg) was significantly higher than mean office IOP fluctuation (4.31 ± 2.6 mm Hg) (p < 0.003). There was a significant correlation between baseline IOP and fluctuation in IOP (r = 0.61, p < 0.001). Conclusion: The mean diurnal IOP and IOP fluctuations were higher than office-hour readings in patients with primary adult onset glaucoma. Diurnal monitoring may be particularly useful in patients with high baseline IOP