Ophthalmic Science and Research

From the editor's desk Sharmila Devi Vadivelu TNOA Journal of Ophthalmic Science and Research 2019 57(1):1-2

Clinical outcome of iris-claw intraocular lens implantation D Anandhi, M Rekha Sravya TNOA Journal of Ophthalmic Science and Research 2019 57(1):3-7 Aim: The aim of this study is to study the indications, visual outcome, and complications in patients undergoing iris-claw intraocular lens (IOL) implantation. Settings and Design: This is a prospective interventional case series conducted between January 2016 and June 2017 in a tertiary care hospital. Materials and Methods: Seventy-nine eyes of 78 patients with aphakia or subluxation of lens of various etiologies were included in the study. Complete ophthalmological examination was conducted. Retropupillary iris-claw IOL implantation was done in the included patients. Patients were followed-up to 6 months for visual acuity, intraocular pressure measurement, and complications. Statistical Analysis Used: Statistical analysis was performed by the Students t-test. Results: The difference between preoperative and postoperative visual acuity was statistically significant in the group of patients undergoing iris-claw IOL implantation as a primary procedure (P < 0.0001). The difference was insignificant in the aphakic patients undergoing secondary IOL implantation. The interval between the primary surgery and the secondary procedure did not make a statistically significant impact on the visual outcome (P = 0.67). Common complications after iris-claw IOL implantation in this study noted were corneal edema, pupil ovalization, raised intraocular pressure, and iris atrophy. Conclusions: Retropupillary iris-claw IOL implantation is a safe and easy method of managing patients with aphakia and subluxation of the lens.

Burden of visual disability in children with other disabilities Arthur Dinukumar, Ganapathy Kalaiselvi, Mouttapa Fredrick, Kannusamy Veena TNOA Journal of Ophthalmic Science and Research 2019 57(1):8-11 Aim: The aim of the study was to assess the visual function of children with other disabilities and to identify the preventable and treatable ocular comorbidities. Materials and Methods: This study was a cross-sectional study included children aged 3–16 years who were on speech therapy sessions. After consent from parents or guardian who accompanied the child, relevant medical history was noted. Distant visual acuities were measured using picture chart, Snellen tumbling E-chart or Cardiff preferential looking cards, and complete ocular examination was performed. Cycloplegic retinoscopy was done in all children. Spectacles and low-vision aids were prescribed appropriately. Results: Out of 83 children with learning disabilities attending speech therapy clinics who were enrolled, fifty four (65%) had ocular disorders. Refractive error was identified in 31 children(37.34%), Strabismus and nystagmus in 12 children (14.45%), cataract in 4 children (4.81%), disc pallor and retinal detachment in 2 children each (2.4%), while microphthalmos, congenital glaucoma and coloboma were noted in one child each (1.2%). Thirty-five children were not cooperative for visual acuity assessment while 13 of them had more than one ocular abnormality. Only two of the 31 students with refractive errors were using spectacles. Conclusion: The poor communication and poor cooperation of these children with disabilities add on to the burden of their disabilities as the ocular abnormalities are not recognized early. Therefore, a multidisciplinary treatment approach needs to be stressed, while the awareness among the parents and caregivers needs to be developed to help these children in their learning process and rehabilitation.

Ocular axial length changes following trauma: Blunt versus penetrating Madhu Shekhar, Hemant Sonawane, Haripriya Aravind TNOA Journal of Ophthalmic Science and Research 2019 57(1):12-16 Aims: This study aims to analyze the effect of penetrating and blunt trauma on ocular axial length. Settings and Design: This is a retrospective study. Subjects and Methods: Seventy cases of unilateral ocular trauma visited between January 2012 and January 2015. Blunt and penetrating groups were formed based on the nature of injury. Mode, nature, age at injury, and presenting age were noted. Best-corrected visual acuity, axial length, keratometry, and biometric values of both eyes were documented. Factors statistically associated with changes in axial length in traumatic eyes were measured. Results: Mean axial length in penetrating trauma group was 25.31 mm (standard deviation [SD]: 1.75), and in blunt trauma group was 24.05 mm (SD: 1.13). Using regression analysis, if the axial length in control eye increases by 1 mm, then in the traumatic eye, it increases by 1.34 mm. Similarly, age at injury, penetrating trauma and longer duration between injury and presentation were statistically significant factors associated with increase in axial length in the traumatic eyes. Conclusions: Elongation of the eyeball is significantly greater in penetrating trauma than in blunt trauma. Trauma at a younger age; presentation at a later age and penetrating type of trauma are statistically significant factors associated with an increase in axial length in the traumatic eye.

Outcomes of phacoemulsification in previously vitrectomized eyes Preethika Gandhi, Naveen Radhakrishnan, Madhu Shekhar TNOA Journal of Ophthalmic Science and Research 2019 57(1):17-20 Aim: To describe and determine the intraoperative and postoperative complications stemming from technical difficulties and anatomical aspects of patients undergoing phacoemulsification after pars plana vitrectomy (PPV). Materials and Methods: In this prospective study, thirty individual eyes who presented with cataract in a previously vitrectomized eye were analyzed. The indications for PPV, operative details of PPV, and postoperative complications were noted. The best-corrected visual acuity after vitrectomy, type of lens opacity that developed following PPV, visual acuity immediately prior to cataract surgery, duration between PPV and subsequent cataract extraction, estimated intraocular lens (IOL) power, formula used for calculating the IOL power, IOL type, intraoperative complications, best final visual acuity following phacoemulsification, and finally the incidence of neodymium-doped yttrium aluminum garnet capsulotomy were noted. Statistical Analysis: SPSS for Windows, version 11.0.1, and Microsoft Excel 2007 were used. Chi-square test was used to compare complication rates. Results: Overall 86% of the eyes had improved visual acuity post cataract surgery, 11% remained the same, and 3% of it worsened. Intraoperatively, small pupil, deepening of the anterior chamber, bowing of iris–lens diaphragm, difficulty in capsulorrhexis, and presence of posterior-capsular plaque were noted. Posterior-capsule opacification was the most common late postoperative complication. Conclusion: Although challenging, with prior knowledge regarding vitrectomized eyes, such cases can be performed safely and complication rates are acceptably low.

Functional and structural changes in the macula in diabetic retinopathy – A correlative study Ranjan Prasad Senthil, Krishnagopal Srikanth, Kirti Nath Jha, AR Rajalakshmi TNOA Journal of Ophthalmic Science and Research 2019 57(1):21-23 Aim: The aim is to study the correlation of macular thickness and sensitivity in type 2 diabetes mellitus patients. Materials and Methods: A cross-sectional comparative study was done on 77 eyes with diabetic retinopathy. Patients were divided into three groups as follows: Group 1 – Diabetic retinopathy without maculopathy, Group 2 – Diabetic maculopathy without clinically significant macular edema (CSME), and Group 3 – CSME. Microperimetry was used to assess macular sensitivity, and optical coherence tomography (OCT) was used to measure retinal thickness. Comparison of retinal sensitivity and thickness was done between groups. Correlation of these parameters to duration of diabetes was also done. Results: The mean macular sensitivity (in dB) in Groups 1, 2, and 3 was 11.57, 11.51, and 8.03, respectively. The mean central macular thickness in Groups 1, 2, and 3 was 199.33, 208.62, and 334.25 μm, respectively. There was statistically significant difference in macular thickness and in macular sensitivity between Groups 1 and 3 (P < 0.001) and between Groups 2 and 3 (P < 0.001). This difference was not statistically significant between Groups 1 and 2 (P > 0.09). Macular sensitivity had a moderate correlation with macular thickness, which was statistically significant (P < 0.001). Conclusions: Macular sensitivity was found to decrease with increasing macular thickness.

Study of incidence, risk factors, and treatment outcomes in retinopathy of prematurity in a tertiary care center Kannegolla Anudeep, Krishnagopal Srikanth, Manavi D Sindal, Kirti Nath Jha TNOA Journal of Ophthalmic Science and Research 2019 57(1):24-26 Aim: The primary aim of the study is to determine the association between incidence, risk factors, and treatment outcomes in retinopathy of prematurity (ROP). Subjects and Methods: A longitudinal observational study was carried out on 65 babies who fulfilled the criteria for ROP screening at a tertiary center. Results: Of the 65 babies screened, 24 (36.9%) developed some stage of ROP with 12 developing Type 1 ROP. Mean birth weight, mean gestational age (GA), and duration of oxygen therapy were significantly associated with the development of ROP (P = 0.047, P < 0.001, and P < 0.001, respectively). One-third of the babies had maternal risk factors also. Of the 24 babies with ROP, zone 3 was involved in 13 (54.1%) babies and zone 2 was involved in 11 (45.8%) babies; 7 (29.1%) had stage 1, 9 (37.5%) had stage 2, and 8 (33.3%) had stage 3. Of 24 babies with ROP, 12 (50%) required treatment with laser photocoagulation and all these babies showed regression of ROP following treatment. Conclusion: Birth weight <1.70 kg, GA <32 weeks, and oxygen therapy were associated with development of ROP. ROP regressed with laser photocoagulation.

Prevalence of convergence insufficiency between 18 and 35 years and its relation to body mass index Ramesh Shruthy Vaishali, Kirti Nath Jha, Krishnagopal Srikanth TNOA Journal of Ophthalmic Science and Research 2019 57(1):27-30 Background: Convergence insufficiency (CI) is a common condition characterized by patient's inability to maintain binocular alignment on objects as they approach from distance to near. One study has found association between low body mass index (BMI) and CI. The purpose of this study is to find the prevalence of CI and its association with BMI among patients aged 18–35 years. Subjects and Methods: In a prospective study, we recorded convergence among individuals aged 18–35 years. We defined CI as near point of convergence of >10 cm, exophoria greater for near than distance, and positive fusional vergence of <18 ΔD. The prevalence of CI was expressed as percentage of the population. BMI was calculated. We calculated the association between CI and BMI by Chi-square test. P < 0.05 was considered as statistically significant. Results: We studied 142 individuals (male: 61 and female: 81). CI was noted in 27.5% of population; 53.84% of these were symptomatic as per symptom survey questionnaire. The average BMI of the study population was 23.78 ± 4.68. No association was found between BMI and CI (P = 0.773). Conclusions: Among 18–35 years of age, 27.5% of individuals exhibited CI. CI and BMI did not show any association.

Pearls in the management of Stevens–Johnson syndrome Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal TNOA Journal of Ophthalmic Science and Research 2019 57(1):31-33 Stevens–Johnson Syndrome, a life-threatening disorder, can lead to severe ocular morbidity and corneal blindness. The discomfort and visual loss caused leads to a considerable impact on the quality of life. The goals of treatment include measures to reduce inflammation, thereby improving comfort and results for visual rehabilitation. The issues to be addressed include dry eye, lid margin keratinization, adnexal disorders, and fornix obliteration. Measures to address these like punctal cautery and mucous membrane graft have been discussed along with their surgical technique. Visual rehabilitation, following stabilization of the ocular surface, can be achieved with optical iridectomy, cataract surgery or in end-stage disease by performing the modified osteo-odonto keratoprosthesis or Type 2 keratoprosthesis. The procedures to stabilize the ocular surface help in preventing further deterioration of the ocular surface and contribute to improved vision and comfort.

Interpretation of optical coherence tomography Ronnie George, Trupti Sudhir Patel, Murali Ariga, Malarchelvi Pazhani, Pratheeba Devi Nivean TNOA Journal of Ophthalmic Science and Research 2019 57(1):34-48 Glaucoma is a progressive disease which can lead to blindness. Early detection is crucial to prevent further damage. Though glaucoma is more a clinical diagnosis but investigative tools like optical coherence tomography can help us diagnose suspicious cupping and early glaucoma. The newer modalities help us to prognostigate the disease by seeing for progression. This article will help the reader interpret OCT with better understanding.

Alexandros Sfakianakis
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