Jyotirmay Eye Clinic

To report unique clinical features and management challenges in patients with co-existing Thyroid Eye Disease (TED) and Floppy Eyelid Syndrome (FES). Retrospective, multicentric, interventional case series of 9 patients presenting as TED with FES over a period of eight years. Seventeen eyes with co-existing TED and FES were analysed. The average age at presentation was 51.5years. There were five males and four females in the cohort. Hypothyroidism and hyperthyroidism were noted in four cases each, while a single patient was euthyroid at presentation. The average exophthalmometry value was 25.5mm (range, 22-30mm). All but one had bilateral presentation. Of the 17 eyes, 13 (76%) had episodes of spontaneous globe luxation. Eleven eyes (65%) had congestive signs or surface exposure, which mimicked clinically active TED. Lash ptosis was observed in six (35%) eyes. All (100%) eyes had significant lower eyelid retraction (LER) with inferior scleral show. Upper eyelid retraction was absent in 14 (82%) eyes. Of the six cases where orbital imaging was available, fat-predominant disease was seen in nine orbits. TED and FES can rarely co-exist. The lax or ptotic upper eyelid tends to mask upper eyelid retraction, with LER being a more obvious sign. Spontaneous globe luxation may be more common in this cohort, warranting early orbital decompression. Congestive signs and corneal exposure may mimic clinically active TED, potentially leading to corticosteroid misuse.

Role of professional organisations is to set and promote standard, ultimately creating professional and personal excellence in supportive environment. Nepal Ophthalmic Society (NOS) plays crucial role in advancing ophthalmology in Nepal through education, research, and advocacy. Established in 1985 AD to promote professional development and enhance health care delivery, NOS has grown from handful of ophthalmologists, to 504 members and 50 associate members (2024 November 20). To assess perspectives of ophthalmologists on impact, activities, and role of NOS. To prepare framework for future to strengthen its organisation with happy members. A cross-sectional survey was conducted among ophthalmologists in Nepal from 2024 May to 2024 July using structured questionnaire. The survey assessed their perspectives on NOS's impact, activities, and role in advancing ophthalmology. Data were collected through online surveys, ensuring a representative sample of practising ophthalmologists across Nepal. The study included 309 ophthalmologists and residents. Majority were young (60.1% aged ≤40 years) and female (54%). Most participants (49.52%) believed primary function of NOS was professional development, followed by advocacy, and public awareness (34.73%). The mean satisfaction rating for NOS's role was 5.6 ± 1.85 out of 10. The major challenges faced by ophthalmologists in Nepal included low salary and financial difficulties (25.72%) as well as poor residency training and lack of surgical exposure (22.51%); 75.56% of respondents considered misuse of 'Doctor" title by non-ophthalmologists a significant issue, with most suggested solutions being press releases and public awareness campaigns (63.43%), followed by notifying regulatory bodies (39.62%) Conclusion: The NOS has been significantly contributing to professional development, advocacy, and skill enhancement in Nepal. Key challenges include low salaries, inadequate surgical training, and misuse of 'Doctor" title. Strengthening membership outreach, advocating professional rights, and addressing concerns will enhance NOS's impact and ensure its long-term sustainability in shaping Nepal's ophthalmology landscape.

Background: Kestenbaum number (KN) is the count of capillaries on the optic disc surface and a number <6 denotes optic atrophy (OA). Materials and Methods: This prospective cross-sectional study included 35 cases of OA who underwent a comprehensive ophthalmic examination, calculation of the KN following fundus photography, visual field analysis, and optical coherence tomography (OCT). Visual acuity was recorded as a logarithm of minimum angle of resolution (logMAR). The data were analyzed using one-way analysis of variance and Pearson correlation. Results: Sixty three eyes of 35 patients had optic atrophy. The average age of presentation was 47.37 ± 13.34 years. Primary OA was the most common morphological type of OA, and pituitary tumor was the most common cause of the same. The differences in average age, logMAR, grade of disc pallor, and KN among various types of OA were not statistically significant. There was a statistically significant negative correlation between KN and logMAR and the grade of disc pallor. Furthermore, KN correlated well with retinal nerve fiber layer thickness and ganglion cell thickness by OCT. There was no significant correlation between KN and visual field parameters. Conclusion: KN is a reliable indicator of the grade of OA. However, it does not aid in differentiating morphological types of OA.

We describe the hybrid technique of tuck-in Tenon's patch graft (TPG) and tissue adhesive bandaged contact lens (TABCL) for large corneal perforations (>5 mm) with intact surrounding stroma. Management of large corneal perforation is often challenging, and urgent availability of donor cornea might be difficult; Tenon patch alone does not provide tectonic support; hence, this hybrid technique can be used safely in large perforations. This involves freshening the perforation edges, creating a 360 0 stromal pocket, harvesting a Tenon's graft 1 mm oversized, tucking into the pocket, and suturing. Then areas of leakage were noted, and only those areas were supplemented with minimal cyanoacrylate glue (CG) at the graft edges. This technique was used in two eyes, one with a large corneal perforation and intact surrounding stroma and the other with 4 mm corneal fistula post healed keratitis with a failed primary TPG alone, and led to epithelialization and a smooth corneal surface at 6 weeks. The advantages include autologous tissue, cost-effective, easily available, minimal post-operative inflammation, vascularization, and surface irregularity.

Aims: The present aimed to assess the knowledge, attitude, and practice regarding infection control among dental undergraduate students of Mumbai, India. Introduction: Healthcare personnel are always susceptible to infectious diseases if inadequate infection control measures are undertaken. In a dental setup, transmission occurs through air, blood, saliva droplets, or improper sterilization of instruments. Despite various standardized protocols in infection control, dental undergraduate students fail to obey the same. Transmission of various existing and emerging new infections can easily occur in dental clinics through various courses which include direct contact with blood, oral fluids, other secretions, indirect contact with contaminated instruments, operatory instruments, and contact with airborne contaminants present in either droplet splatter. Methods: A cross-sectional questionnaire-based study comprising a 13-point close-ended, self-administered questionnaire was prepared and distributed among interns, final-year dental students, and 3rd-year dental students across six dental colleges. The questions were divided into three categories: knowledge, attitude, and practice. The responses were used for data collection and accordingly, results were made. The analysis was done using IBM SPSS Statistics version 22. The statistical significance was considered at P \(\le\) 0.05. Results: A total of 851 undergraduate students were assessed for knowledge, attitude, and practice toward infection control. Only 40% of the interns, 40% of the final-year students, and 42% of the 3rd-year students had precise knowledge about infection control measures. Twenty-four percent of the interns, 27% of the final-year students, and 25% of the 3rd-year students showed accurate attitudes toward infection control. Finally, 41% of the interns, 44% of the final-year students, and 39% of the 3rd-year students inculcated the right practice in controlling infection. Strict monitoring of the routine use of infection control guidelines should be adhered to by all dental schools for the safety of patients and healthcare workers. This will help the dental undergraduate students to instil a positive attitude towards infection control hence improving their quality of dental practice and life. More such surveys should be carried out to authenticate our results thereby accomplishing the goal of infection-free practice. Conclusion: Infection control is essential to reduce the risk of occupational infection to the practitioner and the auxiliary staff. Dental schools should give more emphasis on infection control protocols.

Acute macular neuroretinopathy (AMN) affects the outer retina and is most likely induced by non-inflammatory ischaemia of the retinal deep capillary plexus and choriocapillaris. A man in his early 20s developed Valsalva retinopathy following weightlifting at the gym and presented with blurring of vision in the left eye 1 month after the initial retinal haemorrhages had resolved. A diffuse, purplish, donut-shaped, perifoveal lesion was seen on funduscopy and was well defined by an optical coherence tomography angiography (OCTA) en face image in the left eye. Outer retinal changes on optical coherence tomography (OCT) and a dense co-localised scotoma on a visual field (VF) examination confirmed the diagnosis of AMN, and the patient was started on a tapering dose of oral steroids. Improvement was seen in OCT, OCTA and VF during the 6-month follow-up visit. The use of OCTA en face imaging enabled the accurate identification of the lesion in the affected layers of the retina.

To compare the demographics, clinical features, and changes in the management pattern of acute dacryocystitis at a tertiary care eye institute. A retrospective review was performed of electronic medical records of all patients diagnosed with acute dacryocystitis from January 2013 to January 2023. Data retrieved include demographics, history, presenting symptoms, duration of symptoms, surgical interventions, associated systemic conditions, management, complications, and outcomes. A successful anatomical outcome was defined as patency on lacrimal irrigation, and a successful functional outcome was defined as the resolution of infection and epiphora. The data parameters obtained were compared with the historical published data of the earlier two decades from the same Institute. A total of 363 eyes of 349 patients were enrolled in this retrospective study. The median age was 45years (range: 19-94years). There were 216 (62%) females and 133 (38%) males. Surgery was performed in 320 (88%) patients. Needle aspiration or incision and drainage were performed in 102(32%) patients with lacrimal abscesses. Of the 320 patients, an endoscopic DCR was performed in 138 (43%) patients and an external DCR in 182 (57%). Of the 320 patients who underwent DCR surgery, 308 (96%) demonstrated anatomical and functional success at 1-year follow-up. There is a changing trend towards endoscopic DCR being incorporated as the primary procedure for managing acute dacryocystitis with the advantages of quicker resolution and reduced morbidity. There is a trend for choosing needle aspiration over the traditional incision and drainage in the initial management of lacrimal abscess.

Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.

Purpose:Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open-angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway.Methods:An open-label, real-world, multicentric, observation-based 3-month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first-line therapy. Diurnal IOP measurements, best-corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day-1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months).Results:Four hundred and sixty-nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once-daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring.Conclusion:We found that netarsudil 0.02% w/v solution monotherapy when used as the first-line treatment in primary open-angle glaucoma and ocular hypertension was both safe and effective.

We present a case of Ischemic Central retinal vein occlusion (CRVO) caused by hypertension secondary to renal failure in IgA nephropathy. A 17 year old male came with chief complaints of sudden painless diminution of vision in RE since 15 days. On examination the Right eye showed multiple superficial retinal haemorrhages in all 4 quadrents with dilated veins and cystoid macular edema suggestive of CRVO and Left eye showed superficial flame shaped haemorrhage suggestive of grade 3 hypertensive changes.