Minto Ophthalmic Hospital

Abstract Purpose: The aim of the study is to determine the serum homocysteine, folic levels, Vitamin D3, and thyroid profile in keratoconus (KC) patients. Designs: The design involves hospital-based, prospective, cross-sectional study. Methods: This study included all patients diagnosed with KC between July and October 2024 in our tertiary care center in Karnataka, India, above 12 years of age, inclusive of both genders who/whose guardians were willing to give informed consent. Data were entered in an Excel spreadsheet, and SPSS version 20 was used to perform the statistical analysis. Results: The average age of the subjects was 18.58 ± 5.05 years. The largest age group was 16–20 years, comprising 40.0% of the subjects (n = 45). Females represented 57.8% (n = 26), while males formed 42.2% (n = 45) of the total sample. The means of the parameters were as follows: uncorrected distance visual acuity (UCVA) (0.81 ± 0.42), Avg SimK (53.23 ± 6.08) and Kmax (62.78 ± 8.48). There was no statistically significant correlation of serum homocysteine and folic acid levels with the following parameters: UCVA (P = 0.516; P = 0.618), Avg SimK (P = 0.817; P = 0.734), CCT (P = 0.383; P = 0.326), and KC Severity Index (KISA) index (P = 0.523; P = 0.662). Free thyroxine showed a negative association with Avg SimK (P = 0.033) and KISA Index (P = 0.008), while TSH showed a positive association with CCT (P = 0.042). Conclusion: High serum homocysteine and low serum Vitamin D3 levels were noted in KC patients but did not show any statistically significant association with clinical and tomographic parameters. We did not find any serum folic acid abnormalities. However, thyroid dysfunction was seen in KC patients and exhibited a statistically significant association with tomographic parameters.

Binocular vision is a condition in which an individual uses both of their eyes to fixate on an object of regard, resulting in a simultaneous visual perception. Synoptophore is an appropriate orthoptic device to diagnose and treat most strabismic and nonstrabismic binocular vision anomalies. This article aims to provide information on measuring the angle of deviation, cyclofusion, abnormal retinal correspondence, the accommodative convergence/accommodation ratio, pseudotropia, and various anti-suppression exercises on synoptophore. The previous literature lacks detailed information about the synoptophore and its practical applications. This review involved a search on PubMed and Google Scholar using the keywords “synoptophore” and “binocular vision anomalies” followed by an examination of the relevant papers. We shortlisted 20 relevant papers for this review article. We conducted a cross-examination of the cited references and included the most relevant ones.

Ghost cell glaucoma is caused mainly by degenerated red blood cells or ghost cells, which are formed post vitreous hemorrhage in the posterior segment and traverse to the anterior chamber once the anterior hyaloid face is disrupted.[1] In the anterior chamber, the tiny, khaki-colored cells, circulating slowly, were frequently mistaken for white blood cells. They obstruct the trabecular outflow due to poor pliability, sometimes settling down at the inferior angle as a khaki-colored layer and causing severe glaucoma.[2,3] We present an anterior chamber photograph of a 52-year-old female with ghost cell glaucoma, post-complicated cataract surgery. Patient had developed vitreous hemorrhage post-anterior vitrectomy in view of vitreous loss and posterior capsular rent intra-operatively and presented with complaints of pain and redness to our hospital. On examination, she had a raised intraocular pressure of 48 mmHg, with open angles on gonioscopy, inflammatory, and blood-tinged, khaki-colored cells in the anterior chamber [Fig. 1a and b] with a disrupted anterior hyaloid face suggestive of a ghost cell glaucoma.Figure 1: (a) Slit lamp biomicroscopy revealed multiple khaki-colored ghost cells along with inflammatory cells in the anterior chamber with a posterior chamber intraocular lens visualized through the pharmacologically dilated pupil. (b) Hemorrhagic debris and blood-tinged cell were seen adherent on the endothelium of cornea in a patient diagnosed to have ghost cell glaucoma secondary to vitreous hemorrhage post-complicated cataract surgeryDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.

A 28-year-old male patient presented to our hospital with chief complaints of on and off episodes of coloured halos and blurring of vision in both eyes for 2 years. His best corrected visual acuity in each eye was 6/9 P. On slit lamp examination diffuse corneal oedema was present. Tablet acetazolamide was prescribed, and patient was followed on next day. Mild corneal edema with 26 mm of Hg IOP was noted. Krukenberg’s spindle was seen in both eyes. Upon dilatation, a Zentmayer’s ring or Scheie stripe was noted. Fundoscopy revealed cup disc ratio 0.8 and 0.7 in right and left eye respectively. Gonioscopy examination revealed concave configuration or posteriorly bowing of iris, hyperpigmented trabecular meshwork and Sampaolesi line in both eyes. A diagnosis of bilateral pigmentary glaucoma was entertained, and Bimatoprost (0.01%) eye drops once in a day in both eyes was started. There was a significant improvement in corneal edema and the IOP was 16mmHg in both eyes.

This study aims to establish DROL (disruption of retinal outer layers), PROS (photoreceptor outer segment length), SND (subfoveal neuroretinal detachment), and hyperreflective walls of foveal cystoid spaces (HRW) as optical coherence tomography (OCT) biomarkers and predictors of central macular thickness (CMT) and visual acuity in diabetic macular edema (DME) treated with intravitreal ranibizumab (IVR). In this prospective, interventional study performed at a tertiary care center over a span of 1 year from December 2021 to December 2022, 50 eyes of 46 patients of DME were included. Visual acuity and spectral domain OCT imaging were performed at baseline. Using inbuilt calipers on SD-OCT, the horizontal extent of DROL and the vertical extent of PROS were measured manually. SND and HRW were assessed qualitatively. IVR was administered and patients were followed up at 4, 8, and 12 weeks. The eyes without DROL had statistically significant (P < 0.05) lesser CMT and better BCVA (best-corrected visual acuity) (P < 0.05) after pro re nata injection of IVR. There was a positive correlation between the extent of baseline DROL with final CMT (P < 0.05) and final logMAR BCVA (P > 0.05), whereas negative correlation with the extent of baseline PROS with final CMT (P < 0.05) and final logMAR BCVA (P > 0.05). The presence of HRW and SND predicted non-resolution of CMT and worse visual acuity after treatment with IVR in DME. DROL, PROS, SND, and hyperreflective walls of foveal cystoid spaces may be utilized as qualitative as well as quantitative biomarkers to predict the post-treatment CMT and visual acuity in DME.

To assess the prevalence of ocular trauma and extent of visual loss in paediatric patients at a tertiary care eye hospital in South India.A retrospective study was conducted on all children of age group 15 years and younger, of both genders, sustaining ocular injuries and seeking care within the ophthalmology outpatient department of a tertiary eye care hospital. The study spanned for a duration of six months. The demographic profile of the participants was recorded, detailed history was taken, followed by standardised ocular evaluation. Orbital imaging was done where deemed necessary. An eye was considered blind due to trauma if best corrected visual acuity for distance was worse than 3/60 due to trauma. Patients with pre-existing low vision in the affected eye were excluded in the study.50 children were included in the study. The mean age upon initial presentation manifested was 9.8 years. The demographic distribution revealed a predilection for children within the age group of 11 to 15 years, constituting 38% of the sampled populace, with the subsequent demographic tier of 5-10 years encompassing 36%. Noteworthy differentials emerged between rural and urban cohorts, with rural representation at 64% and urban at 36%. The predominant ocular injuries were categorized as 72% closed globe injuries and 18% open globe injuries. Operative interventions were administered to 54% of the cases, while the remaining 46% were subject to conservative therapeutic modalities. Within the subset of closed globe injuries necessitating surgical intervention (36%), specific pathologies included lid tear, canalicular tear, and traumatic cataract.Ocular trauma in paediatric population can lead to permanent blindness and visual handicap. It also affects the social, emotional and psychological development of the child. Most of these injuries can be prevented by supervision of children during play, educating the children, family members and teachers regarding ocular health and hygiene.

A detailed description of the Limbus and the pupil. Anatomy of limbus which is a cardinal structure in ocular surgeries and its importance in maintaining corneal integrity is discussed. Also provided is a clinical algorithm on assessment of pupil.

Advances in patient treatment depend heavily on clinical trials (CTs). Patient volunteers for CT are tougher to recruit and retain. In order to administer CTs effectively, it is necessary to comprehend how the public views and perceives participating in them. The study assessed the perception and attitudes of patients and bystanders toward CTs in India. This was a multi-centric, cross-sectional study among patients and bystanders using a questionnaire that consisted of socio-demographic characteristics and questions on knowledge and attitude toward participation in CTs. The minimum sample size estimated for the survey was 750. A total of 1260 respondents (patients and bystanders) had participated in the survey. 42% of total respondents were aware about CTs. Unawareness regarding (i) voluntary power of an individual to participate in a CT (only 47%), (ii) entitled benefits of free treatment and medical insurance during enrolment in a CT (only 47%), and (iii) only 16% of the respondents knew involvement of human subjects in CT were the major highlights among those who had prior knowledge about CTs. Education was the most pervasive factor in shaping positive perception among the respondents. Occupation was another ubiquitous factor in shaping their perception regarding CTs. The majority of respondents were not aware of CTs. The major concerns observed were time consumption and harmful nature of CTs that influenced their unwillingness to participate in CTs. Initiatives such as awareness campaigns and survey assessments that would result in scientifically effective health service policies would be strategic methods to enhance CT participation.

Cataract is the leading cause of blindness worldwide. There is an increased incidence of cataract formation in the diabetic population due to several factors. Diabetes mellitus accelerates the development of cataract. Oxidative stress results in most of the diabetic complications including diabetic cataract. Oxidative stress leading to the expression of various enzymes has also been proven as crucial for cataractous changes in the lens in old age. A narrative review was undertaken to investigate the expression of different biochemical parameters as well as enzymes in diabetic and senile cataracts. Identification of these parameters is crucial for the prevention and treatment of blindness. Combinations of MeSH terms and key words were used to do literature search in PubMed. The search resulted 35 articles and among them, 13 were relevant to the topic and were included in synthesis of results. Seventeen different types of enzymes were identified in the senile and diabetic cataracts. Seven biochemical parameters were also identified. Alteration in biochemical parameters and expression of enzymes were comparable. Majority of the parameters were raised or altered in diabetic cataract compared to senile cataract.