Glaucoma characteristics evaluation in myopia – A clinical study

Glaucoma is the leading cause of irreversible blindness, one of the risk factor recognised being high myopia. Intra ocular pressure may be normal in myopic patients, with optic nerve head glaucoma characteristics. Eye ball elongation and optic nerve head tilting may be present in patients with high myopia that will represent field defects mimicking glaucoma. Treating patients with myopia having suspected aspects of glaucoma may be a challenge but even more challenging is the diagnosis of glaucoma in myopic patients.: To evaluate the association of glaucoma features with myopia. To create the awareness regarding the long term follow up.: Patients in the age group of 15 to 45 years who had attended our institution over a period of one year who fulfilled the inclusion and exclusion criteria were subjected for this study. Fifty four patients who were diagnosed to have moderate or high degree myopia were selected for this analytical study. They were subjected to vision, ocular examination, tonometry and results obtained were analysed.: In our study moderate myopes constituted 55.5% and high myopes were 44.5%. The mean Intra ocular pressure and the mean corrected Intra ocular pressure in high myopes were observed to be higher than in moderate myopia. It was observed that higher prevalence of glaucoma was observed in high myopes.: There is a clinically as well as statistically significant difference between mean Intra ocular pressure and mean corrected Intra ocular pressure. So mean corrected Intra ocular pressure should be measured .From our study, there is a clear indication that there is increased prevalence of glaucoma in high myopes.

Diffuse infiltrating retinoblastoma: A diagnostic conundrum

Diffuse infiltrating retinoblastoma (DIR) is characterized by absence of intraocular mass, lack of calcification. It may mimic inflammatory uveitis or exudative retinopathy. An eight-years-old boy presented with progressive loss of vision in left eye. Clinical evaluation revealed neovascular glaucoma with a yellow–gray fundal glow, exudative retinal detachment, subretinal exudation and telangiectatic vessels. The presentation was consistent with exudative retinopathy (Coat’s disease) but for the presence of a family history of retinoblastoma in the younger sibling. Despite the absence of an intraocular mass or calcification on multimodal imaging, the enucleation was done on the basis of clinical suspicion of retinoblastoma. Histopathology confirmed a diagnosis of DIR.: DIR can pose a diagnostic challenge due to its non-characteristic clinical and imaging features and atypical presentation. A high index of suspicion along with a positive family history was key to diagnosis in our case; histopathology was confirmatory.

Treatment of cystoid macular edema in a patient with primary open angle glaucoma and diabetic retinopathy by withdrawal of travoprost

To study the association of cystoid macular edema (CME) and Travoprost eye drops in a patient with diabetic retinopathy (DR).The study was carried out on a 65yr old patient on a regular follow up from 2009-2018.A 65yr old patient of a DR of both eyes who had received 3 sittings of pan retinal photocoagulation (PRP) laser in both eyes and grid laser to his right eye. He was on regular follow up since 2009 with a stable proliferative diabetic retinopathy (PDR). Patient was also on topical antiglaucoma medication and had prophylactic YAG-PI done both eyes. He was on regular follow up since 2009 with a stable proliferative diabetic retinopathy (PDR). Right eye showed macular edema (ME) in 2014 and underwent OCT and FFA. Patient refused for intravitreal injection and preferred laser treatment, so patient underwent micropulse laser treatment in 2014. His edema persisted even after micropulse treatment. His systemic control was good and patient continued to use Travoprost eye drops. So in 2017 suspected CME secondary to topical prostaglandin (PG) analogue as he had strict glycemic control and was no fluctuation in ME. Hence topical PG analogue was withdrawn and stopped. On subsequent follow up after 2 months CME had completely disappeared and the foveal contour returned to normal on OCT. LE was status quo. Patient was followed up for more than 1 year and continuously followed up, 15 days back in June 2018 had no evidence of CME and vision was 6/9 in both eyes.: Differentiation of DME and CME secondary to PG analogue should be made at the earliest.

Management of impacted corneal foreign bodies: A review

Corneal foreign bodies are commonly seen in an ophthalmology emergency. The most common cause of this condition is a workplace-related injury. In these situations, the management differs from patient to patient and depends on a wide range of variables. In this article, we aim to review the literature on corneal foreign bodies in the past 50 years and classify them based on their level of impaction and elaborately discuss all the management options described for each.

Epidemiology, clinical profile, complications and treatment outcomes of chronic dacryocystitis in a tertiary care hospital in post lockdown era: An observational study

to study the epidemiological factors, clinical features, complications and treatment outcomes of chronic dacryocystitis in Odisha after nationwide lockdown in 2020. An observational study was designed from July 2020 to December 2020 in Regional Institute of Ophthalmology, Cuttack, Odisha. Total of 187 patients presenting with chronic dacryocystits were evaluated thoroughly in various epidemiological parameters. The history and clinical features were noted. After proper evaluation and conservative treatment, those patients were subjected for surgery and the surgical outcomes are followed-up upto 3 more months, i.e. March 2021.: The prevalence of chronic dacryocystitis was around 1.224%. Among the 187 patients, 112 were females (59.9%). The disease was found in highest proportion in the age group of 51-60 years (30.5%) followed by 25.7% in the age group of 61-70 years. 90.4% were from rural population. Socioeconomic status and living standard was found to be a significant factor, people belonging to class 4 & 3 were affected more. Majority of the affected were housewives (39.6%) and farmers (21.9%) followed by small businessmen (13.9%) and wage laborers (12.9%). Epiphora was the commonest presenting symptom in 71.6%, followed by mucopurulent discharge in 29.9% and swelling near the medial canthus in 12.3% cases. Complications like conjunctivitis, keratitis, preseptal cellulitis, cutaneous fistula were present in 6.4%, 8.4%, 7.5% and 5.9% cases respectively in our study group. The success rate of external DCR was reported as 85.8% in this study. Chronic Dacryocystitis, though a common problem of lacrimal drainage system, is much less recognized disease, specially in rural population and in lower socio-economic community in Odisha. Thus patients may present late with one or more complications, e.g. conjunctivitis, keratitis, preseptal cellulitis, lacrimal abscess, mucocele, cutaneous fistula, which is the current scenario in post-lockdown 2020 era. Maintaining all precautions and guidelines for COVID-19, we should not delay treating these patients with surgical measures. The surgical success rate (85.8%) however was not affected much in spite of all these factors.

Travoprost versus latanoprost or timolol in primary open angle glaucoma- Efficacy and safety profile

Glaucoma is progressive optical neuropathy which is challenging to treat despite advances in medical and interventional mode of treatments. Primary open angle glaucoma(POAG) is generally associated with diabetes mellitus and hypertension. Any ocular topical pharmacological agent which is to be used in POAG to maintain intraocular pressure have to be very efficacious with good safety profile. We conducted a study comparing travoprost with latanoprost and timolol as single therapeutic agent having favorable outcome.Seventy five patients were included in the study for a period of two years. After ethical clearance, patients were randomly allocated to three groups of treatment arm having 25 patients in each group. IOP was noted at 8 A.M, 10 A.M, 4 P.M on two eligibility visits for the same eye. Data collected included demographic data, blood pressure, visual acuity, ocular hyperaemia, Slit lamp finding, IOP & fundus examination. Travoprost treated patients had minimum IOP significantly lower at all visits than those using timolol (p<0.0001) and latanoprost (p<0.004). Also, Travoprost treated patient had maximum IOP records significantly lower at all visits than those using timolol (p<0.0001) and those using latanoprost (p<0.02). No significant difference was found between travoprost and latanoprost treated patients (p<0.25) while patients treated with timolol had on average a higher IOP variance (p<0.004) suggesting a lower peak control during the day. TRAVOPROST 0.004% once daily or in combination with other agents is the most effective and safest topical agents for patients of primary open angle glaucoma with the best safety profile.