Ophthalmic Science and Research

Editorial Sharmila Devi Vadivelu TNOA Journal of Ophthalmic Science and Research 2020 58(4):237-238

Dematiaceous fungal keratitis: Clinical and microbiologic experience Pratik Gajanan Kunde, V Anitha, R Meenakshi, SH Fathima TNOA Journal of Ophthalmic Science and Research 2020 58(4):239-244 Objective: The objective was to study the epidemiology, clinical features, and treatment outcomes of dematiaceous fungal keratitis. Design: This was a retrospective, noncomparative, observational study. Materials and Methods: Fifty-nine cases of dematiaceous fungal keratitis seen at tertiary care hospital from January 2017 to June 2018 were analyzed for demographic features, predisposing factors, clinical characteristics, microbiological profile, and treatment outcomes. Statistical Analysis: Mean (standard deviation) and frequency (percentage) were used to represent continuous and categorical variables, respectively. Wilcoxon signed rank test was used for comparative analysis. Results: Of 236 cases of fungal keratitis seen during the study period, dematiaceous fungi were the third most common isolates in 59 cases (25%) after Fusarium (n = 101; 43%) and Aspergillus species (n = 76; 32%). Majority of the patients were adult males (male: female = 2:1) from rural areas (51%) with agricultural occupation (51%). Trauma with vegetable matter was the most common predisposing factor in 27 cases (45.8%). The characteristic macroscopic pigmentation was seen in only eight eyes (13.6%). In our study, 24 (40.7%) patients revealed Curvularia species, followed by Bipolaris and Exserohilum species in 20 cases (33.9%) and 10 cases (17%), respectively. The median time of antifungal therapy was 21 days (interquartile range: 21–41 days). Fifty-four (91.5%) responded to medical therapy, whereas five eyes required surgical intervention. Conclusions: This study signifies the importance of dematiaceous fungi as the important causative agent of fungal keratitis. Medical therapy along with debridement of ulcer alone can be effective in treating patients with superficial infiltrate who seek treatment early.

Advanced keratoconus with very low pachymetry – Can contact lens avoid corneal surgery? Radhika Natarajan, Amrutha Mahalakshmi Anandan, Manokamna Agarwal TNOA Journal of Ophthalmic Science and Research 2020 58(4):245-248 Clinical relevance: Keratoconic eyes with low pachymetric values, precluding safe CXL can show significant improvement in vision with newer scleral Contact lenses(CL), which was not possible with older rigid CLs. Purpose: To describe diagnostic and management difficulties in keratoconic eyes with pachymetry too low for CXL (Collagen Cross linking)necessitating surgery for improving tensile strength, yet having significant improvement in vision with newer rigid contact lenses such that immediate keratoplasty can be deferred. Methods: Case records of 16 patients (20 eyes) were reviewed. All patients had advanced keratoconus with low pachymetric values but had significant improvement in vision with rigid CLs. CXL was not safely feasible in these eyes and immediate surgical treatment for tissue strengthening was deferred as they had good vision with newer rigid CLs. Patients were kept under close observation due to the risk of developing corneal hydrops. Results: Mean age was 25.68 years. Mean best-corrected visual acuity with glasses was 0.54logMAR, whereas, with rigid CLs was 0.18logMAR. Mean steep-keratometry (K) was 62.66D. Mean central pachymetry, highest posterior surface elevation, and pachymetry at thinnest location was 314.4, 119.6 and 313.61microns respectively. Mean follow-up was 4 years. Conclusion: Advanced keratoconic eyes may have pachymetric values too low for CXL, therefore needing keratoplasty for tissue strengthening and yet can have good vision with rigid CLs. Quantitative analysis of further progression of keratoconus in these eyes is difficult as imaging techniques become unreliable in advanced stages of the disease. Significant improvement in vision with newer rigid and scleral CLs makes the decision to operate, purely for tissue building, difficult.

Ocular myasthenia gravis: A case series Sandra C Ganesh, Amrutha Sindhu, Jogitha TNOA Journal of Ophthalmic Science and Research 2020 58(4):249-252 Aim: To report the clinical profile of patients with myasthenia gravis (MG) at a tertiary eye care center in Tamil Nadu. Material and Methods: This is a retrospective case series of patients in a single center between February 2019 and March 2020. Result: We present a series of five cases of ocular myasthenia in the pediatric age group (0–16 years), comprising three males and two females. The patients had varied presentations on the initial examination. Conclusion: It is important to differentiate MG from other diagnostic mimics such as neurological causes such as cranial nerve palsy, myopathies, ocular pathologies, and neuromuscular junction pathologies such as botulism and brainstem tumors. Diagnosis and treatment of myasthenia is done as a team effort of ophthalmologist and neurologist. This study is to reinforce a vigilant lookout for this great masquerader.

Preoperative and postoperative comparison of higher order aberrations in individuals 1 month after small incision lenticule extraction N V Arulmozhi Varman, Aadithreya Varman, Dinesh Balakumar TNOA Journal of Ophthalmic Science and Research 2020 58(4):253-257 Aim: This study analysed the visual outcomes of patients with myopia and myopic astigmatism following Small Incision Lenticule Extraction (SMILE). Visual outcomes were determined by Post-operative refraction, Uncorrected Visual Acuity and aberrometry estimated with iTrace aberrometer post operatively immediately and upto day 30. Results: On Post-Operative day 1, the spherocylinder group, attained an uncorrected visual acuity of 6/6. Materials and Methods: The final post-operative refraction in all cases was within ±0.25 diopters of sphere in 18 eyes and within ±0.50 diopters of sphere in 10 eyes. The aberrometry values recorded on iTrace at the end of 30 days revealed a decrease in the total higher order aberrations. Mean higher order aberration is significantly (P<0.05) reduced in the post-operative status Similarly the pure cylinder group attained uncorrected visual acuity of 6/6 in all eyes on POD 30, with a decrease in higher order aberrations. Mean higher order aberration is significantly (P<0.05) reduced in the post-operative status. The final post-operative refraction in all cases was within ±0.25 diopters of cylinder in 48 eyes, within ±0.50 diopters of cylinder in 16 eyes and within ±0.75 in 14 eyes. Conclusion: SMILE is a successful procedure in treatment of both myopic spherical and cylindrical refractive errors. The faster healing and flapless advantage along with lesser incidence of dry eyes has an edge over conventional laser vision corrective procedures. The other important advantage is the reduction of higher order aberrations and better quality of vision. To conclude SMILE is safe and effective procedure for correction of myopic refractive errors and is also beneficial in reducing higher order aberrations.

A retrospective study of patients with visual impairment: Its magnitude, causes, and acceptance of the low vision Aids in a tertiary eye care hospital Annamalai Odayappan, Tiruvengadakrishnan Nirmala Devi, Girish Velis, Priya Sivakumar, Sivagami Nachiappan TNOA Journal of Ophthalmic Science and Research 2020 58(4):258-261 Aim: The study aims to highlight the importance of a low vision clinic and give a profile of patients presenting to a low vision clinic at a tertiary eye care hospital. Materials and Methods: Design: Retrospective study. Setting: Institutional. Study population: Details of 9,601 patients who presented to our low vision clinic between January 2009 and June 2015 were analyzed from our database. Data obtained include age group, best-corrected visual acuity, cause of low vision, type of low vision aids (LVA) prescribed, acceptance of the device, and the provision of additional rehabilitation services. Statistical Analysis: Categorical variables were given in the frequency tables with percentages. Results: Around 70.7% of patients were found to have low vision and 29.3% were found to have blindness. We note that 65% of the patients were <40 years of age. The major causes of visual impairment were retinitis pigmentosa, macular degeneration, diabetic retinopathy, pathological myopia, optic atrophy, glaucoma, albinism, and congenital nystagmus. LVA was prescribed to 2689 individuals. The most commonly prescribed LVA were spectacle magnifiers, hand, and stand magnifiers. However, the acceptance rate was just 38%. The rest were given either standard spectacles or were referred to rehabilitation centers if the vision was very poor. Conclusion: There is a young population with visual impairment and highly under-utilized low vision services. Improving the acceptance rate of these devices would help enhance the individual's quality of life part of which could be done by reducing the cost of these devices.

Dexamethasone implant – An update Richa Pyare, Jyotirmay Biswas TNOA Journal of Ophthalmic Science and Research 2020 58(4):262-267 Uveitic entities may be infectious or noninfectious in etiology. Corticosteroids remain the first-line treatment for noninfectious posterior uveitis. Intravitreal injections of steroids have been useful in targeted therapy of the posterior segment. However, a host of systemic and local adverse effects limits the usefulness of steroids. Intravitreal implants of dexamethasone with sustained release of the drug over months are a more effective and safer option. Various formulations with varying dosage and lifespan such as retisert, ozurdex, and yutiq are available. Ozurdex has a very successful track record over numerous studies in treating posterior uveitis in adults and children. It is important to rule out infectious causes of uveitis before administering ozurdex. We can achieve optimal control of ocular inflammation with minimal systemic side effects when used judiciously.

Newer anti-vascular endothelial growth factor agents Priya Rasipuram Chandrasekaran TNOA Journal of Ophthalmic Science and Research 2020 58(4):268-273 Ocular angiogenesis is a major cause of ocular morbidity worldwide. Vascular endothelial growth factor (VEGF) is a critical regulator of angiogenesis and vascular permeability with diverse roles both during the development and adulthood. This is believed to be the most powerful mediator of angiogenesis leading to ischemia-induced neovascularization in the retinal and choroidal diseases. Anti-VEGF has revolutionized the treatment of such angiogenic and exudative diseases of the retina and choroid. This article gives a brief view of the newer anti-VEGF agents and their role in retinal diseases.

Current concepts in the management of cyclodialysis Vijayalakshmi A Senthilkumar, Sharmila Rajendrababu TNOA Journal of Ophthalmic Science and Research 2020 58(4):274-279 Cyclodialysis clefts are rare. The most common reason for presentation is blunt ocular trauma followed by various iatrogenic interventions. Although gonioscopy is the gold standard technique, diagnosis is particularly challenging, and various noninvasive techniques such as ultrasound biomicroscopy and the newer anterior segment swept-source optical coherence tomography have been found effective. The management of cyclodialysis clefts should be conservative initially followed by a variety of nonsurgical and surgical modalities to achieve closure. In this article, we report the most recent developments in the diagnosis and surgical and nonsurgical treatment strategies of cyclodialysis cleft. An extensive literature search was done using PubMed and Google Scholar with the search terms such as cyclodialysis cleft, ocular hypotony, hypotony maculopathy, cyclopexy, and cyclotamponade.

Myopia: Current concepts and review of literature Kirandeep Kaur, Bharat Gurnani, Veena Kannusamy TNOA Journal of Ophthalmic Science and Research 2020 58(4):280-287 Myopia is the most common cause of refractive error in children. It is the most common ocular disorder worldwide. Apart from genetic factors, age and environmental factors have also been found to be closely associated as predictors of myopia. A comprehensive literature search was on online platforms using terms Myopia review, onset, progression, treatment, control, updates, bifocals, Atropine, and Orthokeratology. All the relevant articles published in English in last 10 years were analyzed and included. Excessive near work and prolonged screen usage have been proven as definite risk factors apart from genetics. Role of Vitamin D and outdoor activities are still having a controversial stand. Myopia treatment has come a long way from glasses/contact lenses to advanced minimally invasive refractive procedures such as femtosecond-assisted procedures and small incision lenticule extraction. With tremendous improvement in technology and increased dependence on digital devices, control of myopia progression remains a big challenge. Use of bifocals, progressive glasses, rigid contact lenses, and soft bifocals lenses have been studied widely. These all measures seem to do well in initial years, but long-standing results are not encouraging. The results with low-dose atropine have been convincing, but long-term follow-up results are still awaited.

#

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

Telephone consultation 11855 int 1193,