Acta Scientific Ophthalmology

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1 Primary Open Angle Glaucoma in the Young Age , Ahmed Mostafa Abdelrahman and Rana H Amin
Primary open angle glaucoma in the young age is known as The Juvenile open angle glaucoma (JOAG) which is a form of primary open angle glaucoma (POAG) that presents with elevated IOP in-traocular pressure between the ages of 4 and 35 years (up to 40 years of age in other reports). Most cases are inherited as an auto-somal dominant trait, and therefore, most families may be aware of their risk of developing this condition. In spite of IOP elevation, it doesn’t usually cause corneal enlargement or Haab's Striae; rather, progressive myopia may continue [1]. The mean age at diagnosis was 26 ± 9.8 years and the estimated prevalence of JOAG ranges from 0.38 to 2 in 100,000 in individuals between 4 and 20 years of age [2].
2 Outbreak of Corona Virus, Ocular Involvement and Scenario in Nepal , Raju Kaiti, Ranjila Shyangbo, Manish Dahal and Bishal Hamal
Coronavirus disease (COVID-19) originating in the Chinese city of Wuhan has rapidly emerged as a global health threat. It is an-ticipated that over 186 countries have been affected, with Nepal being one of the countries at major risk. Nepal reported its first case on 13th January 2020. The novel corona virus 2019 (2019-nCoV) has sparkled global concern but the route of its transmission has not yet been elucidated fully. It is believed to be mainly respiratory. There have been anecdotal reports of ocular transmission. No cases of ocular transmission has been reported in Nepal. Nepal government lacks enough kits for rapid screening. Till date, Nepal is only one country marked Green for Corona virus. It is important for government to to be responsible enough to suppress the cases of COVID-19, prevent transmission and to make necessary arrangements, identify, diagnose cases, isolate and quarantine
3 Black Cataract and SICS: A Safe Surgery with Excellent Outcome , Prasanth Gireesh, Abdulmajeed Alharbi and Poulomi Das
Black cataract is quite common in developing country like India. The biggest problem while dealing with these is, the nucleus is quite hard to break by phaco energy. As a result, post op Striate keratitis is very common. Along with intra op complications are also pretty high for these. On the other hand, SICS is quiet safe surgery when dealing with intra op and post op complications. Here, we are reporting a case report of, how black cataracts can be safely removed by SICS technique. Both intra op and post op complications are less here compared to phaco. Though chances of healing of wound will take a few days longer compared to phaco, but we believe, the odd s are favorable here for SICS surgery.
4 Novel Trends in Screening for Diabetic Retinopathy , Abdulmajeed Alharbi
Diabetic retinopathy screening is the first step to take for treating diabetic patients in a large population. We don't know as of now, how many people are actually suffering from Diabetic Retinopathy. The actual no of patients are much more and it's increasing daily. Because of the slow progress nature of the disease, patients themselves don't know for years, that they are suffering from diabetes. Once it starts affecting all the microvascular structures of body, the effect becomes more prominent. Eye and kidney are one of the most important organs to get affected in diabetes. A no of different tests are getting done in community level to detect DR in early stage. With the progress of telemedicine and wide community awareness it's becoming easy to detect and screen patients in early stages and treat them.
5 Clinical Characteristics and Visual Rehabilitation in Keratoconus Patients Presented at a Tertiary Eye Care Institute in Uttar Pradesh (India) , Jude Nnoruga, Mosaib Omaer, Ashi Khurana and Lokesh Chauhan
Purpose: To assess the clinical characteristics and visual rehabilitation in Keratoconus patients. Methods: Medical records of consecutive patients diagnosed of Keratoconus presented at a tertiary eye care institute during September 2009 to December 2017 were reviewed retrospectively. Demographic details (age, gender, family history of Keratoconus, and occupation), history of contact lens use, history of consanguineous marriages, presenting best corrected visual acuity, refractive error, clinical signs based on slit lamp biomicroscopy and best corrected visual acuity after refractive correction, were noted.Results: Of the 96 patients, 135 eyes of 72 (75%) patients were included in the study. Mean age at the time of diagnosis was 20 ± 6.7 years (8 to 40 years). 87% of them had presented bilaterally. 69.4% of them were students. Myopic astigmatism with a mean equivalent of -1.90DS and increased cylinder of -3.09DC was more prevalent. 54.1% of patients were either in advance or severe stage of Keratoconus. Spectacles were prescribed for 82 (60.7%) eyes, contact lens for 19 (14.1%) eyes, corneal collagen crosslinking with Riboflavin was done in 28 (20.7%) eyes, deep anterior lamellar keratoplasty in 4 (3%) eyes and optical penetrating keratoplasty in 2 (1.5%) eyes. There was significant improvement in BCVA from presentation in all patients.Conclusion: Age of presentation was distributed equally between 8 to 40 years of age. Majority of the patients presented bilaterally with advance to severe form of Keratoconus, which was different from published studies, where patients had presented at mild to moderate stage.
6 Sports Vision: Influence on Athlete's Performance , Patrícia Rodrigues
The ability to see and then create an appropriate motor response is central to optimal sports performance. Elite athletes face intense visuo-motor demands requiring millisecond-level decision making to convert vision into action. Some crucial skills in competition are directly linked to the visual process. It is helpful to classify the areas of assessment in order to better understand how the factors affect performance. It is analyzed a routine check in sports vision consultation, which involves the evaluation plan routine of primary and secondary skills with direct influence on sports performance. These abilities are assessment with an approach to direct correlation with the sporting skill that interferes; the way it should be evaluated and the instruments available on the market. Sport vision training aproaches provide another opportunity for the athlete to enhance vision and visual performance factors that are importante for their sport. In most sports, vision is critical element for sucessful performance and an eyecare professional should be proficient in assessing and training athletes' high-performance vision skills
7 Case of Childhood Bilateral Cataract Complicating a Polymorphous Light Eruption , CEA Filali*, F Chraibi, A Bennis, M Abdellaoui and IA Benatiya
Purpose: To detail the clinical picture and the diagnostic procedure, and to update the therapeutic management.Setting: Ophthalmology Department, Hospital Hassan II, fez.Observation: An 11-year-old boy, a young farmer, without notion of consanguinity or similar familiar cases, visited us with one year history of progressive decline in visual acuity and photophobia. Visual acuity was 6/10 in both eyes. Slit lamp biomicroscopy examination found a very embarrassed child by the light, a conjunctival thickening interesting palpebral fissure and subscapular cataract, no ocular hypertension and a normal fundus examination in both eyes. General examination revealed erythematous and papular lesions on the face, the forearms and the dorsal hands, which are itchy, evolving by relapses and remissions, and exacerbated by solar exposure.A skin biopsy was performed and histopathology disclosed a psoriasiform and spongiotic dermatosis with focal lichenoid reaction in favor of polymorphous light eruption. There were no abnormal laboratory findings, including antinuclear antibody and porphyria profiles. Thus, we diagnosed the patient with PLE complicated by bilateral cataract provoked by overlap solar exposure. Conclusion: Our case, considered as first reported in the literature, encourages good ocular protection against UV at a young age, due to possible complications
8 Outcome of India Ink Corneal Tattooing in Disfigured Corneal Scars , Pallavi Joshi, Sanjana P and Girish Budhrani
Aims: To study the outcome and safety of India ink corneal tattooing for disfigured corneal scars. Settings and Design: This was a single-centre prospective interventional case series of patients who developed corneal scars with nil visual potential and underwent corneal tattooing from June 2017-September 2018 with a follow-up period of at least 6 months. Materials and Methods: 15 consecutive cases were enrolled for the study. All patients desired a cosmetic treatment for their corneal scars in blind eye. Complete ophthalmic examination including B scan and photographs of the patients' eyes were obtained. Chemical corneal tattooing was performed using Indian Ink Powder. Patients underwent either inlay, on lay or mixed tattooing and were followed up at the first, third and fifth post-operative day, at 3rd month, 6th month and 1st year post-operatively.Conclusion: Chemical corneal tattooing is a simple, safe and an efficient technique yielding acceptable cosmetic results. It does not require expensive materials and offers a viable option in comparison to more extensive and invasive reconstructive ocular surgery. Cosmetic contact lenses being unsuitable for majority of cases owing to poor tolerance due to dust exposure and cost effectiveness tattooing of corneal opacities still has a role in cosmetic improvement in cases with unsightly corneal scars. Chemical corneal tattoo by using Indian ink as an alternative proves to give almost equivalent stable, satisfactory cosmetic result with high patient satisfaction in all cases and an improved quality of life.Statistical Analysis Used: Descriptive statistics will be calculated initially. For continuous variables, the mean, standard deviation statistics will be calculated and proportion statistics for categorical data. Results: Among the 15 cases, 7 (46%) patients underwent intralamellar tattooing, 3(20%) patients had onlay tattoo and 5 (33%) patients underwent onlay with inlay tattoo. Patients who underwent onlay tattoo noted fading of tattoo at the end of 3 months. One year postoperatively, 12 cases (80%) especially the inlay tattoo cases were more satisfied compared to onlay tattoo. All patients were asymptomatic with no evidence of any major ocular complications at the end of one year.
9 Ocular Morbidity, Clinical Profile and Visual Loss in Vitamin-D Deficiency; A Systemic Correlation , Meera Mohanakumar, Radha Annamalai, Shriraam Mahadevan and M Muthayya
Purpose: To determine the spectrum of ocular manifestations of vitamin-D deficiency/insufficiency, its effects on vision and the levels at which they occur.Materials and Methods: A prospective study done in concurrence with the department of endocrinology over a period of 1 year on 150 patients who had been referred to the ophthalmology clinic for screening and treatment of ocular complaints. Conclusion: Vitamin-D levels and genetic variations influence the development of a wide range of ocular pathologies, such as myopia, age-related macular degeneration, diabetic retinopathy, glaucoma and uveitis with its anti-angiogenic, anti-inflammatory and anti-fibrotic properties. Many tissues in the eye activate and respond to vitamin-D, suggesting that vitamin-D is a biologically relevant entity to study throughout the eye.Results: Dry eye disease(DED) was found in 102 patients (78%), followed by glaucoma in 33 (27%) patients, diabetic retinopathy in 30 (22%), myopia as the common refractive error in 25 patients (16.7%), hypertensive retinopathy in 13 out of 150 (8.7%) and age related macular degeneration(ARMD) in 6 patients (4%). Among the various ocular features, keratoconjunctivitis sicca was the most common manifestation across all age groups with vitamin-D deficiency; followed by glaucoma. In those with dry eye, decreased TBUT occurred in 30 patients and decreased Schirmer’s in 72 patients. This was found to be statistically significant with a p-value of 0.381. Among those with glaucoma, 4 (2.7%) were disc suspects, 2 (1.3%) had primary angle closure and 13 (8.3%) patients had primary open angle glaucoma and 11 had ocular hypertension. The incidence of glaucoma was higher in women with deficiency and this was found to be statistically significant with p = 0.03. Myopia in 16.7% and diabetic retinopathy in 22% were other features. Visual loss and visual field defects occurred predominantly in patients with glaucoma due to optic nerve head changes
10 The Etiology, Therapy Outcomes and Clinical Predictors among Patients Attending Low Vision Clinics at a tertiary Ophthalmic Referral Center in Tanzania , Chabane P Amisse, J Hoffman and William Makupa
Purpose: To determine the etiology, low vision therapy outcomes and predictors for good clinical outcomes among patients attending low vision therapy at Kilimanjaro Christian Medical Centre.Methodology: We report a cross-sectional, hospital-based study conducted between September 2018 and June 2019 at Kilimanjaro Christian Medical Centre in northern Tanzania. All patients who attended low vision clinic from 2015 to 2018 were reviewed. Excluded were those who had best corrected visual acuity equal to or better than 6/18, patients younger than 5 years and those with no documentation of diagnosis age and/or sex. Wilcoxon signed rank test was used to assess the visual acuity improvement and logistic regression to find the predictors for good visual outcome.Conclusion: In this study low vision therapy often resulted in good visual outcome. Despite this, visual outcome was dependent on the presenting best corrected visual acuity, meaning those most in need tend not respond. Most causes of permanent visual impairment in our setting are preventable or curable if detected early. This is another reminder that prevention is better than cure.Results: 408 patients were included in this study, of which 208/408 (51%) were adults. The 3 leading causes of permanent visual impairment in adults were diabetic retinopathy, 63/208 (30.3%); glaucoma, 21/208 (10.1%); and corneal scarring, 16/208 (7.7%). In children they were oculocutaneous albinism, 80/200 (40%); amblyopia, 20/200 (10%); and glaucoma, 15/200 (7.5%). Good low vision therapy outcome was noted in 151/175 (86.3%) of patients who had assessment for distance therapy and 113/157 (72%) in those assessed for near low vision therapy. The presenting best corrected visual acuity (distance or near) and the age of the patients were found to be significant predictors for good visual outcome (p < 0.001, for both).
11 A Good View of Brain through the Optic Nerve Window , Amir Norouzpour
Optic nerve is developmentally derived from an outpouching of diencephalon leaving the cranial cavity through the optic canal. The most anterior portion of the optic nerve called the optic disc is directly visible through the eye. With modern techniques, the in-tegrity of the optic nerve fibers can be visualized, and the structure and function of the nerve fiber layer can be precisely quantified.
12 A Clinical Profile of Corneal Ulcer in a Rural Tertiary Care Hospital , Avinash Poka, Mohan Das T and Narayan M.
Introduction:Cornea is responsible for three quarters of dioptric power of the eye and hence any injury to it can cause considerable visual disturbances. Avascularity, while absolutely essential for optical purposes is boon to multiplying organisms. In India there are about 18.7 million blind people. The incidence of corneal blindness is 15.4%, the corneal ulcer contributing (9.34%), corneal dys-trophy (0.49%), keratomalacia (1.68%), corneal opacity (3.67%) and others like keratoconus (0.09%) of this. Corneal blindness is a major problem in India, which adds a substantial burden to the community in general and health care resources all over the world. Further, individuals with corneal blindness are usually of a younger age group compared with those suffering from cataract. Hence, in terms blind years the impact of corneal blindness is greater. Objectives:1. To study the clinical features, etiology and microbiological profile of suppurative keratitis. 2. To study the course, final visual and therapeutic outcome of the cases.3. To study the various factors affecting the outcomes and their relationship with the micro biological profile and clinical appear-ance.4. To identify the signs and symptoms (which carry a poorer prognosis or may indicate a fulminant course). Materials and Methods: A prospective observational study was conducted at Department of Ophthalmic, PES Institute of Medical Sciences and Research, Kuppam study period between Jan 2018 - 2019. A total 80 subjects who diagnosed has corneal ulcer at-tending in department of ophthalmology, PESIMSR. The following inclusion and exclusion criteria was used to conduct the research programme inclusion criteria: All cases of suspected Microbial keratitis visiting cornea clinic between January 2018 to June 2019. Exclusion criteria: All cases of clinically suspected non-bacterial and non-fungal keratitis, known cases of degeneration ulcer like Moorens ulcer and Terriens. Patients below 18 years of age and patients unable to give valid consent and one eyed patients.Results:Total 85 cases was considered for the study group. Out of which male comprises 52 (61.18%) and female was 33 (38.82%) with sex ratio 1:2. The significance was tested based on the logistic regression analysis. Irrespective of gender it was found that incidence and exposure of culture organisms was statistically significant (p < 0.01). The laterality was Correlated between Culture organisms, the analysis was done multivariate logistic regression method. As per the resulted findings, the most occurrences of the organisms was Fusarium 23 (27.06%) (p < 0.01) followed by Bacillus species 14 (16.47%) (p < 0.01), Aspergillums fumigates 12 (14.12%) (p < 0.01), Strep. epidermidis 13 (15.29%) (p < 0.01), Staph aureus 11 (12.94%) (p < 0.01), Aspergillums flavus 8 (9.41%) (p < 0.01) and fewer number of organisms are showed to be Strep. pneumococcus 4 (4.71%) (p < 0.01). The occurrence of the organisms when compared with laterality and other associated factors is found to be statistically significant. Conclusion: The definitive diagnosis of ulcers caused by multiple organisms can only be arrived at by microbiological evaluation. Accurate diagnostic tests not only play a key role in patient management but also reduce the risk of the patient developing long-term complications.
13 Computer Vision Syndrome: Is it being Diagnosed and Managed Properly? , Raju Kaiti1, Purushottam Shah, Birkha Bogati, Ranjila Shyangbo, Manish Dahal and Bishal Hamal.
Computer and mobile computing devices such as laptops, tablets, or cell phones are being used by increasingly large number of people today. This has led to variety of ocular symptoms which includes eye strain, tired eyes, irritation, redness, blurred vision, and diplopia, collectively referred to as Computer Vision Syndrome (CVS). CVS may have a significant impact not only on visual comfort but also occupational productivity since between 64% and 90% of computers users experience visual symptoms which may include eye strain, headaches, ocular discomfort, dry eye, diplopia and blurred vision either at near or when looking into the distance after prolonged computer use. So, CVS acts like slow poison for ocular and visual comfort, if not taken into consideration timely. CVS has a multifactorial causation. Several factors have been linked to symptoms. But how often has it been diagnosed and managed properly? The answer is “not satisfactory”. Most of CVS cases have been dispensed merely with eye drops and no other orthoptic interventions and ergonomic awareness are suggested, especially in developing countries like Nepal. A specially designed ocular examination for computer users and associated counseling about the current good practice in computer use would go a long way in preventing loss of productivity and morbidity from the condition.
14 Bulging of Posterior Capsule Associated with Choroidal Effusion during Phacoemulsification , Saraswati J, Umesh Y, Priyanka Sudhakar and Pradeep Bastola.
We report an interesting and a relatively rare case of intraoperative choroidal effusion, during a routine phacoemulsification in a seemingly normal senile cataract, with a bulging of posterior capsule and shallowing of anterior chamber because of choroidal effu-sion which is a very rare intraoperative event in an elective case of phacoemulsification.
15 Serial OCT Imaging of Retina in HELLP Syndrome , Tony Y Chen and Neelakshi Bhagat.
Exudative retinal detachment (ERD) is a rare ophthalmic complication of eclampsia and HELLP syndrome. We report a case of acute painless severe vision loss in a multigravida pregnant woman with HELLP syndrome caused by bilateral ERDs. The use of systemic corticosteroids, and meticulous blood pressure management, resulted in rapid resolution of subretinal fluid and visual re-covery. Disruptions in ellipsoid zone and retinal pigmented epithelium, however, persisted for months after resolution of subretinal fluid.
16 Evaluation of Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer Loss in Patients with Primary Open Angle Glaucoma , Mohamed M Almbsut, Amira G Abdelhameed, Dalia S El-Emam and Asaad A Ghanem.
Aim:This study aimed to compare peripapillary retinal nerve fiber layer (RNFL) and macular retinal ganglion cell-inner plexiform layer (GC-IPL) changes in patients with primary open-angle glaucoma with control subjects by Swept Source optical coherence to-mography. Methods:This was a comparative cross-sectional study included 40 eyes of 40 POAG and 40 eyes of 40 control subjects. Ophthalmic examination, measurement of intraocular pressure, Visual field evaluation by using Humphrey (2003 Carl Zeiss Meditec, Germany) were done. All subjects were scanned using swept source Optical Coherence Tomography (Triton, Topcon, Tokyo, Japan) imaging to measure Macular GC-IPL thickness, peripapillary RNFL thickness. Results:The mean age of the patients with POAG was 58.20 ± 9.12 years; 26 eyes (65.0%) were male and 14 eyes (35.0%) were female. The mean age of control subjects was 54.10 ± 9.11 years. The mean visual field MD was -11.30 ± 6.88 db, SE was -3.43 ± 1.08 D, CMT was 164.3 ± 16.62 Um and IOP was 15.25 ± 1.33 mmHg in patients with POAG, whereas mean visual field MD was -0.97 ± 0.39 db, SE was -3.23 ± 1.04 D, CMT was 170.6 ± 9.21 Um and IOP was 13.20 ± 1.18 mmHg in control subject. A statistically significant dif-ference of IOP, visual field MD was detected between the study groups with p value (p < 0.001). the Mean Macular GC-IPL thickness and peripapillary RNFL thickness were significantly decrease in POAG patients when compared with controls (p < 0.001). Conclusion:Retinal nerve fiber layer and ganglion cell-inner plexiform Layer by Swept-source OCT showed statistically significant decrease in POAG patients.
17 Corneal Lenticule Implantation in Keratoconus Disease with Relex Smile Surgery , Faruk Semiz, Anita Syla Lokaj, Njomëza Hima and Olcay Semiz.
Purpose:The aim of our study is to investigate the feasibility and effect of fresh lenticule implantation as allogenic graft that will be taken from myopic patients to implant in patients with keratoconus disease using VisuMax Femtosecond laser- Smile module surgery with primary objective to increase central corneal thickness and secondary to improve visual acuity and reduces K-values. Methods:All the patients were clinically diagnosed with progressive keratoconus. Twenty patients underwent SMILE surgery (first group), and 20 patients underwent lenticule implantation (lenticule group). Visual acuity, corneal topography, anterior segment opti-cal coherence tomography, were analyzed. Results:Central corneal thickness were improved at the same day of surgery and vision started to improved at first week postop-eratively in the lenticule implant group. Corneal topography showed a statistically significant decrease in the anterior K1 and K2. All the grafts from both groups were clearly visible by anterior segment optical coherence tomography observation. The central corneal thickness was stable during the 6-month study period. No complications were observed during short term follow-up. Conclusion:In conclusion, the present study may suggest that this procedure using fresh lenticule with stromal stem cells and live keratocytes is safely, reliably, and effectively increase corneal thickness and improves visual acuity with no adverse effects, which may provide new avenues in the treatment of corneal ectasia.
18 A Rare Case Report of the Posterior and Bilateral Persistent Hyperplastic Primary Vitreous (PHPV) , Japhet Pobanou Thera, Tiama JM, Konipo A and Dakouo P.
Purpose:The aim of our study was to report a rare case of persistent hyperplastic primary vitreous. Case Report:A 4-year-old girl was brought by her parents for impaired visual acuity. The examination of the lens found a tiny opaci-fication. Fundoscopy revealed a membranous proliferation extending from the papilla to the posterior surface of the lens. Discussion:The persistent primary vitreous is a congenital abnormality. It is due to a failure of regression of the embryonic vitreous to which is added the persistence of the hyoid artery. It occurs around the 6th week of embryo development. Conclusion:Persistent hyperplastic primary vitreous (PHPV) is a rare congenital anomaly. It has many forms. The Posterior form and the isolated bilateral one is rare.
19 Reopening Our Practice and the Woes of the Pandemic , Sana Nadeem
For most of us, the Severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2) is the first and worst pandemic we have ever faced. From its beginnings in Wuhan, China in December 2019; it has exploded; now affecting 213 countries and 10.27 million people worldwide. Claiming 505,071 lives so far; this deadly virus is raging still [1]. A large number of health workers have fallen prey to this virus, which plummeted most of the world into lockdown. As we ophthalmologists were forced to limit our practices to ur-gent cases only; questions now arise on how to keep ourselves’ and our patients’ safe; as the lockdown eases
20 The Role of Jankovic Spasm Grading, Orbicularis Oculi Muscle Function and Functional Improvement Scale Pre-and Post-Treatment in Dosing Botulinum Toxin A in Treatment of Essential Blepharospasm, Meige’s Syndrome and Hemifacial Spasm , Bastola P and Koirala S
Abstract Background:Botulinum Toxin A (BTX A) is a proven medication used in neurological disorders like Meige’s syndrome (MS), essen-tial blepharospasm (ES) and hemifacial spasm (HS). Jankovic spasm grading is a time trusted grading system to detect the severity of these movement disorders pre-treatment. Orbicularis oculi muscle weakness and functional improvement ratings post treatment are trusted guidelines to judge the efficacy of BTX A. Aim/Objective: The study aimed to find out the correct dosing of BTX A in treating cases of MS, ES and HS using Jankovic Spasm grading pre-treatment and orbicularis oculi muscle weakness and functional impairment improvement post treatment. Methods: This was a hospital based, interventional, prospective study. All diagnosed consecutive patients of HS, ES and MS attend-ing the neuro-Ophthalmologic/oculoplastic clinic, general outpatient department of Ophthalmology and or referred diagnosed cases were enrolled for the study, an informed consent was taken from all the patients before the treatment for medico-legal issues. The pre-treatment dosing was done using Jankovic spasm grading, post treatment assessment was done using orbicularis oculi muscle assessment and functional improvement. The study subjects were followed up to 9 months or till spasms reappeared. Results:A total of 50 study subjects were enrolled in the study, 80% of them were women. The highest number of study subjects were in ES (50%) group followed by HS (40%) and MS (10%). Mean Jankovic spasm grading in all study subjects was 3.59 (± 0.38 Std. deviation). The study groups ES and MS required a higher dose of BTX A (P value: < 0.0001) when compared with HS study group. Mean orbicularis oculi muscle weakening and functional impairment improvement scale in all study subjects was 2.7 (± 0.3 Std. de-viation) and 3.8 (± 0.6) respectively. Mean duration of action till the spasms reappeared in the study subjects was 5.1 months (± 1.7 Std. deviation). HS and ES study groups had better treatment when compared to MS. Conclusions:Jankovic spasm grading pre-treatment and orbicularis oculi muscle weakness grading and functional improvement score post treatment plays a very effective role to titrate the correct dose of BTX A in patients of HS, ES and MS.
21 Assessing Awareness and Attitudes of the Arab Diabetic Population in Israel towards their Illness Via Ophthalmic Follow Ups and Questioners , Yael Pikkel Igal, Igal Vadim, Yoav Y Pikkel and Dvora Pikkel
Abstract Background: Diabetes care requires close monitoring and ongoing treatment to minimize related complications. The Arab population in Israel is characterized by high prevalence of diabetes and poor disease control compared to other subpopulations in the region. This study assessed awareness to the disease and self-reported care among Arab persons with diabetes living in northern Israel via examining rates and sequences of ophthalmic examination follow ups and verified questioners. Method: The study was carried out at the outpatient ophthalmic clinics in three Arab towns in Israel. A bilingual (Arabic and Hebrew speaking) physician administered an oral survey that accessed information regarding the awareness of patients towards their disease and their self-care. The survey comprised 12 questions relating to definitions, causes, compliance and attitudes towards diabetes. The patients' responses were compared to the data in their medical files. Results: Participants were 44 men and 56 women. Only 43% acknowledged having diabetes. Twenty (47%) individuals who acknowledged having the disease reported taking their medications regularly, 23 (51%) reported exercising regularly, and 38 (88%) reported visiting an ophthalmologist within the previous year; compared to 0 (0%), 7 (12%) and 38 (67%) respectively of those who did not acknowledge having the disease. Conclusion: This study showed a very low level of awareness of diabetes among patients diagnosed with the disease, as manifested by complete denial of the disease despite recommendations for treatment and large gaps in understanding. Though ophthalmic visits were relatively better in patients with acceptance and denial there are still cultural and socioeconomic barriers that hinder recognition and care of diabetes among Arab Israelis should be addressed.
22 Managing Corneal Epithelial Defects Using High Molecular Weight Fluorescein to Prevent Contact Lens Staining and Removal of Bandage Contact Lenses , Muhammad Hamza, Chrishan Gunasekera, Samar Nahas, Z CX Lin, Hatch Mukherjee and Richard Allen
Abstract: Method: A small group of patients with epithelial defects requiring bandage contact lenses were identified at Colchester Hospital University Hospital. Both Purevision lenses and Biofinity contact lenses were utilized. The lead researcher took anterior segment photography initially devoid of fluorescein. After Fluorosoft was introduced, the process was repeated where anterior section photograph was acquired after 30 seconds to guarantee Fluorosoft was fitted under the lens. Subsequently, removal of the bandage contact lens followed. Later, pictures of the bandage contact lens were taken to evaluate the staining. A second photography was obtained on the anterior segment photograph in order to compare the epithelial defect visibility with normal fluorescein relative to Fluorosoft. Conclusion: • Main aim for this exercise is find a way of not replacing BCL on each examination without compromising the assessment of corneal epithelial defects hence reducing the chance of infection. • The research demonstrates that the fluorosoft (high molecular weight fluorescein) can successfully detect epithelial deficiencies in patients having a series of bandage contact lenses devoid of lens’ staining.
23 Serpentine Appearance of Giant Retinal Tear , Lagan Paul, Neha Chowdhary and Ranobir Ghosh
Giant retinal tears (GRTs) are described as full-thickness cir-cumferential retinal tears involving more than 3 clock hours (90 degrees) of the peripheral retina . GRTs are caused by vitreous traction on the peripheral retina in the area of the vitreous base as there is condensation of the peripheral vitreous along with liq-uefaction of the central vitreous. Due to subsequent transvitreal contraction of the cortical gel, the tear occurs along the vitreous base in a zipper fashion.The sonographic appearance of the GRT has been described in literature as a double linear echo that is dis-continuous with the contour of the globe . We describe the ser-pentine appearance of the GRT on ultrasound B scan
24 Managing Postoperative Astigmatism in Cataract Surgery: A Short Review , Mohammed Abdulkarem and Mustafa Ali Shata
Abstract Cataract surgery is no more a visual rehabilitation surgery. Today along with cataract removal, astigmatism correction has become a routine procedure. Patients want a spectacle free life at any stage of life. 10 years before it was still impressive to have a residual of +2.0 D astigmatism following cataract surgery. But in last 10 years, a lot of technological advancement has happened. The residual astigmatism following cataract surgery has come down from 1.5D to 0.75D, even 0.5D when a premium IOL is implanted. Here we are going to discuss in short the journey of astigmatism correction from choosing the incision in steep axis to Toric IOL implantation and so on.
25 Micro-pulse Diode Laser Transcleral Cyclophotocoagulation- A Rescue in Therapeutic Exhaustion , Meena Menon, Shreeshruthi N, Anand Balasubramaniam and Harshavardhan VK
Abstract Essential iris atrophy (EIA) is one of the most common irido-corneal endothelial syndromes, predominantly characterised by pro-gressive iris stromal atrophy leading to iris hole formation and secondary glaucoma. Predominantly unilateral in affection, glaucoma is refractory to both medical and surgical management. We hereby report a rare case of association of EIA with primary open angle glaucoma (POAG). Glaucoma progressed with the maximum medical treatment and surgical intervention. Micro-pulse diode laser transcleral cyclophotocoagulation (MP-TSCPC) proves effective in control of intra-ocular pressure (IOP) in refractory glaucomas, especially in eyes with good central vision.
26 Comparative Study of Visual Outcomes Following Vitrectomy for Nucleus Drop Caused by Various Aetiologies , Mehul Shah, Shreya Shah, Ruhi Gunay and Raunaq Khanna
Abstract Purpose: Nucleus drop is a rare and serious complication. We investigated visual outcomes following corrective surgery and compared outcomes between surgeries performed in various aetiologies. Method: A retrospective cohort study was performed after obtaining the approval of the ethical committee. The data of patients who underwent vitrectomy for nucleus drop were collected from electronic medical records. Patients were grouped based on the following aetiologies: traumatic, iatrogenic, spontaneous, and congenital. After pars plana vitrectomy and nucleus removal, comorbidities were managed either medically or surgically. All data were collected according to a pretested format and exported to SPSS 22. Results: Our cohort consisted of 169 eyes of 169 patients. The mean age of patients was 55.36 ± 15.7 years. Of 169 patients, 107 (63.3%) were men and 62 (33.7%) were women. Of 169 patients, 44 (26%) were classified as having traumatic nucleus drop and 125 (74%) developed spontaneous nucleus drop without trauma following cataract surgeries (Table 2). In the iatrogenic group, 33 (38.56%) patients developed nucleus drop during phacoemulsification and 59 (62.9%) following MSICS. Conclusion: The visual outcome following corrective vitrectomy for nucleus drop may be satisfactory if managed well; no significant difference in the outcome was noted based on the aetiology.
27 To Assess the Intraoperative Complications in Small Incision Cataract Surgery and Visual Outcome , Smita Kunwar1, Janak Poudel and Jyoti Kattige
Abstract Keywords: Small Incision Cataract Surgery; Intraoperative Complications; Visual OutcomeAbbreviations Background and Objective: Small incision cataract surgical procedure is the most normally performed surgical treatment for cataract in growing countries. This system is safe and effective to boom the output of cataract surgical services, at the identical time affordable. The present have a look at is undertaken to recognize the prevalence of intraoperative complications and how exceptional the complications may be minimized and dealt with and additionally its visual outcome. Method: A general of 471 instances turned into studied. Intraoperative complications have been studied and managed. Visual outcome following these complications have been studied with the aid of noting the BCVA after 1st week and 6th week of surgical treatment. Results: Out of 471 patients, 52(11%) patients The intraoperative complications were posterior capsular rupture occurred in 29 patients (55.8%), iris prolapse in 18 patients (34.6%), premature entry in 6 patients (11.5%), iridodialysis in 1 patient (1.9%), zonular dialysis in 1 patients (1.9%). 52 patients who had intraoperative problem came for follow up till sixth weeks, 28 cases (53.8%) had post-operative BCVA 6/9 or higher in 1st week and 24 cases had post-operative BCVA 6/18 or worse in 1st week. In 6th week 42 patients (80.8%) had 6/9 or better and 10 patients (19.2%) had 6/18 or worse. Interpretation and Conclusion: Small incision cataract surgical operation is top approach which gives early and top visual outcomes. Overall the complication of small incision cataract surgery is less
28 A Case Series of Conjunctival Rhinosporidiosis: Extremes of Presentation , Shobita Nair, Anitha Venugopal, Vinit J Shah and Meenakshi Ravindran
Abstract Rhinosporidiosis is a rare infection caused by Rhinosporidium seeberi, an organism classified into class, Mesomycetozoea. It com-monly affects mucus membranes. The diagnosis of rhinosporidiosis is based on its clinical appearance, microscopic features and the treatment is surgical excision. This condition is endemic in the temperate regions of the Indian subcontinent. Although a rare clinical entity, the possibility of rhinosporidiosis must be considered when evaluating any polypoidal conjunctival mass in patients belonging to any socioeconomic strata. Here we present 3 patients of different age groups and socioeconomic status with varied presentations suggestive of Conjunctival rhinosporidiosis, their evaluation, management, and outcomes
29 Post COVID-19 Era and Ophthalmology Practice , Pratyush Dhakal
In the wake up the global pandemic of novel corona virus and its effects, the entire world has been in its knees for almost 4 months now. It has crushed economy in various countries and has brought the recession again on its peak. Global markets have either stops or are in very bad stage. Many big companies have laid off their employees and declared themselves bankrupt.
30 A New Approach to Microsurgical Medical Education: Mobile Phone Repairs , José Henrique Fazzi, Marina Schor and Paulo Schor
Background: Technology has been increasingly used as a teaching tool in medical education, and simulation training is at the fore-front of that shift in teaching methods. This project proposes an innovative tool for training students in microsurgery. Through fixing their cell phones under the guidance of a supervisor, students got a chance to improve their technique in microscope use. Furthermore, the procedure allowed for students to discuss insecurities surrounding the performance of microsurgery. Materials and Methods: Eight students from the Federal University of São Paulo were involved in the project and were selected through a phone screening process. Those students brought in their own faulty cell phones which were the main materials used. Other materials included pieces that needed replacing in the phones and the tools needed to open, close and handle the apparatus generally. Results: 87.5% of the students achieved the expected result with a successful procedure and 25% of students had technical problems during the procedure. 75% of students, however, had no major technical problems during the procedure. Two of the eight students who participated in this project had trouble with the cell phones one month after the procedure. The remaining had fully functional devices. Conclusion: The majority of students successfully completed the cell phone repairs. Overall, there was a high level of acceptance of the project by students as a successful learning tool which increased both their abilities and self-confidence. Students overall left satisfied with the activity and said they would recommend it to others.
31 Recognizing Uncommon White Retinal Vasculopathy , Paul Varner
Unusual medical presentations present diagnostic challenges, and correct identification of such conditions represents advanced clinical proficiency. White retinal vessels fall into the category of uncommon ophthalmic findings. This paper reviews presentations of white retinal vasculopathy, the pathophysiology behind those conditions, and the limitations of current terminology.
32 Lid Hygiene Versus Lid Hygiene Plus Microblepharoexfoliation for the Treatment of Demodex folliculorum Blepharitis , Michael B. Choi and Rebecca Stein
Purpose:To compare lid hygiene versus lid hygiene and microblepharoexfoliation (MBE) (BlephEx®) in the treatment of Demodex folliculorum blepharitis.Methods:This study was an Institutional Review Board approvedrandomized prospective single masked trial of 50 patients with microscopically proven Demodex blepharitis. All subjects received lid hygiene two times a day and half were randomized to in-office MBE treatment. All subjects at baseline and one month were evaluated for the total number of Demodex on 4 eyelashes, Ocular Surface Disease Index (OSDI), tear osmolarity, MMP-9, Schirmer 1, Non-invasive tear break-up time (NIBUT), lipid layer thickness, meibography, lissamine green staining, and eyelid margin exam. Results:The total number of Demodex decreased by 3.88 from baseline to month 1 for the lid hygiene plus MBE group vs. 0.4 for the lid hygiene alone group (p < 0.001). NIBUT increased 1.1 seconds from baseline to month 1 for the lid hygiene plus MBE group vs. 2.8 seconds for the lid hygiene alone group (p = 0.52). All other measurements were similarly not statistically significantly different (lipid layer thickness, OSDI, Osmolarity, MMP-9, Schirmer 1, meibography, lissamine green staining, and eyelid margin exam). Conclusion:Both lid hygiene plus MBE and lid hygiene alone decreased the amount of Demodex with the group receiving MBE showing a greater decrease that was statistically significant (p < 0.001). MBE may have a positive role in the treatment of Demodexblepharitis
33 Deficit Convergence and Headache: The Invisible Facts , Gaurav Dubey, Mahesh Chandra, Ragni Kumari, Richa Jangra and Aysworya Mohapatra Suneel Kumar Dixit
The inadequate convergence is a state where your eyes will not cooperate if you look at objects in the vicinity. This disorder allows one eye to face out with the other eye, instead of inward, causing a double or blurred vision.Insufficiency in fusion is normally diagnosed in children and teenagers in school age. It may cause reading problems, about which parents or teachers can believe the child is experiencing learning difficulties rather than an eye disease. Persons of all ages can be treated with convergence insufficiency after a stroke or traumatic brain injury
34 Endogenous Endophthalmitis in a Two-Week-Old Neonate with Hypofibrinogenemia , Anuradha Ganesh, Ahlam Al-Hamhami, Maha Mameesh, Sana Al-Zuhaibi, Sameer Raniga S, Yasser Wali and Abdullah Al-Mujaini
We report a two-week-old neonate with congenital hypofibrinogenemia and neonatal sepsis who developed left endogenous endophthalmitis. Gram positive bacillus Rothia dentocariosa and Gram negative bacillus E. coli were isolated from blood culture. De-spite early initiation of both topical and systemic antibiotic therapy the baby had a deteriorating course and the eye was eviscerated.
35 Optimum Utilization of Electric Bulbs , B Shukla
Centuries back all work was done during daytime and night was utilized mainly for rest. In modern times with the development of electric gadgets little difference is left between day and night. Nevertheless, in developing countries and more so in rural areas still electric filament bulbs are the commonest source of illumination. Even in daytime electric bulbs are needed for indoor work. However, the use of these bulbs has been mainly empirical by common sense as knowledge about illumination is rather primitive even in cities and in educated persons also.Continued use of improper illumination is a very common cause of eye strain which may lead to great discomfort and even organic disease. Students who form a large bulk of population suffer the most as they have to read for long hours. In the present work an effort has been made to measure the illumination emitted by different type of bulbs by a luxmeter at different distances. Theoretical requirement of illumination is available from books but hardly anyone knows how to get that illumination by electric bulbs. Even an approximate required illumination for different types of work has been worked out. If this guideline is followed many persons suffering from eye strain can be relieved without any medicine. The efficiency of work will also increase.
36 Needs and Challenges of Correction of Refractive Error among School - Aged Children , Nahid Ferdausi
Visual impairment from uncorrected refractive-errors can have immediate and long-term consequences in school-aged children, such as lost educational opportunities, lost an economic gain for individuals, families, and societies, and impaired quality of life. Un-corrected refractive-error is recognized as the principal cause of visual impairment in school-aged children as failure to the treatment of refractive-error in children may lead to Amblyopia which turns into the blindness of the children.
37 Challenges Face during Fitting of RGP Contact Lenses in Keratoconus , Shivam Bajoria
Introduction: RGP contact lenses is of paramount importance in Keratoconus patient management to rehabilitate vision and improve patients quality of life.There’s always been on focus to find alternative to Contact lenses options which is already been proposed. Like if patient show contact lens intolerance or disease progresses, basically the surgical procedures along with the non optical options can be applied, as looking on to which option the patient is more convenient according to his requirement.Also there's can be an option of Scleral Contact Lenses which can even be the first choice if the RGP intolerance occurs or there can be the option of Kerasoft lenses if the comfort is the main priority of the patient.
38 Evaluation of the Efficacy of Single Dose of Intravitreal Bevacizumab in the Management of Macular Edema due to Retinal Vein Occlusions , Vinit Shah, Panneer Selvam V, Sindhanai VP, Shobita Nair, Amal Gupta, and Radha Jayaraman
Aim: Evaluation of the efficacy of single-dose intravitreal Bevacizumab in the management of macular edema due to retinal vein oc-clusions. Objectives: 1. To evaluate the efficacy of single-dose intravitreal bevacizumab in the management of macular edema due to retinal vein occlu-sions in terms of reduction in central macular thickness. 2. To evaluate the efficacy single dose of intravitreal bevacizumab in the management of macular edema due to retinal vein occlu-sions in terms of improvement in visual acuity. 3. To evaluate the change in the Intraocular pressure in the eyes receiving intravitreal Bevacizumab. Methods: This study was an Institutional Review Board approved prospective interventional study done in a Retina clinic at a ter-tiary eye hospital, where 45 patients were enrolled. All patients clinically diagnosed to have retinal vein occlusions with macular edema with all risk factors were enrolled for the study. After informed consent, all participants were subjected to the following examinations, visual acuity was recorded on Snellen’s vision chart, followed by anterior segment evaluation, intraocular pressure, go-nioscopy, slit-lamp biomicroscopy with 90D lens and fundus finding were confirmed by indirect ophthalmoscopy. Optical coherence tomography was done in every patient. The diagnosis of macular edema was established by clinical examination and optical coher-ence tomography was done to quantify central macular thickness (CMT) at baseline, 4 weeks and 8 weeks after a single injection of 1.25 mg (0.05 ml) intravitreal Bevacizumab. Results: The mean central macular thickness (CMT) at presentation was 482.88 μm ± 173.6 μm (SD). The mean CMT decreased from baseline to 314.3μm ± 129.9 μm at one month. The mean CMT decreased to 237.1 μm ± 97.08 μm at the end of 2 months which was statistically significant (p < 0.05). The logarithm of minimal angle of resolution (logMAR) vision at presentation 1.043 ± 0.443 improved to 0.690 ± 0.424 and 0.529 ± 0.440 at 1 month and 2 months respectively (p < 0.05). There was no statistically insignificant change in IOP after a single injection of Bevacizumab. Conclusion: Intravitreal Bevacizumab even in a single dose is effective in the treatment of all types of retinal vein occlusions. There was a statistically significant improvement in visual acuity, the decrease in the central macular thickness was also statistically signifi-cant and effects were maintained throughout the follow-up period without any changes in IOP
39 How Often Should Healthy Optic Nerves be Scanned for the Development of Glaucomatous Optic Neuropathy? , Paul Varner
Background: No data exist for the time period required for the conversion of healthy optic nerves to glaucomatous optic neuropathy (GON). It is not possible to predict which patients will develop glaucoma. Periodic screening of ONHs via nerve fiber layer (NFL) scans might allow for the early detection of GON. Method: Retrospective chart review of patients who developed definitive unilateral (n = 18) or bilateral (n = 13) glaucoma to de-termine time course for conversion to/discovery of GON, as corroborated by optic nerve head (ONH) evaluation, NFL scans, and automated visual field (VF) perimetry.Results: Median time of conversion for this cohort was 7 years for unilateral and 8 years for bilateral GON. Conclusion: Screening ONHs/NFL at five-year intervals may be adequate for the detection of new cases of GON in its early stages.
40 Outcome of External Dacryocystorhinostomy with Excision of Both the Anterior Lacrimal Sac and Nasal Mucosal Flaps and Preservation of the Posterior Flaps , Abdullah S Al-Mujaini1*, Maryam S Al-Issai2 and Buthaina I Sabt
Purpose: An external dacryocystorhinostomy (Ex-DCR) is a surgical procedure wherein a fistula is created between the lacrimal sac and nasal mucosa. Although the conventional approach to an Ex-DCR procedure is time-consuming and may result in complications, it is considered the gold-standard technique for the management of nasolacrimal duct obstruction (NLDO). This study aimed to evaluate the outcomes of a modified Ex-DCR approach with intubation and in which both the anterior lacrimal sac and nasal mucosal flaps were excised while the posterior flap was left hanging free. Methods: A retrospective chart review study, included all consecutive adult patients with primary NLDO who underwent modified Ex-DCR procedures. Data were collected from electronic patient records, including oculoplastic and orbital surgical notes. All pa-tients underwent a minimum of 12 months of follow-up. Success was defined according to lacrimal patency and symptomatic relief. Results: A total of 45 patients underwent modified Ex-DCR procedures with intubation and excision of both the anterior lacrimal sac and nasal mucosal flaps. During the 12-month follow-up period, 43 (95.6%) demonstrated a patent lacrimal drainage system and were symptom-free. Two patients (4.4%) developed secondary obstruction with persistent epiphora. Conclusion: The excision of both the anterior lacrimal sac and nasal mucosal flaps during a modified Ex-DCR procedure resulted in a high success rate comparable to that reported in the international literature with standard techniques. In addition, this procedure might shorten the surgical time required. However, further studies are required to determine if such modifications hold a statistical advantage over conventional techniques.
41 Ocular Morbidities among the Elderly Attending Outreach Eye Care Clinics in Gandaki Zone, Nepal , Pawan Baral, Indraman Maharjan, Nabin Baral and Bhoja Raj Gautam
Purpose: To determine the causes of visual impairment in patients attending outreach services in Gandaki, Nepal. Methods: This was a prospective cross sectional study conducted within two districts of Gandaki Zone Nepal. The patients forty years and above and attending the screening outreaches conducted by Himalaya Eye Hospital (HEH) were taken for the study. The pa-tients attending the screening outreach underwent a thorough eye examination by an Ophthalmologist and an ophthalmic assistant. For the purpose of the study we only considered the distance and near visual acuity and the diagnoses. Distance visual impairment (DVI) was categorized as the presenting visual acuity of worse than 6/18 to 3/60 in the better eye. Blindness was categorized as the visual acuity of worse than 3/60 in the better eye. For all subjects the near visual impairment (NVI) was categorized as the present-ing near vision of worse than N8 at patient’s preferred reading distance. The main cause of distance visual impairment or blindness was considered the main diagnosis. Results: Eight hundred sixty-two subjects within the age group forty and above were taken for the study. The mean age of the study subjects was 64.75 ± 10.65. The odds ratio of having DVI in persons aged 60 years and older compared to those aged less than 60 years was 4.79 (CI: 2.94 to 7.83; p < 0.0001). The odds ratio of having DVI among illiterates compared to those who were literates was 2.77 (CI: 1.96 to 3.92; p < 0.0001). The odds ratio of having DVI among widowed individuals compared to married or single individuals was 2.86 (CI: 1.44 to 5.63; p = 0.002). 818 (94.9%) of the study population had NVI. The proportion of subjects who had NVI differed significantly between the occupations χ2 (3, N = 861) = 14.37, p = .006. Cataract was the main cause of DVI (56.47%) followed by Age-Related Macular Degeneration (ARMD) (15.29%), refractive error (12.35%), and others (7.06%). Conclusion: These data indicate that DVI and NVI is common in elderly population in Gandaki zone. The DVI and NVI are specifically dependent on the age, education level, occupation and marital status of the elderly people. Considering these factors as the determi-nants of vision loss, more focus on eye care services need to be provided to the population within these categories.
42 Sonographic Features and its Association with Visual Outcome and Microbiological Profile in Acute Post Cataract Surgery Endophthalmitis - A Prospective Analysis , Tharini Senthamizh, Tanpreet Pal Singh, and Haripriya Aravind
Background and Aims: Cataract surgery is the commonest eye surgery performed worldwide. Endophthalmitis is a sight threaten-ing complication of cataract surgery which causes reduced vitreous clarity and media opacities and precludes visualization of the posterior segment. Ultrasonography is done in cases of suspected endophthalmitis with poor media clarity. This study aims at evalu-ating, baseline sonographic features of acute post-cataract surgery endophthalmitis and its association with initial vision, final visual outcome and microbiological profile. Materials and Methods: This prospective study conducted at Aravind Eye Hospital, Madurai, South India, included all patients who presented with clinical symptoms and signs of endophthalmitis, between January 2014 to December 2015. They underwent A-mode and B-mode ultrasonography and were managed with either ‘tap and inject’ strategy or primary vitrectomy and followed up for three months. The sonographic features like vitreous opacities, vitreous membranes, retinal detachment, choroidal detachment, posterior vitreous detachment, and retino-choroidal thickening were documented and their association with vision at presentation, microbio-logical profile and final visual acuity was studied. Results: There were 54 patients (54 eyes), their mean age was 59.9 ± 19.2 years and male : female ratio was 1:1. Of them, 33 patients (61.1%) had dense vitreous opacities, 16 patients (29.6%) had dense vitreous membrane, 3 patients (5.6%) had retinal detachment and 1 patient (1.9%) had choroidal detachment. Median retino-choroidal thickening was found to be 1.82 mm (1.67-1.96 mm). In-creased retino-choroidal thickening (P = 0.049) and dense vitreous opacities (P = 0.000) was significantly associated with poor initial presenting acuity. The occurrence of retinal detachment was significantly associated with poor final vision (P = 0.006) and infection by virulent organisms (P = 0.028). Conclusion: In conclusion, sonographic warning signs are associated with infection by virulent organisms and poor visual outcome.
43 A New CM T Flex Aphakia Foldable IOL with Trabeculectomy for a Case of Traumatic Aphakia with Secondary Glaucoma , Nivean M, Murali Ariga, Pratheeba Devi Nivean and Archana N
Here, we report a case of 37-year-old male who came with a history of traumatic aphakia in the right eye 10 years back along with uncontrolled intraocular pressure (IOP). His Uncorrected vision was hand movements in the right eye at presentation. He was managed with a new CM T-FLEX foldable aphakic scleral fixated intraocular lens with superior trabeculectomy. Fornix based conjunctival partial-thickness triangular scleral flap of 4mm were raised. Mitomycin c was placed for 1 minute. Surgical iridectomy was done using Kelly's punch. Flap closed with releasable sutures. Two partial-thickness limbal-based scleral flaps of 2.5mm*2.5mm were created 180 degree apart; sclerotomies were made using 23G needle 1.5mm away from limbus. The new CM T-flex intraocular lens was injected through the 2.8mm clear corneal incision and the specially designed T shaped lens haptics were externalised with the 23G PraNiv T flex forceps, brought out and left under the scleral flap and using the hand shake technique the second arm was grasped using the NiShi Grasping forceps and exchanged to the PraNiv T flex forceps and brought out through the other sclerotomy. The intraocular lens was stable. Anterior chamber wash was done and air bubble was injected. Fibrin glue was used to close the scleral flaps and conjunctiva. Postoperative period was uneventful. At the end of 1 month, the patient's best corrected visual acuity was 6/24 in the right eye with a good filtering bleb superiorly and a stable, well-centered CM T flex Aphakia intraocular lens.
44 Perception and Scenario of Contact Lens Use in Developing Countries like Nepal , Raju Kaiti and Ranjila Shyangbo
Contact lenses have been making a huge difference to the life of their wearers, providing a certain level of freedom that traditional glasses are unable to. Their existence has been a boon especially for those living with refractive or cosmetic ramifications, as some-times with contact lens use it is impossible to judge if a person is visually impaired or has significant cosmetic concerns. Nowadays, beside their therapeutic and refractive use, contact lenses have been sought-after cosmetic enhancement of the eye. Although the use of contact lenses has been preceding ahead of other means of refractive corrections in developed countries, their use has been stigmatized and severely misunderstood in developing countries like Nepal. Could it owe to lack of knowledge on contact lenses among the patients or are we, eye care professionals, failing them due to our ineptitude to provide proper patient education on con-tact lenses?
45 Does Hypovitaminosis A in Mothers Cause Congenital Malformation of the Eye? , Shreya Shah, Mehul Shah, Ashit Desai, Mrugesha Vaghela and Deeksha Thorat
Abstract Introduction: Congenital malformation is an important cause of childhood blindness. Hence, we attempted to study the factors responsible for it. Methods: This was a retrospective cohort study. We collected data from our hospital EMR for the period 2008 - 2019. We retrieved the total number of paediatric outdoor and children with congenitally malformed eyes. We also explored the history of night blind-ness in mothers during pregnancy, exported the data to excel sheets, and calculated the type of anomalies using descriptive analyses with SPSS 22. Results: Our cohort included 1435 children out of the total 100946 (1.42%) outdoor of paediatric ophthalmology. We found various anomalies in our analyses. We discerned that 423 (29.47%) cases had a history of night blindness to mother during pregnancy, sug-gesting vitamin A deficiency. Conclusion: Based on our clinical observation, it could be concluded that hypovitaminosis A in mother results in maldevelopment and congenital anomalies of the eye in children.Keywords: Vitamin A Deficiency; Congenital Malformation of Eye; Hypovitaminosis A in Mothers
46 Low Level Light Therapy as an Adjunct Treatment for Meibomian Gland Dysfunction , Karl Stonecipher, Casey Komm and Richard Potvin
Abstract Importance: This study highlights the adjunctive value of low-level light therapy (LLLT) in the management of meibomian gland dysfunction (MGD). Background: To evaluate the effects of LLLT treatment on clinical measures of dry eye related to MGD in patients unresponsive to previous therapies.Design:A retrospective chart review of patients treated at one site.Participants:Fifty eyes of 25 treated patients who were documented treatment failures with previous pharmaceuticals and/or devices were evaluated.Methods: LLLT treatment consisted of 3 treatments in one week, with adjunct use of a topical steroid/antibiotic combination. The post-treatment diagnostic measures had to have been made 3 to 5 weeks after the last LLLT treatment. Main Outcome Measures:Results included changes in the graded MGD score (grading scale 0 - 4), tear breakup time (TBUT), an Ocular Surface Disease Index (OSDI) questionnaire score and lissamine green (LG) staining. Results: Significant improvements in the mean OSDI score (p = 0.002), MGD grading (p < 0.001), TBUT (p < 0.001) and both nasal and temporal LG staining (p < 0.02) were observed after treatment. An MGD grade reduction of 1 or more was observed in 72% of eyes (36/50), and 2 or more in 32% of eyes (16/50). There were no ocular or facial adverse events or side effects related to the treatment. Conclusion: The application of LLLT over a short series of sessions for the treatment of MGD appeared to be beneficial in the majority of patients who had failed to improve with alternative pharmaceutical and device interventions.
47 Evaluation of the Efficacy of Subconjunctival Anti Vascular Endothelial Growth Factor Antibody Injection in the Treatment of Retinopathy of Prematurity in an Experimental Rat Model , Tuncay Topal, Yakup Aksoy and Ali Ayata
Abstract IntroductionVEGF plays an essential role in the vasoproliferative process in ROP. It is secreted from Müller cells and astrocytes in response to hypoxia caused by hypoperfusion in the retinal layers. Inhibition of VEGF bioactivation is a key target in the treatment of ROP [1]. The first attempt in ROP treatment was the ablation of VEGF-pro-ducing retinal avascular areas. For this, cryotherapy was first used Purpose: To observe the effect of subconjunctival (SC) approach for the treatment of retinopathy of prematurity (ROP) in an experi-mental rat model. Methods: We used 4 groups (G) comprising 18 new-born rats in each. G1: healthy control, G2: untreated oxygen induced retinopathy (OIR) control, G3: SC rat anti vascular endothelial growth factor antibody (antiVEGFab) injected and G4: Intravitreal (IVT) antiVEG-Fab injected. G2, G3 and G4 were exposed to oxygen fluctuations alternating between 50% and 10% every 24 hours until postnatal day (p) 14 at which time the groups were placed into room air for 4 days. At p18; OIR was observed through fluorescein angiography (FA). G3 and G4 were treated immediately 1 μg/10 μl and 50 ng/2 μl respectively. FAs repeated at p19, p25 and p30. To evaluate OIR; modified retinopathy scoring system (MRSS) was calculated according to the FA images, including retinal vascular development, vascular tuft formation, extraretinal neovascularization, vascular tortuosity and retinal haemorrhage. Blood analysis was performed on the same three days for the measurement of serum VEGF levels. Histopathological evaluation was performed with haematoxylin & eosin staining for the vascular lumen quantification on the retinal specimens of the enucleated eyes on the same days.Results: There was no significant difference between the G3 and G4 at the end of the study according to the MRSS values(p: 0,101), systemic VEGF levels (p: 0,796) and vascular lumen counts of histopathological specimens (p: 0,359). Conclusion: The therapeutic effect of SC and IVT on OIR were similar. SC anti VEGF treatment may be a safer and effective alternative to IVT injection for the treatment of ROP.Keywords: Subconjunctival; Retinopathy of Prematurity; Vascular Endothelial Growth Factor; Oxygen Induced Retinopathy
48 To Study the Effect on Central Foveal Thickness Following Prompt/Deferred Macular Photocoagulation After Single Intravitreal Bevacizumab Injection , Aashka Shah, Vidhi Solanki and Dipal Patel
Abstract Aim:To find out the efficacy of macular photocoagulation when given in the early or late period after single intravitreal bevacizumab injection in terms of central foveal thickness change and visual acuity gain.Methods:40 patient eyes were studied and they were divided into groups based on sex, age, hba1c levels, severity of disease and treatment received over the period of 6 months. Result and Conclusion: Patients receiving deferred macular photocoagulation after a single intravitreal injection of bevacizumab had better outcomes regarding reduction of central foveal thickness and improvement in visual acuity at the end of 6 month observa-tion period compared to those patients receiving prompt macular photocoagulation.
49 A Study of Hypertension and Associated Health Related Life Style Behaviours in Patients with Depression , Varum Malhotra, Hena Dhir1, Rakesh Malhotra, Ankit Daral3 and Rahul Bhargava
Abstract Background: Patients with severe mental illness including depression may have multiple co-morbid physical illnesses. Systemic hypertension and lifestyle factors may increase mortality in patients with depression. Objective: To study co-morbid hypertension and associated lifestyle factors in patients with major depression. Methods: Cross section observational study at a tertiary care hospital. Results: Patients evaluated after exclusion were 400. Majority of patients 69(34.5%) had moderate depression. The mean duration of illness was 58.94 ± 77.26 months with no significant difference between males and females (P = 0.830). Co-morbid psychiatric ill-ness was present in 73(36.5%) study subjects. Co-morbid conditions were present in 106 (26.5%) patients. The prevalence of hyper-tension in our cohort was 18.5%. A total of 216 patients (54%) were found to be obese; it was significantly higher (Chi-square test, P = 0.024) in females (63.7%) as compared to males (47.5%). Inadequate physical activity was seen in 44.5% patients. On correlation analysis, a significant correlation (P<0.05) was observed between hypertension with obesity and family history of non-communi-cable disease. On binary logistic regression, in patients with depression, those with positive family history of non-communicable disease (OR = 2.6), increased duration of illness (OR = 1.3) and physical inactivity (OR = 2.1) were more likely to have hypertension. Conclusion: A bidirectional association may exist between depression and hypertension with increased risk of cardiovascular mor-bidity.
50 Cystic Schwannoma Arising from Supraorbital Nerve Masquerading as a Dermoid: An Unusual Case , Kanishk Singh, Ankur Shrivastava and Amrita Singh
We are presenting a rare case of Cystic Schwannoma which was masquerading as a dermoid .The patient was 23 year old male pre-sented with a slow growing mass over his right supero-medial side of the orbit since last two and a half years. Examination showed a solid, non-tender, freely mobile mass of around 15 × 15 mm in the supero-nasal orbit, which was firm to hard in consistency, non-pulsatile, non-reducible in nature. CT scan of right orbit revealed a well-defined hypo attenuated skin based lesion in the right supra-orbital region which measures 11.9 × 14.6 × 15.2 mm (AP × TRA × CC). A complete tumour resection was performed, and pathologic examination showed it as a case schwannoma of orbit. Schwannomas are infrequent tumours which arise from the orbit coming behind Inflammatory, vascular and lymphoproliferative diseases; treatment is complete resection of the mass with subsequent moni-toring to prevent recurrence.
51 Role of ASOCT in Preoperative Assessment of Posterior Polar Cataract , Abhinav Dhami, Nimratabajaj Dhami and Gobinder Singh Dhami
Abstract Objective: Preoperative anterior segment optical coherence tomography in assessing posterior polar capsule integrity. Method: A prospective observational study of 40 eyes of 25 patients. Patients with posterior polar cataracts undergoing elective cataract surgery were planned for ASOCT [Copernicus Revo (OCT NX700 Optopol technology) and the IOL master 700 (Carl Zeiss Meditec AG, Jena, Germany)] for determining the posterior capsular integrity and planned for phacoemulsification, by two surgeons during the period of January 2019 to December 2019. Posterior polar cataracts were categorized: Type 1- “continuous”; Type 2: abrupt, Type 3: “dehiscent”.Results: A total of 40 eyes (25 patients) were included. 30 eyes (75%) were bilateral (15 patients) and 10 eyes (25%) were unilateral patients. ASOCT findings noted were, type-1 PPC were observed to be 85% (34 eyes) and 70% (30 eyes) equally detected with both the IOL master 700 and the Optopol ASOCT, Type-2 PPC were 12.5% (5) and 15% (6) of the cases and type-3 PPC were 2.5% (1) with the IOL master 700 and 10% (4) with the Optopol Revo ASOCT. The sensitivity and specificity for the IOL master 700 for predicting the PPC integrity was 90.32% and 66.27% each, and for the Optopol REVO ASOCT was 96.77% and 90% each. Intraoperatively, pos-terior capsular rent was noted in type-3 PPC, 2 cases (5%). Conclusion: AS-OCT provides a relevant insight for predicting preoperative PC deficits thus enabling better surgical planning and in anticipating PCR.
52 Brief History of Cataract Surgery , Gowhar Ahmad
history of cataract surgery is very fascinating and our present generation of young ophthalmologists who are and have seen various subspecialities and recent advances in every branch of med-icine might be surprised as what was done long back in the era when we had no anaesthesia no surgeons no medical care so what was done let me answer from ophthalmic point we had one can call them psuedosurgeons or quakes they would operate cataract by a modality called couching and they were called couchers
53 Syndromic Retinitis Pigmentosa: Case Report of Usher Syndrome in Bamako , Théra JP, Tiama JM, Konipo A and Dakouo P
Purpose: To report a very rare case of retinitis pigmentosa. Case Report: We report the case of a 25-year-old man, admitted in the Institute of African Tropical Ophthalmology (IOTA) of Bamako for progressive visual acuity loss associated with deafness, in whom, after clinical investigation, the diagnosis of Usher syndrome type 2 was confirmed. Discussion:Usher syndrome is a rare inherited genetic disorder. It is the first genetic cause associating retinal damage (retinitis pigmentosa) with hearing damage (deafness). Symptomatology varies according to the type. Conclusion: Usher syndrome is a genetically diverse entity and is a leading cause of deaf-blindness. There is no specific care so far, but genetic counselling is of vital importance for its prevention.
54 Clinical Case: Orbital Hydatic Cyst Revealed by Exophthalmia , S Belaaroussi, K Housni, C Baqadir, L Elmaaloum, B Allali and A Elkettani
Orbital hydatidosis is a rare clinical entity that most often affects children and young adults living in rural areas. It is secondary to the orbital development of the taenia Echinococcus granulosus. This aberrant location of hydatidosis is serious because of its consequences, especially of a functional nature, hence the interest of prevention. Morocco is an endemic country where hydatidosis still prevales and is a non-exceptional cause of exophthalmia. We report the case of a 43-year-old patient, in whom an evolutionary unilateral exophthalmia had revealed an orbital hydatic cyst.
55 Lisch Nodules in Schwannomatosis: A New Manifestation , Emanuele Miraglia, Chiara Iacovino, Giovanni Corbo, Fabiana Mallone, Antonietta Moramarco and Sandra Giustini
Schwannomatosis is a syndrome characterized by presence of schwannomas in the absence of bilateral vestibular schwannomas and meningiomas. Schwannomas interest frequently peripheral nerves (90%) and spinal nerves (75%).Schwannomatosis are generally sporadic; in 15 - 25% are familiar. The genes involved are SMARCB1 (40-50% of familial) and LZTR1.The reported phenotype continues to expand and evolve. We report the case of a patient with Schwannomatosis and Lisch nodules, typical manifestation of NF1.
56 Practice of Contact Lens During COVID-19 , Janak Poudel and Premnath Krishnasamy
A novel corona virus (CoV), the severe Acute Respiratory syndrome coronavirus-2 (SARS-CoV-2), results in the coronavirus dis-order 2019 (COVID-19). The SARS-CoV-2 has been detected in the tears and conjunctival secretions in COVID-19 patients with con-junctivitis. Till date there is no proof that contact lens wearers are more likely to contract COVID-19 than spectacle wearers. The virus is known to be transferred through hand contact, and thus could be transferred to contact lenses throughout their application and removal. Five essential areas of action applicable in CL exercise to reduce the transmission of COVID-19 are: Patient management, personal protective equipment, disinfection of CL equipment and CL trail set, hand hygiene, CL practitioner and staff monitoring. Although the pandemic is increasing day by day, as optometrists should provide the care as well as services to the needy people fol-lowing the recommended guidelines.
57 MINT-Wigris Postulates , Gudrun Kalmbach HE
The new models of MINT-Wigris are based on few postulates 1.-9. which can be used for the states of energy systems. It is not necessary to use in infite dimensional Hilbert space for this. Octonians are sufficient whose coordinates carry charges and energies: color, electrical, mass charges, heat, kinetic, magnetic, rotational, electromagnetic (interaction) energies. They evolve from a black hole Horn torus which contains retracts of quarks. Beside the radius inversion at the Schwarzschild radius in 1., for speeds is postula-ted a Minkowski cone inversion at the speed of light. To the physics standard model with the U(1)xSU(2)xSU(3) symmetry are added finite symmetries like the CPT Klein group of the quark dihedral D 2 , the quark triangle S 3 and S 4 of the tretrahedron. There are two dimension changes in 4. through the fusion model from 6 to space xyz-coordinates which relates to the Heisenberg uncertainties and from 4 octonians which add to coordinates the above energies for measurements. The evolution of energies in 2. is followed in 3. by a nucleon dynamical model, desscribed by the SU(3) strong interaction SI rotor. It makes cyclic integrations. In a crystalized version the rgb-graviton whirl has its tip in the center of a deuteron and forms as base triple a tetrahedron as model (Figure 6) with the quarks sitting at the endpointss of its three pairwise orthogonal vectors. The new tetrahedrons discrete symmetry of order 24 factorizes through the quark dihedrals CPT Klein symmetry of order 4. Obtained are for the equivalence classes that each color charge has associated one of the coordinates, has a symmetry of the quark triangle D 3 group (similar as spin has the Pauli symmetry of SU(2) generators). The fourth member in each class is one out of six basic energies (two for POT, kinetic, rotation, magnetic, heat). Gravity is included in the different postulates. It uses in many instances projective geometry and projections. The general relativitic version in 7. is due to a central projection. Mass rescalings occur in different form: added inner frequencies to a mass at rest, its Minkowski special relativistic scaling which give group speeds for matter waves. In 6. As new measuring devies according to the Copenhagen interpretation for quantum measures are added the Gleason frames GF as spin-like orthogonal vector base triples. Their weights atta-ched to the three vectors can be non-negative real numbers with sum > 0 or complex or quaternionic numbers. Superpositions of GF occur. In figure 8 a list of 8 tools demonstrate some GF and are more general for teaching purposes. The Fano memo shows 7 GF, but there are more, also for SU(3). SU(2) has also some GF. For waves in 8. the cylindrical helix quantization is through winding numbers. Only full windings in a circular U(1) projection are stored as energy. U(1) is a rolled Kaluza-Klein coordinate for the electromagnetic interaction symmetry. In 7. the first octonian coordinate provides a vector needle for the U(1) compasses disk. It can set units for measuring the energy coordinates and generates in discrete form numerical or energy based cyclic structures with the nth roots of unity for polar dihedrals. They relate to the SU(2) Hopf geometry in 5. with the Heegard decompositions for colliding systems. In 9. to the wave particle duality is added as third character whirls. They occur in many conic geometries for quasiparticles. This set of postulates is published under researchgate for the MINT-Wigris project. Wanted are colaboraters, especialy for producing models.
58 Analysis of Emergency Ocular Surgeries during a Pandemic- Experience of a Tertiary Eye Care Centre , Vinitha L Rashme, Sankarananthan R, Madhu Shekhar and Senthil Prasad
Objective: To analyze the demography and clinical profile of ocular emergency surgeries performed during COVID-19 pandemic in a tertiary eye care center. Design:This is a retrospective study. We included data of the patients who underwent ocular emergency surgeries from 24.03.2020 to 15.05.2020 (24.03.2020 was the date of commencement of national wide lockdown in our country). Data from the corresponding time of the previous year (24.03.2019 to 15.05.2019) were taken for comparative analysis. Setting: This is a retrospective Hospital based study. The data were retrieved from electronic medical record system. Participants:Patients who underwent emergency ocular surgery during the study period were included. 242 patients were included for 2020 study period and 948 for 2019 study period. Results:Overall 242 patients underwent ocular emergency surgeries during the pandemic. The mean age of the patients was 41.52 ± 22.6, median was 45 years (Interquartile range, IQR: 24 - 60), were mostly adults 187 (79.3%). Majority of them were males 157 (64.9%). More than half of our patients 127 (52.69%) presented from within 60 km of the point of care. History of ocular trauma was seen in 130 (53.9%) patients and among them 42 (32.3%) fall under the age group of 0 - 15 years. Most common indications for surgery were open globe injury 64 (26.4%) and rhegmatogenous retinal detachment 38 (15.7%). There was significant increase in open globe injury (from 12.8% to 26.4%) and lens induced glaucoma (7.7% to 13.2%) when compared to the corresponding time of the previous year. Conclusion:We need to educate people regarding the importance of timely treatment of ocular emergencies to get a better outcome. Health care sector should be well equipped and accessible to handle emergencies during these pandemics. Hospitals need to prepare for expected surge in patients during post pandemic era.
59 Comparison of Optical Quality, Spherical Aberration and Contrast Sensitivity between Spherical and Aspheric Intraocular Lenses , Subekshya Khanal, Kalpana Bhandari, Nirmal Debnath and Sharath N S
Background: The goal of cataract surgery today is not only to restore visual acuity but also to provide the best quality of vision pos-sible. With modern techniques and advancements in the manufacture of Intra Ocular Lenses (IOLs), improvement in patients’ visual performance and quality of life has become the main goals after cataract surgery. Method: 70 eyes of 70 patients (35 aspheric IOL and 35 spherical IOL) between the age group of 45 - 73 years with BCVA of 6/6 at postoperative period of 3 months were enrolled in the study. HD -Analyzer was used to measure the optical quality, FACT for check-ing the contrast sensitivity and i-Trace for measuring the spherical aberration. Informed consent was obtained from all participants. For each case Pro Forma sheet including patient’s demographic data, best corrected visual acuity and type of IOL implanted were maintained.Results: There was significant better contrast sensitivity, optical quality and less of spherical aberration in patient who were im-planted with aspheric IOL than compare to the patients implanted with spherical IOL. Conclusion:After the postoperative period of 3 months, patient with aspheric IOL were found to have good optical quality, contrast sensitivity and reduced spherical aberration than those of spherical IOL group.
60 COVID-19 and Ophthalmology Practice at University Hospital “Policlinico Umberto I” in Rome , Leopoldo Spadea; Andrea Iannaccone.
61 Relationship of Negative, Positive Relative Accommodation and Negative, Positive Fusional Vergence in Ammetropes and Emmetropes in a Young Population of Nepal , Mohammad Masihuzzaman1; Pratyush Dhakal; Kishor Gautam.
Purpose:This study aims to correlate accommodative, vergence parameters in myopia, hypermetropia and Emmetropia in young Nepalese population.Methods:A cross sectional study design was conducted in subjects of Chitwan Eye Hospital, Bharatpur Nepal. All the samples un-derwent the measurement of uncorrected and corrected visual acuity and refraction. Then far and near cover tests were performed. The near point of convergence (NPC), accommodation, accommodation facility, negative relative accommodation (NRA) and positive relative accommodation (PRA) and vergence parameters for distance and near were evaluated in all participants. Statistical analysis was done using the one-way ANOVA and correlate bivariate in SPSS 16 Software.Results:The mean age of the 108 participants was 22.95 ±3.17 years (18-35 years). The mean value of NRA was +2.88 ± 0.74 diopter (D) and PRA was -3.54 ± 1.15 (D) in total sample. Mean NRA and mean PRA was highest in hyperopic participants. The NRA was correlated with the Positive Fusional Vergence (PFV) distance in which significant (p < 0.040) and it was also correlated with the Negative Fusional Vergence (NFV) near with significant difference at the level of 0.05 (p < 0.03). But the NRA have no any statically correlation with the NFV distance in our study. The mean value of NFV in distance and near was 10.14 ± 3.40 prism diopter (PD) and 14.71 ± 5.48 prism diopter (PD), respectively. And the mean fusional value for PFV distance and near was 21.58 ±10.65 prism diopter (PD) and 23.14 ± 11.43 prism diopter (PD), respectively. Conclusion:This study provides the normal range of NRA and PRA in Nepalese population. The results found in this study provides the direct relationship between NRA and PFV in hyperopic participants. Both NRA, PRA and NFV, PFV should considered when evalu-ating vergence and accommodative systems and even during orthoptic training. This study also provides the normal values of two parameter contributes to the diagnosis of the type of disorder and differential diagnosis. Keywords: Negative Relative Accommodation; Positive Relative Accommodation; Fusional Vergence; Refractive Errors
62 Identification of a Nonsense Mutation in AIPL1 Gene Causing Leber Congenital Amaurosis in a Family Clinically Diagnosed as Retinitis Pigmentosa , Sheth Jayesh J; Shah Jay S; Gandhi Ajit; Patel Chandni.
Leber congenital amaurosis is a rare inherited retinopathy resulting in severe vision loss at an early age. We present a family wherein leber congenital amaurosis was clinically misdiagnosed as retinitis pigmentosa in a pregnant women with a clinically documented family history of retinal dystrophy. Clinical exome study in the proband identified a nonsense variant (c.834 G>A / p.W278X) in the AIPL1 gene. A prenatal study from the chorionic villus found the foetus to be heterozygous for the identified variant, confirming the carrier status. This study highlights the utility of advanced genomic diagnosis for the phenotypically overlapping ophthalmic disorders.
63 Histopathologic and Immunohistochemical Analysis of Conjunctivochalasis , John A Pilavas1; Kirkland L Castellano; Max N Chikovsky; Tatyana Milman; Marcelle M Morcos; Henry D Perry.
Purpose:To histopathologically and immunohistochemically investigate conjunctivochalasis (CCh) and compare it to normal con-junctival tissue.Methods:20 consecutive conjunctivochalasis specimens and 5 age-matched controls were submitted for pathologic evaluation be-tween 2010 and 2017.Control tissue was harvested from age appropriate Eye Bank donors with no ocular or ophthalmic surgical history. Specimens were stained with Hematoxylin and Eosin (H&E), Verhoeff-von Gieson (VVG), M2A (D2-40) lymphatic endothelial marker and CD68 macrophage marker. Collagen interfibril distance, elastin fiber density, lymphatic vessel density and macrophage density were mea-sured using Aperio Imagescope software. Patient identifying information was masked from observers. Statistical analysis performed using Mann-Whitney Test.Results:H&E Control: mean collagen interfibril distance 4.10 microns compared to CCh: mean interfibril distance 7.54 microns (p = 0.018). In the VVG Control: mean 22.63 elastic fibrils per 10 collagen fibers compared to CCh: mean 8.92 elastic fibrils per 10 collagen fibers (p = 0.007). In the M2A (D2-40) subset Control: 0.012 lymphatic vessels per square millimeter; CCh: 0.027 lymphatic vessels per square millimeter (p = 0.0124). CD68 subset Control: 0.038 macrophages per square millimeters to CCh: 0.12 macrophages per square millimeters (p = 0.045, z-score -2.00), all comparisons showed statistically significant differences. Conclusion:Statistically significant increased collagen interfibril distance, decreased elastic tissue density, higher lymphatic vessel density and increased CD68 macrophage count occurred in the CCh subset compared to controls. These findings support the influ-ence of mechanical and inflammatory factors as being central to causation of conjunctivochalasis.Keywords:Conjunctivochalasis; Histopathology; Lymphangiectasis; Elasticity; Infiltration
64 Effect of Refractive Error on Visual Evoked Potential in Myopic Males and Females , Chanda Kumari Gupta; Smriti Ranabhat; Rahul Roy.
Introduction:Visual Evoked Potentials are summated electrical signals generated by occipital regions of cortex in response to visual stimuli and recorded from human scalp. Visual evoked potential measures the conduction time of neuronal activity from retina to oc-cipital cortex, the measure of integrity and function of visual pathway. The amplitude and latency of visual evoked potential are affect-ed by variety of physiological factors like refractive errors, age, gender, eye movement and also the techniques like check size, color, distance to pattern etc. To find out the effect of myopia on visual evoked potential, this study was conducted on males and females. Methods: 50 controls [25 males, 25 females] and 50 myopic [25males, 25 females] aged between 18-30 years with refractive error in range of -0.5D to -5.00 D were participated with cylindrical component less than -1.00 D with no significant difference in spherical equivalent between the eyes. VEP was measured using full field pattern reversal checkerboard pattern as stimuli and refractive error as measured both objectively and subjectively.Results:Statistical analysis showed significant prolongation of P100 latency in myopic subjects along with significant reduction in P100 amplitude. When compared according to gender P100 latency significantly increased and the amplitude decrease was also found significant. When Spherical equivalent was co related with VEP latency and amplitude in the whole group, VEP latency showed negative correlation and weak positive correlation for VEP amplitude which was insignificant. When co-relating in males, we found negative correlation for latency and insignificant amplitude whereas in females, latency showed negative correlation with significant amplitude. Conclusion:As significant changes in VEP was seen in case of myopia in both genders, refractive errors should also be kept in mind while performing VEP for optic pathway evaluations in order to minimize false positive results.Keywords:VEP - Pattern Reversal; Amplitude; Latency; Myopia; BMI
65 Long-term Effects of Eyewash Solution Use on the Conjunctival Bacterial Flora , Takafumi Saeki; Miho Tanaka; Manabu Nozaki; Hiroko Yano; Hiroyuki Yazu; Hiroshi Fujishima.
Purpose:Commercial eyewash solutions are widely used in Japan for the removal of foreign bodies from the ocular surface and relief from unpleasant symptoms, and many individuals use them daily. However, the effects of habitual eye washing on the conjunctival bacterial flora have not been investigated yet. In this study, the bacterial flora in healthy eyes was evaluated after one month of con-tinuous use of a commercial eyewash solution.Methods:In total, 29 participants with healthy eyes were recruited. Eyebon® W, a commercial eyewash solution available in Japan, was used as the test eyewash. The eyes were randomly designated as treatment (group 1) and no treatment (group 2). The eyes in group 1 were washed twice daily with Eyebon® W for one month. The eyes in group 2 were not treated with any eyewashes or eye drops. Samples were collected from the inferior palpebral conjunctiva. Ultimately, a sufficient amount of cDNA for analysis was obtained from 11 individuals (22 eyes). The viable bacterial count was determined and the bacterial flora was analyzed using next-generation sequencing of 16S rRNA amplicons.Results:In both groups, the bacterial flora was mainly composed of 6–7 genera. There were no statistically significant differences in the average rates for each genus in the conjunctival bacterial flora, regardless of the eyewash condition (P > 0.05). Conclusion:Our findings suggest that washing eyes twice a day using eyewash is unlikely to have a significant impact on the con-junctival bacterial flora.Keywords:Eyebon®; Eyewash; Ocular Surface; Microbial Flora; Safety; Long Time-use
66 Leptonic Octonians , Gudrun Kalmbach HE.
67 Ophthalmology in the Era of COVID 19 , Joseph Pikkel.
The recent year has brought us new challenges, mainly coping with the COVID 19 pandemic. In addition to obvious concern of protecting the patients and ourselves we had to work and live in uncertain surroundings. Working in such conditions is definitely different than any other scenario we are used to – even mass casu-alty incidents, war trauma and other extreme situations.
68 Non Strabismic Binocular Vision Disorders Among VDU Users of Bangalore, Karnataka , Sunaina Mary Alex; John Michael; Aditya Goyal; Diwakar Rao.
Purpose:To evaluate major symptoms and non strabismic binocular vision disorders among VDU users in Bangalore. Methodology: Among 90 VDU users, assessment included visual acuity, retinoscopy, convergence, accommodation, fusional ver-gence, vergence facility and accommodation facility. Subjects’ symptoms were recorded in the COVD questionnaire (QOL 19).Results:Mean age of subjects was 25.8 ± 3 years. Ocular changes were reported in 85% of the total subjects. The common non strabismic binocular vision anomaly was Convergence insufficiency with a secondary accommodative excess. The most common symptoms (p < 0.001) were headache with near work and trouble keeping attention on reading.Conclusion:Convergence insufficiency associated with a secondary accommodative excess and headache with near work were the most common abnormalities and symptom reported. Non strabismic binocular vision disorders were correlated with symptoms as-sessed through COVD questionnaire (QOL 19).Keywords:VDU; Non Strabismic Binocular Vision Disorders
69 Comparative Efficacy of Olopatadine 0.2%, Bepotastine 1.5% and Alcaftadine 0.25% in Treatment of Allergic Conjunctivitis , Upasna Ajmani; Anand Aggarwal; Karamjit Singh; Prempal Kaur; Monisha SP; Shivani.
Objective:To compare the efficacy of 0.2% olopatadine, 1.5% bepotastine and 0.25% alcaftadine in treatment of allergic conjuncti-vitis. Design: This was a prospective study conducted on 90 consecutive patients who presented to out-patient department with signs and symptoms of allergic conjunctivitis from December 2018 to July 2020 i.e. 20 months. Randomization was done by envelope method in which randomly generated treatment regimens were sealed within opaque envelopes and allocated to the patients after obtaining their informed consent.Results:Out of 90 patients, 55 (61.11%) patients were males. Overall mean age was 16.67 ± 10.59 years. 74.44% patients resided in rural areas. 38(42.22%) patients had symptoms of allergic rhinitis such as running nose and sneezing. The mean time for beginning of itch relief after instilling eye drops at first visit was 6.35 ± 1.99 minutes with no significant difference between Group A, B and C (p = 0.58). Paired analysis of median itch scores showed significant improvement in median itch score (p< 0.05) at each follow-up visit when compared to the previous visit in all groups. On comparing the median symptom scores and sign scores, there was no statistically significant difference (p > 0.05) between the scores of group A, B and C at the time of presentation as well as at follow-up visit on day 1, day 3, 1 week, 1 month and 3 months. All the symptoms were completely resolved in group A, B and C by the end of 1 month. Papillary reaction persisted in 35(38.89%) of patients at the end of 3 months. The average cost of treatment for 1 month was 280.00 INR, 495.00 INR and 450 INR in Group A, Group B and Group C respectively which shows that olopatadine 0.2% was most cost-effective. Conclusion:Olopatadine 0.2%, bepotastine 1.5% and alcaftadine 0.25% are comparable in treating symptoms and signs of mild to moderate allergic conjunctivitis. None of these drugs are effective as monotherapy in treating severe allergic conjunctivitis. Olopata-dine 0.2% is most cost-effective and equally effective as bepotastine 1.5% and alcaftadine 0.25% in treating allergic conjunctivitis. Olopatadine 0.2% may be prescribed to patients as initial therapy considering the low socio-economic status of majority of patients in our country.Keywords:Allergic; Conjunctivitis; Olopatadine; Bepotastine; Alcaftadine
70 Rare and Interesting Case of Choroidal Melanoma Presenting As. A Case of a Congestive Glaucoma Left Eye in a Male Patient of 55 Years of Age , Gowhar Ahmad.
Choroidal Melanomas are one of the commonest intraocular tumours which are• Benign• Malignant• Pigmented• Non pigmentedAre more common in Whites than Blacks have got an early tendency for liver metastases however if diagnosed and treated in time and properly one can prevent metastases. They are 6 per Million in USA 7.5 Per Million in Denmark And Other Scandinavian Coun-tries They are 80 percent Choroidal 12 Percent involve C body 8 percent involve Iris Very difficult to diagnose due to their atypical Manifestations. However, on B scan ultrasound and indirect ophthalmoscopy present as solid or exudative retinal detachment.Keywords:Progressive and Painless; Visual Field Loss; Paracentral Scotoma; Blued Vision; A C Glaucoma; Sec Glaucoma; Vitreous Flouters; Severe Ocular Paine
71 Histotechnical Virtual Review of Pigmentary Retinal Epithelium , Zarate Jorge O; Zarate Jesica M.
For the sequencing of OCT images to histological morphology, the postulates of Fourier Physics and Mathematics are generally followed with their transforms, Schannon's Theory of Information and the concepts of Güdel's logic using the pixelometry for the dru-sa study in the retinal tissue (non invasive digital retinal biopsy).We study the pigmentary epithelium and can appreciate images of the different constituents ,degradation and production of .hya-line substance.
72 Insight and Notion of Novel Coronavirus (nCoV-19) Among Medical and Nonmedical Person Practising and Visiting Eye Hospital of Banepa Respectively: A Pilot Cross Sectional Study , Sanket Parajuli; Prerana Singh; Ruchi Shrestha; Senny Chapagain; Ramesh Shrestha.
Aim:To assess the level of knowledge, practices and attitude among medical persons and non-medical persons practicing and visit-ing Eye Hospital of Banepa respectively.. Subject and methods: Affecting 213 countries as of September 25, 2020 with 32,487,622 confirmed cases and mortality of 988,962, this pandemic of Coronavirus has not only challenged the current medical practices, but also imposed a huge psychological and socio-economic burden to the entire world. This is a cross sectional, descriptive study of Banepa Residencies and medical Practitioners conducted from June 1, 2020 to June 9, 2020. A standardized questionnaire was distributed and completed by all participants during a week period of the study.Results:The age range of the participants was 18-64 years and mean age was 36 years. More than 80% (P = 0.001) of the subject had sufficient knowledge about nCoV-19. Conclusion:Both the groups (medical and nonmedical) in Banepa (a hilly city on the outskirts of capital city) showed a satisfactory level of knowledge and positive attitude towards nCoV-19. However, there is a noticeable difference in knowledge level between the professions from medical group whereas, gender bias knowledge gap from nonmedical subjects.Keywords:Corona Virus; Novel Corona Virus; Covid-19; Eye
73 Dry Eye Occurrence in Type II Diabetics and Non-diabetics: A Prospective Cohort Study , Premnath Raman1; Mehak Jasuja; Anuj Kumar Singal.
Purpose:To compare the prevalence and severity of dry eye in Type 2 diabetics with non-diabetics. Methods: A total of 200 eyes of 200 patients; 100 patients whom were diagnosed cases of type 2 diabetes and 100 non-diabetics who presented with ocular discomfort were evaluated over 12 months. Right eye was taken up for the study in all the patients. Dry eye was confirmed by diagnostic tests namely: Schirmer’s test, Tear break up time, Tear meniscus height, Fluorescein staining and Lissamine green staining. Ocular Surface Disease Index questionnaire was filled. On the basis of symptoms, signs and test results, Dry eye was graded from grade 1 to grade 4 according to the Dry eye workshop dry eye severity grading scheme.Results:Most patients (82%) above the age of 50 were diabetics. Diabetics presented to the clinic nearly eight years later than non-diabetics (p < 0.0001). Itching (In Non-diabetics) and grittiness (In diabetics) were the most common symptoms (p = 0.04). Schirmer’s test and Tear Break up time was found to be abnormal in more diabetics as compared to non-diabetics. Tear meniscus height was similar in both groups. Diabetics also had much higher grade of dry eye disease (p value = 0.002). Prevalence of dry eye among diabetics was 43 % while in non-diabetics was 30 %.Conclusion:Patients in diabetic group had higher grade of dry eye as compared to non-diabetic patients. Schirmer’s test value was significantly lower in diabetics than non-diabetics.Keywords:Diabetes Mellitus (DM); Tears; Xerophthalmia
74 Comparative Evaluation of Meibomian Gland Dysfunction in Diabetic and Non-Diabetic Patients at a Tertiary Care Centre in Punjab , Shivani.
Objective:To evaluate and compare meibomian gland dysfunction in diabetic and non-diabetic patients.. Design: This was a prospective study conducted on 400 eyes of 100 diabetic patients (group 1) and 100 non- diabetic patients (group 2) who presented to out-patient department and were diagnosed with meibomian gland dysfunction from January 2019 to January 2020.Meibomain gland dysfunction was evaluated by noting the symptoms, determining the grade of meibomian gland expressibility and meibum quality under slit lamp and ocular surface staining. Clinical staging of meibomian gland dysfunction was obtained and the results were compared in both the groups.Results:The age range of patients in both the groups was 40 to 65 years. The mean blood sugar level in group 1 was 225.16 ± 53.29 (mg/dl) while in group 2 was 99.64 ± 8.58 (mg/dl). Burning sensation in the eyes was found to be the most common symptom in both the groups. The severity of symptoms was significantly more among the diabetic group compared to non-diabetic group (p = 0.001). Meibum quality and expressibility grading was significantly greater in group 1 compared to group 2 (p < 0.05). There was statistically significant increase in ocular surface staining in group 1 compared to group 2 (p < 0.001).Clinical staging of meibomian gland dysfunction was obtained which showed significantly high stage (stage 3,4) meibomian gland dysfunction in diabetic patients compared to non-diabetic patients (p < 0.001). Conclusion:Our data suggests that meibomian gland dysfunction in diabetic patients is more severe compared to non-diabetic patients.Keywords:Meibomian Gland; Meibum; Meibomian Gland Dysfunction; Diabetes
75 Bilateral Medial RECTII Recessions as a Surgical Modality in Cases of Bilateral Alternating Infantile Esotropia in 6 Months Old Make Twins , Gowhar Ahmad.
Squint also termed as strabismus is a common occular disorder characterised by an abnormal occular deviation with loss of normal ophthalmic paralisam and paucity of binocular vision which has following stages.• Simultaneous perception.• Fusion• StereopsisKeywords:Squint; RECTII; Cosmetic