• We are available for your help 24/7
  • Email: info@isindexing.com, submission@isindexing.com



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
76 Lens Fixation Today as Easy as it should , Ahmed Galal
Today, both Aphakic eyes problem and defective intraocular lenses replacement problem, have changed considerable since the Yamane described secondary IOL implantation using intrascleral fixation of a sulcus-based 3-piece IOL with haptics-end modifi-cation by applying high-temperature cautery to create bulbous flanged tips. This method has replaced worldwide the use of scleral flaps, scleral sutures, glued intraocular lenses or any other lenses model such as Artisan Iris claw lenses to address the problem of Aphakia in general. As this technique maturated along the last few years, the use of the other methods is becoming each day less. The easy of this technique and the familiarity of the anterior segment surgeon with such manipulations, made it easy for the Yahame technique to become today the surgery of choice for such cases. A conjunctival peritomy is not necessary but careful marking the needles entry points is mandatory. Placing a mark 1.5-2 mm pos-terior the limbus and both are exactly allocated in a line with the pupil center, ensures haptic placement exactly 180 degrees will provide excellent centration. Then one 27-gauge needle is bent in line with the bevel approximately 6-8 mm long from the tip. A CT LUCIA 602 ZEISS which is an acrylic hydrophobic 3-piece IOL with Polyvinylidene fluoride (PVDF) monofilament haptics is in current use. A ZEISS R28 IOL Delivery System (ZEISS Z28 Cartridge IOL Delivery System) would be used to deliver the folded IOL in the anterior chamber. Both are from Carl ZEISS Meditec, Jena Germany.
77 Comparative Evaluation of 0.1% and 0.01% Topical Atropine Eyedrops in Myopic Children , Sonam Juneja, Anand Aggarwal, Prempal Kaur1, Karamjit Singh1, Harvinder Nagpal2, Chiman Lal2 and Konica Singla
Aim: To compare effects of 0.1% and 0.01% topical atropine eyedrops in myopic children.Methods : This prospective randomized study was conducted on 80 eyes of 40 myopic children irrespective of age, type of myopia and amount of spherical equivalent correction. 40 eyes were subjected to 0.1% (Group A) and 40 to 0.01% (Group B) topical atropine once at night. Follow-up was done at 3 months,6 months, 1 and 2 years. The effect of atropine on mean change in spherical equivalent, axial length, pupil diameter, keratometry and intra ocular pressure was recorded and compared between two groups. Any adverse effect as well as drop in near vision due to atropine was also noted.Results: Mean age group studied in two groups was 10.5 years (range 5-13 years). The mean change in spherical equivalent after 2 years of atropine therapy was -0.35 ± 0.93 D in group A and -0.04 ± 0.57 D in group B (p < 0.05), the mean change in axial length was 0.27 ± 0.38 mm in group A and 0.05 ± 0.30 mm in group B (p > 0.05) and the mean change in pupil diameter was 1.05 ± 0.36 in group A and 0.84 ± 0.14 in group B (p < 0.05). 11 (55%) patients of group A and 6 (30%) patients of group B had difficulty while reading. However no statistical significant change was found in intraocular pressure and keratometric readings.Conclusion: Both 0.1% and 0.01% topical atropine have comparable role in stabilization of myopia over 2 years. However, fewer visual side effects were noted with 0.01% atropine vs 0.1% atropine.Keywords: Atropine; Children; Myopia; Spherical Equivalent
78 Atypical Torpedo Maculopathy , Keshav Lahoti*, Mahesh Shanmugam and Divyansh Mishra
Torpedo maculopathy is a rare congenital anomaly of RPE in the temporal macula with unknown etiology. The diagnosis of this lesion is primarily clinical, often an incidental finding as it tends to spare the fovea. The lesion characteristics includes location temporal to fovea, hypopigmentation, horizonally oval shape with certain variable features like intraretinal cleft, fundus excavation, variable hyperpigmentation and associated visual field defects. Here we report a case of nasal macular location of the lesion which represents a rare clinical presentation and is supported by multimodal imaging findings.Keywords: Torpedo Maculopathy; Atypical; Torpedo; Nasal Location; Maculopathy
79 Pediatric Ocular Conditions - Guidelines for Treatment During COVID 19 Pandemic , Meenakshi Wadhwani
Covid-19 caused by SARS COV-2, is associated with neurologi-cal and opthamological manifestations. It is one the largest global pandemic affecting over 3 million people in 213 countries world-wide. It has led to a death toll of > 200 thousand people in a short period of 4 months as per WHO on May 1 2020. India has reported over 33,000cases with > 1000 deaths
80 Combining Partial-tendon Knapps Procedure with Posterior Tenectomy of Superior Oblique in a Case of Inferior Oblique Palsy , Sandra C Ganesh1*, Aylette D’Silva2, Shilpa G Rao1 and Murali Krishnan S2
Introduction:Isolated inferior oblique palsy is one of the rarest among extra ocular muscle palsies. In addition to posing a diagnostic challenge, multiple surgical techniques have been described in its surgical treatment. Case Report: A 23-year old female presented with unilateral right eye hypotropia and diminished vision. Following detailed evalu-ation, she was diagnosed with right eye inferior oblique palsy with A pattern exotropia and strabismic amblyopia. We performed a combined surgical procedure involving a partial Knapp's procedure with augmentation (using superior halves of medial and lateral recti), LR recession (using inferior half of split LR) and posterior tenectomy of superior oblique (PTSO), which resulted in a satisfac-tory postoperative outcome.Conclusion: IO palsy is a rare condition, which requires to be differentiated from neurological causes, Brown syndrome and skew deviation. Both exotropia and hypotropia have been corrected in the same procedure, using split halves of only two horizontal recti muscles, thus preventing possibility of anterior segment ischemia. This combination, along with LR recession, for exotropia and PTSO, produces satisfactory alignment.Keywords: Inferior Oblique Palsy; Split Tendon Knapp's Procedure; Posterior Tenectomy of Superior Oblique; A-Pattern Exotropia; Right Hypotropia
81 The Use of Ripasudil Hydrochloride Hydrate in Endothelial Decompensation – A Case Series , Pedro Manuel Baptista1*, Nelson Sena4-6, Fernando Faria-Correia2-4, Marcella Salomão4,7-10 and Renato Ambrósio Jr4-9
Purpose: To describe the preliminary clinical experience, including corneal structural response to Ripasudil hydrochloride hydrate (Glanatec® ophthalmic solution 0.4 %, Kowa Company, Ltd, Japan) in cases of corneal endothelial dysfunction.Methods: Retrospective observational study based on patients’ clinical records treated with Ripasudil hydrochloride hydrate three times a day for different conditions of corneal endothelial dysfunction. Outcome measures included clinical data with subjective re-sponse, uncorrected distance visual acuity (UDVA, Snellen), central corneal thickness (CCT, μm) measured with rotating Scheimpflug tomography (Pentacam HR, Oculus®, Wetzlar, Germany), intraocular pressure (IOP, mmHg) measured with dynamic Scheimpflug imaging (Corvis ST, Oculus®, Wetzlar, Germany) and endothelial cell density (ECD, cells/mm2) measured with EM-4000 Specular Microscope (Tomey®, Nuremberg, Germany).Results: Five patients were analyzed, four women and one man, with a mean age of 74.2 ± 12.4 years. Two cases of Fuchs’ endothelial corneal dystrophy (FECD), two of pseudophakic bullous keratopathy (PBK) and one of penetrating keratoplasty graft decompensa-tion (PKGD) were included. Treatment duration until results range from 1 to 6 months (mean 3.4 months). A good response was observed in both the cases of FECD and PBK. Despite a good initial response, a bad result was observed in the PKGD case. There were no ocular or systemic side effects related.Conclusion: The ROCK inhibitor Ripasudil hydrochloride hydrate is potentially effective in the treatment of different forms of cor-neal endothelial decompensation. Our work shows the short-term efficacy and safety of topical Ripasudil in the management of FECD and PBK derived endothelial decompensation. More studies with large samples and longer follow-up are needed.Keywords: Ripasudil Hydrochloride Hydrate; ROCK Inhibitor; Fuchs Endothelial Corneal Dystrophy; Pseudophakic Bullous Kera-topathy; Corneal Endothelium Decompensation
82 Diagnosing Dry Eye Disease: Simplifying the Process and Avoiding Pitfalls , Marc Labetoulle1, Elisabeth M Messmer2 and Stefano Barabino
Dry eye disease is often under diagnosed or misdiagnosed, in spite of its high prevalence and its impact on quality of life and mental health. The 2017 Definition and Classification report, the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II in 2017, continued to recognize dry eye disease as multifactorial, and updated the definition to include loss of homeostasis and neurosensory abnormalities as key elements of the disease. This review proposes key steps for simplifying and clarifying the diagnosis of dry eye disease in everyday clinical practice, based on the TFOS-DEWS-II report and the clinical experience of the oph-thalmologist authors. It addresses key diagnostic principles, assessment of patient symptoms (such as dryness and ocular fatigue), and signs (such as tear film instability and meibomian dysfunction), the role of new technologies, and the potential pitfalls to avoid. Dry eye disease is a disease of the ocular system as a whole, and diagnosis can be an easy process if carried out systematically and logically. Fluorescein and lissamine green staining, and corneal sensitivity testing are simple tools that can provide a lot of diagnostic information. New technologies are also available which, although not essential for daily practice, can help explore the disease patho-physiology and also help communication with patients.Keywords:Dry Eye Disease; Diagnosis; TFOS-DEWS II; Ocular Surface
83 Illuminating on the Mysteries of Your Body , Edward A Skoufi
The human body is different but at the same time unique (as general consensus ). Is essential to know your body in details, to translate and interpret anything about it and to cooperate with it. Really believe that is marvelously complex machine, but not “fu-turistic”, not perpetual with specified capacity. Therefore you need to be always "its ally”, respecting its integrity, in broader context to have actually information which is needed to improve human body care protecting actually by a gamme of viruses and microbial impacts.Purpose: To describe as accurate as possible, my concepts for knowing the human body and how should you translate and perceive it, and how you could protect it.Keywords: Human Body; Mysteries; Knowing; Education; Study; Protection
84 Predictability of Optical Coherence Tomography Parameters in Preperimetric Glaucoma , Dalia Sabry1, Ahmed S Elwehidy1, Ameera Gamal Abdelhameed2, Ehab Tharwat3 and Amr M Abdelkader
Purpose: To investigate the diagnostic value of inner macular layers (IMLs) thickness, Bruch's membrane opening-minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) in the diagnosis of pre perimetric glaucoma (PPG). Patients and Methods: This was an observational study included 79 eyes with PPG and 58 control eyes. Measurements of the BMO-MRW, pRNFLT and individual IMLs including the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL) and inner plexiform layer (IPL) were performed using Premium glaucoma Module for Spectralis SD-OCT.Results: PPG parameters showed a statistically significant difference with control eyes except the superonasal sector of the pRNFLT. Apart from superonasal sector of the pRNFLT, Spearman correlation showed a positive correlation between PPG and all tested pa-rameters. GCL and IPL, followed by the global pRNFL had the strongest predictability of PPG as proved by binary logistic regression analysis. Conclusion: Individual IMLs (mRNFL, GCL and IPL), pRNFL and BMO-MRW and their subsectors were helpful in detecting PPG. GCL and IPL showed the highest predictability followed by the global thickness of the pRNFLT.Keywords: Glaucoma; OCT; IMLs; BMO-MRW; pRNFL; mRNFL; GCL; IPL
85 Determination of Glaucoma Grade with Cup to Disc Ratio , Jyoti Patil* and Sharmila Chaudhari
Assurance of the vertical cup/plate proportion (CDR) chooses glaucoma suspect. For ordinary eye, the even C/D proportion is generally bigger than the vertical C/D proportion, yet considers have demonstrated that the vertical proportion progress quicker in ahead of schedule and transitional phases of glaucoma. In our exploration we have measure real size of the cup and optic plate. This examination is chip away at optic plate restriction/location. At that point by optic plate division and by Optic cup division, we dis-cover little circles as having vertical widths under 1.5 mm and enormous circles as having vertical distances across more prominent than 2.2 mm. we choose grade like on the off chance that C/D proportion is 0≤CDR≤0.4 at that point eye is ordinary. On the off chance that C/D proportion is 0.4<CDR<0.55 then glaucoma malady condition is moderate and on the off chance that it is CDR≥0.55, at that point eye is in serious phase of glaucoma infection.Keywords: Glaucoma; Cup/Disc Ratio (CDR); Segmentation
86 Retinal Diseases and Ways of Reducing Avoidable Blindness in Low Middle Income Countries , Raba Thapa
Retinal diseases are the leading cause of low vision and blind-ness globally. In high income countries, blindness due to retinal diseases especially of avoidable blindness is largely under control. This is because of increase in awareness, access to timely detection and treatment.
87 Importance of Colorimetric Quantities in Ophthalmology and Optometry , Nilgun Baydogan
The explanation of the nature of colour has critical importance in ophthalmology and optometry. Colour is one of the most distin-guishing characteristics of people vision. In order to understand how colour affects our vision, it will be significant to understand how colour develops. Because the vision sensitivity problems of optical materials used in ophthalmology and optometry pertain to variations in colour. The evaluation of variations in the colourimet-ric quantities is important to compare the optical performance. The investigation of the colourimetric changes provides information on optical properties to determine colourimetric quantities by us-ing the CIE and CIELAB colour systems
88 Straatsma Syndrome - Report of Two Cases , Pedro Manuel Baptista1,2*, João Heitor Marques1, Natália Ferreira1, Luísa Malheiro1, Sofia Maia1, Vasco Miranda1,2, Ricardo Parreira1 and Pedro Menéres
Introduction: Straatsma syndrome is a rare disease characterized clinically by the exuberant persistence of myelin fibers in the retina associated or not with the presence of myopia, strabismus and amblyopia. The present study is aimed to describe two cases of this entity.Methods: Retrospective patient’s clinical records review.Results: In case 1, a 17-year-old male was referred to the ophthalmology consultation due to decreased visual acuity in the right eye (RE). With no relevant systemic or ophthalmological history, he had a better corrected visual acuities (BCVA) of 20/200 in the RE and 20/20 without correction in the left eye (LE), with no oculomotricity changes and fundoscopy revealed the persistence of myelinated retinal nerve fibers (MRNF) near the upper temporal arch and myopic choroid in the RE and no alteration in the LE. In case 2, a 39-year-old male with family history of myopia was referred with a diagnosis of rhegmatogenous retinal detachment on the LE. On ophthalmic examination, BCVA were 20/20 on the RE and hand motion on the LE. During the pars plana vitrectomy, a total rhegmatogenous retinal detachment was observed in the LE, with MRNF accompanying the temporal arcades and a macular hole (MH). After three pars plana vitrectomies, including an inverted ILM flap technique attempted to close the MH, and eight months after silicone oil extraction, the aphakic LE presented a 20/200 BCVA with the retina fully attached and the MH closed.Conclusion: Despite some controversy in its features, Straatsma syndrome should be included in the differential diagnosis of leuko-coria and must be suspected in the presence of refractive errors with anisometropia. The general prognosis is poor to moderate, but better results can be achieved with a prompt diagnosis and amblyopia management.Keywords: Myelinated Retinal Nerve Fibers (MRNF); Straatsma Syndrome; Macular Hole (MH); Anisometropia; Amblyopia; Strabismus; Better Corrected Visual Acuities (BCVA)
89 Long-Term Structural Effects of Retinal Photocoagulation in Diabetic Retinopathy , Pedro Manuel Baptista1*, Ana Ambrósio Marta1,2, João Heitor Marques1, André Ferreira1,3, Diana José1, Daniel Almeida1, António Ribeiro1,2 and Irene Barbosa1,2
Background and Objective:Pan-retinal photocoagulation (PRP) have potential structural deleterious effects in retinal and cho-roidal tissues. To assess the long-term retinal and choroidal status after PRP and to correlate the results with treatment strategies.Design/Materials and Methods: Observational cross-sectional study including eyes with diabetic retinopathy who underwent PRP, with or without macular treatments.Results: 227 eyes with a mean time since PRP of 10.0 ± 7.2 years.In a multivariable model, the only treatment characteristics with predictive value were the macular laser treatment with modified grid for worse BCVA, the higher number of laser spots for higher CT and GCLV and the laser treatment with Argon for lower FNFLT.Conclusion: This study demonstrates long-term stability in the BCVA and choroidal and retinal structural parameters with only mild correlation with treatment strategies, highlighting the role of PRP in the management of diabetic retinopathy in an era with evolving less aggressive laser options.Keywords: Pan-Retinal Photocoagulation (PRP); Proliferative Diabetic Retinopathy (pDR); BCVA
90 Prevalence and Associated Factors of Cataract among Diabetic Patients in West Bank, Palestine: A Cross Sectional Study , Yousef Shanti1, Ibrahim Taha2*, Adnan Busttami3, Hamzeh Al Zabadi4, Saif-eddin Malhas3, Qutaiba Mahmoud3, Rami Othman5, Liana Al-Labadi6 and Alshaarawi Salem7
Background: Cataract is a major cause of visual impairment among diabetic patients. The study aimed to assess the prevalence of cataracts and its associated factors among diabetes mellitus patients in the West Bank, Palestine, in order to better identify the tar-gets for future healthcare policy and interventions.Materials and Methods: A prospective quantitativecross-sectional study was conducted in all governorates of the West Bank with a proportionally and randomly selected sample size of 385 subjects. The participants were interviewed face to face for an average of ten minutes to fill in a previously validated Early Treatment Diabetic Retinopathy Study (ETDRS) questionnaire. Then after, blood and urine samples were collected and finally, the participants were passed for an ophthalmic examination performed by a certified ophthalmologist.Results: The prevalence of any cataract, nuclear cataract, cortical cataract, and posterior subcapsular cataract was found to be 47.8%, 28.1%, 14.0%, and 4.7% respectively. The most significant factors for any cataract were: age (55 - 64) (OR 5.375), age (≥ 65) (OR 30.238), DM duration (10 - 19) (OR 2.251), DM duration (≥ 20) (OR 5.771), systemic steroid therapy (OR 0.411). For nuclear cataract, significant associated factors were age (55 - 64) (OR 9.576), age (≥ 65) (OR 17.928), DM duration (≥ 20) (OR 3.059), ALK PHOS (OR 0.354).For cortical cataract: DM duration (≥ 20) (OR 6.134) was the only significant factor. And in the case of posterior subcapsular cata-ract, age was the only significant factor (OR 1.076).Conclusion: The high prevalence of cataract among diabetic patients in West Bank indicates the importance of cataract screening program for DM patients as an attempt to prevent visual impairment and related disabilities. Keywords: Diabetes Mellitus; Cataract; Blindness
91 Eales Disease , Gowhar Ahmad
William Henry wale in the year 1817 an Australian ophthalmol-ogist to describe this condition characterized by recurrent.Vitreous hemorrhage occurring in an young healthy individu-als.A kind of disease exclusively occurring in young Asian people.
92 Scenario of Cataract Surgery Past and Present , Gowhar Ahmad
Cataract surgery is one of the most common ophthalmic sur-gery performed by almost every ophthalmologist throughout the world and perhaps one of the only eye surgery which ensures vi-sion to a cataract patient if it is successful
93 Achieving Durable Dry Macula in Diffuse Diabetic Macular Edema: A Meta-analysis , Avinoam Ophir
Enduring diabetic macular edema (DME) might injure foveal layers, which may lead to progressive deterioration of visual acuity (VA). The aim of DME therapy is therefore to improve current VA and to achieve early, complete and durable macular drying. Therapy of centrally-involved diffuse DME (DDME) when macular traction is undetected has hitherto remained the major challenge. This me-ta-analysis focuses on the achievements of these two targets in DDME. However, monotherapy by repeated intravitreal anti-vascular endothelial growth factor (-VEGF) medications does not achieve, as a rule, a lasting outcome. Modified grid laser photocoagulation (mGLP) was found efficacious in only a relatively small group of eyes. While using time-domain optical coherence tomography (TD-O-CT), delayed pars plana vitrectomy (PPV) for intractable DME usually elicited a variable or no improvements of VA. After more than a decade of numerous DME trials by intravitreal medications, the two leading international study groups called for additional inves-tigations to determine if VA can be better maintained with different management approaches.The advent of high-resolution OCT has enabled a preoperative foveal layers assessment. Using this, early- PPV in DDME treat-ment-naive eyes attained very high efficacy in improvement of VA and in complete, durable macular drying. These findings can be explained by the two novel DDME pathogeneses. In contrast, delayed PPV achieved an improved VA but often only reduced the edema, leaving residual edema that necessitated continuous treatments. mGLP was found durably efficacious for DDME in certain conditi-ons. Early-PPV and mGLP are also the most cost-effective therapies for DDME. Limitations refer to the lack of a controlled study of early-PPV, which provides a durable outcome, vs. medications that provide only a transient response. Until then, the long-lasting, hi-ghly efficacious, objective (OCT) outcomes of early-PPV, or mGLP in specific conditions, may initially assist in therapeutic decisions at least to populations where budgets and availability of medications are constraint. These two therapeutic approaches here described being perhaps their best or only options for saving their sights.Keywords: Diabetic Macular Edema; Extrafoveal Traction; 3D-OCT; Pars Plana Vitrectomy; Grid Laser Photocoagulation; Anti-VEGF
94 Association Between Serum Vitamin-D Level and Dry Eye Syndrome - A prospective Cross-sectional Study , Prasenjit Saha1*, Tania Basaiawmoit2, J V Basaiawmoit3 and Anton Decruse Wanbah4
Aim: This study is to investigate the association between the patients with dry eye syndrome and serum vitamin D level in hospital-based population.Study Design: Prospective, cross-sectional study.Methods: 88 participants (including male and female) diagnosed with Dry Eye Syndrome having no ocular diseases or any auto-immune systemic diseases were included. Comprehensive eye examination was done for all subjects. OSDI questionnaire, Schirmer’s Test I and II and Tear Break up Time (TBUT) along with the measurement of Serum vitamin D level were performed for all the sub-jects. Analyses were made using the SPSS.Results: The mean age of the participants was 37.67 ± 14.17 years (95% CI: 34.92-40.65). Mean ST-I was found to be 8.54 ± 3.43mm (95% CI: 34.92-40.65), mean OSDI score was 45.80 ± 9.74 (95% CI: 43.76-47.80), mean ST-II was 5.86 ± 2.92mm (95% CI: 5.30-6.34), mean TBUT was 5.98 ± 2.23 seconds (95% CI: 5.47-6.47) and Serum Vit-D level was 20.21 ± 9.24 ng/ml (95% CI: 18.06-21.98). Sta-tistically significant difference was observed between ST-I and ST-II (P Ë‚ 0.001). Regression analysis showed a significant association for OSDI (r = 0.938, p Ë‚ 0.001), ST-II (r = 0.28, p Ë‚ 0.04) and TBUT (r = 0.64, p Ë‚ 0.001) with Serum Vit-D level.Conclusion: In our study, OSDI score, low tear secretion level and tear break up time suggested to show significantly low Serum Vitamin-D concentration in blood which may be the contributory factor for DES. The results of the study suggest that serum Vit-D supplementation can be a useful and effective treatment of DES.Keywords: Cross Sectional Study; OSDI Questionnaire; Dry Eye Syndrome; Tear Secretion; Serum 25 Hydroxyvitamin-D Level
95 Medical and Non Incisional Management of Glaucoma , Gowhar Ahmad
Glaucoma is one of the commonest ocular condition seen by al-most all ophthalmologists.It is a kind of visual threatening disorder if not diagnosed or managed in time main problem with glaucoma is whatever vision is lost can't be restored back by any means so whatever vision is left has to be protected either by medical or surgical modalities at present since we are in the era of subspecialities we have glau-coma experts and also lot of research is going on in this field do the prognosis of glaucoma has become reasonably satisfactory we also do glaucoma screening to pick up silent cases by screening people randomly after 40 years and do refraction IOP measurement scler-al rigidity and facility of aqueous outflow
96 Epidemiology of United States Pediatrics Sports-Related Ocular Injuries from 2000-2019 , Parth S Patel1,2, Aditya Uppuluri1, Marco A Zarbin1 and Neelakshi Bhagat1*
AbstractObjective: To characterize the epidemiology of sports-related ocular injuries in school aged children ages 5 - 18 in the United States, 2000 - 2019.Methods:Data was sourced from the National Electronic Injury Surveillance System for this retrospective epidemiology study. Inclu-sion criteria for this study included: patient age between 5 - 18 years, eye injury between 2000 and 2019, and eye injury involving sports at all geographic sites. Data were divided into two age groups: 5 - 11 and 12 - 18 years. Results: There were an estimated 264,648 ED visits for sports-related ocular injury of which 73% were males and 42% between the ages 5 - 11 years. Over 96% of children were treated and released from the ED, suggesting minor injury. The sports most commonly associated with eye injuries were basketball, baseball/softball, swimming, football, and soccer. In terms of location, 56% of injuries occurred on the court. In the 5 - 11 cohort, home was the most common location for off-court injuries, while in children aged 12 - 18, most off-court injuries occurred at school. Conclusion:Sports-related pediatric ocular injuries between 2000 - 2019, mostly were contusions in older male children and were encountered primarily on the basketball court. Off-court injuries occurred mainly at school. Keywords: Pediatrics; Eye; Sports; Basketball; Baseball/Softball
97 Inhaled Corticosteroid Use and Central Serous Chorioretinopathy , Bisant A Labib
AbstractIntroduction:Central serous chorioretinopathy (CSCR) is an idiopathic and self-limiting condition manifesting as one or more se-rous detachments of the neurosensory retina. It typically occurs unilaterally and in the macular region, with most cases resolving spontaneously. Besides clinical examination, many supplementary tools can be utilized in confirming the diagnosis of CSCR, such as fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). The exact mecha-nism is unknown, but corticosteroids have been suggested to play a role in the pathogenesis of CSCR. This case report describes inhaled corticosteroid use as the cause of CSCR.Case Report: A 43-year-old Caucasian female reports with subjective visual blur in her left eye only for several weeks in correspon-dence with use of a nasal spray. Despite good measured visual acuity, a mildly elevated macular appearance was suspected on fundus examination. OCT testing confirmed these findings and elucidated a diagnosis of central serous chorioretinopathy. Resolution with observation and discontinued use of inhaled corticosteroids was achieved.Discussion: The OCT is a helpful and non-invasive tool in the assessment of macular changes, due in this case to CSCR. It appears as a serous detachment of the neurosensory retina in the macular region, and often with accompanying pigment epithelial detachment (PED). Complications are rare, but may include OCT findings of choroidal neovascular membrane (CNVM) formation, warranting prompt referral and treatment. The cause of CSCR is multifactorial and not yet well understood. Among other factors, corticosteroids are associated with CSCR.Conclusion: Most cases of CSCR are self-limiting and resolve spontaneously without treatment, yielding a generally good visual prognosis. Since observation is the most common management approach for acute CSCR, serial OCT testing at initial examination and follow-ups are imperative in monitoring the improvement or worsening of condition. In those worsening or even persistent cases, referral for treatment must be considered to reduce the risk of permanent macular changes and irreversible vision loss.Keywords: Central Serous Chorioretinopathy; Corticosteroids; Optical Coherence Tomography
98 Iluvien Implant for the Treatment of Cystoid Macular Edema Following Vitrectomy and Epiretinal Membrane Peel , Hadi Zambarakji1* and Amany Abelaziz
AbstractIn the present report, we present a unique case of a 65-year-old male patient who underwent bilateral vitrectomy and epiretinal membrane (ERM) peel, complicated by resistant cystoid macular edema (CME). Subsequent treatment with bilateral Fluocinolone implants (Iluvien) resulted in resolution of CME, which was maintained beyond 3 years of follow-up as well as a reduction in the need for IOP lowering medications. Visual acuity improved and there was a reduction in eyelid congestion, redness and discomfort.Keywords: Cystoid Macular Edema; Vitrectomy; Fluocinolone Implant; Iluvien
99 The Importance of Seeing Beauty and Order , Doris Bergen
When we moved to our new, smaller house last year, I bought a new bedspread for our master bedroom and it presently graces our bed in this house. We had only been in our new house a few months, however, before the coronavirus pandemic began and so we have spent many months primarily at home, with only a few vital trips to grocery and doctor since then. Of course, we have had no visitors and thus there has been no one other than my husband and myself to observe this lovely bedspread.
100 Correlation of Central Corneal Thickness with Refractive Errors and Corneal Curvature in the South Indian Population , Nair Shobita*, V Panneer Selvam, Shah Vinit J, Jayaraman Radha, V Vijayraghavan and Gupta Amal
AbstractAims and Objectives: To determine the correlation between central corneal thickness (CCT), Refractive errors, and corneal curva-ture. To investigate any association between Central corneal thickness (CCT) and variables, namely, age, refractive errors, mainly Myopia and Hypermetropia, Corneal curvature, and axial length.Methods and Material: Observational Hospital-based Cross-sectional study of the data collected from patients with refractive errors presenting to the outpatient department (OPD) at our hospital. 240 eyes of 120 patients who met the inclusion criteria included in the study. Following examinations were performed for all the patients, measuring best-corrected visual acuity, central corneal thickness, corneal curvature by Topography, and axial length by A-scan ultrasonography. All patients underwent a complete slit-lamp examination.Statistical Analysis: Correlation between central corneal thickness (CCT) and four factors, namely, age of the patient, degree of myopia and hypermetropia, corneal curvature, and axial length, was studied using Karl Pearson's correlation coefficient(r). We did data analysis with the SPSS 20.0 software.Results: The mean central corneal thickness of our study population was 531.9 microns. The mean age of the overall study popula-tion was 27.02 years. The mean corneal curvature 44.34 D, and the mean axial length was 24.24mm. Central corneal thickness was significantly associated with corneal curvature.Conclusions:Central corneal thickness has a negative correlation with Corneal curvature, i.e., as the corneal curvature increases, the central corneal thickness decreases, and vice versa. However, there was no significant association between Central corneal thickness and other parameters like Age, Degree of Myopia, Hypermetropia, and Axial length.Keywords: Central Corneal Thickness; Myopia; Hypermetropia; Axial Length; Corneal Curvature; Correlation Analysis; Age
101 Relevance of Intraocular Pressure Measurement in Ulcerative Microbial Keratitis , Shikha Jain, Ashok Pathak*, Rahul Verma and Punam Kapoor
AbstractPurpose: Intraocular pressure measurement in a case of ulcerative microbial keratitis is often neglected as treatment of ulcer takes precedence. However, prolonged rise in IOP can cause optic nerve damage and failure of visual recovery even after complete resolu-tion of keratitis. This prospective longitudinal comparative study was done to evaluate the importance of IOP measurement in cases of ulcerative keratitis.Methods: 122 cases of ulcerative microbial keratitis were divided into three groups based on their etiology- bacterial (Group A), fungal (Group B) and indeterminate (Group C). Comparative evaluation of IOP between all the three groups was done and results recorded.Results: On presentation, IOP was significantly high in bacterial and indeterminate group (Group A and C) but subsequently re-sponded to treatment. In fungal keratitis, higher IOP was noted later in the follow up visits. The IOP was also related to the size of ulcer and depth of infiltrate with size more than 5 mm and midstromal level of infiltrate showing a significantly high IOP.Conclusion: IOP measurement and management although difficult in cases of keratitis if neglected can cause permanent loss of vi-sion.Keywords: Ulcerative Microbial Keratitis; Intraocular Pressure; Non Contact Tonometry
102 Fluorescein Load Test: A New Diagnostic Test to Determine Location and Extension of Corneal Conjunctivalization in Partial and Total Limbal Stem Cells Deficiency , Maurizio Rolando1 and Stefano Barabino
AbstractPurpose:To evaluate the different fluorescein diffusion under the corneal epithelium and to compare its location and extension with the expression of cytokeratine (cK) 3 and cK 19 by epithelial cells of corneal surface.Methods: Seventeen subjects with clinical signs of limbal failure participated in the examination. Fluorescein load test (FLT) was per-formed by instilling 1% fluorescein every 10 seconds for 1 minute. Fluorescein diffusion under the corneal epithelium was observed with cobalt blue filter after 1 minute from the last instillation. Impression cytology samples were collected from corneal surfaces to observe the expression of specific corneal (cK 3) and conjunctival (cK 19) cytokeratines analysed by immunocytochemistry. The cK 3/cK 19 rate was compared with the extension and localization of FLT. Results: Immunocytochemistry analysis discovered in the corneal surface the presence of cK 3 and cK 19. Samples with more than 80% of cK 3+ cells were found in 70% of eyes with negative FLT. Furthermore, more than 50% of cells which expressed cK 19 in cor-neal epithelial samples were accompanied with 100% correlation between location of positive FLT and cK 19+ cells.Conclusion: Since surgical approach is different in partial versus total limbal deficiency, it is important to recognize the localization and the extension of corneal conjunctivalization. The fluorescein load test is a simple diagnostic test to detect corneal area with limbal loss.Keywords: Conjunctivalization; Fluorescein Staining; Corneal Stem Cells; Limbal Failure
103 Application of Pulsed Laser Radiation of the Far Ultraviolet Range for Corneal Crosslinking , Igor Kornilovskiy
AbstractPurpose: Justify the advisability of using pulsed laser radiation in the far ultraviolet range for corneal crosslinking.Material and Methods: Experimental (20 pig eyes, 90 rabbit eyes) and clinical (596 photorefractive and phototherapeutic opera-tions) studies on the assessment of corneal crosslinking using ablative and subablative energy densities of an argon-fluorine excimer laser were analyzed. In all cases, stromal saturation with 0.1% or 0.25% isotonic riboflavin solution was performed after photothera-peutic ablation of the epithelium. For an objective assessment of the effect of excimer laser crosslinking, the methods of biomechani-cal testing, light, electron microscopy, computed keratotopography, aberrometry, optical coherence tomography and densitometry were used.Results: In experiments after phototablation with riboflavin, biomechanical testing revealed an increase in the strength character-istics of the thinned cornea. According to transmission electron microscopy, an increase in the number of cross-links in the collagen structures of the stroma characteristic of cross-linking was observed. In the clinic, OCT and densitometry confirmed the presence of the crosslinking effect in photorefractive and phototherapeutic ablation with riboflavin. Such prophylactic crosslinking was suf-ficient to compensate for the weakening of the strength properties of the thinned cornea, and did not violate its elastic properties. For therapeutic crosslinking in keratoconus, secondary keratoectasias and other corneal pathology, the radiation energy densities of an argon-fluorine excimer laser below the ablation threshold were applied. With this technology, according to the data on OCT and corneal densitometry, all the classic signs of crosslinking with an increase in optical density, the formation and reverse development of a demarcation line in the stroma were revealed.Conclusion: Secondary radiation induced by ablative and subablative energy densities of an argon-fluorine excimer laser initiates crosslinking in the riboflavin-saturated corneal stroma. This indicates that the use of pulsed laser radiation of the far ultraviolet range is promising for corneal cross-linking.Keywords: Pulsed Ultraviolet Laser Radiation; Argon-Fluorine Excimer Laser; Riboflavin; Corneal Crosslinking; Photorefractive Keratectomy; Phototherapeutic Keratectomy; Keratoconus; Secondary Keratoectasias
104 Exposure of Hospital Staff to Infections: The Effect of the Hospital Environment on the Microbial Flora of the Conjunctiva , Dvora Pikkel
AbstractAim:To examine the microbial flora of the conjunctiva among hospital employees as a test case for assessing the degree that the hospital environment affects the microbiota of its inhabitants. Methods: We took samples from the conjunctival sack (from both eyes) of hospital staff from different departments and incubated these samples in order to find the existence of microbial flora. As a control group we tested in the same way people who were not exposed to hospital environment and had no conjunctivitis at the last 3 months. We compared the results of the 2 groups.Results: The microbial flora of the conjunctiva did not differ between healthy health care professionals and a control group. However, greater bacteria incidence and diversity were found among staff in internal medicine wards compared to other departments. Conclusion: In general, hospital staff are not in risk to be infected more than the regular population, however some of the people working at internal medical wards are more exposed to conjunctival contamination. A follow-up study of the participants of this work is needed to examine if re-current contamination is responsible for alterations in the conjunctival flora of health professionals; and a multi-center study is needed to confirm differences in bacteria incidence between hospital departments.Keywords: Conjunctiva; Microbial Flora; Health Professionals; Hospital Environment; Recurrent Contamination; Bacterial Infection Incidence
105 Scenario of Limbal Dermoid , Gowhar Ahmad
Limbal dermoid are kind of cong anomalies have got genetic predisposition are associated with other associated with other cong Anomalies of ant segment.They are usually unilateral however in rare conditions can be bilateral if associated with cong presence of preauricular skin tag or preauricular apo engage the condition is known as Goldenhar Syndrome Maurice Goldenhar an Australian ophthalmologist who in the year 1850 was the first to describe this syndrome complex sometimes presence of squint anophthalmos coloboma of the up-per lid iris retina astigmatism microphthalmos blepharophimosis syndrome however it is very rare.
106 Spectacle Lens Materials and their Special Coatings at a Glance , Manika Manika1 and Meenakshi Wadhwani2
As technology advances so, too, do eyeglass lenses. Eyeglass lenses were mainly made up of glass in the past. Today, most eye-glasses are made of various types of advanced plastics. These new lenses are lighter, more scratch resistant, do not break as easily as glass lenses or the older common plastic lenses and can be treated with a filter to shield eyes from damaging ultraviolet light. The material used in glasses or sunglass lenses will affect their clar-ity, durability weight and cost. Below are the main advantages and disadvantages of the various lens materials.
107 Stereopsis in Accommodative Esotropia at Al-Ibrahim Eye Hospital, Karachi, Pakistan , Shua Azam1*, Abdul Hameed Talpur2, Sadia Bukhari3, Tania Waseem4, Shehnaz Bhatti4, Mahnoor Shafique4 and Safia Nisar
AbstractObjective: To determine stereopsis in accommodative esotropia.Design: Cross-sectional descriptive study between August 2020 to December 2020.Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi.Methodology: Non-probability, convenient sampling was used. This study included 23 subjects diagnosed with accommodative eso-tropia under 5 to 15 years of age, either male and female. Stereopsis was assessed by the Frisby test and Lang II test. SPSS version 20.0 was used to analyze the data. Research Ethical Committee (REC) of ISRA Postgraduate Institute of Ophthalmology gave ethical approval.Results: A total of 340 subjects were registered at the Orthoptic Clinic. 155 subjects were diagnosed with Esotropia. Among the 155 subjects, 23 subjects were diagnosed with Accommodative Esotropia. The age ranged from 5 to 15 years. Among 23 patients, 10 were females and 13 were males. Stereopsis on Frisby test showed that 7 subjects had weak (340) stereopsis but after refractive correc-tion they attained good (85) stereopsis while 3 had mild (170) stereopsis and it becomes good (85) after refractive correction with a p-value of 0.018 which is statistically significant. 10 subjects who failed to perform on Frisby test their stereoacuity was assessed by Lang-II test. Without refractive correction on Lang-II test 4 patients had 200 sec/arc, 2 patients had 400 sec/arc, 1 patient had 600 sec/arc and 3 patients had no stereopsis. With refractive correction on Lang-II test 5 patients had 200 sec/arc, 3 patients had 400 sec/arc and 2 patients had 600 sec/arc.Conclusion: The study concluded that stereopsis was good after refractive correction in the majority of the subjects.Keywords: Stereopsis; Accommodative Esotropia; Frisby Test
108 The Impact of HBA1C on Diabetic Macular Edema , Gamze KarataÅŸ1*, Burak Erden2, Akın Çakir2, Selim BölükbaÅŸi2, Serkan Erdenöz2, Bora Deniz Argon2 and Mustafa Nuri ElçioÄŸlu
AbstractPurpose:We aimed to reveal the relationship between HbA1c and diabetic macular edema.Materials and Methods:The study evaluated 79 eyes of 57 patients who have not yet received treatment due to DME. All patients had type 2 diabetes mellitus and were treatment-naive. The patients were selected according to macular edema related to diabetes mellitus and central macular thickness (CMT) measurements higher than 260 μm. Patients with a history of glaucoma, phakic eyes, any vitreomacular interface pathologies detected by spectral domain optical coherence tomography (SD-OCT), other vitreoretinal diseases, and retinopathies, a history of vitrectomy were excluded. Patient data including age, gender, duration of diabetes, baseline glycated haemoglobin (HbA1c) level. We formed groups according to 8, which is the average HbA1c value of our patients. The patients with HBA1c levels above and below 8 were divided into two groups and the correlation between CMT and best corrected visual acuity (BCVA) was evaluated.Results:HbA1c values of less than 8.0% were named Group-1, and HbA1c values of 8.0% or more were named Group-2. Group-1 consists of 42 eyes, Group-2 consists of 37 eyes. When the demographic and clinical features of the patients were examined in all groups and subgroups, there was no statistically significant difference between the groups (p > 0.05). Group-1 mean CMT values were 458 ± 128.17 μm, Group-2 mean CMT values were 415 ± 74.18 μm (p = 0.089). Group-1 mean BCVA was 0.46 ± 0.25 logMAR, Group-2 mean BCVA was 0.45 ± 0.29 logMAR (p = 0.896). Factors affecting BCVA in patients were evaluated statistically. CMT (beta coefficient: 0.504, p < 0.001) was found effective on BCVA. Factors affecting CMT in patients were statistically evaluated. It was found to be HbA1c (beta coefficient: - 0.102, p = 0.370) on CMT.Conclusion: Systemic parameters should also be used in the treatment of our diabetic macular edema patients. HbA1c is one of these parameters.Keywords: Diabetic Macular Oedema; HbA1c; Diabetic Retinopathy
109 A Study Determining the Efficacy of Brock String Therapy in the Treatment of Convergence Insufficiency , Simran Dhakal1*, Sunaina Mary Alex2 and Sourav Karmakar
AbstractAim:To determine the efficacy of brock string therapy in convergence insufficiency treatment.Methodology: It is a prospective study where the subjects were taken from Naseema Institute of Optometry and Research. Students in the age group of 18 - 31 years meeting the criteria of inclusion and exclusion were considered. Thirty subjects with CI were studied. The following test i.e. Cover test, PBCT, NPC, NRA, positive fusional vergence, negative fusional vergence, vergence facility and ac-commodative facility evaluation were done. Measurements from the CI subjects were obtained before and after brock string therapy. Fifteen subjects underwent regular therapy and 15 underwent occasional therapy. Statistics were calculated using SPSS V 16 for windows. Exophoria, NPC and vergence tests were compared for before and after therapy and on between regular and occasional therapy subjects.Results: A total of 30 students were evaluated under the age group of 18-31 years. Out of 30 subjects, 12(40%) were males and 18 (60%) were females. Subjects before vergence therapy were between 8∆ exophoria to 11∆ exophoria and after vergence therapy it had a range of 6∆ to 4∆. The break point for NPC improved from 7.75 cm to 6 cm in case of accommodative target and in case of non-accommodative target, it improved from 10.5 cm to 8 cm. PFV break increased from 14∆ to 30∆ at near. There was significant improvement in NPC and PFV in the study.Conclusion: Brock string therapy appears to be an easy and effective therapy for CI. Thus this study concludes that regular therapy is effective for the stability of the result.Keywords: Convergence Insufficiency; Vision Therapy; Near Point of Convergence; Exophoria; Brock String
110 The Effect of Light and Heat Upon Choroidal Thickness in Healthy Young Adults , Saleh A AlKhaldi1* and Lyle S Gray
AbstractAim: Investigate the effect of external factors such light and heat upon choroidal thickness in healthy adults.Methods: 40 young healthy adults were included in this study. Choroidal thickness was measured using swept source optical co-herence tomography before and after they were exposed to different levels of light illumination and external source of heat. In the first experiment, 30 subjects were divided into 3 refractive groups (myopes, emmetropes and hyperopes). In the second experiment, another 10 myopic subjects wore pre-heated eye compress for 10 minutes.Results: In the first experiment, no significant change in choroidal thickness was recorded after exposing the subjects to 4 differ-ent illuminations and this was the case for all participants (p > 0.05). In the second experiment, no significant change in choroidal thickness was found duo to wearing the eye compress for 10 minutes in all choroidal areas except for the outer nasal area (p > 0.05). However, one subject showed substantial change in all choroidal areas.Conclusion: Short exposure to different illuminations has no significant effect upon choroidal thickness. Wearing pre-heated eye compress did not substantially affect choroidal thickness except for outer nasal area, while one subject showed substantial change in all choroidal areas which requires further investigation.Keywords: Choroid; Choroidal Thickness; Optical Coherence Tomography; Light Exposure; Outdoor Activity; Eye Compress
111 The Effect of Sustained Eye Rotation Upon Axial and Peripheral Eye Length in Young, Adult Myopic Subjects , Saleh A AlKhaldi1* and Lyle S Gray
AbstractAim:To determine whether ocular movement can affect the shape of the globe and lead to measurable change in axial and peripheral eye length.Methods:Ten subjects aged 18 to 30 years old (6M/4F) participated with informed consent. Mean spherical equivalent refractive error was ≤ -1.00DS with cylindrical refraction < -1.25DC. One drop of tropicamide hydrochloride 1% was instilled 20 minutes prior to measurement to induce mydriasis and mild cycloplegia. Using IOL Master, eye length was measured centrally and temporally (25 degrees off-axis) in four different positions. Subjects then rotated their eye 25 degrees in the temporal direction to fixate on a target for 10 minutes. After that, the same measurements were repeated. Results: Prior to rotation, the group mean peripheral eye length was significantly shorter than the central eye length (p < 0.05). There was no significant variation in central or peripheral eye length due to off-axis fixation, either after the initial eye rotation, or after fixation for 10 minutes at the off-axis point. The difference between central and peripheral eye length was maintained after ten minutes of temporal fixation (p < 0.05).Conclusions: Peripheral eye length was shorter than central eye length showing the prolate shape associated with myopia. The action of the extraocular muscles on the globe has no significant effect upon the retinal shape assessed by off-axis eye length meas-urement in myopic subjects.Keywords: Eye Rotation; Eye Shape; Central Eye Length; Peripheral Eye Length; Myopia; IOL- Master
112 The Incidence of Macular Ectopia in Eyes Previously Diagnosed as Amblyopic , Nataliia Karandiuk* and Anastasiia Kalyshenko
AbstractBackground/Objectives: To define the incidence of macular ectopy in amblyopic children and evaluate the relationship between the presence of macular ectopia and visual acuity (VA) using optical coherence tomography (OCT).Subjects/Methods: There were evaluated 52 eyes of 37 patients. 32 patients (52 eyes) were in control group with best corrected visual acuity (BCVA) and no OCT findings of macular ectopia. Control group was used to define standard deviation of distance be-tween fovea and optic nerve. To define the presence\ absence of macular ectopia was used manual tool “caliper” of measurements. The measurement was performed from the beginning of complex of RPE+Bruch’s membrane from Optic disc and ending in the foveal center. In cases of dislocation of macula up or down from optic nerve (figure 3) we calculated distance by the Pythagorean Theorem. The correlation between presence, distance and direction of macular ectopia and BCVA was determined.Results: Of 52 amblyopic eyes 34 were with macular ectopia, 19,2% of eyes presented strabismus and 26,9% of eyes had a hypo-plasia macular. BCVA in logMAR was not correlated with presence of macular ectopia (p value=0,086712 ) nor with CMT (p val-ue=0,670086). The majority of eyes (58,8%) with macular ectopia has just temporal displacement (p value=0,006741).Conclusions: The incidence of macular ectopia in amblyopia eyes is 65,3%. The OCT measurements according to distance between Optic disc and foveal center are effective for determining the presence of macular ectopia. Majority of patients with strabismus have macular displacement. The presence of macular ectopia doesn’t affect visual acuity. Keywords: Macular Ectopia; Amblyopia; Optical Coherence Tomography (OCT)
113 Efficacy and Safety Profile of Preservative Free Brimonidine 0.2%/Timolol 0.5% Fixed Dose Combination (BTFC) vs Benzalkonium Chloride (BKC) Preserved Brimonidine 0.2%/Timolol 0.5% Fixed Dose Combination: A Prospective Study , Divya Tara1, Gursatinder Singh1, Suresh Kalra2, Anand Aggarwal1*, Ishwar Singh1, Neetu Sharma3 and Talvir Sidhu
AbstractPurpose: The aim of the study was to compare the intraocular pressure (IOP) lowering efficacy and side effect profile of preservative free brimonidine 0.2%/timolol 0.5% fixed dose combination (BTFC) versus benzalkonium chloride (BKC) preserved brimonidine 0.2%/timolol 0.5% fixed dose combination.Methods: A prospective, randomized, comparative, 8-week study was conducted on sixty patients of primary open angle glaucoma (POAG) or ocular hypertension. Enrolled patients were randomized into two groups (Group 1 and 2) with thirty patients in each group. Group 1 (Preservative free BTFC) patients were given preservative free brimonidine 0.2%/timolol 0.5% fixed dose combina-tion one drop twice daily and Group 2 (BKC preserved BTFC) patients were given benzalkonium chloride preserved brimonidine 0.2%/timolol 0.5% fixed dose combination one drop twice daily for 8 weeks, and IOP was recorded at baseline and at 4 week and 8 week visit at 9 am (before instillation of drug) and 11 am (post dose, peak effect). IOP lowering potential, side effect profile was noted at each visit and cost analysis was done for both the study drugs.Results: There was no statistically significant difference in patient demographics of the two groups. The mean age for Group 1 (Pre-servative free BTFC) was 62.97 years and for Group 2 (BKC preserved BTFC) was 61.67 years. In Group 1 (Preservative free BTFC), 18 (60%) were females and in Group 2 (BKC preserved BTFC), 16 (53.33%) were females. There was no statistical difference between the baseline IOP of both the groups. Significant reduction of IOP from the baseline was seen at both time points, throughout the follow up visits, in both the groups (p < 0.00001). Mean reduction from the baseline for Group 1 (Preservative free BTFC) was found to be 8.67 ± 1.30 mmHg (33.50%) and for Group 2 (BKC preserved BTFC) was 8.82 ± 1.98 mmHg (33.32%) and the difference between the two groups was statistically insignificant (p = 0.73). Although there was no statistically significant difference in number of each side effect encountered by the patients in both the groups but side effects did show higher tendency in number in Group 2 (BKC preserved BTFC) than in Group 1 (Preservative free BTFC). Using cost minimization analysis, it was found that BKC preserved BTFC costs Rs. 181.89 ± 5.96 ($ 2.39 ± 0.27) more than Preservative free BTFC to attain similar IOP lowering effect over 8 weeks.Conclusion: Preservative free 0.2% Brimonidine/0.5% Timolol fixed drug combination is an effective, safe and cheaper alternative to BKC preserved 0.2% Brimonidine/0.5% Timolol fixed drug combination in medical management of POAG.Keywords: Fixed Dose Combination (BTFC); Benzalkonium Chloride (BKC); Brimonidine
114 My Child has Insect Crawling on his Eye , Meenakshi Wadhwani1* and Shubhangi Kursange
Phthiriasis palpebrarum is a rare eyelid infestation caused by Phthiriasis pubis or Crab lice. These lice have a predominant liking for axilla, groin, thighs but occasionally may invade eyelashes or eyelids [1]. The main common route for transfer is sexual contact followed by areas with history of overcrowding and poor hygiene.Phthiriasis palpebrarum infestation affects 1 to 2% of the human population worldwide [2]. There is history of around 30% of the cases associated with another sexually transmitted diseases. We hereby, report the case of unusual presentation of this infestation in a 5 year old child.
115 Clinical Classification of Glaucoma , Gowhar Ahmad
Glaucoma is one of the commonest ocular disorders seen by almost all ophthalmologists it is a kind of visual Threatening dis-order if not diagnosed and managed in time and properly the main problem with this disorder is that whatever vision is lost can't be restored back by any means be it drugs surgery etc. however in recent times of ophthalmic subspecialities we have got glaucoma experts and with latest research taking place in the field of glau-coma the prognosis of this disorder is much better EEC also have a kind of glaucoma screening where silent patients are picked up by random examination of people after 40 years of age whose as-sessment of IOP refraction facility of Aqueous outflow and scleral rigidity is done
116 Blow Out Orbital Fracture , Gowhar Ahmad
Lid hematoma enophthalmos supratarsal retraction limitations of movements in upwards and downward gaze diplopia.Dullness of sensation in infraorbital region infraorbital nerve.Blow out orbital fracture is a king of disorder which is charac-terized by an increase in the intraorbital pressure as a result of injury by a closed fist cricket or hockey ball or rt accident.Fracture lies 1 to 3 mm medial to the post part of infraorbital groove because medial wall of orbit is the weekest we can confirm the fracture by CT scan orbits or x-rays orbits
117 Successful Treatment of Palpebral Pyogenic Granuloma with Topical Timolol: A Case Report , El Kaissoumi Loubna1*, El Moize Zakaria1 and Cherkaoui Ouafae
AbstractPyogenic granuloma is a benign vascular tumor appearing usually as a response of a local tissue to an irritation or a trauma.This lesion can be sessile or pedunculated, and it can measure few millimeters or several centimeters. It is usually located on the face or the fingers.It generally occurs among young patients and it’s seems to have a female predilection prevalence.It can be induced by trauma, drugs, or may appear spontaneously, like it was the case of our patient.Different therapeutic options may be proposed to treat pyogenic granulomas, some being more invasive like curettage, shave removal, surgical excision by electrocautery, laser, microembolization or sclerotherapy.Topical timolol can be an interesting option to treat pyogenic granulomas, but further studies have to be done to demonstrate its effectiveness in the treatment of this pathological entity.Keywords: Palpebral Lesion; Pyogenic Granuloma; Topical Timolol
118 Biodegradable Material (Ologen Implant) Using in Treatment of Refractory Glaucomas , Mona Abdelkader1*, Shereen Hagras2, Ahmed Soltan1, Eman Hefney1and Asad Ghanem
AbstractPurpose: To evaluate the role of the bioengineered collagen matrix implant (Ologen) on the outcome of trabeculectomy in patients with refractory glaucomas. Subjects and Methods: This prospective, nonrandomized, interventional case series study included 60 eyes of 60 patients with refractory glaucoma. Patients were divided into 2 groups according to the age. Group I; age ≤ 18 years old and group II; age > 18 years old. Preoperative data included age, gender, type of glaucoma, intraocular pressure (IOP) and number of preoperative glau-coma medications. Conventional fornix based trabeculectomy with implantation of subconjunctival ologen was performed in all patients. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Blebs were graded according to Wuezrburg bleb classification system (WBCS) and were imaged with ultrasound biomicroscopy (UBM). Patients were followed up for at least 6 months. Results: The mean preoperative IOP was 28.5 ± 4.96 mmHg in group I and 30.13 ± 6.33 mmHg in group II. The range of anti-glauco-matous medications was 2 - 3 in both groups. The means of postoperative IOP showed no statistical significant difference between both groups except at the 1st month where group I had higher IOP values. At 6th month; the percentage of pressure reduction was 48.74% in group I and 57.25% in group II, with significant higher mean of pressure reduction in group II. Complete success was achieved in 71.43% of eyes by the end of the 6th month in group I and in 81.25% in group II. Complete degradation of the ologen implant before 6 months was noticed in 50% of the cases in group I and none in group II. No relation was found between the bleb scores and the IOP control along the follow up period. There was statistically significant correlation between IOP control and bleb wall reflectivity on UBM at 1st and 6th month. Conclusion: Ologen was effective in controlling IOP in refractory glaucoma. It was a safe method in augmentation of trabeculectomy with no special complications. Keywords: Trabeculectomy; Ologen; 5-fluorouracil (5-FU); Mitomycin C (MMC)
119 An Objective Approach in Diagnosis of Retinopathy of Prematurity Stages , Maria A Kovalevskaya* and Oxana A Pererva
AbstractObjective: To develop the concept of a universal diagnostic platform that will reduce the risk of subjectivity in diagnosis and treat-ment choice for ROP, DME, DARP, AMD, RVO and glaucoma and will allow to achieve objective nosology’s data and targeted reasonable investment of health care resources.Materials and Methods: 1278 retinal images and 77 OCT results of 412 patients were analyzed. 5 clinical group with subgroups were created: 1- ROP (n = 272), 2- Diabetic retinopathy (n = 120), 3- CRVO (n = 6), 4- AMD (n = 4), 5- Control (n = 10). A concept of an information platform was developed to exclude subjectivity in the interpretation and to automatize the multifactorial image analysis in the diagnosis of social valuable diseases of the retina and optic nerve. The platform works by analyzing 3D and 4D images, anam-nesis data and laboratory tests by CNN. Results and Discussion: Statistically valuable difference (Mann-Whitney U test) was indicated between Df in immature retina group (1,27 ± 0,01) and all stages of ROP (1 stage - 1,32 ± 0,02; 2 stage 1,4 ± 0,06; 3 stage 1,450 ± ,02; 4 stage 1,55 ± 0,01). In DARP groups p < 0,05 was only in groups with proliferate (1,52 ± 0,04) and terminal (1,43 ± 0,04) stages relatively to patients with normal retina (1,55 ± 0,04). A concept of an information platform was developed to exclude subjectivity in the interpretation and to automatize the multifactorial image analysis in the diagnosis of social valuable diseases of the retina and optic nerve. Platform modules for a wide-field fundus image modeling of infants, localization of the macula as a mark for morphometry and isolation of the vascular network using deep convolutional neural networks have been developed.Keywords: Retina Images; Fractal Analysis; Complexity of Vascular System; Retinopathy of Prematurity; Diabetic Macular Edema; Diabetic Angioretinopathy; Retinal Vein Occlusion; Glaucoma
120 Rare Case of Goldenhar Syndrome in a 3 Years Old Male Child , Gowhar Ahmad
AbstractCong limbal dermoid preauricular skin tag appendage squint enophthalmos colobomas of upper lid iris retina astigmatism mi-crophthalmos blepharophimosis syndrome facial asymmetry high arched palate hare lip cleft palate double ureters hydronephrosis defects in limbs and spine cong heart dental anomalies hearing defects impairment of memory intelligence mental facility 7th nerve involvement trigeminal anasthesia.Keywords: Goldenhar Syndrome; Cong Limbal Dermoid; Squint Enophthalmos
121 Rare Case of Goldenhar Syndrome in a 3 Years Old Male Child , Gowhar Ahmad
AbstractCong limbal dermoid preauricular skin tag appendage squint enophthalmos colobomas of upper lid iris retina astigmatism mi-crophthalmos blepharophimosis syndrome facial asymmetry high arched palate hare lip cleft palate double ureters hydronephrosis defects in limbs and spine cong heart dental anomalies hearing defects impairment of memory intelligence mental facility 7th nerve involvement trigeminal anasthesia.Keywords: Goldenhar Syndrome; Cong Limbal Dermoid; Squint Enophthalmos
122 SARS-CoV2 Infects Eye Too , P D Gupta
Abstract Discovery of SARS-CoV2 belonging to SARS family to begin with confused scientists and clinicians both and they were concentrat-ing only on lung infection. But when it became pandemic and millions of people suffered, clinicians started examine each and every organs of the Covid-19 patients, they found that eyes are also getting infected. The eyes suffered with conjunctiva which is not a very serious diseases but further investigations revealed that the eye can be a potent source of infection.Keywords: SARS-CoV2; Covid-19; Eye
123 Redefining Forme Fruste Keratoconus as Ectasia Susceptibillity , Louise Pellegrino Gomes Esporcatte1,2*, Marcella Q Salomão1-5, Bernardo T Lopes1,6, Nelson Sena Jr7, Aydano P Machado3,4,8 and Renato Ambrósio Jr
Abstract The term form fruste keratoconus was initially coined by Marc Amsler in 1938 in cases with slightly tilted Java mires and, later on, longitudinal studies using Polaroid Placido photokerastocopy for describing patterns of irregularity that did precede clinical kerato-conus. The term fruste is derived from French and means "confused, crude, or unfinished." Fruste refers to an incomplete and abor-tive form of the disease, in contrast to the concept of the full-blown presentation. Rabinowitz describes forme fruste keratoconus as the eyes with unremarkable biomicroscopy and no visual impairment having good distance corrected visual acuity by glasses, which present a typical keratoconus irregularity on the topographic mapping. In 2009, Klyce proposed that the term forme fruste keratoco-nus should also apply to the contralateral eye of keratoconus patients with no clinical findings of any sort. There is no consensus on the current definition of forme fruste keratoconus. The recent 2015 Global consensus states that kera-toconus is bilateral disease and that ectasia may occur unilaterally due to purely biomechanical stress. Nevertheless, FFCK has been recognized as the most important risk factor for developing progressive ectasia after refractive laser correction. This article provides a prospective review of the definition of forme fruste keratoconus as the cases with high susceptibility for corneal biomechanical decompensation and ectasia progression.Keywords: Forme Fruste Keratoconus; Corneal Ectasia; Multimodal Corneal Imaging
124 To Determine the Occurrence of Various Intra Operative Complications of Manual Small Incision Cataract Surgery from a Rural Background in a Tertiary Hospital , Ramya M and Soumya Ramani
AbstractKeywords: Manual Small Incision Cataract Surgery; Complications; Posterior Capsular Rupture; Zonular DehiscencePurpose: To determine the occurrence and frequency of various intra operative complications of manual small incision cataract surgery. Materials and Methods: A retrospective study was conducted to find the complications that occurred after small incision cataract surgery. All the records of 990 patients who underwent small incision cataract surgery were reviewed from January 2019 to Decem-ber 2019. Among the 990 patients, 89 patients had intra operative complications. The details regarding the surgical procedure was recorded in these patients, including type of surgery, intraocular lens placed, the type of complication and the remedial measures that were taken. The study was conducted as per the tenets of the Declaration of Helsinki (2008).Results: Among the 89 patients, who had intra-operative complications, 52.8% percent were males and 47.2% were females. The percentage of right eye surgeries was 51.7%, and that of left eye surgeries was 48.3%. The average age of the patients was 65.07 +- 9.5 years. The most common complication was a posterior capsular rent. In females, the propensity of developing complications such as zonular dehiscence and Descemet’s membrane detachment were higher (p = 0.06). In those cases, that had a posterior capsular rupture, the most common intraocular lens placed was a retropupillary iris fixated lens (p = 0.00). Conclusion: Manual small incision cataract surgery is a safe and effective surgery for the treatment of cataract, especially in a devel-oping country. It is important to be aware of the possibility of occurrence of complications, so that preventive measures can be taken and once they do occur, appropriate steps can be taken to ensure that optimal outcomes can be obtained.
125 The Relationship between Central Macular Thickness and Metabolic Parameters Changes in Patients with Non-Proliferative Diabetic Retinopathy , Ayse Gul Kocak Altintas1*, Cagri Ilhan2 and Mehmet Citirik
AbstractKeywords: Central Macular Thickness; Diabetic Macular Edema; Diabetic Retinopathy; HbA1c; LipidAim: To compare the directions changes in central macular thickness (CMT), glycosylated hemoglobin (HbA1c) and fasting serum lipids in patients with non-proliferative diabetic retinopathy (NPDR) along three-month follow-up.Methods: Sixty-eight eyes of 68 patients with NPDR were included in this retrospective observational case series. CMT was measured using spectral domain optical coherence tomography at baseline and at third month follow-up visit. Fasting serum lipids including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG) and HbA1clevels were evaluated on the same day of CMT measurements. A potential relationship between HbA1c, serum lipids and CMT values were investigated by statistical methods.Results: The mean age of the patients was 57.5 ± 9.8years (38 - 80) and male-to-female ratio was 30/38 (p > 0.05). Along three-month follow-up period, CMT value increased in 31 eyes, decreased in 30 eyes and remained in the same level in 7 eyes. In the same period, HbA1c values increased in 39 patients and decreased in 22 patients and did not changed the rest of them. The directions of changes in CMT and HbA1c were same for totally 41 patients (p = 0.01). These same directional changes were observed in totally 36 patients for CMT and HDL, in 23 patients for CMT and LDL, and in 28 patients for CMT and TG (p > 0.05, for all). Conclusion: This study demonstrates the directions of changes in CMT and HbA1c levels were same; however, similar relationship was not observed for CMT and serum lipids including HDL, LDL, and TG along three-month follow-up in patients with NPDR.
126 Efficacy and Cost Analysis of Brinzolamide 1%/Brimonidine 0.2% Fixed Combination (BBFC) Therapy Vs Separate Concomitant Brinzolamide 1% and Brimonidine 0.2% Therapy: A Comparative Study , Jashandeep Singh1, Anil Pathak1, Gagan Kalra2, Anand Aggarwal1*, Manpreet Kaur1, Neeru Sharma3, Kamlinder Kaur1 and Ravneet Pannu1
AbstractKeywords: Brinzolamide; Brimonidine; Brim Therapy; BBFC TherapyPurpose: The aim of the study was to compare the intraocular pressure (IOP) lowering efficacy and cost analysis of Brinzolamide 1%/Brimonidine 0.2% fixed combination (BBFC) therapy versus separate concomitant Brinzolamide 1% and Brimonidine 0.2% (Brinz + Brim) therapy.Methods: A prospective, randomized, comparative, cross over, 12-week study was conducted on forty patients of primary open angle glaucoma or ocular hypertension. Enrolled patients were randomized into two groups (Group A and B) of twenty patients each. For the first 6 weeks of the 12-week study period, Group A patients received Brinzolamide 1%/Brimonidine 0.2% fixed combination (BBFC) therapy and Group B patients received concomitant Brinzolamide 1% and brimonidine 0.2% (Brinz + Brim) therapy, each given twice daily. After the 6-week follow-up visit, Group A patients were crossed over to concomitant Brinzolamide 1% and Bri-monidine 0.2% (Brinz + Brim) therapy while the Group B patients were crossed over to Brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) therapy. IOP was assessed at baseline and at 6-week and 12-week visits at 9 am (before instillation of drug) and 11 am (post dose, peak effect). The daily cost of both the therapies was calculated by maximum retail price and average drop count per bottle. The cost-effectiveness of both therapies was then calculated as cost of therapy/mm Hg fall in IOP.Results: There was no statistically significant difference between the patient characteristics of the two groups. The mean age for Group A was 64.15 years and for Group B was 63.45 years. In Group A, 10 (50%) were females and in Group B, 11 (55%) were fe-males. There was no statistical difference between the baseline IOP of both the groups. At both time points, IOP lowering from base-line after 6 weeks of therapy with either BBFC or Brinz + Brim was statistically significant (p < 0.00001). After 6 weeks, the mean IOP reduction from baseline in Group A (BBFC) was calculated to be 7.98 ± 1.31 mmHg (31.11%) and for Group B (Brinz + Brim) was calculated to be 7.87 ± 0.98 mmHg (30.56%). The difference in mean IOP reduction between both the groups at 6 weeks was statistically insignificant (p = 0.39). After 6 weeks visit when the therapies were switched among both groups, the mean IOP at the 12-week visit was statistically similar to the mean IOP of the same group at 6 weeks visit. The side effect profile of both the therapies was similar, none of the patients having any serious side effect warranting discontinuation of the treatment. For 6-week study period, cost per mm Hg IOP reduction for BBFC therapy and Brinz + Brim therapy was respectively found to be Rs 45.7 ± 0.4 per mmHg and Rs 67.54 ± 0.29/mmHg per mmHg. The total 6-weekly cost of BBFC therapy was found to be Rs 364.72 ± 3.15 ($ 4.2) while that of Brinz + Brim therapy was Rs 531.55 ± 2.33 ($ 7.43). Using cost minimization analysis, it was found that Brinz + Brim therapy costs Rs 166.83 ± 3.27 ($ 2.63) more than BBFC therapy to attain similar IOP reduction for a period of 6 weeks.Conclusion: Brinzolamide 1%/Brimonidine 0.2% fixed combination (BBFC) is an effective and safe IOP lowering therapy with an auxiliary advantage of being more economical than concomitant separate Brinzolamide 1% and Brimonidine 0.2% therapy.
127 To Determine the Occurrence of Various Intra Operative Complications of Manual Small Incision Cataract Surgery from a Rural Background in a Tertiary Hospital , Ramya M and Soumya Ramani
AbstractKeywords: Manual Small Incision Cataract Surgery; Complications; Posterior Capsular Rupture; Zonular DehiscencePurpose: To determine the occurrence and frequency of various Intra operative complications of manual Small Incision Cataract Surgery. Materials and Methods: A retrospective study was conducted to find the complications that occurred after small incision cataract surgery. All the records of 990 patients who underwent small incision cataract surgery were reviewed from January 2019 to Decem-ber 2019. Among the 990 patients, 89 patients had intra operative complications. The details regarding the surgical procedure was recorded in these patients, including type of surgery, intraocular lens placed, the type of complication and the remedial measures that were taken. The study was conducted as per the tenets of the Declaration of Helsinki (2008).Results: Among the 89 patients, who had intra-operative complications, 52.8% percent were males, and 47.2% were females. The percentage of right eye surgeries was 51.7%, and that of left eye surgeries was 48.3%. The average age of the patients was 65.07 +- 9.5 years. The most common complication was a posterior capsular rent. In females, the propensity of developing complications such as zonular dehiscence and Descemet’s membrane detachment were higher (p = 0.06). In those cases, that had a posterior capsular rupture, the most common intraocular lens placed was a retropupillary iris fixated lens (p = 0.00). Conclusion: Manual small incision cataract surgery is a safe and effective surgery for the treatment of cataract, especially in a devel-oping country. It is important to be aware of the possibility of occurrence of complications, so that preventive measures can be taken and once they do occur, appropriate steps can be taken to ensure that optimal outcomes can be obtained
128 A Novel Surgical Technique of Removal of Sub-Macular Hemorrhage in Post Traumatic Cases , Mohammad Khalife1*, Mojtaba Abrishami2*, Purva Date3 and Matteo Forlini4
AbstractKeywords: Sub Macular Hemorrhage; Vitrectomy; Visual Function; Trauma Purpose: To describe a new technique in removing sub-macular hemorrhages (SMH) in traumatic patients and results.Methods: In this technique, patients with SMH, a complete three port vitrectomy was performed. Using a back flush instrument and soft tip needle, considering safe distance from silicon tip to retina, SMH is swept using gentle flushes to an other site far from the macula in which clots were removed via a retinotomy site. In a case with macular hole, the hemorrhage was drained via the hole.Results: In case one, SMH was swept to the temporal of the macula and removed via a retinotomy. Best corrected visual acuity was improved from hand motion to 20/ 30. In the second patient, four weeks after trauma, SMH was removed and after three weeks the BCVA was improved to 20/25 (after three weeks). In the third case that had traumatic macular hole in first place, the SMH was drained via the macular hole and BCVA was improved from hand motion to 20/100.Conclusion: Sub-Macular hemorrhage sweeping using back flush after a complete vitrectomy seems to be efficacious in restoring macular anatomical and visual function.
129 Glaucoma in Penetrating Keratoplasty , Prateeksha Sharma*
AbstractGlaucoma following penetrating keratoplasty (PKP) is one of the most common causes for irreversible visual loss [1] and the second leading cause for graft failure after rejection [2]. The management of penetrating keratoplasty and glaucoma remains controversial mainly because of the high risk of graft failure associated with treatment.Keywords: Penetrating Keratoplasty (PKP); Glaucoma; IOP
130 Hints for Wearing Contact Lenses in all Age Groups , Dileep Kumar Chennamsetti
Better to replace contact lenses, although you did not wear them daily or used for once or contact lens looks fresh or forgot to clean lenses or forgot to take out contact lenses while sleeping as they are daily disposable lenses, as these all increases chances of infections in the eyes.
131 Ocular Manifestation of Liver Fluke: A Little Mentioned Clinical Issue , Viroj Wiwanitkit
Opisthorchis viverrini infection or liver fluke infestation is a common tropical trematode disease. This infection can causes chronic biliary tract irritation and can result in a deadly malignan-cy, cholangiocarcinoma. The hepatobiliary presentation of opis-thorchiasis is well documented. However, there might also other atypical presentation. Here, I would like to draw an attention to ocular presentation of opisthorchiasis. In infected animal, the ocu-lar manifestation of liver fluke infection is possible [1]. For human, it is little mentioned [2,3]. The conjunctivitis might be a presenta-tion of opisthorchiasis [2,3]. The exact pathophysiology is not well clarified but it might be an immunopathological process.
132 Meibomian Gland Dysfunction and Short-Term Visual Outcomes Following Laser-Assisted In Situ Keratomileusis , Sara Sella1, Nitsan Duvdevan3, Michael Mimouni and Igor Kaiserman
AbstractPurpose: To assess the association between short-term visual outcomes following LASIK and meibomian gland dysfunction. Methods: This retrospective case series included consecutive patients who underwent LASIK for myopic correction during August 2016 at the Care Vision Refractive Clinic, Israel. Pre-operative data included clinical signs of dry eyes, meibomian gland dysfunc-tion (MGD) score, eyelid telangiectasia, recent history of hordeolum, conjunctival hyperemia (CH), tear film break-up time (TBUT), spherical equivalent (SE) and pre-operative best corrected visual acuity (BCVA). The association between these parameters and uncorrected visual acuity on postoperative days (POD) 1, 7, and 30 was assessed. Results: This study included 95 patients at a mean age of 30 ± 7.2 years, 75% were men. Mean MGD score was 2.2 ± 0.8. The mean logarithm of minimum angle of resolution (LogMAR) visual acuity on POD 1, 7, and 30 were 0.096 ± 0.16 (20/25), 0.1 ± 0.11 (20/20), and 0.0 ± 0.11 (20/20). LogMAR visual acuity was inversely proportional to pre-operative MGD grading (p = 0.020) on POD 1. Preoperative CH was seen in 33.6% (32/95) patients, who showed a trend toward poorest LogMAR visual acuity on POD1 (p = 0.09). It was significantly worse on POD7 (P = 0.002). LogMAR visual acuity was proportional to pre-operative TBUT on POD 1 and 7, but not POD 30. Preoperative history of recent hordeolum, noted in 28.4% (27/95) patients, was associated with worse LogMAR visual acuity (P = 0.04).Conclusion: Patients with preoperative ocular surface signs of dry eye disease, such as high MGD score, low TBUT or CH, may be advised to expect slower restoration of visual acuity following LASIK. Keywords: Meibomian Gland Dysfunction; LASIK; Dry Eye; Ocular Surface Disease Index (OSDI)
133 Dry Eye Disease in Covid Era - How Ocular Surface is Effected , Dileep Kumar Chennamsetti
Most common symptom observed in this covid era is dry eyes and negative impacts on health of the ocular surface. Pre-covid time, dry eye cases are 10% and during this covid era, dry eye cases have increased tremendously to 60% in all age groups. In particu-lar, what we have observed are few mechanisms responsible for the onset for the dry eyes worsening or increasing symptomatol-ogy.
134 Juvenile Open Angle Glaucoma: A Report of Three Sons in One Family , Said M Shalaby, Wesam Shamseldin Shalaby* and Ahmed F Elmaria
AbstractA male child aged 16 years old diagnosed with bilateral juvenile open angle glaucoma (JOAG) underwent trabeculectomy with mitomycin C (MMC) in both eyes. For 5 years follow-up, no complications were recorded, and the intraocular pressure (IOP) was well controlled. Family screening was done and revealed JOAG in his brother, 13 years old, and his sister, 9 years old. Both underwent trabeculectomy with MMC. Ologen implant was intraoperatively added in the younger sister. Examination of the parents revealed that their mother, 45 years old, had mild primary open angle glaucoma and medical treatment was prescribed for her with good IOP control, stable perimetry and retinal nerve fiber layer thickness for 4 years follow-up.Keywords: Juvenile Open Angle Glaucoma; Mitomycin C; Ologen; Trabeculectomy
135 Causes of Secondary Glaucoma among Patients Presenting in Glaucoma Clinic at Al-Ibrahim Eye Hospital, Karachi , Shua Azam1*, Abdul Hameed Talpur2, Aqsa Batool3, Nimra Anwer4, Zainab Palijo5, Sadia Bukhari6 and Muhammad Asif7
AbstractObjective: To determine the causes of Secondary Glaucoma in Glaucoma clinic in Al-Ibrahim Eye Hospital, Malir Karachi.Materials and Methods: This hospital based, Cross-sectional study was carried out at glaucoma clinic of Al Ibrahim Eye Hospital from June to November, 2019. Non-probability, purposive sampling technique was used. A total of 1000 subjects attended glaucoma clinic. Among 2000 eyes, 40 eyes were diagnosed with secondary glaucoma. All ocular examination belonged to secondary glaucoma were performed. Demographics features and etiologies were recorded. SPSS version 20.0 was used to analyze the data. Research Ethical Committee (REC) of ISRA Postgraduate Institute of Ophthalmology gave ethical approval. SPSS version 20.0 was used to analyze the data.Results: A total of 80 eyes of 40 subjects with secondary glaucoma were included. Among 80 eyes, 40 eyes were affected with second-ary glaucoma (SG). 31 subjects (77.5%) were males while 9 subjects (22.5%) were females. Frequency of secondary glaucoma was found to be 4%. Pseudoexfoliation glaucoma was the most common cause of secondary glaucoma present in 20 eyes (50%), Neovas-cularization glaucoma was presented in 13 (32.5%) eyes, 4 (10%) eyes were affected by Angle recession glaucoma while 3 (7.5%) eyes were involved in Steroid induced glaucoma.Conclusion: This study concluded that the common cause of secondary glaucoma was Pseudoexfoliation glaucoma and males were more affected than females.Keywords: Glaucoma; Secondary Glaucoma; Causes
136 Current treatments for Meibomian Gland Dysfunction and Eye Lid Margin Disease , Karl Stonecipher*, Kody Stonecipher, Megan Stonecipher and Brent Kramer
AbstractImportance: This study highlights the value of current therapeutic devices in the authors practice for the management of meibomian gland dysfunction (MGD) and eyelid margin disease (ELD).Background: To evaluate the effects of current therapeutic devices on clinical measures of dry eye related to MGD and ELD in pa-tients unresponsive to previous therapies.Design: A retrospective chart review of patients treated at one site.Participants: One thousand three hundred eighty-six eyes of 711 treated patients who were documented treatment failures with previous pharmaceuticals and/or devices were included in the patient population.Methods: Treatments for MGD included: lid exfoliation, low level light therapy in combination or alone with intense pulsed light therapy (LLLT or LLLT/IPL), thermal pulsation, blink assisted thermal energy, and radiofrequency thermal energy all performed at one center. Main Outcome Measures: Results included changes in the graded MGD score (grading scale 0 - 4), tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) questionnaire score and lissamine green staining (LGS).Results: Significant improvements in the MGD scores, TBUT, OSDI questionnaire scores and LGS were seen. There were no ocular or facial adverse events or side effects related to any of the treatments.Conclusion: The application of an algorithm for the treatment of MGD and ELD is beneficial in the majority of patients who had failed to improve with alternative pharmaceutical and device interventions.Keywords: Low Level Light Therapy (LLLT); Intense Pulsed Light (IPL); Meibomian Gland Dysfunction; Ocular Surface Disease Index (OSDI); Dry Eye Disease (DED); Eye Lid Margin Disease(ELD)
137 Use of Artificial Intelligence and Machine Learning in Screening and Treatment of ROP in COVID Era , Muhammad Ahmed Qayyum1* and Seema Qayyum2
Artificial intelligence is a term used for software that can imi-tate cognitive tasks such as comprehension and analysis of data and scientific problem solving [1]. This assists in reducing human involvement by a considerable degree and as a result helps in re-ducing human errors by doctors in a field where such errors would be fatal. The increasingly large influence of artificial intelligence in today’s world is undeniable, as is its effect on society in mak-ing it a more technologically advanced civilization. As such, it was inevitable for this technology to leak into the world of healthcare to assist medical practitioners in efficient diagnosis and treatment. Research on the application of AI technology in healthcare began as early as the 1960s and soon enough its application extended to the branch of ophthalmology in an attempt to attain early diagno-sis and cure for leading illnesses related to the eye.
138 A Survey based Study: Usage of Electronic Devices and Ocular Manifestations during Quarantine (Covid-19) among Students , Priyanka1, Amara Baloch2, Shua Azam3*, Mariyum Fatima2, Shumaila Masood4
AbstractPurpose: To evaluate the ocular manifestation due to electronic devices on the eye during a lockdown and ocular symptoms due to excessive use of devices for education purpose. Methods: A self-made questionnaire about qualitative and quantitative usage of the electronic devices was completed by students attending online classes during the quarantine phase of pandemic COVID 19. All the data were gathered and analyzed using a statisti-cal package for social sciences (Version 22). Results: A total of500 students were responded to this survey. The most common usage devices among students were 60% mobiles phone, 20% for laptops, and 20% for other electronic devices. 75% of students had eye strain after using devices at day end followed by 25% of students who had no ocular discomfort. There is a strong relation (p = 0.05) between ocular manifestation and excessive use of the electronic device.Conclusion: Eye health issues are emerging as electronic devices time increases for students due to institutes being closed and on-line mode of education started in the Covid-19 pandemic. As there is a strong association between usage of electronic devices (smart-phones and laptops) and ocular manifestations including blurriness of vision, burning sensation in eyes, headache, and strain in eyes. Keywords: Electronic Devices; Laptop; SmartPhones; Ocular Manifestations; COVID19; Quarantine; Pandemic; Survey
139 The Dangers of Telemedicine for Glaucoma in the Light of COVID-19 Without Being Able to Assess Disease Parameters , Samar Elnahas and Alastair Lockwood*
AbstractBoth screening and monitoring for glaucoma in patients have been severely hampered by COVID-19. In some areas of medicine virtual consultations using telephone or video have helped in triaging, diagnosing and treating conditions without the need for face-to-face clinics, thus reducing the risk of COVID-19 exposure and transmission. Their use has risen dramatically since the onset of the pandemic. However, glaucoma is usually asymptomatic until being very advanced. We present a case of severe irreversible vision loss from glaucoma not known to be out of control in a patient over a period of 4 months who had received 3 virtual consultations. We caution against the use of virtual consultations without being able to measure glaucoma disease parameters such as intraocular pressure.Keywords: Glaucoma Telephone Telemedicine; Blindness; COVID-19
140 Basics of Binocular Single Vision and Strabismus , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah
AbstractThis paper describes about Basic information of Binocular Single Vision and Strabismus.Keywords: Binocular Single Vision; Strabismus; Retinal point
141 Non-Penetrating Deep Sclerectomy: A Lifetime Dedication and Economical Considerations , Ahmed Mostafa Abdelrahman*
AbstractThe present review describes simple economical procedures that were introduced to the literature by the author to facilitate Non-penetrating Deep Sclerectomy and enhance the efficacy in lowering the intraocular pressure in glaucoma patients.Keywords: Non-penetrating Deep Sclerectomy (NPDS); Intraocular Pressure (IOP); Schlemm's Canal
142 Basics of Anatomy and Physiology of Cornea , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah
AbstractThis paper describes about basic details on anatomy and physiology of cornea.Keywords: Anatomy; Physiology; Cornea
143 Brief Discussion on Accommodation , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah
AbstractThis paper describes about introduction to accommodation, it components, factors and its treatment modalities.Keywords: Accommodation; Modalities; Components
144 Intermittent Exotropia , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes about introduction to intermittent exotropia, its classification and treatment.Keywords: Intermittent Exotropia; Classification; Treatment
145 Brief on Bacterial Keratitis and Fungal Keratitis , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes brief about bacterial and fungal keratitis.Keywords: Bacterial Keratitis; Fungal Keratitis; Inflammation; Cornea
146 Brief Note on Papilloedema, Optic Neuritis and Optic Atrophy , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes about papilloedema, optic atrophy and optic neuritis.Keywords: Papilloedema; Optic Atrophy; Optic Neuritis
147 Retinoblastoma , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper gives brief information on retinoblastoma.Keywords: Retinoblastoma; Optic Nerve Layer; Retina
148 Brief on Retinal Detachment and Central Serous Retinopathy , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes about basics of retinal detachment and central serous retinopathy.Keywords: Retinal Detachment; Central Serous Retinopathy; Retina
149 Retinopathy of Prematurity , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes introduction to retinopathy of prematurity, its classification and its treatment.Keywords: Retinopathy; Prematurity; Classification; Treatment
150 Comparison of Visual Field Characteristics Between Normal Tension Glaucoma and Primary Open Angle Glaucoma , Shouvik Chattopadhayay1*, Monica Choudhry2 and Shahiban Shethi3
AbstractPurpose: To compare pattern of visual field in cases of normal tension Glaucoma versus primary open angle Glaucoma. Material and Methodology: This retrospective cross-sectional study was conducted in Aroonodaya Deseret eye hospital. We took their 40 Primary open angle glaucoma patients (of above 40 years and with no other systemic and medical problem) record with HVF report by their permission.Results: In these 40 patients 20 has normal tension and 20 has high tension. Each of the 20 patients of HTG and NTG made a pair by their age matched, refractive error matched and Mean deviation matched. In NTG there are 10 male patient and 10 female patients in other hand in HTG there are 7 male and 13 female patients. According to the age there are 5 subgroups were made 1, 2, 3, 4 and 5; 41 - 50, 51 - 60, 61 - 70, 71 - 80 and 81 - 90 respectively. The mean age ± standard deviation was 64.2 ± 12.3 for the group of NTG and for the HTG it was 62.8 ± 11.2. So, there are no significant difference found in this study. In the case of PSD value which was analyzed age group wise was significant. Because the P value is 0.016 and when we had done the same test among the NTG and POAG sub groups in the basis of pattern deviation plot map; the 38th point is significant which is actually placed under the blind spot and two points nasally. We had done GHT cluster analysis, there we found two points which were statistically significant these two significantly dif-ferent points are ICL3b and ICL5b the P value of this points are 0.039 and 0.048 respectively. We had analyzed MD and PSD values on the basis of the stage of severity of the disease while the comparison of both the group together we found some significant difference. Conclusion: In conclusion, there are two parts. firstly, when we use the Pattern deviation map point wise analysis, we have got a dif-ference in inferior paracentral area. The GHT wise analysis has shown the difference in inferior nasal step and in inferior scotomata area. And secondly, we can see MD wise analysis in mild to moderate, mild to severe and moderate to severe, and we got statistically significant differences. PSD value analysis has shown in NTG group a statistically significant difference in moderate to severe group. Similarly, in case of mild to moderate comparison, HTG group has shown the statistically significant difference. Keywords: Visual Field; Normal Tension Glaucoma; Primary Open Angle Glaucoma
151 Comparison of Blue Block Lenses and Anti-Reflection Coated Lenses on Reading Speed and Visual Fatigue , Vidhya L1*, Nilesh Thite2, Aditya Goyal3, Dhanaraju BM4, Deepthi AR5and Murtuza Abbas Kanchwala6
AbstractPurpose: To compare the effect of blue block lenses and anti-reflection coated (ARC) on reading speed in visual display unit (VDU) and printed chart and on visual fatigue questionnaire.Methods: A double-masked, controlled crossover study was carried out on 146 healthy subjects (92 males and 54 females) aged 18 to 30 years who used digital devices for a minimum two hours daily. The duration of the study was August 2019 to February 2020. Baseline visual fatigue questionnaire response and reading speed with hard coated lenses on digital MNRead and printed MNRead was recorded. Subjects were then divided into two groups by randomization. A well-fitted spectacle with blue block lenses was given to the first group and ARC lenses to the second group. After a week, the response to the visual fatigue questionnaire and reading speed was noted. Hard coat lenses were given for a week to wean off the previous lenses' influence if any. Then the intervention was crossed over and the response of the visual fatigue questionnaire and reading speed data were collected again after a week. All the collected data were compiled and statistically analyzed using ANOVA-Fisher's test.Results: Blue block lenses had a significant increase in reading speed in terms of words per minute (WPM) compared to baseline and ARC lenses in both VDU and printed chart. Blue block lenses showed a WPM of 137 (± 23.3) in VDU and 145 (± 23.3) with the printed chart (p < 0.001). ARC lens showed WPM of 128 (± 17.7) in VDU and 135 (± 17.7) in the printed chart (p < 0.001). While the baseline recording with hard coat lenses was WPM of 123 (± 27.2) in VDU and 134 (± 20) with the printed chart. While a significant decrease in symptoms of digital eye strain was noted with the usage of blue block lenses, especially in terms of dryness, eye fatigue in the visual fatigue questionnaire (p < 0.001).Conclusions: Blue block lenses were more effective with respect to reading speed and reducing digital eye strain as compared to ARC lenses. In our study, the blue block lenses showed an improved reading speed of about 7% in comparison with ARC lenses on both VDU and printed chart.Keywords: Blue Block Lenses; ARC Lenses; Reading Speed on Visual Display Unit; Printed Material
152 Efficacy and Safety of Brinzolamide 1% vs Timolol 0.5% as an Adjunctive Medication to Latanoprost 0.005% in Medically Uncontrolled Primary Open Angle Glaucoma , Gurpreet Dhaliwal1, Pradeep Dewan2, Ashok Aggarwal3, Anand Aggarwal1*, Shubham Mittal1, Shavina Garg1, Sonika Bansal1 and Rajinder Khalsa
AbstractAim:The aim of the study was to compare Intraocular pressure (IOP) lowering efficacy of Brinzolamide 1% versus Timolol 0.5% as an adjunctive medication to Latanoprost 0.005% in medically uncontrolled primary open angle glaucoma. Materials and Methods: A prospective, open-label, comparative, transition trial was conducted on 30 patients of POAG attending the Outpatient Department of Ophthalmology, Government Medical College, Patiala. Patients fulfilling the inclusion criteria and hav-ing none of the exclusion criteria were enrolled in the study after obtaining written informed consent. Patients who were already on Latanoprost 0.005% monotherapy for more than 8 weeks were included in the study. IOP readings were recorded at the base-line before starting the study, at 8:00 am, 10:00 am and 4:00 pm. Timolol 0.5% twice daily was then added to Latanoprost 0.005% monotherapy for 8 weeks and IOP was recorded at 8:00 am, 10:00 am and 4:00 pm at 4 weeks and 8 weeks. Timolol 0.5% was then substituted with Brinzolamide 1% twice daily as an add on for another 8 weeks to Latanoprost 0.005%. IOP was again recorded at 8:00 am, 10:00 am and 4:00 pm at 12 weeks and 16 weeks of starting the study. Side effects were recorded at each follow up visit. Results: The mean age of presentation was 64.60 years with 20 (66.67%) males and 10 (33.33%) females. Baseline mean IOP was 20.87 mmHg. Both Timolol 0.5% and Brinzolamide 1% showed comparable additional IOP reduction at both 8 and 16 weeks. The mean decrease in IOP with Timolol 0.5% and Brinzolamide 1% as an adjunct to Latanoprost 0.005% was 3.49 ± 0.97 mmHg (16.93%) and 3.46 ± 0.97 mmHg (16.77%) respectively. The difference in mean diurnal IOP reduction between the two groups at all follow up visits was statistically insignificant (p value = 0.946).Conclusion: Both Brinzolamide 1% and Timolol 0.5% showed similar IOP lowering efficacy when used as an adjunct to Latanoprost 0.005% but Timolol being cheaper may be preferred as an adjunctive of first choice.Keywords: Primary Open Angle Glaucoma; Timolol; Latanoprost; Brinzolamide
153 Ocular Manifestations of Schimmelpenning-Feuerstein- Mims syndrome - A Rare Phakomatosis , Sharah Rahman1*, Sarwar Alam1, Chandana Sultana1, Mahmood Mujtaba1, Abdus Salam1, ASM Moinuddin1 and Rashed Alam1
AbstractSchimmelpenning-Feuerstein-Mims (SFM) syndrome is a rare phacomatosis characterized by sebaceous nevus of Jadasson asso-ciated with extracutaneous abnormalities affecting the brain, eyes and bones. Though Nevus sebaceous is the most common type of organoid epidermal nevus, but its association with Schimmelpenning-Feuerstein-Mims syndrome is rarely established. The purpose is to report the ocular manifestations of Schimmelpenning-Feuerstein-Mims syndrome of an 11-year-old boy. The patient had the classic triad of epibulbar choristomas, lid and retinal coloboma, and nevus sebaceus of Jadassohn. His vision in right eye was 1.00 and left eye was 0.30 in LogMAR chart. He had lid coloboma, multiple limbal and scleral choristoma, cloudy cornea, retinal and optic disc coloboma in right eye. Left eye had limbal dermoid but cornea was relatively clear with a normal fundus. A brownish black verrucous plaque on the right facial area was discovered spreading ipsilaterally to the cervical region, combined with cicatricial alopecia, micro-tia, periocular nodule and pigmentation. The retinal and optic disc coloboma was confirmed with B scan ultrasonography of right eye.Keywords: Nevus sebaceous of Jadassohn; Phacomatosis; Limbal dermoid; Coloboma; Epibulbar choristomas
154 Dry Eye in Children: An Occult Public Health Crisis Exacerbated by the COVID-19 Pandemic , Amy Nau*, Reeti Rhawal and Olivia Nau
Excessive use of screens in our society was a concern among eye care practitioners even before the pandemic forced the world into a condition of full-time digital engagement. Among children, the average amount of screen time skyrocketed during 2020. De-vice-based learning became mandatory in schools across the globe and screens emerged as a surrogate for entertainment when chil-dren could no longer occupy their time with sports, after-school programs or in-person interactions with friends. Parents of young children quickly realized that digital media produced sufficient distraction to allow for a few hours of uninterrupted virtual work and teens discovered that the unlimited options for engagement provided an escape from the monotony of lockdown. Multiple sur-veys which have queried parents about use of screens demonstrat-ed a rampant increase in their use.
155 Slow-Release Technique of Dexamethasone Implant , Mayur Kulkarni*, Divyansh Mishra and Mahesh Shanmugam
AbstractDexamethasone implant (Ozurdex®) is a sustained-release Intravitreal implant which contains dexamethasone 0.7 mg in a drug delivery system called ‘NOVADUR’. Certain cases may require dexamethasone implant injection along with vitrectomy, however, there is a lot of confusion, misconception and fear regarding the use of ozurdex implant in vitrectomized eyes [1]. In a vitrectomized eye where vitreous gel is absent, the chance of iatrogenic retinal injury is always there if adequate precautions are not taken while inject-ing the implant. Aim of the article is to demonstrate an in vivo safe technique of slow injection of the dexamethasone implant into vitrectomized eye along with vitrectomy surgery or in post-vitrectomy eye where only ozurdex implant is planned.Keywords: Dexamethasone Implant; Ozurdex; NOVADUR
156 Patient Satisfaction with Regard to Ophthalmic Ultrasound Services Offered at King Khaled Eye Specialist Hospital, Riyadh City, Saudi Arabia: A Cross-Sectional Study , Thafer S Bedaiwi1,2*, Ahmed A AlKhalifa2, Rajiv Khandekar3 and Saleh A AlKhaldi4
AbstractAim: To review patient satisfaction of ultrasound services at a tertiary eye care center.Methods: This cross sectional study was performed in 2019. A survey was performed in Arabic, that queried patient demographics, staff interaction, ease of access, patient satisfaction, and quality of the techniques. Responses were graded on a 5-point Likert scale. The logit score for satisfaction was correlated to demographics and other variables was statistically significant (p < 0.05).Results: Three hundred and sixty-six patients were interviewed. The median patient satisfaction logit score was -13.0 [Interquar-tile range (IQR) -16.1, -8.3; Minimum -29.6, Maximum-8.3]. There were 333 (91%) patients who reported positive satisfaction and 33 (9%) reported very positive satisfaction. Patient satisfaction did not differ based on gender (Mann Whitney p = 0.77). Age was statistically significantly correlated to patient satisfaction (Pearson p = 0.038). The median score of a subgroup of satisfaction for ‘Interaction and Communication’ (-5.1) was statistically better than ‘Technical Quality of Services Offered’ (0.4) and general issues of service (0.2). (p < 0.001). However, it was not significantly different from satisfaction with accessibility of services (-3.3). Conclusion: The high level of patient satisfaction for the ultrasound services provided at a tertiary eye hospital is encouraging. The factors affecting patient satisfaction could be further improved to ensure greater enhancement of ancillary services for ophthalmic patients. Keywords: Client Satisfaction; Ultrasonography Services; Comprehensive Eye Care
157 A Survey on Self-Medication in Ophthalmology in the Lebanese Population , Alaa Bou Ghannam1, Ibrahim Hashim1, Ahmad Al Attar2, Wajiha Jurdi Kheir1, Julien Selim Torbey1, Hana A. Mansour1 and Joanna S. Saade1*
AbstractPurpose:Over the counter eye drops are commonly used in the Lebanese population to manage eye redness and symptoms. We sought to investigate its prevalence in Lebanon by conducting a survey. Methods: This is a cross-sectional prospective study done between November 2017 and March 2020. Volunteers above 18 years of age filled a questionnaire regarding participants’ demographics as well as information about eye redness and related consultations and drop use. Results: Of the 265 individuals studied, the majority were women (58.1%). 111 individuals reported having red eyes in the last 5 years (41.9%). Of these, 72.1% reported using drops, and 83.8% reported consulting someone for their symptoms (pharmacist, medical doctor, ophthalmologist, or others). Ophthalmologists were primarily consulted in 55.9% of cases. Ophthalmologists and pharmacists were more likely to be consulted by individuals between 31 and 50, as opposed to non-healthcare-worker consultations who were more likely sought by individuals between 51 and 70 years (p = 0.038). Tearing (p = 0.002), foreign body sensation (p > 0.001), and blurry vision (p = 0.016) were correlated with consulting someone for eye redness. Tearing (p = 0.003) and foreign body sensation (p = 0.002) were correlated with drop use. Only 34.1% of drop users read instructions, and individuals with a college level of education were more likely to do so. Conclusion: A large proportion of Lebanese patients will self-medicate with over-the-counter drops without consulting a medical doctor or reading the medication pamphlets. This can be potentially detrimental to patients’ eyes, especially if they are unaware of the side effects.Keywords: Self-Medication in the Middle East; Over the Counter Eye Drops Usage; Awareness to Medication Side Effects; Guidelines for Regulation of Dispensing of Medications
158 Analysis of After-Hours Emergent Ophthalmic Surgery in the Ambulatory Surgery Center Setting , Mark Obri*, Alexander Miller, Andrew Yazji, Emily Petrinec and David Miller
AbstractPurpose: To evaluate the feasibility of emergent ophthalmologic surgeries in an ambulatory surgery center (ASC) care setting com-pared to routine ophthalmologic surgeries performed in an ASC. Methods: A retrospective cohort study at a single ASC included an analysis of emergent surgical cases compared to non-emergent surgical cases. Data was provided by searching the ophthalmology practice’s ASC case management database. An emergent case was defined as any case starting after 5:00 pm or any case completed during weekend on-call hours. Cases that were delayed and ran over the 5:00 pm time limit were excluded. The emergent cases were then analyzed based on the type of procedure performed and compared to the non-emergent ophthalmologic surgeries performed at the ASC. Results: In 2018, 27 (34.2%) of emergent cases were started after 5:00 pm and 52 (65.8%) cases were performed during week-end call hours. This is compared to over 6113 ophthalmologic procedures done at the ASC in the same year during normal hours of operation. The division of total 2018 surgeries at this center was 3975 anterior segment eye surgeries, 1919 posterior segment surgeries, 211 oculoplastic surgeries, and 6 corneal surgeries. In total, 79 procedures were done emergently, representing 1.29% of all procedures. Posterior segment procedures were 100% of the emergent cases and constituted 64 retinal detachments (81%), 9 endophthalmitis (11.4%), 2 choroidal hemorrhages (2.5%), 2 vitreous hemorrhages (2.5%), and 2 retained lenses (2.5%). No cases were refused, cancelled, or transferred elsewhere for emergent treatment, or because of lack of access to the facility by patients. Conclusion: A total of 79 cases were successfully completed after-hours or during on-call weekend hours, representing 1.29% of the total amount of cases done in the 2018 calendar year. By allowing weekday 5:00 pm starts and weekend call hours for emergent cases, it appears the ASC setting is able to accommodate for all emergent ophthalmic cases, all of which were posterior segment sur-geries, comprised mostly of retinal detachments.Keywords: Ambulatory Surgical Centers (ASC); Ophthalmic Surgery
159 Teleophthalmology , Reena Gupta1*, Rohan Madan2, Chekitaan Singh3 and Neebha Anand1
AbstractThe current Covid-19 pandemic is recharting the definition of medical consultancy services, in the interest of safety of both pa-tients and health care providers. Telemedicine is a tool that has seen renewed interest in this regard. Doctors across various fields in-cluding ophthalmology are switching to e-consultation formats to improve access to their clientele and to deliver emergency as well as routine care. It is essential to be aware of the various outreach modalities available under the broad umbrella of telemedicine, as well as the medicolegal aspects of such consultancy services. Case consultation for ophthalmologist through telemedicine platforms poses unique challenges and one must be aware as to which tool could act as an efficient adjunct for optimum patient care.Keywords: Telemedicine; Tele-consultation; COVID-19 Pandemic; Telemedicine Challenges; Digital Health Policy; Tele-ROP; ARMD; Diabetic Retinopathy
160 Silent Maxillary Sinus Syndrome , Brittney M Brady
AbstractSilent Sinus Syndrome is an often-overlooked diagnosis and may serve as a diagnostic challenge for clinicians unaware of the condition. Caused by an accumulation of fluid within the maxillary sinus, formation of a negative pressure gradient leads to eventual inward displacement of the sinus walls and downward displacement of the orbital floor. Increased orbital volume, due to reduced maxillary sinus size, may result in painless enophthalmos and hypoglobus on the effected side. Patients may present with complaints of a mild ptosis, facial asymmetry, or vertical diplopia. Although a diagnosis of exclusion, SSS must be considered in the differential diagnosis of any patient presenting with such findings. Neuroimaging is considered essential to make this diagnosis. Keywords: Silent Maxillary Sinus; SSS; Enophthalmos; Hypoglobus
161 Corona Virus and Ophthalmologists , Shahzad Waseem*
We, the humans are facing this novel Corona virus, named Co-vid-19 for the last two years. It has jolted the whole world. Perhaps no human being living today has never seen this type of disease before. The new disease initially was thought to be a respiratory disease.But with each passing day, we are finding its new clinical symp-toms.
162 Effect of Refractive Index on Diopter Glasses for Optical Analysis of Human Eye Using Electromagnetic Wave at Ophthalmology Systems , Nilgun Baydogan
AbstractThe detection of the refractive error is important for the utilization of the optical lens in eye diseases and the determination of the refractive properties is a key parameter at optical sensor systems. Refraction detection is one of the procedures performed by ophthalmologists, and the detection of this feature in the lens of the eye is one of the basic ophthalmology topics to decide the use of the high diopter glasses. Keywords: Coating; Diopter Glasses; Refractive Index
163 Factors Influencing Utilization of Pediatric Eye Care Services in Bangladesh: A Qualitative Study , Nahid Ferdausi1*, Jarin Tasnim Khan2 and Tausif Akib Khan3
AbstractBackground: Visual impairment and blindness in children can be devastating if not addressed timely. The impact of unmet pedi-atric eye care needs in Bangladesh is compounded by barriers to accessing eye care, limited engagement with communities, lack of awareness of parents and caregivers, poor health-seeking behavior, lack of an organized system of case findings, lack of appropriate referral network, and affordability. The purpose of this study was to elucidate factors that influence, positively or negatively, people's willingness to seek and utilize pediatric eye care services.Methods: A qualitative study was conducted to have an in-depth understanding of the utilization of current pediatric eye care ser-vices in Bangladesh. In-Depth-Interviews (IDIs) and Focus Group discussions (FGDs) were used for data collection. Twenty IDIs were completed among policymakers, eye care managers, and service providers. Four FGDs were carried out among parents who attended eye care management in the public hospital and private chamber. Two FGDs were conducted among schoolteachers during school sight testing programs. Thematic analysis carried out.Results: Thisstudy identified several interconnected barriers and enablers that affect the utilization of pediatric eye care services. Several factors like non-availability, poor accessibility of services, non-affordability, poor knowledge of available services have been identified that prevent parents from using pediatric eye care services for their children. Lack of knowledge and information about timely intervention of eye diseases recognized as major barrier. There is an urgent need for involving all key stakeholders to create a greater impact in reducing the burden of childhood blindness.Conclusion:Early detection and management of eye diseases will reduce the burden of visual impairment and disability. Utilization of available eye care services is necessary for the reduction of the burden of visual impairment. Awareness campaigns on available pediatric eye health care services, especially amongst those who live in the rural and remote areas are essential.Keywords: Factors; pediatric eye care utilization; Bangladesh
164 Diagnostic Errors in Ophthalmic Practice during COVID-19 Pandemic , Faizan Mehmood1*, Nabeel Firoz2, Jyoti Shukla1, Sana Alam3 and Pooja Mishra1
AbstractBackground and Objective: The area of diagnostic errors in ophthalmology in COVID-19 pandemic remains profoundly under-studied. To describe a case series of 7 patients with diagnostic errors during COVID-19 lockdown in ophthalmology department of a multispecialty government hospital in north India.Design: Retrospective case series of 7 patients.Participants:Seven patients who visited the general ophthalmology clinic during COVID-19 lockdown period in India.Methods: Retrospective case series of 7 patients who visited the general ophthalmology clinic between April 1 and June 30, 2020 and were found to have diagnostic error on their subsequent visits after further examination and investigations.Results: In case 1, the diagnosis of central serous retinopathy was delayed until the patient returned with worsening of symptoms and was further evaluated for it. In case 2, 3 and 4, misdirected eyelashes, a 1 x 1 mm corneal opacity and a posterior subcapsular cataract respectively were missed on their first visit but the diagnosis was revised on next visit. Cases 5, 6 and 7 presented as red eyes. Allergic conjunctivitis was misdiagnosed as dry eyes in case 5 and as bacterial conjunctivitis in case 6. A foreign body lodged in conjunctiva was misdiagnosed as nodular episcleritis in case 7. The causes for these errors may be unique to the pandemic as both the patients and physicians tried to minimize their exposure.Conclusion: COVID-19 pandemic has been a stressful situation for patient and healthcare workers where prevention strategy lies in hygiene and social distancing measures. While taking all the necessary precautions to control the transmission, it is also our duty to minimize the incidence of diagnostic errors during routine consultations.Keywords: COVID-19; Diagnostic Error; Ophthalmic Practice; Slit-Lamp; Pandemic
165 Retinal Vein Occlusion: Demography, Types and Risk Factors - A Cross-Sectional Hospital based Study , Hara Maya Gurung, Eliya Shrestha, Babita Gurung, Hari Bikram Adhikari and Pawan Baral*
AbstractPurpose: To assess the demographic pattern, types and risk factors of retinal vein occlusion disease of the patients visiting Himalaya Eye Hospital.Methods: A cross-sectional observation study of 246 patients was done at Himalaya Eye Hospital, Pokhara, Nepal during the period from July 2017 to July 2020. All these patients were diagnosed with retinal vein occlusion during this period and were included in the study. Patients with associated complications such as vitreous hemorrhage and macular edema without retinal vein occlusion were excluded from the study.Results: A total of 246 patients were diagnosed as a case of retinal vein occlusion disease during this study period. Age of the patients ranged from 29 to 87 years old with the mean age being 65.95 (± 11.47) years. Elderly populations were found vulnerable to this disease. Total number of males (50.40%) were slightly higher than females (49.59%). Branch retinal vein occlusion (74.80%) was observed to be three times more common than central retinal vein occlusion (25.20%). Hypertension was detected as the most im-portant risk factor for retinal vein occlusion disease followed by increase in age, combined hypertension and diabetes, dyslipidemia and smoking. Conclusion: This hospital-based study of demographic pattern, types and risk factors of retinal vein occlusion would help us to tar-get the specific population of community for awareness programme.Keywords: CRVO; BRVO; Hypertension; Increase in Age
166 Rationale of Ab Interno Trabeculotomy in Combined Surgery of Cataract and Glaucoma in Patients with Far-Advanced Stage of Glaucoma , Ivanov DI*, Nikulin ME and Prokopyeva YS
Purpose of the StudyTo estimate the status of aqueous outflow pathways in vivo dur-ing combined surgery in patients with cataract and far-advanced glaucoma. To estimate the results of phaco with ab interno trabec-ulotomy in patients with far-advanced glaucoma. MethodsAn intraoperative contrast study of natural outflow pathways was performed in 50 eyes with far-advanced glaucoma after ab in-terno trabeculotomy during combined surgery.A retrospective analysis of 38 operations in 32 patients aged from 59 to 83 years (23 males, 15 females) in terms of 3 years and over after surgery. Preoperative visual acuity ranged from light perception to 0.75 (mean, 0.24), IOP varied from 19 to 42 mm Hg (mean, 28 mm Hg). Preoperative hypotensive therapy was used in 85% of cases.
167 Atypical Ophthalmic Manifestations in Covid 19 Pandemic , Gowhar Ahmad
We have been facing COVID 19 pandemic for a long time now and lot of modalities in term of its preventive aspect has been in terms of• Social distancing facial masking and sanitization.• Govt also came up with respective lock downs.Still lot of cases of COVID-19 pandemic occurred may were treated and many lost their precious lives however we have now come up with vivid 19 vaccine with the hope to break the chain of COVID-19
168 Refractive Changes in a Recently Diagnosed Diabetic Patient , Esosa Okundaye
AbstractDiabetes mellitus is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Hyperglycemia is the most significant risk factor for diabetes and fluctuating levels can result in fluctuating vision. Transient refrac-tive changes are well-recognized features of diabetes and these patients may have both short-term as well as permanent refractive alterations. I present a case of a newly diagnosed type 2 diabetic patient who presented with hyperglycemic induced- hypermetropia on initial examination, with variation in refraction one month after.Keywords: Diabetes Mellitus; Hyperglycemia; Refractive Error; Visual Acuity
169 Torpedo Maculopathy Associated with RP1L1 Mutation and Rod-Cone Dystrophy , Manoj Soman1,2, Jay U Sheth1,2*, Asmita Indurkar1,2 and Unnikrishnan Nair1,
AbstractGenetic analysis of patients with Torpedo maculopathy is scarce in literature with only two previously documented cases with genetic analysis. We report a case of Torpedo maculopathy with Rod-Cone dystrophy associated with an RP1L1 mutation. This case highlights the need for genetic testing in this rare retinal pathology as this may give a clue to the presence of other ocular associations and systemic abnormalities. Keywords: Torpedo Maculopathy; RP1L1 Mutation; Rod-Cone Dystrophy; Genetic Testing; Electroretinogram
170 Retinopathy of Prematurity at the University and Departmental Hospital of Borgou-Alibori in 2019 , Assavedo Codjo Rodrigue Abel1*, Alfa Bio A1, Abouki Coa3, Hounwanou A1, Monteiro S1, Kpanidja G2, Agossou J2, Alamou S3, Sounouvou I3, Tchabi Hounnou S3 and Doutetien Gbaguidi C
AbstractIntroduction: Retinopathy of prematurity is one of the leading causes of childhood blindness, which extent should be known in Benin and especially in Parakou. Aim: To study the retinopathy of prematurity in the University Hospital of Borgou-Alibori in 2019.Methods: It was a cross-section, descriptive and analytical study with prospective data collection, over a period of 6 months, from April 2019 to September 2019 including all premature regardless of birth weight, having received or not oxygen and having at least 04 weeks of postnatal life. They were listed exhaustively after informed consent of the parents.Results: Out of a total of 68 identified premature newborn, 36 had been undergone a fundus examination between the 04th and 06th week of postnatal life. The overall frequency of retinopathy of prematurity was 27.78%. The majority of abnormalities were stage 1 and Area 3 in temporal and were found more among males than in females. The oxygen therapy time (p = 0.026), gestational age (p = 0.0003), low birth weight (p = 0.026), the intraventricular hemorrhage (p = 0.015) and the red cell transfusion (p = 0.015) were significantly factors associated with retinopathy of prematurity.Conclusion:The frequency of retinopathy of prematurity in CHUD-B/A at Parakou is relatively high. It would be wise to educate health professionals for a systematic proposal of a fundus examination in all premature infants that may allow to make an early diagnosis of this disease.Keywords: Retinopathy of Prematurity; Blindness; Associated Factors; Parakou
171 Evaluation of Keratoconus Progression after Intrastromal Corneal Ring Segments Implantation , Livia Cristina Rios1*, Aristofanes Canamary Jr1,3, Henrique Figueiredo2, Mariana Amaranto de Souza2, Pablo Felipe Rodrigues3, Rodrigo Teixeira Santos1,3 and Bernardo Kaplan Moscovici1,3
AbstractObjectives: To report the evaluation of keratoconus progression after Ferrara intrastromal corneal ring segment implantation. Materials and Methods: In this retrospective study, we evaluated progression in eyes with keratoconus after intrastromal corneal ring segments implant. It was considered progression when the increase of the maximum keratometry was greater than 1 diopter (D) when comparing the first postoperative exam (6 months), and the last exam.Results: There was no progression after the surgery. when comparing the mean maximum keratometry pre-op (46.75D) and the pos op data (46.01D), with statistically significant (p-value: 0.047). An increase of less than 1 D in these patients was also observed. In a descriptive analysis, 41 eyes were studied: 8 eyes had an increase greater than 1 D, 19 eyes had an increase equal or less than 1 D and 14 eyes maintained the initial D or had decreased within the years. Analyzing patients ≤ 21 years, the variation of maximum keratometry between 6 months postoperatively was higher in this group (1.82 D ± 3.11) than in the group with more than 21 years(0.5 D ± 1.27). This data was not statistically significant (p = 0.148). Conclusion:This study showed an evolution of maximum keratometry in the postoperative period of the intrastromal ring surgery. However, this increase in the stipulated time of the study was less than 1 D in the majority of patients.Keywords: Keratoconus; Corneal Diseases; Corneal Stroma; Cornea; Corneal Topography
172 Analysis of Choroidal Macular Thickness in Early Post-Covid-19 Patients , Jeniffer Domingues de Jesus1*, Raquel J Soares1, Libânia M Dias2, Suzana M Ventura1 and João C Pedro1
AbstractPurpose: Corona Virus Disease 2019 (COVID-19) is considered a critical global health challenge. Several investigations have sug-gested vascular dysfunction caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, but regarding ophthalmic involvement, only few data are available. Our aim was to evaluate the choroidal involvement in post-COVID-19 patients.Methods: 40 eyes from 40 patients with previous SARS-CoV-2 infection and 40 eyes from 40 age matched controls were included. Choroidal measurements were made using Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) at 13 different loca-tions: at central fovea and at intervals of 500μm to 1500μm away from the fovea in the temporal, nasal, superior and inferior regions. Results: Post-COVID-19 patients showed a significant increase in choroidal thickness compared with the control group for all the regions analyzed (all p <0.01). In the Post-COVID-19 group, the choroid is thickest subfoveally and thinnest 1500μm nasal from fovea. In both groups, the superior and temporal macular choroid has been measured thicker than the inferior and nasal macular choroid, respectively. Conclusion: Our results cautiously suggest that post-COVID-19 patients showed an increase in choroidal thickness compared to control groups. This choroidal thickening may reflect the importance of vascular factors in the pathogenesis of SARS-CoV-2 infection. Keywords: Choroid; COVID-19; Hemodynamic Changes; Ocular Circulation; Retina; SARS-CoV-2
173 Psychological First Aid (PFA) in Improving Staff Confidence in an Eye Hospital during Times of Uncertainty from Ensuing Covid19 Pandemic , Kaushik Murali1*, Gokul Ratakonda2 and Geeta Fulari3
AbstractPurpose: To study the effect of using principles ofPsychological First Aid (PFA) in improving healthcare worker (staff) confidence in an eye hospital during times of uncertainty from ensuing COVID19 pandemic.Methods: Patient Health Questionnaire was designed to gather data about the impact of current pandemic on doctors and staff. Data was also gathered through interviewing the staff and the doctors. To address all the concerns, 5 components of Psychological First Aid (PFA) in communication were used, and also in the provisions made at the workplace to help alleviate this impact. PFA is an initial disaster response intervention with the goal to promote safety, stabilize survivors of disasters and connect individuals to help and provide resources. Staff were re-interviewed to assess their confidence levels. Campaign was created to look at other aspects of routine hospital functioning that could impact safety and outcomes beyond COVID19 and report to the Quality Team. Results: The mean PHQ before interventions was 3.98. Post intervention and return to work, the PHQ score in doctors and staff was only 0.94. Survey showed absolutely no signs of any psychological distress amongst staff. Targeted trainings showed 94% response rate. 3% staff opted for sabbatical which was taken as a surrogate for safety. A random survey of 29 staff showed that 48% were con-fident of all tasks adhering to COVID19 protocols, which increased to 96.5% in 3 months. Discussion: Motivation of healthcare workers was seen to be beyond just financial aspects. There was a strong sense of belonging and duty as identified in our survey. This increases the onus on organisations towards addressing the concerns of healthcare workers providing psychological support. PFA is a proven tool that can help reduce distress in a time of fear, anxiety and uncertainty. Though we did not implement the PFA in the manner it is used typically in natural disasters for individuals, implementing a programme, looking at the principles of - feeling safe, connected, efficacious, calm and hopeful for the cohort of health workers, brought down the distress as measured by the PHQ-9 questionnaire from 3.2 to 0.94 and seems to have a value even beyond the pandemic. Conclusion: Implementing targeted interventions based on the principles of psychological first aid can help reduce psychological distress among health care workers in times of uncertainty in an eye hospital.Keywords: COVID-19; PFA (Psychological First Aid); Psychological Distress; Pandemic; PHQ (Patient Health Questionnaire); Coun-selling; SanQALP - Sankara Quality Assurance and Learning Programme
174 Evaluation of Factors Predicting Glaucoma Damage in Patients with Primary Open-angle Glaucoma , Maria Marenco1, Andrea Palamini1, Carlo Alberto Cutolo1, Giulia Agosto1, Antonio Ferreras2, Carlo Enrico Traverso1 and Michele Iester1*
AbstractPurpose:To evaluate factors predicting glaucoma damage in primary open-angle glaucoma (POAG) eyes.Methods:20 POAG patients were examined in this retrospective study. The most affected eye was analyzed. Peripapillary (P) cho-roidal thickness (CT) and macular (M) CT were measured by Swept Source Optical Coherence Tomography. Correlation between CT retinal nerve fiber layer thickness (RNFLT) and ganglion cell-inner plexiform layer thickness (GCIPLT) and various other factors inc-luding mean deviation (MD), pattern standard deviation (PSD), mean superior and inferior hemifield sensitivity was also assessed by Pearson’s r correlation coefficients and linear regression model.Results:Superior and inferior nasal MCT and PCT were significantly correlated with MD (r = 0.509, r = 0.507, r = 0.577, respectively). MD was positively associated with mean GCIPLT (r = 0.517, p = 0.02) and each GCIPLT sector (p < 0.05), except for the nasal sector. A positive relationship was found between RNFL thickness (mean and each sector) and MD (p < 0.05). PSD was negatively correlated to both GCIPLT (r = - 0.695, p = 0.001) and RNFL thickness (p < 0.05). Among mean PCT, mean MCT, RNFL thickness and mean GCIPLT, only RNFL thickness (β = 0.85, p = 0.011) and mean PCT (β = 0.521, p = 0.021) were predictive factors of MD in the linear regression model.Conclusions: RNFL thickness was the most predictive factor of MD, followed by mean PCT. RNFL thickness seems to be the most useful parameter to predict glaucoma damage in clinical practice.Keywords: Glaucoma; Swept Source Optical Coherence Tomography; Choroidal Thickness; Retinal Nerve Fiber Layer
175 Phacomatosis and Ocular Manifestations of Neurofibromatosis , Gowhar Ahmad
Phacomatosis is a group of conditions where their is tumour formation in CNS skin and eye exact cause is not known however genetic predisposition is a strong factor usual onset with life long duration it has got systemic complications treatment is not kind of certainty however laser therapy and removal of growths is ad-vocated.
176 Treatment Update for Dry Eyes and Blepharitis , .Shahid Bashir Ahmad*
These ocular conditions are very common but difficult to treat. Treatment strategy depends upon the severity of signs and symp-toms. Following is a general guideline on the different tools avail-able for managing these poorly-understood and multi-factorial conditions.
177 Digital Eye Strain during Pandemic Covid-19 , Shua Azam*
As we went through high exposure to digital screen during pandemic of Covid 19 and almost every person faced ocular dis-comfort. Disturbance and discomfort related to the use of digital devices which affect ocular system and results from glare, accom-modation disorders, fixation disparity, dryness, fatigue is termed as digital eye strain [1]. There are two types of eye strain. In in-ternal type sensations of strain and pain is felt inside the eye and caused by accommodative and convergence disorders while in an external type dryness and irritation is felt on the front of the eye and caused by changes environmental conditions [2]. Blurred vi-sion, tearing, tired eyes, burning sensation, redness and double vi-sion are common ocular symptoms and stiff neck, general fatigue, headache and backache are non-ocular symptoms associated with eye strain [3-5]. Studies around the world showed that increased use of digital devices correlates with increased symptoms of digi-tal eye strain [6]
178 Evolving Evidence about the Role of Choriocapillaris in Pathogenesis of Uveitis , Hashim Ali Khan1,2* and Smaha Jahangir2
AbstractChoriocapillaris and retinal pigment epithelium maintain as mutualistic metabolic relationship. Insult to either tissue affects the other in number of chorioretinal diseases. Many uveitides have their main activity around retinal pigment epithelium and surround-ing tissue. Optical coherence tomography angiographic (OCTA) studies have demonstrated the involvement of choriocapillaris in acute phases and subsequent disruption and formation of irregular capillaries in multiple studies. OCTA has expanded our abilities to study choriocapillaris with greater detail. This short review summarizes the changes in choriocapillaris in choriocapillaropathies and other uveitides. Keywords: Retinal Pigment Epithelium (RPE); Choriocapillaris (CC); Indocyanine Green Angiography (ICGA); Fundus Fluorescein Angiography (FFA)
179 Comparing and Evaluating Photo Stress Recovery Time in Diabetic and Normal Population , Aakash Shrestha1 and Manish Dahal2*
AbstractBackground:Photo stress recovery time is the time it takes for the macula to come back to its normal function level after exposure to a strong light source. Early diagnosis is well known to be important for effective diabetic retinopathy treatment. In recent years, the focus has been on considering macular recovery after glare as a parameter that is altered not only in manifest retinopathy, but also in the preclinical stage. Method: A cross-sectional study was conducted at ASG Eye Hospital, Nepal. The study population consisted normal, diabetic and diabetic retinopathy patients. The photo stress test was performed on each patient. Statistical analysis was performed using SPSS for windows. Result: Of total 90 subjects, the mean photo stress recovery time (PSRT) of normal patients on right eye and left eye were 7.46 ± 1.87 and 7.5 ± 1.54 sec respectively, mean PSRT of diabetic patients on right eye and left eye were 14.03 ± 2.39 and 14 ± 2.32 sec respec-tively and mean PSRT of diabetic retinopathy patients on right eye and left eye were 55.83 ± 8.26, 57.46 ± 7.76 sec respectively. PSRT obtained from the 3 groups of subjects was statistically different (p < 0.001).Conclusion: PSRT values depend upon the clinical status of the retina. These findings highlight the need and efficacy of simple tech-nique which can be very useful to anticipate diabetic retinopathy from diabetic patients.Keywords: Diabetes; Diabetic Retinopathy; Macular Function; Photo Stress Recovery Time; Retinal Recovery
180 The Effect of Mitomycin-C Application Time on Pterygium Recurrence After Surgical Excision , Pir Salim Mahar1*, Abdul Sami Memon2 and Israr Ahmed Bhutto
AbstractObjective: The purpose of the study was to establish the safest and the most efficacious duration of application of MMC in patients undergoing primary pterygium excision to prevent recurrence. Methods: An interventional study wascarried out at Isra Postgraduate Institute of Ophthalmology/Al-Ibrahim Eye Hospital, Karachi, Pakistan from 2010 till 2017. Patients underwent surgical removal of pterygium using bare sclera method with MMC in concentra-tion of 0.2 mg/ml (0.02%) with variable exposure time of 1 - 5 minutes. Classification of patients was done randomly with MMC ap-plication time ranging from 1 to 5 minutes. Patients were followed at 3, 6, 9 and 12 months postoperatively to record any recurrence. Results: A total 273 eyes of male patients with mean age of 35.9 ± 1.23 years were included in the study. The overall pterygium recur-rence rate at each follow-up was 5.66%, 6.92%, 7.90% and 9.3% at 3rd, 6th, 9th and 12th months respectively. There was a significant decline in recurrence in the number of patients with MMC application time of greater than 3 minutes at all follow-ups. Maximum of recurrence was seen in patients between 31 to 40 years at the final follow-up.Conclusion: These results suggest that a MMC application time of less than 3 minutes increases the chances of pterygium recurrence after surgical excision. MMC application time of greater than 3 minutes is recommended to prevent recurrence of such high risk recurrent pathology. Keywords: Pterygium; Recurrence; Mitomycin-C; Duration
181 Secondary Angle Closure Following Panretinal Yellow PASCAL Laser Photocoagulation , Tatiana Vélez Osorio1*, Nassim Abreu2 and William McCollum
AbstractObjective:To report the case of a patient with severe non-proliferative diabetic retinopathy who developed angle closure after un-dergoing retinal photocoagulation (PRP) with a yellow Pascal 577 nm laser.Observation: 30-year-old male with severe non-proliferative diabetic retinopathy presented with severe ocular painand nausea one day after undergoing laser photocoagulation in the left eye for the treatment of his diabetic retinopathy. His visual acuity was 20/200 and his intraocular pressure (IOP) was 45 in his left eye. It had a shallow anterior chamber that was closed on gonioscopy. Ultrasonic biomicroscopy (UBM) reported an anterior chamber of 1.68 mm with narrow iridocorneal angles. He was managed with medica-tions to reduce IOP, which includedcycloplegics, topical and oral steroids. He was closely followed with serial examination and the intraocular pressure was reduced before developing glaucoma.Conclusion: Patients presenting with ocular pain and increased IOP afterlaser photocoagulation should increase suspicion for angle closure. Limiting the number of laser burns and the amount of retinal area treated can prevent this problem from occurring.Keywords: Secondary Angle Closure; Angle Closure Glaucoma; Retinal Pan-Photocoagulation
182 Retinal and Body’ Stem Cells Reprogramming , Massimo Lombardi*
A new therapeutic method for the Regenerative Ophthalmic and General Medicine.Using an homotoxicological pharmaceutical blend therapy through retrobulbar injections to “reset” the “body’ programma-tion” deteriorated by environmental life’ conditions completely and worsly changed from the first “original programmation” in the legendary “Eden” where through the “environmental con-ditions”, in which life is then started and “humans” have been originally created and programmated, that were completely dif-ferent from to day environmental planet-earth conditions com-pletely deteriorated, reason for which the human autologous stem cells, to day, do not work any more completely, automati-cally repairing and regenerating damaged tissues and organs as should be by their original programmation and mission because practically now we are subjected to completely modified and de-teriorated biological situations
183 Disabling Cataract in Swat; How Big is the Problem? , Yasir Iqbal Malik1*, Aqsa Malik2 and Waqas Ahmad3
AbstractBackground: Visual impairment caused by cataract is a major cause of treatable blindness. Vision 2021: the Right to Sight, a global initiative launched by a coalition of non-government organization and the World health Organization (WHO), is to eliminate avoid-able visual impairment and blindness on a global scale. In order to accomplish this goal it is important to know the prevalence of disabling cataract in community, especially in developing countries. Objective: To estimate the prevalence of disabling cataract in Swat who need surgery.Settings: Conducted at free eye camps in seven Tehsils of Swat, KPK. Duration: 4 months from September 2018 to January 2019.Materials and Methods: It was a descriptive study using convenient sampling method for sample collection. The selection criteria was patients having cataract of any age and of any gender. The exclusion criteria was no perception of light in the eye, mental retarda-tion, psychiatric illness and physically handicap or too young patients unable to undergo slit lamp examination. Retro illumination technique was adopted on the slit lamp to detect presence and type of cataract according to Lens Opacity Classification System III (LOCS III). Demographic data and ocular examination were recorded on a proforma and was analyzed using SPSS version 22. Results: The disabling cataract was estimated to be 17.5% in patients with a mean age of 62.28 ± 9.10 years. The most common type of cataract was found to be nuclear followed by posterior sub capsular. Bilateral cataract was found in 31.3% of the females.Conclusion: The prevalence of disabling cataract in swat region is high leading to high rate of reversible blindness in the region. Specific measures should be taken by the health authorities to address the problem.Keywords: Cataract; Swat; Blindness
184 Corneal Epithelial Toxicity Following Intraoperative Use of Mitomycin C during Trabeculectomy - A Case Report , Lalitha KJ1*, Meena Gopinath Menon1 and Pallavi Joshi2
AbstractWe report a case of post-operative corneal epithelial toxicity following intra operative subconjunctival use of Mitomycin C for 1.5 minutes in twin site phacoemulsification and Trabeculectomy. Patient was doing well till 15 days after the surgery with the clear cornea and 20/20 vision. Then he noticed diminution of vision and cornea showed multiple punctate corneal erosion. On persistence of the lesion till five weeks after the surgery corneal scraping was done and sent for histopathological examination which showed Mitomycin related toxicity. With proper diagnosis and treatment patient improved well with a central clear cornea and vision 20/30. With guarded use and keen eye for possible complications in the follow-up visits one can avoid the undesirable and hazardous effects of MMC.Keywords: Corneal Epithelial Toxicity; Mitomycin C; Trabeculectomy
185 A New Insight into Ophthalmology: Calculation of Choroidal Vascularity Index , Cihan Buyukavsar*
The significance of the choroid in ophthalmology is increasing day by day. The unknowns about the choroid continue to be elu-cidated in light of many studies in the literature thanks to the de-velopment of optical coherence tomography (OCT) technology and the use of enhanced depth imaging (EDI) features. The primary function of the choroidal layer, which is mainly composed of blood vessels, is to provide blood supply to the outer retina. Interstitial stroma containing melanocytes and connective tissue are other structures that make up the choroid along with blood vessels [1]. Today, the choroidal layer has at least three other main functions, which are thermoregulation, adjustment of retinal position by choroidal thickness change and secretion of growth factors. Any defect that may occur in the choroidal layer may lead to degeneration, neovascularization, myopia, or hyperopia due to impaired emmetropization and possibly the initiation of various pathological processes that would be revealed through further studies [2]. The choroid plays a crucial role not only in choroidal inflammation but also in retinochoroidal diseases, which are com-mon in populations, such as diabetic retinopathy (DRP) and age-related macular degeneration (AMD) [
186 Some of Ocular Side Effects of D M and Obesity , Gowhar Ahmad
The incidence and prevalence of DM I has shown a great spike and it is a kind of global.Disease which is now attributed to the life style pattern so many factors are responsible for its hike.Genetic sedentary life style lack of regular exercises over eat-ing family history of DCM smoking CVS ailments stress strain in obesity.
187 Analysis of Vitamin D Levels in Children with Progressive Myopia , Sowmya Raveendra Murthy1* and Nitya Raghu2
AbstractBackground: The increasing prevalence of myopia in children today deserves more exploration into the causes and possible modifi-able factors. With the growing prevalence of vitamin D deficiency in India, and its effect on numerous body systems, we attempted to find a possible association between vitamin D deficiency and progressive myopia. Aim: To analyse the vitamin D levels in children with progressive myopia.Methods: This is a pilot study. Children with progressive myopia on treatment with low dose atropine showing progression (> 0.5D increase in last 6 months) were included to be a part of the study. Few of these children showed progression despite being on low dose atropine which prompted us to search further. Serum levels of vitamin D3 levels were ordered and analyzed.Results: Total of 20 children, 9 boys and 11 girls, were included, all in the age group of 11 to 17 years. Low dose atropine eye drops were being used for more than a year in 17 children and rest for past 5 months. Serum vitamin D 3 levels were noted to be deficient (< 20 ng/ml) in 15 patients and insufficient (20 - 30 ng/ml) in 3 cases. Only 2 patients were noted to have normal levels above 30 ng/ml. Conclusion: Our pilot study throws light on possibly using vitamin D 3 levels in our protocols in treating children with progressive myopia.Keywords: Progressive Myopia; Vitamin D Deficiency; Atropine Eye Drops
188 Orbital Lymphoma and Spontaneous Gastric Perforation, Rare and Fatal Complication , Juan-Edrick Gonzalez-Mondragon1, Luis Renato Vidaña Torres1, Adriana Dávila Camargo2*
AbstractOrbital lymphomas represent 1% of non-Hodgkin lymphomas. Spontaneous bowel lymphoma perforation is rare and mostly asso-ciated with aggressive behavior. Diffuse large B-cell lymphoma is the most common lymphoma associated with intestinal perforation. We present a case report of a 56 years old patient who presented to our Oculoplastics department with a history of rapidly progres-sive proptosis and severe visual loss. After orbital lymphoma suspicion, a biopsy was conducted. During the post-operative period, the patient began with acute abdomen symptoms that required exploratory laparotomy. Multiple intestinal perforations were found through the surgery. Unfortunately, our patient evolved torpidly, presenting as well SARS-COVID 19 infection, perishing in the next days. In conclusion, even though a primary orbital lymphoma is suspected, we recommend deliberate systemic evaluation at the time of diagnosis and remembering COVID pandemic can worsen any hospitalized patient's prognosis.Keywords: Orbit; Orbital Lymphoma; SARS CoV-2; Orbital Tumor; Gastric Perforation
189 Corneo-Uveal-Retinal Adverse Effects after Single Course of Targeted Anti-Cancer Therapy: Case Report and Review of Literature , Maaly Abdel Halim Abdel Fattah1,2,3*, Tariq Abdulmohsen Al-Anazi2, Sara Sohail Kayali3, Yasser Saleh Almuzaini4 and Faisal Mesfer AlQahtani
AbstractOral anti vascular endothelial growth factors therapeutic agents have been evolving rapidly over the last past decades and became one of the great contributors to advancement of cancer therapy and increasing survival rate of the treated patients.Sorafenib is FDA approved medications for the treatment of solid tumors.In this article, we reported the clinical features of the first Saudi patient presenting with corneo-uveal retinal adverse effects with subsequent bilateral irreversible blindness.Keywords: Hepatocellular Carcinoma; Targeted Anti-Cancer Therapy; Sorafenib; Oral Anti-Vascular Endothelial Growth Factor; Ocular Toxicity; Irreversible Blindness
190 Analysis of Visual Function and the Effectiveness of Assistive Devices in a Glaucoma Cohort at a Tertiary Eye Hospital , Meena G Menon*
AbstractBackground: Since quality of life depends fairly on individual ability to perform everyday tasks, a better understanding of the dif-ferent types of visual disability that patients with glaucoma encounter, becomes almost imperative to the clinician in tailoring their approach to delivering superior visual care. Aims: To analyse effect of glaucoma on parameters of visual function, across 3 grades of disease severity and to evaluate efficacy of assistive devices in functionally rehabilitating these individuals. Settings and Design: Observational 3 group cohort clinical assessment study of 120 eyes of 60 patients diagnosed with glaucoma, between August 2017 and January 2018. Materials and Methods: The disease severity of these eyes were graded. Visual function was subjectively assessed with a question-naire and objectively by colour vision, contrast sensitivity, visual field, binocular function. Data thus obtained was analysed against each grade of disease severity. Based on subjective assessment; assistive devices (magnifying spectacles, magnifiers, illumination devices, Fresnel prisms) were tried and their effectiveness analysed. Statistical Analysis: Paired and unpaired t test and ANOVA. Results: 61 patients (40 males and 21 females), with mean age of 60.43 years were enrolled. Majority (69.16%) had Primary open angle glaucoma. Most of them had moderate to severe (29.6%) and severe (27.7%) glaucoma. While there was no significant dif-ference among groups in terms of colour vision loss, significant loss of contrast sensitivity in 65.7% and stereoacuity in 66.6% was observed. Of the 19 eyes evaluated for low vision, 14 of them were given trial of magnifiers and illumination devices for reading difficulty, other 5 were given trial of Fresnel prism. All of them improved with the respective devices. Conclusion: Glaucoma affects colour vision, contrast sensitivity and stereopsis, in addition to visual field and acuity, thus contribut-ing to poor quality of vision. One cannot ignore the possibility of including evaluation of these parameters of visual function as part of the routine glaucoma work-up, for a holistic approach to visual care Fresnel prism as a potential visual aid, subject to further study.Keywords: Visual Function; Fresnel Prism; Assistive Devices; QoL
191 Macular Thickness Changes in Normal and Glaucomatous Eyes , Mona Abdelkader*
AbstractPurpose: To evaluate macular nerve fiber layer thickness (NFL) in glaucoma patients by optical coherence tomography, to correlate between total macular thickness, macular NFL thickness and peripapillary NFL thickness and to correlate between macular thick-ness and peripapillary NFL thickness and visual field changes. Participants: Total "60" subjects (110 eyes) were studied including: 30 normal subjects (60 eyes) and 30 glaucoma patients (50 eyes).Methods: Optical coherence tomography (OCT) was used to measure macular NFL thickness, total macular thickness and peripapil-lary NFL thickness in each diagnostic group. Main Outcome Measures:Measurements of macular NFL thickness, total macular thickness, peripapillary NFL thickness in total mean, (4) quadrants and (12) clock hours.Results: A significant difference in macular NFL thickness between normal and glaucoma patients was observed. Mean macular NFL thickness demonstrated a stronger correlation with visual function than mean total macular thickness (R = 0.7, P =0.02 versus R = 0.45, P = 0.05). Inner ring, outer ring, mean macular thickness were found to be significantly different between normal and glaucoma patients.Conclusion: Thinning of both macular NFL and peripapillary NFL in glaucoma suggested that retinal ganglion cells of both the macu-lar and peripheral retina are involved in the degenerative process of glaucoma. Macular NFL is a better surrogate marker for glaucomatous damage than total macular thickness. Peripapillary NFL may be the most useful clinical marker in diagnosing and monitoring glaucomatous damages among all three measurements. Keywords: Macular Nerve Fiber Layer Thickness; Glaucoma; Optical Coherence Tomography
192 Efficacy and Safety of Corneal Collagen Crosslinking in Treatment of Progressive Keratoconus with Consideration to the Long-Term Results , Solodkova EG, Fokin VP, Balalin SV* and Melikhova IA
AbstractPurpose: To evaluate the efficacy and safety of a modified technique of corneal collagen crosslinking (CXL) versus standard protocol basing on changes of clinical and morphological characteristics of the cornea in the early and late postoperative period.Materials and Methods: Two groups of patients were examined: group I (25 persons/25 eyes) consisted of patients treated for progressive keratoconus in accordance with a standard protocol of corneal collagen crosslinking, group II comprised those, who underwent crosslinking, performed in a modified technique - 36 persons (36 eyes). Prior to and after the procedure (1, 3, 6 and 12 months postoperatively), all patients had an extensive eye examination, including optical coherence tomography (OCT) of the cornea (OCT RS-3000, Nidek, Japan), confocal microscopy (Confoscan4, Nidek, Japan).Results: Faster re-epithelialization of the cornea occurred in the 2nd group. In both groups there was observed a significant increase of UCVA (from 0,15 ± 0,12 to 0,35 ± 0,14 in the first group and from 0,13 ± 0,11 to 0,33 ± 0,14 in the second) and BCVA (from 0,3 ± 0,18 to 0,05 ± 0,12 in the first group and from 0,4 ± 0,16 to 0,6 ± 0,18 in the second group) at 6 and 12 months follow-ups. One month postoperatively a well-defined rear stromal haze or "demarcation line" was confirmed by OCT and microscopy in all the treated eyes. By that time the depth of "demarcation line" location averaged 262 ± 15,0 μm in the 1st group and 255 ± 10,0 μm in the 2nd. The confocal microscopy revealed that histomorphologic changes were more pronounced in the first group within the whole follow-up period. Starting from the third month of observation a statistically significant downtrend in the rating of all the studied symptoms, with persistence of that tendency in the time that followed - at 6 and 12 months check-ups, was registered in the 2nd group of patients, which pointed at milder and faster corneal recovery after CXL performed in accordance with the modified technique. Endothelial cell density (ECD) remained unchanged in all the cases in both groups within the whole follow-up period. Conclusion: 1. Positive dynamics in postoperative UCVA and BCVA values, inalterability of ECD in all the cases allowed considering both op-tions of corneal collagen crosslinking safe, with comparable clinical efficacy.2. However, in view of more evident increase of BCVA in the second group, milder recovery in the early postoperative period and achievement of adequate and safe level of histomorphologic corneal changes after CXL, the modified technique of progressive keratoconus treatment seemed to be more advantageous.Keywords: Keratoconus; Crosslinking; Modified Technique
193 Catcher Pole Scleral Fixation for Repositioning of Dislocated IOL in Vitreous Chamber , A Scupola1,3, Maria Ludovica Ruggeri1*, A Savastano2,3, MA Blasi1,3 and S Rizzo2,
AbstractPurpose:To describe a new surgical instrument for IOL repositioning in scleral fixation procedures designed to help the surgeon to catch the haptics of the dislocated IOL and then handle them to scleral fixation. Methodology: Twenty-one eyes of 21 patients who underwent IOL repositioning procedure through the handling of this new surgi-cal tool were enrolled in this observational study. The instrument is a flute needle with several side slits that allow the passage of a looped suture (10-0 polypropylene ethicon Prolene EH7896) in order to obtain a tool similar to a catcher pole to engage the haptics and ease the handling during scleral fixation procedure.Results: This procedure has shown to be effective in terms of optic rehabilitation and surgical outcomes.Conclusion: The use of this tool simplifies IOL repositioning during sutured scleral fixation technique representing a valuable help for the surgeon in obtaining satisfying anatomical and visual outcomes.Keywords: Intraocular Lens Dislocation; Intraocular Lens Repositioning; Personalized Medicine; Innovative Biotechnologies; Scleral Fixation; Vitrectomy
194 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].
195 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
196 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.
197 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.
198 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.
199 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
200 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
201 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.
202 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
203 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).
204 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.
205 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.
206 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.
207 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.
208 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.
209 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.
210 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.
211 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.
212 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
213 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.
214 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.
215 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.
216 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
217 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.
218 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.
219 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.
220 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
221 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
222 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.
223 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.
224 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.
225 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
226 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
227 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.
228 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.
229 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.
230 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.
231 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
232 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.
233 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.
234 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.
235 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.
236 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.
237 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?
238 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
239 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.
240 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
241 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.
242 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.
243 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.
244 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.
245 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
246 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.
247 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.
248 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.
249 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.
250 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.
251 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.
252 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.
253 COVID-19 and Ophthalmology Practice at University Hospital “Policlinico Umberto I” in Rome , Leopoldo Spadea; Andrea Iannaccone.
254 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
255 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.
256 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
257 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
258 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
259 Leptonic Octonians , Gudrun Kalmbach HE.
260 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.
261 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
262 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
263 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
264 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.
265 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
266 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
267 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
268 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
269 Lens Fixation Today as Easy as it should , Ahmed Galal
Today, both Aphakic eyes problem and defective intraocular lenses replacement problem, have changed considerable since the Yamane described secondary IOL implantation using intrascleral fixation of a sulcus-based 3-piece IOL with haptics-end modifi-cation by applying high-temperature cautery to create bulbous flanged tips. This method has replaced worldwide the use of scleral flaps, scleral sutures, glued intraocular lenses or any other lenses model such as Artisan Iris claw lenses to address the problem of Aphakia in general. As this technique maturated along the last few years, the use of the other methods is becoming each day less. The easy of this technique and the familiarity of the anterior segment surgeon with such manipulations, made it easy for the Yahame technique to become today the surgery of choice for such cases. A conjunctival peritomy is not necessary but careful marking the needles entry points is mandatory. Placing a mark 1.5-2 mm pos-terior the limbus and both are exactly allocated in a line with the pupil center, ensures haptic placement exactly 180 degrees will provide excellent centration. Then one 27-gauge needle is bent in line with the bevel approximately 6-8 mm long from the tip. A CT LUCIA 602 ZEISS which is an acrylic hydrophobic 3-piece IOL with Polyvinylidene fluoride (PVDF) monofilament haptics is in current use. A ZEISS R28 IOL Delivery System (ZEISS Z28 Cartridge IOL Delivery System) would be used to deliver the folded IOL in the anterior chamber. Both are from Carl ZEISS Meditec, Jena Germany.
270 Comparative Evaluation of 0.1% and 0.01% Topical Atropine Eyedrops in Myopic Children , Sonam Juneja, Anand Aggarwal, Prempal Kaur1, Karamjit Singh1, Harvinder Nagpal2, Chiman Lal2 and Konica Singla
Aim: To compare effects of 0.1% and 0.01% topical atropine eyedrops in myopic children.Methods : This prospective randomized study was conducted on 80 eyes of 40 myopic children irrespective of age, type of myopia and amount of spherical equivalent correction. 40 eyes were subjected to 0.1% (Group A) and 40 to 0.01% (Group B) topical atropine once at night. Follow-up was done at 3 months,6 months, 1 and 2 years. The effect of atropine on mean change in spherical equivalent, axial length, pupil diameter, keratometry and intra ocular pressure was recorded and compared between two groups. Any adverse effect as well as drop in near vision due to atropine was also noted.Results: Mean age group studied in two groups was 10.5 years (range 5-13 years). The mean change in spherical equivalent after 2 years of atropine therapy was -0.35 ± 0.93 D in group A and -0.04 ± 0.57 D in group B (p < 0.05), the mean change in axial length was 0.27 ± 0.38 mm in group A and 0.05 ± 0.30 mm in group B (p > 0.05) and the mean change in pupil diameter was 1.05 ± 0.36 in group A and 0.84 ± 0.14 in group B (p < 0.05). 11 (55%) patients of group A and 6 (30%) patients of group B had difficulty while reading. However no statistical significant change was found in intraocular pressure and keratometric readings.Conclusion: Both 0.1% and 0.01% topical atropine have comparable role in stabilization of myopia over 2 years. However, fewer visual side effects were noted with 0.01% atropine vs 0.1% atropine.Keywords: Atropine; Children; Myopia; Spherical Equivalent
271 Atypical Torpedo Maculopathy , Keshav Lahoti*, Mahesh Shanmugam and Divyansh Mishra
Torpedo maculopathy is a rare congenital anomaly of RPE in the temporal macula with unknown etiology. The diagnosis of this lesion is primarily clinical, often an incidental finding as it tends to spare the fovea. The lesion characteristics includes location temporal to fovea, hypopigmentation, horizonally oval shape with certain variable features like intraretinal cleft, fundus excavation, variable hyperpigmentation and associated visual field defects. Here we report a case of nasal macular location of the lesion which represents a rare clinical presentation and is supported by multimodal imaging findings.Keywords: Torpedo Maculopathy; Atypical; Torpedo; Nasal Location; Maculopathy
272 Pediatric Ocular Conditions - Guidelines for Treatment During COVID 19 Pandemic , Meenakshi Wadhwani
Covid-19 caused by SARS COV-2, is associated with neurologi-cal and opthamological manifestations. It is one the largest global pandemic affecting over 3 million people in 213 countries world-wide. It has led to a death toll of > 200 thousand people in a short period of 4 months as per WHO on May 1 2020. India has reported over 33,000cases with > 1000 deaths
273 Combining Partial-tendon Knapps Procedure with Posterior Tenectomy of Superior Oblique in a Case of Inferior Oblique Palsy , Sandra C Ganesh1*, Aylette D’Silva2, Shilpa G Rao1 and Murali Krishnan S2
Introduction:Isolated inferior oblique palsy is one of the rarest among extra ocular muscle palsies. In addition to posing a diagnostic challenge, multiple surgical techniques have been described in its surgical treatment. Case Report: A 23-year old female presented with unilateral right eye hypotropia and diminished vision. Following detailed evalu-ation, she was diagnosed with right eye inferior oblique palsy with A pattern exotropia and strabismic amblyopia. We performed a combined surgical procedure involving a partial Knapp's procedure with augmentation (using superior halves of medial and lateral recti), LR recession (using inferior half of split LR) and posterior tenectomy of superior oblique (PTSO), which resulted in a satisfac-tory postoperative outcome.Conclusion: IO palsy is a rare condition, which requires to be differentiated from neurological causes, Brown syndrome and skew deviation. Both exotropia and hypotropia have been corrected in the same procedure, using split halves of only two horizontal recti muscles, thus preventing possibility of anterior segment ischemia. This combination, along with LR recession, for exotropia and PTSO, produces satisfactory alignment.Keywords: Inferior Oblique Palsy; Split Tendon Knapp's Procedure; Posterior Tenectomy of Superior Oblique; A-Pattern Exotropia; Right Hypotropia
274 The Use of Ripasudil Hydrochloride Hydrate in Endothelial Decompensation – A Case Series , Pedro Manuel Baptista1*, Nelson Sena4-6, Fernando Faria-Correia2-4, Marcella Salomão4,7-10 and Renato Ambrósio Jr4-9
Purpose: To describe the preliminary clinical experience, including corneal structural response to Ripasudil hydrochloride hydrate (Glanatec® ophthalmic solution 0.4 %, Kowa Company, Ltd, Japan) in cases of corneal endothelial dysfunction.Methods: Retrospective observational study based on patients’ clinical records treated with Ripasudil hydrochloride hydrate three times a day for different conditions of corneal endothelial dysfunction. Outcome measures included clinical data with subjective re-sponse, uncorrected distance visual acuity (UDVA, Snellen), central corneal thickness (CCT, μm) measured with rotating Scheimpflug tomography (Pentacam HR, Oculus®, Wetzlar, Germany), intraocular pressure (IOP, mmHg) measured with dynamic Scheimpflug imaging (Corvis ST, Oculus®, Wetzlar, Germany) and endothelial cell density (ECD, cells/mm2) measured with EM-4000 Specular Microscope (Tomey®, Nuremberg, Germany).Results: Five patients were analyzed, four women and one man, with a mean age of 74.2 ± 12.4 years. Two cases of Fuchs’ endothelial corneal dystrophy (FECD), two of pseudophakic bullous keratopathy (PBK) and one of penetrating keratoplasty graft decompensa-tion (PKGD) were included. Treatment duration until results range from 1 to 6 months (mean 3.4 months). A good response was observed in both the cases of FECD and PBK. Despite a good initial response, a bad result was observed in the PKGD case. There were no ocular or systemic side effects related.Conclusion: The ROCK inhibitor Ripasudil hydrochloride hydrate is potentially effective in the treatment of different forms of cor-neal endothelial decompensation. Our work shows the short-term efficacy and safety of topical Ripasudil in the management of FECD and PBK derived endothelial decompensation. More studies with large samples and longer follow-up are needed.Keywords: Ripasudil Hydrochloride Hydrate; ROCK Inhibitor; Fuchs Endothelial Corneal Dystrophy; Pseudophakic Bullous Kera-topathy; Corneal Endothelium Decompensation
275 Diagnosing Dry Eye Disease: Simplifying the Process and Avoiding Pitfalls , Marc Labetoulle1, Elisabeth M Messmer2 and Stefano Barabino
Dry eye disease is often under diagnosed or misdiagnosed, in spite of its high prevalence and its impact on quality of life and mental health. The 2017 Definition and Classification report, the Tear Film and Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) II in 2017, continued to recognize dry eye disease as multifactorial, and updated the definition to include loss of homeostasis and neurosensory abnormalities as key elements of the disease. This review proposes key steps for simplifying and clarifying the diagnosis of dry eye disease in everyday clinical practice, based on the TFOS-DEWS-II report and the clinical experience of the oph-thalmologist authors. It addresses key diagnostic principles, assessment of patient symptoms (such as dryness and ocular fatigue), and signs (such as tear film instability and meibomian dysfunction), the role of new technologies, and the potential pitfalls to avoid. Dry eye disease is a disease of the ocular system as a whole, and diagnosis can be an easy process if carried out systematically and logically. Fluorescein and lissamine green staining, and corneal sensitivity testing are simple tools that can provide a lot of diagnostic information. New technologies are also available which, although not essential for daily practice, can help explore the disease patho-physiology and also help communication with patients.Keywords:Dry Eye Disease; Diagnosis; TFOS-DEWS II; Ocular Surface
276 Illuminating on the Mysteries of Your Body , Edward A Skoufi
The human body is different but at the same time unique (as general consensus ). Is essential to know your body in details, to translate and interpret anything about it and to cooperate with it. Really believe that is marvelously complex machine, but not “fu-turistic”, not perpetual with specified capacity. Therefore you need to be always "its ally”, respecting its integrity, in broader context to have actually information which is needed to improve human body care protecting actually by a gamme of viruses and microbial impacts.Purpose: To describe as accurate as possible, my concepts for knowing the human body and how should you translate and perceive it, and how you could protect it.Keywords: Human Body; Mysteries; Knowing; Education; Study; Protection
277 Predictability of Optical Coherence Tomography Parameters in Preperimetric Glaucoma , Dalia Sabry1, Ahmed S Elwehidy1, Ameera Gamal Abdelhameed2, Ehab Tharwat3 and Amr M Abdelkader
Purpose: To investigate the diagnostic value of inner macular layers (IMLs) thickness, Bruch's membrane opening-minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) in the diagnosis of pre perimetric glaucoma (PPG). Patients and Methods: This was an observational study included 79 eyes with PPG and 58 control eyes. Measurements of the BMO-MRW, pRNFLT and individual IMLs including the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL) and inner plexiform layer (IPL) were performed using Premium glaucoma Module for Spectralis SD-OCT.Results: PPG parameters showed a statistically significant difference with control eyes except the superonasal sector of the pRNFLT. Apart from superonasal sector of the pRNFLT, Spearman correlation showed a positive correlation between PPG and all tested pa-rameters. GCL and IPL, followed by the global pRNFL had the strongest predictability of PPG as proved by binary logistic regression analysis. Conclusion: Individual IMLs (mRNFL, GCL and IPL), pRNFL and BMO-MRW and their subsectors were helpful in detecting PPG. GCL and IPL showed the highest predictability followed by the global thickness of the pRNFLT.Keywords: Glaucoma; OCT; IMLs; BMO-MRW; pRNFL; mRNFL; GCL; IPL
278 Determination of Glaucoma Grade with Cup to Disc Ratio , Jyoti Patil* and Sharmila Chaudhari
Assurance of the vertical cup/plate proportion (CDR) chooses glaucoma suspect. For ordinary eye, the even C/D proportion is generally bigger than the vertical C/D proportion, yet considers have demonstrated that the vertical proportion progress quicker in ahead of schedule and transitional phases of glaucoma. In our exploration we have measure real size of the cup and optic plate. This examination is chip away at optic plate restriction/location. At that point by optic plate division and by Optic cup division, we dis-cover little circles as having vertical widths under 1.5 mm and enormous circles as having vertical distances across more prominent than 2.2 mm. we choose grade like on the off chance that C/D proportion is 0≤CDR≤0.4 at that point eye is ordinary. On the off chance that C/D proportion is 0.4<CDR<0.55 then glaucoma malady condition is moderate and on the off chance that it is CDR≥0.55, at that point eye is in serious phase of glaucoma infection.Keywords: Glaucoma; Cup/Disc Ratio (CDR); Segmentation
279 Retinal Diseases and Ways of Reducing Avoidable Blindness in Low Middle Income Countries , Raba Thapa
Retinal diseases are the leading cause of low vision and blind-ness globally. In high income countries, blindness due to retinal diseases especially of avoidable blindness is largely under control. This is because of increase in awareness, access to timely detection and treatment.
280 Importance of Colorimetric Quantities in Ophthalmology and Optometry , Nilgun Baydogan
The explanation of the nature of colour has critical importance in ophthalmology and optometry. Colour is one of the most distin-guishing characteristics of people vision. In order to understand how colour affects our vision, it will be significant to understand how colour develops. Because the vision sensitivity problems of optical materials used in ophthalmology and optometry pertain to variations in colour. The evaluation of variations in the colourimet-ric quantities is important to compare the optical performance. The investigation of the colourimetric changes provides information on optical properties to determine colourimetric quantities by us-ing the CIE and CIELAB colour systems
281 Straatsma Syndrome - Report of Two Cases , Pedro Manuel Baptista1,2*, João Heitor Marques1, Natália Ferreira1, Luísa Malheiro1, Sofia Maia1, Vasco Miranda1,2, Ricardo Parreira1 and Pedro Menéres
Introduction: Straatsma syndrome is a rare disease characterized clinically by the exuberant persistence of myelin fibers in the retina associated or not with the presence of myopia, strabismus and amblyopia. The present study is aimed to describe two cases of this entity.Methods: Retrospective patient’s clinical records review.Results: In case 1, a 17-year-old male was referred to the ophthalmology consultation due to decreased visual acuity in the right eye (RE). With no relevant systemic or ophthalmological history, he had a better corrected visual acuities (BCVA) of 20/200 in the RE and 20/20 without correction in the left eye (LE), with no oculomotricity changes and fundoscopy revealed the persistence of myelinated retinal nerve fibers (MRNF) near the upper temporal arch and myopic choroid in the RE and no alteration in the LE. In case 2, a 39-year-old male with family history of myopia was referred with a diagnosis of rhegmatogenous retinal detachment on the LE. On ophthalmic examination, BCVA were 20/20 on the RE and hand motion on the LE. During the pars plana vitrectomy, a total rhegmatogenous retinal detachment was observed in the LE, with MRNF accompanying the temporal arcades and a macular hole (MH). After three pars plana vitrectomies, including an inverted ILM flap technique attempted to close the MH, and eight months after silicone oil extraction, the aphakic LE presented a 20/200 BCVA with the retina fully attached and the MH closed.Conclusion: Despite some controversy in its features, Straatsma syndrome should be included in the differential diagnosis of leuko-coria and must be suspected in the presence of refractive errors with anisometropia. The general prognosis is poor to moderate, but better results can be achieved with a prompt diagnosis and amblyopia management.Keywords: Myelinated Retinal Nerve Fibers (MRNF); Straatsma Syndrome; Macular Hole (MH); Anisometropia; Amblyopia; Strabismus; Better Corrected Visual Acuities (BCVA)
282 Long-Term Structural Effects of Retinal Photocoagulation in Diabetic Retinopathy , Pedro Manuel Baptista1*, Ana Ambrósio Marta1,2, João Heitor Marques1, André Ferreira1,3, Diana José1, Daniel Almeida1, António Ribeiro1,2 and Irene Barbosa1,2
Background and Objective:Pan-retinal photocoagulation (PRP) have potential structural deleterious effects in retinal and cho-roidal tissues. To assess the long-term retinal and choroidal status after PRP and to correlate the results with treatment strategies.Design/Materials and Methods: Observational cross-sectional study including eyes with diabetic retinopathy who underwent PRP, with or without macular treatments.Results: 227 eyes with a mean time since PRP of 10.0 ± 7.2 years.In a multivariable model, the only treatment characteristics with predictive value were the macular laser treatment with modified grid for worse BCVA, the higher number of laser spots for higher CT and GCLV and the laser treatment with Argon for lower FNFLT.Conclusion: This study demonstrates long-term stability in the BCVA and choroidal and retinal structural parameters with only mild correlation with treatment strategies, highlighting the role of PRP in the management of diabetic retinopathy in an era with evolving less aggressive laser options.Keywords: Pan-Retinal Photocoagulation (PRP); Proliferative Diabetic Retinopathy (pDR); BCVA
283 Prevalence and Associated Factors of Cataract among Diabetic Patients in West Bank, Palestine: A Cross Sectional Study , Yousef Shanti1, Ibrahim Taha2*, Adnan Busttami3, Hamzeh Al Zabadi4, Saif-eddin Malhas3, Qutaiba Mahmoud3, Rami Othman5, Liana Al-Labadi6 and Alshaarawi Salem7
Background: Cataract is a major cause of visual impairment among diabetic patients. The study aimed to assess the prevalence of cataracts and its associated factors among diabetes mellitus patients in the West Bank, Palestine, in order to better identify the tar-gets for future healthcare policy and interventions.Materials and Methods: A prospective quantitativecross-sectional study was conducted in all governorates of the West Bank with a proportionally and randomly selected sample size of 385 subjects. The participants were interviewed face to face for an average of ten minutes to fill in a previously validated Early Treatment Diabetic Retinopathy Study (ETDRS) questionnaire. Then after, blood and urine samples were collected and finally, the participants were passed for an ophthalmic examination performed by a certified ophthalmologist.Results: The prevalence of any cataract, nuclear cataract, cortical cataract, and posterior subcapsular cataract was found to be 47.8%, 28.1%, 14.0%, and 4.7% respectively. The most significant factors for any cataract were: age (55 - 64) (OR 5.375), age (≥ 65) (OR 30.238), DM duration (10 - 19) (OR 2.251), DM duration (≥ 20) (OR 5.771), systemic steroid therapy (OR 0.411). For nuclear cataract, significant associated factors were age (55 - 64) (OR 9.576), age (≥ 65) (OR 17.928), DM duration (≥ 20) (OR 3.059), ALK PHOS (OR 0.354).For cortical cataract: DM duration (≥ 20) (OR 6.134) was the only significant factor. And in the case of posterior subcapsular cata-ract, age was the only significant factor (OR 1.076).Conclusion: The high prevalence of cataract among diabetic patients in West Bank indicates the importance of cataract screening program for DM patients as an attempt to prevent visual impairment and related disabilities. Keywords: Diabetes Mellitus; Cataract; Blindness
284 Eales Disease , Gowhar Ahmad
William Henry wale in the year 1817 an Australian ophthalmol-ogist to describe this condition characterized by recurrent.Vitreous hemorrhage occurring in an young healthy individu-als.A kind of disease exclusively occurring in young Asian people.
285 Scenario of Cataract Surgery Past and Present , Gowhar Ahmad
Cataract surgery is one of the most common ophthalmic sur-gery performed by almost every ophthalmologist throughout the world and perhaps one of the only eye surgery which ensures vi-sion to a cataract patient if it is successful
286 Achieving Durable Dry Macula in Diffuse Diabetic Macular Edema: A Meta-analysis , Avinoam Ophir
Enduring diabetic macular edema (DME) might injure foveal layers, which may lead to progressive deterioration of visual acuity (VA). The aim of DME therapy is therefore to improve current VA and to achieve early, complete and durable macular drying. Therapy of centrally-involved diffuse DME (DDME) when macular traction is undetected has hitherto remained the major challenge. This me-ta-analysis focuses on the achievements of these two targets in DDME. However, monotherapy by repeated intravitreal anti-vascular endothelial growth factor (-VEGF) medications does not achieve, as a rule, a lasting outcome. Modified grid laser photocoagulation (mGLP) was found efficacious in only a relatively small group of eyes. While using time-domain optical coherence tomography (TD-O-CT), delayed pars plana vitrectomy (PPV) for intractable DME usually elicited a variable or no improvements of VA. After more than a decade of numerous DME trials by intravitreal medications, the two leading international study groups called for additional inves-tigations to determine if VA can be better maintained with different management approaches.The advent of high-resolution OCT has enabled a preoperative foveal layers assessment. Using this, early- PPV in DDME treat-ment-naive eyes attained very high efficacy in improvement of VA and in complete, durable macular drying. These findings can be explained by the two novel DDME pathogeneses. In contrast, delayed PPV achieved an improved VA but often only reduced the edema, leaving residual edema that necessitated continuous treatments. mGLP was found durably efficacious for DDME in certain conditi-ons. Early-PPV and mGLP are also the most cost-effective therapies for DDME. Limitations refer to the lack of a controlled study of early-PPV, which provides a durable outcome, vs. medications that provide only a transient response. Until then, the long-lasting, hi-ghly efficacious, objective (OCT) outcomes of early-PPV, or mGLP in specific conditions, may initially assist in therapeutic decisions at least to populations where budgets and availability of medications are constraint. These two therapeutic approaches here described being perhaps their best or only options for saving their sights.Keywords: Diabetic Macular Edema; Extrafoveal Traction; 3D-OCT; Pars Plana Vitrectomy; Grid Laser Photocoagulation; Anti-VEGF
287 Association Between Serum Vitamin-D Level and Dry Eye Syndrome - A prospective Cross-sectional Study , Prasenjit Saha1*, Tania Basaiawmoit2, J V Basaiawmoit3 and Anton Decruse Wanbah4
Aim: This study is to investigate the association between the patients with dry eye syndrome and serum vitamin D level in hospital-based population.Study Design: Prospective, cross-sectional study.Methods: 88 participants (including male and female) diagnosed with Dry Eye Syndrome having no ocular diseases or any auto-immune systemic diseases were included. Comprehensive eye examination was done for all subjects. OSDI questionnaire, Schirmer’s Test I and II and Tear Break up Time (TBUT) along with the measurement of Serum vitamin D level were performed for all the sub-jects. Analyses were made using the SPSS.Results: The mean age of the participants was 37.67 ± 14.17 years (95% CI: 34.92-40.65). Mean ST-I was found to be 8.54 ± 3.43mm (95% CI: 34.92-40.65), mean OSDI score was 45.80 ± 9.74 (95% CI: 43.76-47.80), mean ST-II was 5.86 ± 2.92mm (95% CI: 5.30-6.34), mean TBUT was 5.98 ± 2.23 seconds (95% CI: 5.47-6.47) and Serum Vit-D level was 20.21 ± 9.24 ng/ml (95% CI: 18.06-21.98). Sta-tistically significant difference was observed between ST-I and ST-II (P Ë‚ 0.001). Regression analysis showed a significant association for OSDI (r = 0.938, p Ë‚ 0.001), ST-II (r = 0.28, p Ë‚ 0.04) and TBUT (r = 0.64, p Ë‚ 0.001) with Serum Vit-D level.Conclusion: In our study, OSDI score, low tear secretion level and tear break up time suggested to show significantly low Serum Vitamin-D concentration in blood which may be the contributory factor for DES. The results of the study suggest that serum Vit-D supplementation can be a useful and effective treatment of DES.Keywords: Cross Sectional Study; OSDI Questionnaire; Dry Eye Syndrome; Tear Secretion; Serum 25 Hydroxyvitamin-D Level
288 Medical and Non Incisional Management of Glaucoma , Gowhar Ahmad
Glaucoma is one of the commonest ocular condition seen by al-most all ophthalmologists.It is a kind of visual threatening disorder if not diagnosed or managed in time main problem with glaucoma is whatever vision is lost can't be restored back by any means so whatever vision is left has to be protected either by medical or surgical modalities at present since we are in the era of subspecialities we have glau-coma experts and also lot of research is going on in this field do the prognosis of glaucoma has become reasonably satisfactory we also do glaucoma screening to pick up silent cases by screening people randomly after 40 years and do refraction IOP measurement scler-al rigidity and facility of aqueous outflow
289 Epidemiology of United States Pediatrics Sports-Related Ocular Injuries from 2000-2019 , Parth S Patel1,2, Aditya Uppuluri1, Marco A Zarbin1 and Neelakshi Bhagat1*
AbstractObjective: To characterize the epidemiology of sports-related ocular injuries in school aged children ages 5 - 18 in the United States, 2000 - 2019.Methods:Data was sourced from the National Electronic Injury Surveillance System for this retrospective epidemiology study. Inclu-sion criteria for this study included: patient age between 5 - 18 years, eye injury between 2000 and 2019, and eye injury involving sports at all geographic sites. Data were divided into two age groups: 5 - 11 and 12 - 18 years. Results: There were an estimated 264,648 ED visits for sports-related ocular injury of which 73% were males and 42% between the ages 5 - 11 years. Over 96% of children were treated and released from the ED, suggesting minor injury. The sports most commonly associated with eye injuries were basketball, baseball/softball, swimming, football, and soccer. In terms of location, 56% of injuries occurred on the court. In the 5 - 11 cohort, home was the most common location for off-court injuries, while in children aged 12 - 18, most off-court injuries occurred at school. Conclusion:Sports-related pediatric ocular injuries between 2000 - 2019, mostly were contusions in older male children and were encountered primarily on the basketball court. Off-court injuries occurred mainly at school. Keywords: Pediatrics; Eye; Sports; Basketball; Baseball/Softball
290 Inhaled Corticosteroid Use and Central Serous Chorioretinopathy , Bisant A Labib
AbstractIntroduction:Central serous chorioretinopathy (CSCR) is an idiopathic and self-limiting condition manifesting as one or more se-rous detachments of the neurosensory retina. It typically occurs unilaterally and in the macular region, with most cases resolving spontaneously. Besides clinical examination, many supplementary tools can be utilized in confirming the diagnosis of CSCR, such as fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). The exact mecha-nism is unknown, but corticosteroids have been suggested to play a role in the pathogenesis of CSCR. This case report describes inhaled corticosteroid use as the cause of CSCR.Case Report: A 43-year-old Caucasian female reports with subjective visual blur in her left eye only for several weeks in correspon-dence with use of a nasal spray. Despite good measured visual acuity, a mildly elevated macular appearance was suspected on fundus examination. OCT testing confirmed these findings and elucidated a diagnosis of central serous chorioretinopathy. Resolution with observation and discontinued use of inhaled corticosteroids was achieved.Discussion: The OCT is a helpful and non-invasive tool in the assessment of macular changes, due in this case to CSCR. It appears as a serous detachment of the neurosensory retina in the macular region, and often with accompanying pigment epithelial detachment (PED). Complications are rare, but may include OCT findings of choroidal neovascular membrane (CNVM) formation, warranting prompt referral and treatment. The cause of CSCR is multifactorial and not yet well understood. Among other factors, corticosteroids are associated with CSCR.Conclusion: Most cases of CSCR are self-limiting and resolve spontaneously without treatment, yielding a generally good visual prognosis. Since observation is the most common management approach for acute CSCR, serial OCT testing at initial examination and follow-ups are imperative in monitoring the improvement or worsening of condition. In those worsening or even persistent cases, referral for treatment must be considered to reduce the risk of permanent macular changes and irreversible vision loss.Keywords: Central Serous Chorioretinopathy; Corticosteroids; Optical Coherence Tomography
291 Iluvien Implant for the Treatment of Cystoid Macular Edema Following Vitrectomy and Epiretinal Membrane Peel , Hadi Zambarakji1* and Amany Abelaziz
AbstractIn the present report, we present a unique case of a 65-year-old male patient who underwent bilateral vitrectomy and epiretinal membrane (ERM) peel, complicated by resistant cystoid macular edema (CME). Subsequent treatment with bilateral Fluocinolone implants (Iluvien) resulted in resolution of CME, which was maintained beyond 3 years of follow-up as well as a reduction in the need for IOP lowering medications. Visual acuity improved and there was a reduction in eyelid congestion, redness and discomfort.Keywords: Cystoid Macular Edema; Vitrectomy; Fluocinolone Implant; Iluvien
292 The Importance of Seeing Beauty and Order , Doris Bergen
When we moved to our new, smaller house last year, I bought a new bedspread for our master bedroom and it presently graces our bed in this house. We had only been in our new house a few months, however, before the coronavirus pandemic began and so we have spent many months primarily at home, with only a few vital trips to grocery and doctor since then. Of course, we have had no visitors and thus there has been no one other than my husband and myself to observe this lovely bedspread.
293 Correlation of Central Corneal Thickness with Refractive Errors and Corneal Curvature in the South Indian Population , Nair Shobita*, V Panneer Selvam, Shah Vinit J, Jayaraman Radha, V Vijayraghavan and Gupta Amal
AbstractAims and Objectives: To determine the correlation between central corneal thickness (CCT), Refractive errors, and corneal curva-ture. To investigate any association between Central corneal thickness (CCT) and variables, namely, age, refractive errors, mainly Myopia and Hypermetropia, Corneal curvature, and axial length.Methods and Material: Observational Hospital-based Cross-sectional study of the data collected from patients with refractive errors presenting to the outpatient department (OPD) at our hospital. 240 eyes of 120 patients who met the inclusion criteria included in the study. Following examinations were performed for all the patients, measuring best-corrected visual acuity, central corneal thickness, corneal curvature by Topography, and axial length by A-scan ultrasonography. All patients underwent a complete slit-lamp examination.Statistical Analysis: Correlation between central corneal thickness (CCT) and four factors, namely, age of the patient, degree of myopia and hypermetropia, corneal curvature, and axial length, was studied using Karl Pearson's correlation coefficient(r). We did data analysis with the SPSS 20.0 software.Results: The mean central corneal thickness of our study population was 531.9 microns. The mean age of the overall study popula-tion was 27.02 years. The mean corneal curvature 44.34 D, and the mean axial length was 24.24mm. Central corneal thickness was significantly associated with corneal curvature.Conclusions:Central corneal thickness has a negative correlation with Corneal curvature, i.e., as the corneal curvature increases, the central corneal thickness decreases, and vice versa. However, there was no significant association between Central corneal thickness and other parameters like Age, Degree of Myopia, Hypermetropia, and Axial length.Keywords: Central Corneal Thickness; Myopia; Hypermetropia; Axial Length; Corneal Curvature; Correlation Analysis; Age
294 Relevance of Intraocular Pressure Measurement in Ulcerative Microbial Keratitis , Shikha Jain, Ashok Pathak*, Rahul Verma and Punam Kapoor
AbstractPurpose: Intraocular pressure measurement in a case of ulcerative microbial keratitis is often neglected as treatment of ulcer takes precedence. However, prolonged rise in IOP can cause optic nerve damage and failure of visual recovery even after complete resolu-tion of keratitis. This prospective longitudinal comparative study was done to evaluate the importance of IOP measurement in cases of ulcerative keratitis.Methods: 122 cases of ulcerative microbial keratitis were divided into three groups based on their etiology- bacterial (Group A), fungal (Group B) and indeterminate (Group C). Comparative evaluation of IOP between all the three groups was done and results recorded.Results: On presentation, IOP was significantly high in bacterial and indeterminate group (Group A and C) but subsequently re-sponded to treatment. In fungal keratitis, higher IOP was noted later in the follow up visits. The IOP was also related to the size of ulcer and depth of infiltrate with size more than 5 mm and midstromal level of infiltrate showing a significantly high IOP.Conclusion: IOP measurement and management although difficult in cases of keratitis if neglected can cause permanent loss of vi-sion.Keywords: Ulcerative Microbial Keratitis; Intraocular Pressure; Non Contact Tonometry
295 Fluorescein Load Test: A New Diagnostic Test to Determine Location and Extension of Corneal Conjunctivalization in Partial and Total Limbal Stem Cells Deficiency , Maurizio Rolando1 and Stefano Barabino
AbstractPurpose:To evaluate the different fluorescein diffusion under the corneal epithelium and to compare its location and extension with the expression of cytokeratine (cK) 3 and cK 19 by epithelial cells of corneal surface.Methods: Seventeen subjects with clinical signs of limbal failure participated in the examination. Fluorescein load test (FLT) was per-formed by instilling 1% fluorescein every 10 seconds for 1 minute. Fluorescein diffusion under the corneal epithelium was observed with cobalt blue filter after 1 minute from the last instillation. Impression cytology samples were collected from corneal surfaces to observe the expression of specific corneal (cK 3) and conjunctival (cK 19) cytokeratines analysed by immunocytochemistry. The cK 3/cK 19 rate was compared with the extension and localization of FLT. Results: Immunocytochemistry analysis discovered in the corneal surface the presence of cK 3 and cK 19. Samples with more than 80% of cK 3+ cells were found in 70% of eyes with negative FLT. Furthermore, more than 50% of cells which expressed cK 19 in cor-neal epithelial samples were accompanied with 100% correlation between location of positive FLT and cK 19+ cells.Conclusion: Since surgical approach is different in partial versus total limbal deficiency, it is important to recognize the localization and the extension of corneal conjunctivalization. The fluorescein load test is a simple diagnostic test to detect corneal area with limbal loss.Keywords: Conjunctivalization; Fluorescein Staining; Corneal Stem Cells; Limbal Failure
296 Application of Pulsed Laser Radiation of the Far Ultraviolet Range for Corneal Crosslinking , Igor Kornilovskiy
AbstractPurpose: Justify the advisability of using pulsed laser radiation in the far ultraviolet range for corneal crosslinking.Material and Methods: Experimental (20 pig eyes, 90 rabbit eyes) and clinical (596 photorefractive and phototherapeutic opera-tions) studies on the assessment of corneal crosslinking using ablative and subablative energy densities of an argon-fluorine excimer laser were analyzed. In all cases, stromal saturation with 0.1% or 0.25% isotonic riboflavin solution was performed after photothera-peutic ablation of the epithelium. For an objective assessment of the effect of excimer laser crosslinking, the methods of biomechani-cal testing, light, electron microscopy, computed keratotopography, aberrometry, optical coherence tomography and densitometry were used.Results: In experiments after phototablation with riboflavin, biomechanical testing revealed an increase in the strength character-istics of the thinned cornea. According to transmission electron microscopy, an increase in the number of cross-links in the collagen structures of the stroma characteristic of cross-linking was observed. In the clinic, OCT and densitometry confirmed the presence of the crosslinking effect in photorefractive and phototherapeutic ablation with riboflavin. Such prophylactic crosslinking was suf-ficient to compensate for the weakening of the strength properties of the thinned cornea, and did not violate its elastic properties. For therapeutic crosslinking in keratoconus, secondary keratoectasias and other corneal pathology, the radiation energy densities of an argon-fluorine excimer laser below the ablation threshold were applied. With this technology, according to the data on OCT and corneal densitometry, all the classic signs of crosslinking with an increase in optical density, the formation and reverse development of a demarcation line in the stroma were revealed.Conclusion: Secondary radiation induced by ablative and subablative energy densities of an argon-fluorine excimer laser initiates crosslinking in the riboflavin-saturated corneal stroma. This indicates that the use of pulsed laser radiation of the far ultraviolet range is promising for corneal cross-linking.Keywords: Pulsed Ultraviolet Laser Radiation; Argon-Fluorine Excimer Laser; Riboflavin; Corneal Crosslinking; Photorefractive Keratectomy; Phototherapeutic Keratectomy; Keratoconus; Secondary Keratoectasias
297 Exposure of Hospital Staff to Infections: The Effect of the Hospital Environment on the Microbial Flora of the Conjunctiva , Dvora Pikkel
AbstractAim:To examine the microbial flora of the conjunctiva among hospital employees as a test case for assessing the degree that the hospital environment affects the microbiota of its inhabitants. Methods: We took samples from the conjunctival sack (from both eyes) of hospital staff from different departments and incubated these samples in order to find the existence of microbial flora. As a control group we tested in the same way people who were not exposed to hospital environment and had no conjunctivitis at the last 3 months. We compared the results of the 2 groups.Results: The microbial flora of the conjunctiva did not differ between healthy health care professionals and a control group. However, greater bacteria incidence and diversity were found among staff in internal medicine wards compared to other departments. Conclusion: In general, hospital staff are not in risk to be infected more than the regular population, however some of the people working at internal medical wards are more exposed to conjunctival contamination. A follow-up study of the participants of this work is needed to examine if re-current contamination is responsible for alterations in the conjunctival flora of health professionals; and a multi-center study is needed to confirm differences in bacteria incidence between hospital departments.Keywords: Conjunctiva; Microbial Flora; Health Professionals; Hospital Environment; Recurrent Contamination; Bacterial Infection Incidence
298 Scenario of Limbal Dermoid , Gowhar Ahmad
Limbal dermoid are kind of cong anomalies have got genetic predisposition are associated with other associated with other cong Anomalies of ant segment.They are usually unilateral however in rare conditions can be bilateral if associated with cong presence of preauricular skin tag or preauricular apo engage the condition is known as Goldenhar Syndrome Maurice Goldenhar an Australian ophthalmologist who in the year 1850 was the first to describe this syndrome complex sometimes presence of squint anophthalmos coloboma of the up-per lid iris retina astigmatism microphthalmos blepharophimosis syndrome however it is very rare.
299 Spectacle Lens Materials and their Special Coatings at a Glance , Manika Manika1 and Meenakshi Wadhwani2
As technology advances so, too, do eyeglass lenses. Eyeglass lenses were mainly made up of glass in the past. Today, most eye-glasses are made of various types of advanced plastics. These new lenses are lighter, more scratch resistant, do not break as easily as glass lenses or the older common plastic lenses and can be treated with a filter to shield eyes from damaging ultraviolet light. The material used in glasses or sunglass lenses will affect their clar-ity, durability weight and cost. Below are the main advantages and disadvantages of the various lens materials.
300 Stereopsis in Accommodative Esotropia at Al-Ibrahim Eye Hospital, Karachi, Pakistan , Shua Azam1*, Abdul Hameed Talpur2, Sadia Bukhari3, Tania Waseem4, Shehnaz Bhatti4, Mahnoor Shafique4 and Safia Nisar
AbstractObjective: To determine stereopsis in accommodative esotropia.Design: Cross-sectional descriptive study between August 2020 to December 2020.Place and Duration of Study: Al-Ibrahim Eye Hospital, Karachi.Methodology: Non-probability, convenient sampling was used. This study included 23 subjects diagnosed with accommodative eso-tropia under 5 to 15 years of age, either male and female. Stereopsis was assessed by the Frisby test and Lang II test. SPSS version 20.0 was used to analyze the data. Research Ethical Committee (REC) of ISRA Postgraduate Institute of Ophthalmology gave ethical approval.Results: A total of 340 subjects were registered at the Orthoptic Clinic. 155 subjects were diagnosed with Esotropia. Among the 155 subjects, 23 subjects were diagnosed with Accommodative Esotropia. The age ranged from 5 to 15 years. Among 23 patients, 10 were females and 13 were males. Stereopsis on Frisby test showed that 7 subjects had weak (340) stereopsis but after refractive correc-tion they attained good (85) stereopsis while 3 had mild (170) stereopsis and it becomes good (85) after refractive correction with a p-value of 0.018 which is statistically significant. 10 subjects who failed to perform on Frisby test their stereoacuity was assessed by Lang-II test. Without refractive correction on Lang-II test 4 patients had 200 sec/arc, 2 patients had 400 sec/arc, 1 patient had 600 sec/arc and 3 patients had no stereopsis. With refractive correction on Lang-II test 5 patients had 200 sec/arc, 3 patients had 400 sec/arc and 2 patients had 600 sec/arc.Conclusion: The study concluded that stereopsis was good after refractive correction in the majority of the subjects.Keywords: Stereopsis; Accommodative Esotropia; Frisby Test
301 The Impact of HBA1C on Diabetic Macular Edema , Gamze KarataÅŸ1*, Burak Erden2, Akın Çakir2, Selim BölükbaÅŸi2, Serkan Erdenöz2, Bora Deniz Argon2 and Mustafa Nuri ElçioÄŸlu
AbstractPurpose:We aimed to reveal the relationship between HbA1c and diabetic macular edema.Materials and Methods:The study evaluated 79 eyes of 57 patients who have not yet received treatment due to DME. All patients had type 2 diabetes mellitus and were treatment-naive. The patients were selected according to macular edema related to diabetes mellitus and central macular thickness (CMT) measurements higher than 260 μm. Patients with a history of glaucoma, phakic eyes, any vitreomacular interface pathologies detected by spectral domain optical coherence tomography (SD-OCT), other vitreoretinal diseases, and retinopathies, a history of vitrectomy were excluded. Patient data including age, gender, duration of diabetes, baseline glycated haemoglobin (HbA1c) level. We formed groups according to 8, which is the average HbA1c value of our patients. The patients with HBA1c levels above and below 8 were divided into two groups and the correlation between CMT and best corrected visual acuity (BCVA) was evaluated.Results:HbA1c values of less than 8.0% were named Group-1, and HbA1c values of 8.0% or more were named Group-2. Group-1 consists of 42 eyes, Group-2 consists of 37 eyes. When the demographic and clinical features of the patients were examined in all groups and subgroups, there was no statistically significant difference between the groups (p > 0.05). Group-1 mean CMT values were 458 ± 128.17 μm, Group-2 mean CMT values were 415 ± 74.18 μm (p = 0.089). Group-1 mean BCVA was 0.46 ± 0.25 logMAR, Group-2 mean BCVA was 0.45 ± 0.29 logMAR (p = 0.896). Factors affecting BCVA in patients were evaluated statistically. CMT (beta coefficient: 0.504, p < 0.001) was found effective on BCVA. Factors affecting CMT in patients were statistically evaluated. It was found to be HbA1c (beta coefficient: - 0.102, p = 0.370) on CMT.Conclusion: Systemic parameters should also be used in the treatment of our diabetic macular edema patients. HbA1c is one of these parameters.Keywords: Diabetic Macular Oedema; HbA1c; Diabetic Retinopathy
302 A Study Determining the Efficacy of Brock String Therapy in the Treatment of Convergence Insufficiency , Simran Dhakal1*, Sunaina Mary Alex2 and Sourav Karmakar
AbstractAim:To determine the efficacy of brock string therapy in convergence insufficiency treatment.Methodology: It is a prospective study where the subjects were taken from Naseema Institute of Optometry and Research. Students in the age group of 18 - 31 years meeting the criteria of inclusion and exclusion were considered. Thirty subjects with CI were studied. The following test i.e. Cover test, PBCT, NPC, NRA, positive fusional vergence, negative fusional vergence, vergence facility and ac-commodative facility evaluation were done. Measurements from the CI subjects were obtained before and after brock string therapy. Fifteen subjects underwent regular therapy and 15 underwent occasional therapy. Statistics were calculated using SPSS V 16 for windows. Exophoria, NPC and vergence tests were compared for before and after therapy and on between regular and occasional therapy subjects.Results: A total of 30 students were evaluated under the age group of 18-31 years. Out of 30 subjects, 12(40%) were males and 18 (60%) were females. Subjects before vergence therapy were between 8∆ exophoria to 11∆ exophoria and after vergence therapy it had a range of 6∆ to 4∆. The break point for NPC improved from 7.75 cm to 6 cm in case of accommodative target and in case of non-accommodative target, it improved from 10.5 cm to 8 cm. PFV break increased from 14∆ to 30∆ at near. There was significant improvement in NPC and PFV in the study.Conclusion: Brock string therapy appears to be an easy and effective therapy for CI. Thus this study concludes that regular therapy is effective for the stability of the result.Keywords: Convergence Insufficiency; Vision Therapy; Near Point of Convergence; Exophoria; Brock String
303 The Effect of Light and Heat Upon Choroidal Thickness in Healthy Young Adults , Saleh A AlKhaldi1* and Lyle S Gray
AbstractAim: Investigate the effect of external factors such light and heat upon choroidal thickness in healthy adults.Methods: 40 young healthy adults were included in this study. Choroidal thickness was measured using swept source optical co-herence tomography before and after they were exposed to different levels of light illumination and external source of heat. In the first experiment, 30 subjects were divided into 3 refractive groups (myopes, emmetropes and hyperopes). In the second experiment, another 10 myopic subjects wore pre-heated eye compress for 10 minutes.Results: In the first experiment, no significant change in choroidal thickness was recorded after exposing the subjects to 4 differ-ent illuminations and this was the case for all participants (p > 0.05). In the second experiment, no significant change in choroidal thickness was found duo to wearing the eye compress for 10 minutes in all choroidal areas except for the outer nasal area (p > 0.05). However, one subject showed substantial change in all choroidal areas.Conclusion: Short exposure to different illuminations has no significant effect upon choroidal thickness. Wearing pre-heated eye compress did not substantially affect choroidal thickness except for outer nasal area, while one subject showed substantial change in all choroidal areas which requires further investigation.Keywords: Choroid; Choroidal Thickness; Optical Coherence Tomography; Light Exposure; Outdoor Activity; Eye Compress
304 The Effect of Sustained Eye Rotation Upon Axial and Peripheral Eye Length in Young, Adult Myopic Subjects , Saleh A AlKhaldi1* and Lyle S Gray
AbstractAim:To determine whether ocular movement can affect the shape of the globe and lead to measurable change in axial and peripheral eye length.Methods:Ten subjects aged 18 to 30 years old (6M/4F) participated with informed consent. Mean spherical equivalent refractive error was ≤ -1.00DS with cylindrical refraction < -1.25DC. One drop of tropicamide hydrochloride 1% was instilled 20 minutes prior to measurement to induce mydriasis and mild cycloplegia. Using IOL Master, eye length was measured centrally and temporally (25 degrees off-axis) in four different positions. Subjects then rotated their eye 25 degrees in the temporal direction to fixate on a target for 10 minutes. After that, the same measurements were repeated. Results: Prior to rotation, the group mean peripheral eye length was significantly shorter than the central eye length (p < 0.05). There was no significant variation in central or peripheral eye length due to off-axis fixation, either after the initial eye rotation, or after fixation for 10 minutes at the off-axis point. The difference between central and peripheral eye length was maintained after ten minutes of temporal fixation (p < 0.05).Conclusions: Peripheral eye length was shorter than central eye length showing the prolate shape associated with myopia. The action of the extraocular muscles on the globe has no significant effect upon the retinal shape assessed by off-axis eye length meas-urement in myopic subjects.Keywords: Eye Rotation; Eye Shape; Central Eye Length; Peripheral Eye Length; Myopia; IOL- Master
305 The Incidence of Macular Ectopia in Eyes Previously Diagnosed as Amblyopic , Nataliia Karandiuk* and Anastasiia Kalyshenko
AbstractBackground/Objectives: To define the incidence of macular ectopy in amblyopic children and evaluate the relationship between the presence of macular ectopia and visual acuity (VA) using optical coherence tomography (OCT).Subjects/Methods: There were evaluated 52 eyes of 37 patients. 32 patients (52 eyes) were in control group with best corrected visual acuity (BCVA) and no OCT findings of macular ectopia. Control group was used to define standard deviation of distance be-tween fovea and optic nerve. To define the presence\ absence of macular ectopia was used manual tool “caliper” of measurements. The measurement was performed from the beginning of complex of RPE+Bruch’s membrane from Optic disc and ending in the foveal center. In cases of dislocation of macula up or down from optic nerve (figure 3) we calculated distance by the Pythagorean Theorem. The correlation between presence, distance and direction of macular ectopia and BCVA was determined.Results: Of 52 amblyopic eyes 34 were with macular ectopia, 19,2% of eyes presented strabismus and 26,9% of eyes had a hypo-plasia macular. BCVA in logMAR was not correlated with presence of macular ectopia (p value=0,086712 ) nor with CMT (p val-ue=0,670086). The majority of eyes (58,8%) with macular ectopia has just temporal displacement (p value=0,006741).Conclusions: The incidence of macular ectopia in amblyopia eyes is 65,3%. The OCT measurements according to distance between Optic disc and foveal center are effective for determining the presence of macular ectopia. Majority of patients with strabismus have macular displacement. The presence of macular ectopia doesn’t affect visual acuity. Keywords: Macular Ectopia; Amblyopia; Optical Coherence Tomography (OCT)
306 Efficacy and Safety Profile of Preservative Free Brimonidine 0.2%/Timolol 0.5% Fixed Dose Combination (BTFC) vs Benzalkonium Chloride (BKC) Preserved Brimonidine 0.2%/Timolol 0.5% Fixed Dose Combination: A Prospective Study , Divya Tara1, Gursatinder Singh1, Suresh Kalra2, Anand Aggarwal1*, Ishwar Singh1, Neetu Sharma3 and Talvir Sidhu
AbstractPurpose: The aim of the study was to compare the intraocular pressure (IOP) lowering efficacy and side effect profile of preservative free brimonidine 0.2%/timolol 0.5% fixed dose combination (BTFC) versus benzalkonium chloride (BKC) preserved brimonidine 0.2%/timolol 0.5% fixed dose combination.Methods: A prospective, randomized, comparative, 8-week study was conducted on sixty patients of primary open angle glaucoma (POAG) or ocular hypertension. Enrolled patients were randomized into two groups (Group 1 and 2) with thirty patients in each group. Group 1 (Preservative free BTFC) patients were given preservative free brimonidine 0.2%/timolol 0.5% fixed dose combina-tion one drop twice daily and Group 2 (BKC preserved BTFC) patients were given benzalkonium chloride preserved brimonidine 0.2%/timolol 0.5% fixed dose combination one drop twice daily for 8 weeks, and IOP was recorded at baseline and at 4 week and 8 week visit at 9 am (before instillation of drug) and 11 am (post dose, peak effect). IOP lowering potential, side effect profile was noted at each visit and cost analysis was done for both the study drugs.Results: There was no statistically significant difference in patient demographics of the two groups. The mean age for Group 1 (Pre-servative free BTFC) was 62.97 years and for Group 2 (BKC preserved BTFC) was 61.67 years. In Group 1 (Preservative free BTFC), 18 (60%) were females and in Group 2 (BKC preserved BTFC), 16 (53.33%) were females. There was no statistical difference between the baseline IOP of both the groups. Significant reduction of IOP from the baseline was seen at both time points, throughout the follow up visits, in both the groups (p < 0.00001). Mean reduction from the baseline for Group 1 (Preservative free BTFC) was found to be 8.67 ± 1.30 mmHg (33.50%) and for Group 2 (BKC preserved BTFC) was 8.82 ± 1.98 mmHg (33.32%) and the difference between the two groups was statistically insignificant (p = 0.73). Although there was no statistically significant difference in number of each side effect encountered by the patients in both the groups but side effects did show higher tendency in number in Group 2 (BKC preserved BTFC) than in Group 1 (Preservative free BTFC). Using cost minimization analysis, it was found that BKC preserved BTFC costs Rs. 181.89 ± 5.96 ($ 2.39 ± 0.27) more than Preservative free BTFC to attain similar IOP lowering effect over 8 weeks.Conclusion: Preservative free 0.2% Brimonidine/0.5% Timolol fixed drug combination is an effective, safe and cheaper alternative to BKC preserved 0.2% Brimonidine/0.5% Timolol fixed drug combination in medical management of POAG.Keywords: Fixed Dose Combination (BTFC); Benzalkonium Chloride (BKC); Brimonidine
307 My Child has Insect Crawling on his Eye , Meenakshi Wadhwani1* and Shubhangi Kursange
Phthiriasis palpebrarum is a rare eyelid infestation caused by Phthiriasis pubis or Crab lice. These lice have a predominant liking for axilla, groin, thighs but occasionally may invade eyelashes or eyelids [1]. The main common route for transfer is sexual contact followed by areas with history of overcrowding and poor hygiene.Phthiriasis palpebrarum infestation affects 1 to 2% of the human population worldwide [2]. There is history of around 30% of the cases associated with another sexually transmitted diseases. We hereby, report the case of unusual presentation of this infestation in a 5 year old child.
308 Clinical Classification of Glaucoma , Gowhar Ahmad
Glaucoma is one of the commonest ocular disorders seen by almost all ophthalmologists it is a kind of visual Threatening dis-order if not diagnosed and managed in time and properly the main problem with this disorder is that whatever vision is lost can't be restored back by any means be it drugs surgery etc. however in recent times of ophthalmic subspecialities we have got glaucoma experts and with latest research taking place in the field of glau-coma the prognosis of this disorder is much better EEC also have a kind of glaucoma screening where silent patients are picked up by random examination of people after 40 years of age whose as-sessment of IOP refraction facility of Aqueous outflow and scleral rigidity is done
309 Blow Out Orbital Fracture , Gowhar Ahmad
Lid hematoma enophthalmos supratarsal retraction limitations of movements in upwards and downward gaze diplopia.Dullness of sensation in infraorbital region infraorbital nerve.Blow out orbital fracture is a king of disorder which is charac-terized by an increase in the intraorbital pressure as a result of injury by a closed fist cricket or hockey ball or rt accident.Fracture lies 1 to 3 mm medial to the post part of infraorbital groove because medial wall of orbit is the weekest we can confirm the fracture by CT scan orbits or x-rays orbits
310 Successful Treatment of Palpebral Pyogenic Granuloma with Topical Timolol: A Case Report , El Kaissoumi Loubna1*, El Moize Zakaria1 and Cherkaoui Ouafae
AbstractPyogenic granuloma is a benign vascular tumor appearing usually as a response of a local tissue to an irritation or a trauma.This lesion can be sessile or pedunculated, and it can measure few millimeters or several centimeters. It is usually located on the face or the fingers.It generally occurs among young patients and it’s seems to have a female predilection prevalence.It can be induced by trauma, drugs, or may appear spontaneously, like it was the case of our patient.Different therapeutic options may be proposed to treat pyogenic granulomas, some being more invasive like curettage, shave removal, surgical excision by electrocautery, laser, microembolization or sclerotherapy.Topical timolol can be an interesting option to treat pyogenic granulomas, but further studies have to be done to demonstrate its effectiveness in the treatment of this pathological entity.Keywords: Palpebral Lesion; Pyogenic Granuloma; Topical Timolol
311 Biodegradable Material (Ologen Implant) Using in Treatment of Refractory Glaucomas , Mona Abdelkader1*, Shereen Hagras2, Ahmed Soltan1, Eman Hefney1and Asad Ghanem
AbstractPurpose: To evaluate the role of the bioengineered collagen matrix implant (Ologen) on the outcome of trabeculectomy in patients with refractory glaucomas. Subjects and Methods: This prospective, nonrandomized, interventional case series study included 60 eyes of 60 patients with refractory glaucoma. Patients were divided into 2 groups according to the age. Group I; age ≤ 18 years old and group II; age > 18 years old. Preoperative data included age, gender, type of glaucoma, intraocular pressure (IOP) and number of preoperative glau-coma medications. Conventional fornix based trabeculectomy with implantation of subconjunctival ologen was performed in all patients. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Blebs were graded according to Wuezrburg bleb classification system (WBCS) and were imaged with ultrasound biomicroscopy (UBM). Patients were followed up for at least 6 months. Results: The mean preoperative IOP was 28.5 ± 4.96 mmHg in group I and 30.13 ± 6.33 mmHg in group II. The range of anti-glauco-matous medications was 2 - 3 in both groups. The means of postoperative IOP showed no statistical significant difference between both groups except at the 1st month where group I had higher IOP values. At 6th month; the percentage of pressure reduction was 48.74% in group I and 57.25% in group II, with significant higher mean of pressure reduction in group II. Complete success was achieved in 71.43% of eyes by the end of the 6th month in group I and in 81.25% in group II. Complete degradation of the ologen implant before 6 months was noticed in 50% of the cases in group I and none in group II. No relation was found between the bleb scores and the IOP control along the follow up period. There was statistically significant correlation between IOP control and bleb wall reflectivity on UBM at 1st and 6th month. Conclusion: Ologen was effective in controlling IOP in refractory glaucoma. It was a safe method in augmentation of trabeculectomy with no special complications. Keywords: Trabeculectomy; Ologen; 5-fluorouracil (5-FU); Mitomycin C (MMC)
312 An Objective Approach in Diagnosis of Retinopathy of Prematurity Stages , Maria A Kovalevskaya* and Oxana A Pererva
AbstractObjective: To develop the concept of a universal diagnostic platform that will reduce the risk of subjectivity in diagnosis and treat-ment choice for ROP, DME, DARP, AMD, RVO and glaucoma and will allow to achieve objective nosology’s data and targeted reasonable investment of health care resources.Materials and Methods: 1278 retinal images and 77 OCT results of 412 patients were analyzed. 5 clinical group with subgroups were created: 1- ROP (n = 272), 2- Diabetic retinopathy (n = 120), 3- CRVO (n = 6), 4- AMD (n = 4), 5- Control (n = 10). A concept of an information platform was developed to exclude subjectivity in the interpretation and to automatize the multifactorial image analysis in the diagnosis of social valuable diseases of the retina and optic nerve. The platform works by analyzing 3D and 4D images, anam-nesis data and laboratory tests by CNN. Results and Discussion: Statistically valuable difference (Mann-Whitney U test) was indicated between Df in immature retina group (1,27 ± 0,01) and all stages of ROP (1 stage - 1,32 ± 0,02; 2 stage 1,4 ± 0,06; 3 stage 1,450 ± ,02; 4 stage 1,55 ± 0,01). In DARP groups p < 0,05 was only in groups with proliferate (1,52 ± 0,04) and terminal (1,43 ± 0,04) stages relatively to patients with normal retina (1,55 ± 0,04). A concept of an information platform was developed to exclude subjectivity in the interpretation and to automatize the multifactorial image analysis in the diagnosis of social valuable diseases of the retina and optic nerve. Platform modules for a wide-field fundus image modeling of infants, localization of the macula as a mark for morphometry and isolation of the vascular network using deep convolutional neural networks have been developed.Keywords: Retina Images; Fractal Analysis; Complexity of Vascular System; Retinopathy of Prematurity; Diabetic Macular Edema; Diabetic Angioretinopathy; Retinal Vein Occlusion; Glaucoma
313 Rare Case of Goldenhar Syndrome in a 3 Years Old Male Child , Gowhar Ahmad
AbstractCong limbal dermoid preauricular skin tag appendage squint enophthalmos colobomas of upper lid iris retina astigmatism mi-crophthalmos blepharophimosis syndrome facial asymmetry high arched palate hare lip cleft palate double ureters hydronephrosis defects in limbs and spine cong heart dental anomalies hearing defects impairment of memory intelligence mental facility 7th nerve involvement trigeminal anasthesia.Keywords: Goldenhar Syndrome; Cong Limbal Dermoid; Squint Enophthalmos
314 Rare Case of Goldenhar Syndrome in a 3 Years Old Male Child , Gowhar Ahmad
AbstractCong limbal dermoid preauricular skin tag appendage squint enophthalmos colobomas of upper lid iris retina astigmatism mi-crophthalmos blepharophimosis syndrome facial asymmetry high arched palate hare lip cleft palate double ureters hydronephrosis defects in limbs and spine cong heart dental anomalies hearing defects impairment of memory intelligence mental facility 7th nerve involvement trigeminal anasthesia.Keywords: Goldenhar Syndrome; Cong Limbal Dermoid; Squint Enophthalmos
315 SARS-CoV2 Infects Eye Too , P D Gupta
Abstract Discovery of SARS-CoV2 belonging to SARS family to begin with confused scientists and clinicians both and they were concentrat-ing only on lung infection. But when it became pandemic and millions of people suffered, clinicians started examine each and every organs of the Covid-19 patients, they found that eyes are also getting infected. The eyes suffered with conjunctiva which is not a very serious diseases but further investigations revealed that the eye can be a potent source of infection.Keywords: SARS-CoV2; Covid-19; Eye
316 Redefining Forme Fruste Keratoconus as Ectasia Susceptibillity , Louise Pellegrino Gomes Esporcatte1,2*, Marcella Q Salomão1-5, Bernardo T Lopes1,6, Nelson Sena Jr7, Aydano P Machado3,4,8 and Renato Ambrósio Jr
Abstract The term form fruste keratoconus was initially coined by Marc Amsler in 1938 in cases with slightly tilted Java mires and, later on, longitudinal studies using Polaroid Placido photokerastocopy for describing patterns of irregularity that did precede clinical kerato-conus. The term fruste is derived from French and means "confused, crude, or unfinished." Fruste refers to an incomplete and abor-tive form of the disease, in contrast to the concept of the full-blown presentation. Rabinowitz describes forme fruste keratoconus as the eyes with unremarkable biomicroscopy and no visual impairment having good distance corrected visual acuity by glasses, which present a typical keratoconus irregularity on the topographic mapping. In 2009, Klyce proposed that the term forme fruste keratoco-nus should also apply to the contralateral eye of keratoconus patients with no clinical findings of any sort. There is no consensus on the current definition of forme fruste keratoconus. The recent 2015 Global consensus states that kera-toconus is bilateral disease and that ectasia may occur unilaterally due to purely biomechanical stress. Nevertheless, FFCK has been recognized as the most important risk factor for developing progressive ectasia after refractive laser correction. This article provides a prospective review of the definition of forme fruste keratoconus as the cases with high susceptibility for corneal biomechanical decompensation and ectasia progression.Keywords: Forme Fruste Keratoconus; Corneal Ectasia; Multimodal Corneal Imaging
317 To Determine the Occurrence of Various Intra Operative Complications of Manual Small Incision Cataract Surgery from a Rural Background in a Tertiary Hospital , Ramya M and Soumya Ramani
AbstractKeywords: Manual Small Incision Cataract Surgery; Complications; Posterior Capsular Rupture; Zonular DehiscencePurpose: To determine the occurrence and frequency of various intra operative complications of manual small incision cataract surgery. Materials and Methods: A retrospective study was conducted to find the complications that occurred after small incision cataract surgery. All the records of 990 patients who underwent small incision cataract surgery were reviewed from January 2019 to Decem-ber 2019. Among the 990 patients, 89 patients had intra operative complications. The details regarding the surgical procedure was recorded in these patients, including type of surgery, intraocular lens placed, the type of complication and the remedial measures that were taken. The study was conducted as per the tenets of the Declaration of Helsinki (2008).Results: Among the 89 patients, who had intra-operative complications, 52.8% percent were males and 47.2% were females. The percentage of right eye surgeries was 51.7%, and that of left eye surgeries was 48.3%. The average age of the patients was 65.07 +- 9.5 years. The most common complication was a posterior capsular rent. In females, the propensity of developing complications such as zonular dehiscence and Descemet’s membrane detachment were higher (p = 0.06). In those cases, that had a posterior capsular rupture, the most common intraocular lens placed was a retropupillary iris fixated lens (p = 0.00). Conclusion: Manual small incision cataract surgery is a safe and effective surgery for the treatment of cataract, especially in a devel-oping country. It is important to be aware of the possibility of occurrence of complications, so that preventive measures can be taken and once they do occur, appropriate steps can be taken to ensure that optimal outcomes can be obtained.
318 The Relationship between Central Macular Thickness and Metabolic Parameters Changes in Patients with Non-Proliferative Diabetic Retinopathy , Ayse Gul Kocak Altintas1*, Cagri Ilhan2 and Mehmet Citirik
AbstractKeywords: Central Macular Thickness; Diabetic Macular Edema; Diabetic Retinopathy; HbA1c; LipidAim: To compare the directions changes in central macular thickness (CMT), glycosylated hemoglobin (HbA1c) and fasting serum lipids in patients with non-proliferative diabetic retinopathy (NPDR) along three-month follow-up.Methods: Sixty-eight eyes of 68 patients with NPDR were included in this retrospective observational case series. CMT was measured using spectral domain optical coherence tomography at baseline and at third month follow-up visit. Fasting serum lipids including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG) and HbA1clevels were evaluated on the same day of CMT measurements. A potential relationship between HbA1c, serum lipids and CMT values were investigated by statistical methods.Results: The mean age of the patients was 57.5 ± 9.8years (38 - 80) and male-to-female ratio was 30/38 (p > 0.05). Along three-month follow-up period, CMT value increased in 31 eyes, decreased in 30 eyes and remained in the same level in 7 eyes. In the same period, HbA1c values increased in 39 patients and decreased in 22 patients and did not changed the rest of them. The directions of changes in CMT and HbA1c were same for totally 41 patients (p = 0.01). These same directional changes were observed in totally 36 patients for CMT and HDL, in 23 patients for CMT and LDL, and in 28 patients for CMT and TG (p > 0.05, for all). Conclusion: This study demonstrates the directions of changes in CMT and HbA1c levels were same; however, similar relationship was not observed for CMT and serum lipids including HDL, LDL, and TG along three-month follow-up in patients with NPDR.
319 Efficacy and Cost Analysis of Brinzolamide 1%/Brimonidine 0.2% Fixed Combination (BBFC) Therapy Vs Separate Concomitant Brinzolamide 1% and Brimonidine 0.2% Therapy: A Comparative Study , Jashandeep Singh1, Anil Pathak1, Gagan Kalra2, Anand Aggarwal1*, Manpreet Kaur1, Neeru Sharma3, Kamlinder Kaur1 and Ravneet Pannu1
AbstractKeywords: Brinzolamide; Brimonidine; Brim Therapy; BBFC TherapyPurpose: The aim of the study was to compare the intraocular pressure (IOP) lowering efficacy and cost analysis of Brinzolamide 1%/Brimonidine 0.2% fixed combination (BBFC) therapy versus separate concomitant Brinzolamide 1% and Brimonidine 0.2% (Brinz + Brim) therapy.Methods: A prospective, randomized, comparative, cross over, 12-week study was conducted on forty patients of primary open angle glaucoma or ocular hypertension. Enrolled patients were randomized into two groups (Group A and B) of twenty patients each. For the first 6 weeks of the 12-week study period, Group A patients received Brinzolamide 1%/Brimonidine 0.2% fixed combination (BBFC) therapy and Group B patients received concomitant Brinzolamide 1% and brimonidine 0.2% (Brinz + Brim) therapy, each given twice daily. After the 6-week follow-up visit, Group A patients were crossed over to concomitant Brinzolamide 1% and Bri-monidine 0.2% (Brinz + Brim) therapy while the Group B patients were crossed over to Brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) therapy. IOP was assessed at baseline and at 6-week and 12-week visits at 9 am (before instillation of drug) and 11 am (post dose, peak effect). The daily cost of both the therapies was calculated by maximum retail price and average drop count per bottle. The cost-effectiveness of both therapies was then calculated as cost of therapy/mm Hg fall in IOP.Results: There was no statistically significant difference between the patient characteristics of the two groups. The mean age for Group A was 64.15 years and for Group B was 63.45 years. In Group A, 10 (50%) were females and in Group B, 11 (55%) were fe-males. There was no statistical difference between the baseline IOP of both the groups. At both time points, IOP lowering from base-line after 6 weeks of therapy with either BBFC or Brinz + Brim was statistically significant (p < 0.00001). After 6 weeks, the mean IOP reduction from baseline in Group A (BBFC) was calculated to be 7.98 ± 1.31 mmHg (31.11%) and for Group B (Brinz + Brim) was calculated to be 7.87 ± 0.98 mmHg (30.56%). The difference in mean IOP reduction between both the groups at 6 weeks was statistically insignificant (p = 0.39). After 6 weeks visit when the therapies were switched among both groups, the mean IOP at the 12-week visit was statistically similar to the mean IOP of the same group at 6 weeks visit. The side effect profile of both the therapies was similar, none of the patients having any serious side effect warranting discontinuation of the treatment. For 6-week study period, cost per mm Hg IOP reduction for BBFC therapy and Brinz + Brim therapy was respectively found to be Rs 45.7 ± 0.4 per mmHg and Rs 67.54 ± 0.29/mmHg per mmHg. The total 6-weekly cost of BBFC therapy was found to be Rs 364.72 ± 3.15 ($ 4.2) while that of Brinz + Brim therapy was Rs 531.55 ± 2.33 ($ 7.43). Using cost minimization analysis, it was found that Brinz + Brim therapy costs Rs 166.83 ± 3.27 ($ 2.63) more than BBFC therapy to attain similar IOP reduction for a period of 6 weeks.Conclusion: Brinzolamide 1%/Brimonidine 0.2% fixed combination (BBFC) is an effective and safe IOP lowering therapy with an auxiliary advantage of being more economical than concomitant separate Brinzolamide 1% and Brimonidine 0.2% therapy.
320 To Determine the Occurrence of Various Intra Operative Complications of Manual Small Incision Cataract Surgery from a Rural Background in a Tertiary Hospital , Ramya M and Soumya Ramani
AbstractKeywords: Manual Small Incision Cataract Surgery; Complications; Posterior Capsular Rupture; Zonular DehiscencePurpose: To determine the occurrence and frequency of various Intra operative complications of manual Small Incision Cataract Surgery. Materials and Methods: A retrospective study was conducted to find the complications that occurred after small incision cataract surgery. All the records of 990 patients who underwent small incision cataract surgery were reviewed from January 2019 to Decem-ber 2019. Among the 990 patients, 89 patients had intra operative complications. The details regarding the surgical procedure was recorded in these patients, including type of surgery, intraocular lens placed, the type of complication and the remedial measures that were taken. The study was conducted as per the tenets of the Declaration of Helsinki (2008).Results: Among the 89 patients, who had intra-operative complications, 52.8% percent were males, and 47.2% were females. The percentage of right eye surgeries was 51.7%, and that of left eye surgeries was 48.3%. The average age of the patients was 65.07 +- 9.5 years. The most common complication was a posterior capsular rent. In females, the propensity of developing complications such as zonular dehiscence and Descemet’s membrane detachment were higher (p = 0.06). In those cases, that had a posterior capsular rupture, the most common intraocular lens placed was a retropupillary iris fixated lens (p = 0.00). Conclusion: Manual small incision cataract surgery is a safe and effective surgery for the treatment of cataract, especially in a devel-oping country. It is important to be aware of the possibility of occurrence of complications, so that preventive measures can be taken and once they do occur, appropriate steps can be taken to ensure that optimal outcomes can be obtained
321 A Novel Surgical Technique of Removal of Sub-Macular Hemorrhage in Post Traumatic Cases , Mohammad Khalife1*, Mojtaba Abrishami2*, Purva Date3 and Matteo Forlini4
AbstractKeywords: Sub Macular Hemorrhage; Vitrectomy; Visual Function; Trauma Purpose: To describe a new technique in removing sub-macular hemorrhages (SMH) in traumatic patients and results.Methods: In this technique, patients with SMH, a complete three port vitrectomy was performed. Using a back flush instrument and soft tip needle, considering safe distance from silicon tip to retina, SMH is swept using gentle flushes to an other site far from the macula in which clots were removed via a retinotomy site. In a case with macular hole, the hemorrhage was drained via the hole.Results: In case one, SMH was swept to the temporal of the macula and removed via a retinotomy. Best corrected visual acuity was improved from hand motion to 20/ 30. In the second patient, four weeks after trauma, SMH was removed and after three weeks the BCVA was improved to 20/25 (after three weeks). In the third case that had traumatic macular hole in first place, the SMH was drained via the macular hole and BCVA was improved from hand motion to 20/100.Conclusion: Sub-Macular hemorrhage sweeping using back flush after a complete vitrectomy seems to be efficacious in restoring macular anatomical and visual function.
322 Glaucoma in Penetrating Keratoplasty , Prateeksha Sharma*
AbstractGlaucoma following penetrating keratoplasty (PKP) is one of the most common causes for irreversible visual loss [1] and the second leading cause for graft failure after rejection [2]. The management of penetrating keratoplasty and glaucoma remains controversial mainly because of the high risk of graft failure associated with treatment.Keywords: Penetrating Keratoplasty (PKP); Glaucoma; IOP
323 Hints for Wearing Contact Lenses in all Age Groups , Dileep Kumar Chennamsetti
Better to replace contact lenses, although you did not wear them daily or used for once or contact lens looks fresh or forgot to clean lenses or forgot to take out contact lenses while sleeping as they are daily disposable lenses, as these all increases chances of infections in the eyes.
324 Ocular Manifestation of Liver Fluke: A Little Mentioned Clinical Issue , Viroj Wiwanitkit
Opisthorchis viverrini infection or liver fluke infestation is a common tropical trematode disease. This infection can causes chronic biliary tract irritation and can result in a deadly malignan-cy, cholangiocarcinoma. The hepatobiliary presentation of opis-thorchiasis is well documented. However, there might also other atypical presentation. Here, I would like to draw an attention to ocular presentation of opisthorchiasis. In infected animal, the ocu-lar manifestation of liver fluke infection is possible [1]. For human, it is little mentioned [2,3]. The conjunctivitis might be a presenta-tion of opisthorchiasis [2,3]. The exact pathophysiology is not well clarified but it might be an immunopathological process.
325 Meibomian Gland Dysfunction and Short-Term Visual Outcomes Following Laser-Assisted In Situ Keratomileusis , Sara Sella1, Nitsan Duvdevan3, Michael Mimouni and Igor Kaiserman
AbstractPurpose: To assess the association between short-term visual outcomes following LASIK and meibomian gland dysfunction. Methods: This retrospective case series included consecutive patients who underwent LASIK for myopic correction during August 2016 at the Care Vision Refractive Clinic, Israel. Pre-operative data included clinical signs of dry eyes, meibomian gland dysfunc-tion (MGD) score, eyelid telangiectasia, recent history of hordeolum, conjunctival hyperemia (CH), tear film break-up time (TBUT), spherical equivalent (SE) and pre-operative best corrected visual acuity (BCVA). The association between these parameters and uncorrected visual acuity on postoperative days (POD) 1, 7, and 30 was assessed. Results: This study included 95 patients at a mean age of 30 ± 7.2 years, 75% were men. Mean MGD score was 2.2 ± 0.8. The mean logarithm of minimum angle of resolution (LogMAR) visual acuity on POD 1, 7, and 30 were 0.096 ± 0.16 (20/25), 0.1 ± 0.11 (20/20), and 0.0 ± 0.11 (20/20). LogMAR visual acuity was inversely proportional to pre-operative MGD grading (p = 0.020) on POD 1. Preoperative CH was seen in 33.6% (32/95) patients, who showed a trend toward poorest LogMAR visual acuity on POD1 (p = 0.09). It was significantly worse on POD7 (P = 0.002). LogMAR visual acuity was proportional to pre-operative TBUT on POD 1 and 7, but not POD 30. Preoperative history of recent hordeolum, noted in 28.4% (27/95) patients, was associated with worse LogMAR visual acuity (P = 0.04).Conclusion: Patients with preoperative ocular surface signs of dry eye disease, such as high MGD score, low TBUT or CH, may be advised to expect slower restoration of visual acuity following LASIK. Keywords: Meibomian Gland Dysfunction; LASIK; Dry Eye; Ocular Surface Disease Index (OSDI)
326 Dry Eye Disease in Covid Era - How Ocular Surface is Effected , Dileep Kumar Chennamsetti
Most common symptom observed in this covid era is dry eyes and negative impacts on health of the ocular surface. Pre-covid time, dry eye cases are 10% and during this covid era, dry eye cases have increased tremendously to 60% in all age groups. In particu-lar, what we have observed are few mechanisms responsible for the onset for the dry eyes worsening or increasing symptomatol-ogy.
327 Juvenile Open Angle Glaucoma: A Report of Three Sons in One Family , Said M Shalaby, Wesam Shamseldin Shalaby* and Ahmed F Elmaria
AbstractA male child aged 16 years old diagnosed with bilateral juvenile open angle glaucoma (JOAG) underwent trabeculectomy with mitomycin C (MMC) in both eyes. For 5 years follow-up, no complications were recorded, and the intraocular pressure (IOP) was well controlled. Family screening was done and revealed JOAG in his brother, 13 years old, and his sister, 9 years old. Both underwent trabeculectomy with MMC. Ologen implant was intraoperatively added in the younger sister. Examination of the parents revealed that their mother, 45 years old, had mild primary open angle glaucoma and medical treatment was prescribed for her with good IOP control, stable perimetry and retinal nerve fiber layer thickness for 4 years follow-up.Keywords: Juvenile Open Angle Glaucoma; Mitomycin C; Ologen; Trabeculectomy
328 Causes of Secondary Glaucoma among Patients Presenting in Glaucoma Clinic at Al-Ibrahim Eye Hospital, Karachi , Shua Azam1*, Abdul Hameed Talpur2, Aqsa Batool3, Nimra Anwer4, Zainab Palijo5, Sadia Bukhari6 and Muhammad Asif7
AbstractObjective: To determine the causes of Secondary Glaucoma in Glaucoma clinic in Al-Ibrahim Eye Hospital, Malir Karachi.Materials and Methods: This hospital based, Cross-sectional study was carried out at glaucoma clinic of Al Ibrahim Eye Hospital from June to November, 2019. Non-probability, purposive sampling technique was used. A total of 1000 subjects attended glaucoma clinic. Among 2000 eyes, 40 eyes were diagnosed with secondary glaucoma. All ocular examination belonged to secondary glaucoma were performed. Demographics features and etiologies were recorded. SPSS version 20.0 was used to analyze the data. Research Ethical Committee (REC) of ISRA Postgraduate Institute of Ophthalmology gave ethical approval. SPSS version 20.0 was used to analyze the data.Results: A total of 80 eyes of 40 subjects with secondary glaucoma were included. Among 80 eyes, 40 eyes were affected with second-ary glaucoma (SG). 31 subjects (77.5%) were males while 9 subjects (22.5%) were females. Frequency of secondary glaucoma was found to be 4%. Pseudoexfoliation glaucoma was the most common cause of secondary glaucoma present in 20 eyes (50%), Neovas-cularization glaucoma was presented in 13 (32.5%) eyes, 4 (10%) eyes were affected by Angle recession glaucoma while 3 (7.5%) eyes were involved in Steroid induced glaucoma.Conclusion: This study concluded that the common cause of secondary glaucoma was Pseudoexfoliation glaucoma and males were more affected than females.Keywords: Glaucoma; Secondary Glaucoma; Causes
329 Current treatments for Meibomian Gland Dysfunction and Eye Lid Margin Disease , Karl Stonecipher*, Kody Stonecipher, Megan Stonecipher and Brent Kramer
AbstractImportance: This study highlights the value of current therapeutic devices in the authors practice for the management of meibomian gland dysfunction (MGD) and eyelid margin disease (ELD).Background: To evaluate the effects of current therapeutic devices on clinical measures of dry eye related to MGD and ELD in pa-tients unresponsive to previous therapies.Design: A retrospective chart review of patients treated at one site.Participants: One thousand three hundred eighty-six eyes of 711 treated patients who were documented treatment failures with previous pharmaceuticals and/or devices were included in the patient population.Methods: Treatments for MGD included: lid exfoliation, low level light therapy in combination or alone with intense pulsed light therapy (LLLT or LLLT/IPL), thermal pulsation, blink assisted thermal energy, and radiofrequency thermal energy all performed at one center. Main Outcome Measures: Results included changes in the graded MGD score (grading scale 0 - 4), tear breakup time (TBUT), Ocular Surface Disease Index (OSDI) questionnaire score and lissamine green staining (LGS).Results: Significant improvements in the MGD scores, TBUT, OSDI questionnaire scores and LGS were seen. There were no ocular or facial adverse events or side effects related to any of the treatments.Conclusion: The application of an algorithm for the treatment of MGD and ELD is beneficial in the majority of patients who had failed to improve with alternative pharmaceutical and device interventions.Keywords: Low Level Light Therapy (LLLT); Intense Pulsed Light (IPL); Meibomian Gland Dysfunction; Ocular Surface Disease Index (OSDI); Dry Eye Disease (DED); Eye Lid Margin Disease(ELD)
330 Use of Artificial Intelligence and Machine Learning in Screening and Treatment of ROP in COVID Era , Muhammad Ahmed Qayyum1* and Seema Qayyum2
Artificial intelligence is a term used for software that can imi-tate cognitive tasks such as comprehension and analysis of data and scientific problem solving [1]. This assists in reducing human involvement by a considerable degree and as a result helps in re-ducing human errors by doctors in a field where such errors would be fatal. The increasingly large influence of artificial intelligence in today’s world is undeniable, as is its effect on society in mak-ing it a more technologically advanced civilization. As such, it was inevitable for this technology to leak into the world of healthcare to assist medical practitioners in efficient diagnosis and treatment. Research on the application of AI technology in healthcare began as early as the 1960s and soon enough its application extended to the branch of ophthalmology in an attempt to attain early diagno-sis and cure for leading illnesses related to the eye.
331 A Survey based Study: Usage of Electronic Devices and Ocular Manifestations during Quarantine (Covid-19) among Students , Priyanka1, Amara Baloch2, Shua Azam3*, Mariyum Fatima2, Shumaila Masood4
AbstractPurpose: To evaluate the ocular manifestation due to electronic devices on the eye during a lockdown and ocular symptoms due to excessive use of devices for education purpose. Methods: A self-made questionnaire about qualitative and quantitative usage of the electronic devices was completed by students attending online classes during the quarantine phase of pandemic COVID 19. All the data were gathered and analyzed using a statisti-cal package for social sciences (Version 22). Results: A total of500 students were responded to this survey. The most common usage devices among students were 60% mobiles phone, 20% for laptops, and 20% for other electronic devices. 75% of students had eye strain after using devices at day end followed by 25% of students who had no ocular discomfort. There is a strong relation (p = 0.05) between ocular manifestation and excessive use of the electronic device.Conclusion: Eye health issues are emerging as electronic devices time increases for students due to institutes being closed and on-line mode of education started in the Covid-19 pandemic. As there is a strong association between usage of electronic devices (smart-phones and laptops) and ocular manifestations including blurriness of vision, burning sensation in eyes, headache, and strain in eyes. Keywords: Electronic Devices; Laptop; SmartPhones; Ocular Manifestations; COVID19; Quarantine; Pandemic; Survey
332 The Dangers of Telemedicine for Glaucoma in the Light of COVID-19 Without Being Able to Assess Disease Parameters , Samar Elnahas and Alastair Lockwood*
AbstractBoth screening and monitoring for glaucoma in patients have been severely hampered by COVID-19. In some areas of medicine virtual consultations using telephone or video have helped in triaging, diagnosing and treating conditions without the need for face-to-face clinics, thus reducing the risk of COVID-19 exposure and transmission. Their use has risen dramatically since the onset of the pandemic. However, glaucoma is usually asymptomatic until being very advanced. We present a case of severe irreversible vision loss from glaucoma not known to be out of control in a patient over a period of 4 months who had received 3 virtual consultations. We caution against the use of virtual consultations without being able to measure glaucoma disease parameters such as intraocular pressure.Keywords: Glaucoma Telephone Telemedicine; Blindness; COVID-19
333 Basics of Binocular Single Vision and Strabismus , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah
AbstractThis paper describes about Basic information of Binocular Single Vision and Strabismus.Keywords: Binocular Single Vision; Strabismus; Retinal point
334 Non-Penetrating Deep Sclerectomy: A Lifetime Dedication and Economical Considerations , Ahmed Mostafa Abdelrahman*
AbstractThe present review describes simple economical procedures that were introduced to the literature by the author to facilitate Non-penetrating Deep Sclerectomy and enhance the efficacy in lowering the intraocular pressure in glaucoma patients.Keywords: Non-penetrating Deep Sclerectomy (NPDS); Intraocular Pressure (IOP); Schlemm's Canal
335 Basics of Anatomy and Physiology of Cornea , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah
AbstractThis paper describes about basic details on anatomy and physiology of cornea.Keywords: Anatomy; Physiology; Cornea
336 Brief Discussion on Accommodation , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah
AbstractThis paper describes about introduction to accommodation, it components, factors and its treatment modalities.Keywords: Accommodation; Modalities; Components
337 Intermittent Exotropia , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes about introduction to intermittent exotropia, its classification and treatment.Keywords: Intermittent Exotropia; Classification; Treatment
338 Brief on Bacterial Keratitis and Fungal Keratitis , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes brief about bacterial and fungal keratitis.Keywords: Bacterial Keratitis; Fungal Keratitis; Inflammation; Cornea
339 Brief Note on Papilloedema, Optic Neuritis and Optic Atrophy , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes about papilloedema, optic atrophy and optic neuritis.Keywords: Papilloedema; Optic Atrophy; Optic Neuritis
340 Retinoblastoma , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper gives brief information on retinoblastoma.Keywords: Retinoblastoma; Optic Nerve Layer; Retina
341 Brief on Retinal Detachment and Central Serous Retinopathy , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes about basics of retinal detachment and central serous retinopathy.Keywords: Retinal Detachment; Central Serous Retinopathy; Retina
342 Retinopathy of Prematurity , Dr Partha Haradhan Chowdhury1* and Brinda Haren Shah2
AbstractThis paper describes introduction to retinopathy of prematurity, its classification and its treatment.Keywords: Retinopathy; Prematurity; Classification; Treatment
343 Comparison of Visual Field Characteristics Between Normal Tension Glaucoma and Primary Open Angle Glaucoma , Shouvik Chattopadhayay1*, Monica Choudhry2 and Shahiban Shethi3
AbstractPurpose: To compare pattern of visual field in cases of normal tension Glaucoma versus primary open angle Glaucoma. Material and Methodology: This retrospective cross-sectional study was conducted in Aroonodaya Deseret eye hospital. We took their 40 Primary open angle glaucoma patients (of above 40 years and with no other systemic and medical problem) record with HVF report by their permission.Results: In these 40 patients 20 has normal tension and 20 has high tension. Each of the 20 patients of HTG and NTG made a pair by their age matched, refractive error matched and Mean deviation matched. In NTG there are 10 male patient and 10 female patients in other hand in HTG there are 7 male and 13 female patients. According to the age there are 5 subgroups were made 1, 2, 3, 4 and 5; 41 - 50, 51 - 60, 61 - 70, 71 - 80 and 81 - 90 respectively. The mean age ± standard deviation was 64.2 ± 12.3 for the group of NTG and for the HTG it was 62.8 ± 11.2. So, there are no significant difference found in this study. In the case of PSD value which was analyzed age group wise was significant. Because the P value is 0.016 and when we had done the same test among the NTG and POAG sub groups in the basis of pattern deviation plot map; the 38th point is significant which is actually placed under the blind spot and two points nasally. We had done GHT cluster analysis, there we found two points which were statistically significant these two significantly dif-ferent points are ICL3b and ICL5b the P value of this points are 0.039 and 0.048 respectively. We had analyzed MD and PSD values on the basis of the stage of severity of the disease while the comparison of both the group together we found some significant difference. Conclusion: In conclusion, there are two parts. firstly, when we use the Pattern deviation map point wise analysis, we have got a dif-ference in inferior paracentral area. The GHT wise analysis has shown the difference in inferior nasal step and in inferior scotomata area. And secondly, we can see MD wise analysis in mild to moderate, mild to severe and moderate to severe, and we got statistically significant differences. PSD value analysis has shown in NTG group a statistically significant difference in moderate to severe group. Similarly, in case of mild to moderate comparison, HTG group has shown the statistically significant difference. Keywords: Visual Field; Normal Tension Glaucoma; Primary Open Angle Glaucoma
344 Comparison of Blue Block Lenses and Anti-Reflection Coated Lenses on Reading Speed and Visual Fatigue , Vidhya L1*, Nilesh Thite2, Aditya Goyal3, Dhanaraju BM4, Deepthi AR5and Murtuza Abbas Kanchwala6
AbstractPurpose: To compare the effect of blue block lenses and anti-reflection coated (ARC) on reading speed in visual display unit (VDU) and printed chart and on visual fatigue questionnaire.Methods: A double-masked, controlled crossover study was carried out on 146 healthy subjects (92 males and 54 females) aged 18 to 30 years who used digital devices for a minimum two hours daily. The duration of the study was August 2019 to February 2020. Baseline visual fatigue questionnaire response and reading speed with hard coated lenses on digital MNRead and printed MNRead was recorded. Subjects were then divided into two groups by randomization. A well-fitted spectacle with blue block lenses was given to the first group and ARC lenses to the second group. After a week, the response to the visual fatigue questionnaire and reading speed was noted. Hard coat lenses were given for a week to wean off the previous lenses' influence if any. Then the intervention was crossed over and the response of the visual fatigue questionnaire and reading speed data were collected again after a week. All the collected data were compiled and statistically analyzed using ANOVA-Fisher's test.Results: Blue block lenses had a significant increase in reading speed in terms of words per minute (WPM) compared to baseline and ARC lenses in both VDU and printed chart. Blue block lenses showed a WPM of 137 (± 23.3) in VDU and 145 (± 23.3) with the printed chart (p < 0.001). ARC lens showed WPM of 128 (± 17.7) in VDU and 135 (± 17.7) in the printed chart (p < 0.001). While the baseline recording with hard coat lenses was WPM of 123 (± 27.2) in VDU and 134 (± 20) with the printed chart. While a significant decrease in symptoms of digital eye strain was noted with the usage of blue block lenses, especially in terms of dryness, eye fatigue in the visual fatigue questionnaire (p < 0.001).Conclusions: Blue block lenses were more effective with respect to reading speed and reducing digital eye strain as compared to ARC lenses. In our study, the blue block lenses showed an improved reading speed of about 7% in comparison with ARC lenses on both VDU and printed chart.Keywords: Blue Block Lenses; ARC Lenses; Reading Speed on Visual Display Unit; Printed Material
345 Efficacy and Safety of Brinzolamide 1% vs Timolol 0.5% as an Adjunctive Medication to Latanoprost 0.005% in Medically Uncontrolled Primary Open Angle Glaucoma , Gurpreet Dhaliwal1, Pradeep Dewan2, Ashok Aggarwal3, Anand Aggarwal1*, Shubham Mittal1, Shavina Garg1, Sonika Bansal1 and Rajinder Khalsa
AbstractAim:The aim of the study was to compare Intraocular pressure (IOP) lowering efficacy of Brinzolamide 1% versus Timolol 0.5% as an adjunctive medication to Latanoprost 0.005% in medically uncontrolled primary open angle glaucoma. Materials and Methods: A prospective, open-label, comparative, transition trial was conducted on 30 patients of POAG attending the Outpatient Department of Ophthalmology, Government Medical College, Patiala. Patients fulfilling the inclusion criteria and hav-ing none of the exclusion criteria were enrolled in the study after obtaining written informed consent. Patients who were already on Latanoprost 0.005% monotherapy for more than 8 weeks were included in the study. IOP readings were recorded at the base-line before starting the study, at 8:00 am, 10:00 am and 4:00 pm. Timolol 0.5% twice daily was then added to Latanoprost 0.005% monotherapy for 8 weeks and IOP was recorded at 8:00 am, 10:00 am and 4:00 pm at 4 weeks and 8 weeks. Timolol 0.5% was then substituted with Brinzolamide 1% twice daily as an add on for another 8 weeks to Latanoprost 0.005%. IOP was again recorded at 8:00 am, 10:00 am and 4:00 pm at 12 weeks and 16 weeks of starting the study. Side effects were recorded at each follow up visit. Results: The mean age of presentation was 64.60 years with 20 (66.67%) males and 10 (33.33%) females. Baseline mean IOP was 20.87 mmHg. Both Timolol 0.5% and Brinzolamide 1% showed comparable additional IOP reduction at both 8 and 16 weeks. The mean decrease in IOP with Timolol 0.5% and Brinzolamide 1% as an adjunct to Latanoprost 0.005% was 3.49 ± 0.97 mmHg (16.93%) and 3.46 ± 0.97 mmHg (16.77%) respectively. The difference in mean diurnal IOP reduction between the two groups at all follow up visits was statistically insignificant (p value = 0.946).Conclusion: Both Brinzolamide 1% and Timolol 0.5% showed similar IOP lowering efficacy when used as an adjunct to Latanoprost 0.005% but Timolol being cheaper may be preferred as an adjunctive of first choice.Keywords: Primary Open Angle Glaucoma; Timolol; Latanoprost; Brinzolamide
346 Ocular Manifestations of Schimmelpenning-Feuerstein- Mims syndrome - A Rare Phakomatosis , Sharah Rahman1*, Sarwar Alam1, Chandana Sultana1, Mahmood Mujtaba1, Abdus Salam1, ASM Moinuddin1 and Rashed Alam1
AbstractSchimmelpenning-Feuerstein-Mims (SFM) syndrome is a rare phacomatosis characterized by sebaceous nevus of Jadasson asso-ciated with extracutaneous abnormalities affecting the brain, eyes and bones. Though Nevus sebaceous is the most common type of organoid epidermal nevus, but its association with Schimmelpenning-Feuerstein-Mims syndrome is rarely established. The purpose is to report the ocular manifestations of Schimmelpenning-Feuerstein-Mims syndrome of an 11-year-old boy. The patient had the classic triad of epibulbar choristomas, lid and retinal coloboma, and nevus sebaceus of Jadassohn. His vision in right eye was 1.00 and left eye was 0.30 in LogMAR chart. He had lid coloboma, multiple limbal and scleral choristoma, cloudy cornea, retinal and optic disc coloboma in right eye. Left eye had limbal dermoid but cornea was relatively clear with a normal fundus. A brownish black verrucous plaque on the right facial area was discovered spreading ipsilaterally to the cervical region, combined with cicatricial alopecia, micro-tia, periocular nodule and pigmentation. The retinal and optic disc coloboma was confirmed with B scan ultrasonography of right eye.Keywords: Nevus sebaceous of Jadassohn; Phacomatosis; Limbal dermoid; Coloboma; Epibulbar choristomas
347 Dry Eye in Children: An Occult Public Health Crisis Exacerbated by the COVID-19 Pandemic , Amy Nau*, Reeti Rhawal and Olivia Nau
Excessive use of screens in our society was a concern among eye care practitioners even before the pandemic forced the world into a condition of full-time digital engagement. Among children, the average amount of screen time skyrocketed during 2020. De-vice-based learning became mandatory in schools across the globe and screens emerged as a surrogate for entertainment when chil-dren could no longer occupy their time with sports, after-school programs or in-person interactions with friends. Parents of young children quickly realized that digital media produced sufficient distraction to allow for a few hours of uninterrupted virtual work and teens discovered that the unlimited options for engagement provided an escape from the monotony of lockdown. Multiple sur-veys which have queried parents about use of screens demonstrat-ed a rampant increase in their use.
348 Slow-Release Technique of Dexamethasone Implant , Mayur Kulkarni*, Divyansh Mishra and Mahesh Shanmugam
AbstractDexamethasone implant (Ozurdex®) is a sustained-release Intravitreal implant which contains dexamethasone 0.7 mg in a drug delivery system called ‘NOVADUR’. Certain cases may require dexamethasone implant injection along with vitrectomy, however, there is a lot of confusion, misconception and fear regarding the use of ozurdex implant in vitrectomized eyes [1]. In a vitrectomized eye where vitreous gel is absent, the chance of iatrogenic retinal injury is always there if adequate precautions are not taken while inject-ing the implant. Aim of the article is to demonstrate an in vivo safe technique of slow injection of the dexamethasone implant into vitrectomized eye along with vitrectomy surgery or in post-vitrectomy eye where only ozurdex implant is planned.Keywords: Dexamethasone Implant; Ozurdex; NOVADUR
349 Patient Satisfaction with Regard to Ophthalmic Ultrasound Services Offered at King Khaled Eye Specialist Hospital, Riyadh City, Saudi Arabia: A Cross-Sectional Study , Thafer S Bedaiwi1,2*, Ahmed A AlKhalifa2, Rajiv Khandekar3 and Saleh A AlKhaldi4
AbstractAim: To review patient satisfaction of ultrasound services at a tertiary eye care center.Methods: This cross sectional study was performed in 2019. A survey was performed in Arabic, that queried patient demographics, staff interaction, ease of access, patient satisfaction, and quality of the techniques. Responses were graded on a 5-point Likert scale. The logit score for satisfaction was correlated to demographics and other variables was statistically significant (p < 0.05).Results: Three hundred and sixty-six patients were interviewed. The median patient satisfaction logit score was -13.0 [Interquar-tile range (IQR) -16.1, -8.3; Minimum -29.6, Maximum-8.3]. There were 333 (91%) patients who reported positive satisfaction and 33 (9%) reported very positive satisfaction. Patient satisfaction did not differ based on gender (Mann Whitney p = 0.77). Age was statistically significantly correlated to patient satisfaction (Pearson p = 0.038). The median score of a subgroup of satisfaction for ‘Interaction and Communication’ (-5.1) was statistically better than ‘Technical Quality of Services Offered’ (0.4) and general issues of service (0.2). (p < 0.001). However, it was not significantly different from satisfaction with accessibility of services (-3.3). Conclusion: The high level of patient satisfaction for the ultrasound services provided at a tertiary eye hospital is encouraging. The factors affecting patient satisfaction could be further improved to ensure greater enhancement of ancillary services for ophthalmic patients. Keywords: Client Satisfaction; Ultrasonography Services; Comprehensive Eye Care
350 A Survey on Self-Medication in Ophthalmology in the Lebanese Population , Alaa Bou Ghannam1, Ibrahim Hashim1, Ahmad Al Attar2, Wajiha Jurdi Kheir1, Julien Selim Torbey1, Hana A. Mansour1 and Joanna S. Saade1*
AbstractPurpose:Over the counter eye drops are commonly used in the Lebanese population to manage eye redness and symptoms. We sought to investigate its prevalence in Lebanon by conducting a survey. Methods: This is a cross-sectional prospective study done between November 2017 and March 2020. Volunteers above 18 years of age filled a questionnaire regarding participants’ demographics as well as information about eye redness and related consultations and drop use. Results: Of the 265 individuals studied, the majority were women (58.1%). 111 individuals reported having red eyes in the last 5 years (41.9%). Of these, 72.1% reported using drops, and 83.8% reported consulting someone for their symptoms (pharmacist, medical doctor, ophthalmologist, or others). Ophthalmologists were primarily consulted in 55.9% of cases. Ophthalmologists and pharmacists were more likely to be consulted by individuals between 31 and 50, as opposed to non-healthcare-worker consultations who were more likely sought by individuals between 51 and 70 years (p = 0.038). Tearing (p = 0.002), foreign body sensation (p > 0.001), and blurry vision (p = 0.016) were correlated with consulting someone for eye redness. Tearing (p = 0.003) and foreign body sensation (p = 0.002) were correlated with drop use. Only 34.1% of drop users read instructions, and individuals with a college level of education were more likely to do so. Conclusion: A large proportion of Lebanese patients will self-medicate with over-the-counter drops without consulting a medical doctor or reading the medication pamphlets. This can be potentially detrimental to patients’ eyes, especially if they are unaware of the side effects.Keywords: Self-Medication in the Middle East; Over the Counter Eye Drops Usage; Awareness to Medication Side Effects; Guidelines for Regulation of Dispensing of Medications
351 Analysis of After-Hours Emergent Ophthalmic Surgery in the Ambulatory Surgery Center Setting , Mark Obri*, Alexander Miller, Andrew Yazji, Emily Petrinec and David Miller
AbstractPurpose: To evaluate the feasibility of emergent ophthalmologic surgeries in an ambulatory surgery center (ASC) care setting com-pared to routine ophthalmologic surgeries performed in an ASC. Methods: A retrospective cohort study at a single ASC included an analysis of emergent surgical cases compared to non-emergent surgical cases. Data was provided by searching the ophthalmology practice’s ASC case management database. An emergent case was defined as any case starting after 5:00 pm or any case completed during weekend on-call hours. Cases that were delayed and ran over the 5:00 pm time limit were excluded. The emergent cases were then analyzed based on the type of procedure performed and compared to the non-emergent ophthalmologic surgeries performed at the ASC. Results: In 2018, 27 (34.2%) of emergent cases were started after 5:00 pm and 52 (65.8%) cases were performed during week-end call hours. This is compared to over 6113 ophthalmologic procedures done at the ASC in the same year during normal hours of operation. The division of total 2018 surgeries at this center was 3975 anterior segment eye surgeries, 1919 posterior segment surgeries, 211 oculoplastic surgeries, and 6 corneal surgeries. In total, 79 procedures were done emergently, representing 1.29% of all procedures. Posterior segment procedures were 100% of the emergent cases and constituted 64 retinal detachments (81%), 9 endophthalmitis (11.4%), 2 choroidal hemorrhages (2.5%), 2 vitreous hemorrhages (2.5%), and 2 retained lenses (2.5%). No cases were refused, cancelled, or transferred elsewhere for emergent treatment, or because of lack of access to the facility by patients. Conclusion: A total of 79 cases were successfully completed after-hours or during on-call weekend hours, representing 1.29% of the total amount of cases done in the 2018 calendar year. By allowing weekday 5:00 pm starts and weekend call hours for emergent cases, it appears the ASC setting is able to accommodate for all emergent ophthalmic cases, all of which were posterior segment sur-geries, comprised mostly of retinal detachments.Keywords: Ambulatory Surgical Centers (ASC); Ophthalmic Surgery
352 Teleophthalmology , Reena Gupta1*, Rohan Madan2, Chekitaan Singh3 and Neebha Anand1
AbstractThe current Covid-19 pandemic is recharting the definition of medical consultancy services, in the interest of safety of both pa-tients and health care providers. Telemedicine is a tool that has seen renewed interest in this regard. Doctors across various fields in-cluding ophthalmology are switching to e-consultation formats to improve access to their clientele and to deliver emergency as well as routine care. It is essential to be aware of the various outreach modalities available under the broad umbrella of telemedicine, as well as the medicolegal aspects of such consultancy services. Case consultation for ophthalmologist through telemedicine platforms poses unique challenges and one must be aware as to which tool could act as an efficient adjunct for optimum patient care.Keywords: Telemedicine; Tele-consultation; COVID-19 Pandemic; Telemedicine Challenges; Digital Health Policy; Tele-ROP; ARMD; Diabetic Retinopathy
353 Silent Maxillary Sinus Syndrome , Brittney M Brady
AbstractSilent Sinus Syndrome is an often-overlooked diagnosis and may serve as a diagnostic challenge for clinicians unaware of the condition. Caused by an accumulation of fluid within the maxillary sinus, formation of a negative pressure gradient leads to eventual inward displacement of the sinus walls and downward displacement of the orbital floor. Increased orbital volume, due to reduced maxillary sinus size, may result in painless enophthalmos and hypoglobus on the effected side. Patients may present with complaints of a mild ptosis, facial asymmetry, or vertical diplopia. Although a diagnosis of exclusion, SSS must be considered in the differential diagnosis of any patient presenting with such findings. Neuroimaging is considered essential to make this diagnosis. Keywords: Silent Maxillary Sinus; SSS; Enophthalmos; Hypoglobus
354 Corona Virus and Ophthalmologists , Shahzad Waseem*
We, the humans are facing this novel Corona virus, named Co-vid-19 for the last two years. It has jolted the whole world. Perhaps no human being living today has never seen this type of disease before. The new disease initially was thought to be a respiratory disease.But with each passing day, we are finding its new clinical symp-toms.
355 Effect of Refractive Index on Diopter Glasses for Optical Analysis of Human Eye Using Electromagnetic Wave at Ophthalmology Systems , Nilgun Baydogan
AbstractThe detection of the refractive error is important for the utilization of the optical lens in eye diseases and the determination of the refractive properties is a key parameter at optical sensor systems. Refraction detection is one of the procedures performed by ophthalmologists, and the detection of this feature in the lens of the eye is one of the basic ophthalmology topics to decide the use of the high diopter glasses. Keywords: Coating; Diopter Glasses; Refractive Index
356 Factors Influencing Utilization of Pediatric Eye Care Services in Bangladesh: A Qualitative Study , Nahid Ferdausi1*, Jarin Tasnim Khan2 and Tausif Akib Khan3
AbstractBackground: Visual impairment and blindness in children can be devastating if not addressed timely. The impact of unmet pedi-atric eye care needs in Bangladesh is compounded by barriers to accessing eye care, limited engagement with communities, lack of awareness of parents and caregivers, poor health-seeking behavior, lack of an organized system of case findings, lack of appropriate referral network, and affordability. The purpose of this study was to elucidate factors that influence, positively or negatively, people's willingness to seek and utilize pediatric eye care services.Methods: A qualitative study was conducted to have an in-depth understanding of the utilization of current pediatric eye care ser-vices in Bangladesh. In-Depth-Interviews (IDIs) and Focus Group discussions (FGDs) were used for data collection. Twenty IDIs were completed among policymakers, eye care managers, and service providers. Four FGDs were carried out among parents who attended eye care management in the public hospital and private chamber. Two FGDs were conducted among schoolteachers during school sight testing programs. Thematic analysis carried out.Results: Thisstudy identified several interconnected barriers and enablers that affect the utilization of pediatric eye care services. Several factors like non-availability, poor accessibility of services, non-affordability, poor knowledge of available services have been identified that prevent parents from using pediatric eye care services for their children. Lack of knowledge and information about timely intervention of eye diseases recognized as major barrier. There is an urgent need for involving all key stakeholders to create a greater impact in reducing the burden of childhood blindness.Conclusion:Early detection and management of eye diseases will reduce the burden of visual impairment and disability. Utilization of available eye care services is necessary for the reduction of the burden of visual impairment. Awareness campaigns on available pediatric eye health care services, especially amongst those who live in the rural and remote areas are essential.Keywords: Factors; pediatric eye care utilization; Bangladesh
357 Diagnostic Errors in Ophthalmic Practice during COVID-19 Pandemic , Faizan Mehmood1*, Nabeel Firoz2, Jyoti Shukla1, Sana Alam3 and Pooja Mishra1
AbstractBackground and Objective: The area of diagnostic errors in ophthalmology in COVID-19 pandemic remains profoundly under-studied. To describe a case series of 7 patients with diagnostic errors during COVID-19 lockdown in ophthalmology department of a multispecialty government hospital in north India.Design: Retrospective case series of 7 patients.Participants:Seven patients who visited the general ophthalmology clinic during COVID-19 lockdown period in India.Methods: Retrospective case series of 7 patients who visited the general ophthalmology clinic between April 1 and June 30, 2020 and were found to have diagnostic error on their subsequent visits after further examination and investigations.Results: In case 1, the diagnosis of central serous retinopathy was delayed until the patient returned with worsening of symptoms and was further evaluated for it. In case 2, 3 and 4, misdirected eyelashes, a 1 x 1 mm corneal opacity and a posterior subcapsular cataract respectively were missed on their first visit but the diagnosis was revised on next visit. Cases 5, 6 and 7 presented as red eyes. Allergic conjunctivitis was misdiagnosed as dry eyes in case 5 and as bacterial conjunctivitis in case 6. A foreign body lodged in conjunctiva was misdiagnosed as nodular episcleritis in case 7. The causes for these errors may be unique to the pandemic as both the patients and physicians tried to minimize their exposure.Conclusion: COVID-19 pandemic has been a stressful situation for patient and healthcare workers where prevention strategy lies in hygiene and social distancing measures. While taking all the necessary precautions to control the transmission, it is also our duty to minimize the incidence of diagnostic errors during routine consultations.Keywords: COVID-19; Diagnostic Error; Ophthalmic Practice; Slit-Lamp; Pandemic
358 Retinal Vein Occlusion: Demography, Types and Risk Factors - A Cross-Sectional Hospital based Study , Hara Maya Gurung, Eliya Shrestha, Babita Gurung, Hari Bikram Adhikari and Pawan Baral*
AbstractPurpose: To assess the demographic pattern, types and risk factors of retinal vein occlusion disease of the patients visiting Himalaya Eye Hospital.Methods: A cross-sectional observation study of 246 patients was done at Himalaya Eye Hospital, Pokhara, Nepal during the period from July 2017 to July 2020. All these patients were diagnosed with retinal vein occlusion during this period and were included in the study. Patients with associated complications such as vitreous hemorrhage and macular edema without retinal vein occlusion were excluded from the study.Results: A total of 246 patients were diagnosed as a case of retinal vein occlusion disease during this study period. Age of the patients ranged from 29 to 87 years old with the mean age being 65.95 (± 11.47) years. Elderly populations were found vulnerable to this disease. Total number of males (50.40%) were slightly higher than females (49.59%). Branch retinal vein occlusion (74.80%) was observed to be three times more common than central retinal vein occlusion (25.20%). Hypertension was detected as the most im-portant risk factor for retinal vein occlusion disease followed by increase in age, combined hypertension and diabetes, dyslipidemia and smoking. Conclusion: This hospital-based study of demographic pattern, types and risk factors of retinal vein occlusion would help us to tar-get the specific population of community for awareness programme.Keywords: CRVO; BRVO; Hypertension; Increase in Age
359 Rationale of Ab Interno Trabeculotomy in Combined Surgery of Cataract and Glaucoma in Patients with Far-Advanced Stage of Glaucoma , Ivanov DI*, Nikulin ME and Prokopyeva YS
Purpose of the StudyTo estimate the status of aqueous outflow pathways in vivo dur-ing combined surgery in patients with cataract and far-advanced glaucoma. To estimate the results of phaco with ab interno trabec-ulotomy in patients with far-advanced glaucoma. MethodsAn intraoperative contrast study of natural outflow pathways was performed in 50 eyes with far-advanced glaucoma after ab in-terno trabeculotomy during combined surgery.A retrospective analysis of 38 operations in 32 patients aged from 59 to 83 years (23 males, 15 females) in terms of 3 years and over after surgery. Preoperative visual acuity ranged from light perception to 0.75 (mean, 0.24), IOP varied from 19 to 42 mm Hg (mean, 28 mm Hg). Preoperative hypotensive therapy was used in 85% of cases.
360 Atypical Ophthalmic Manifestations in Covid 19 Pandemic , Gowhar Ahmad
We have been facing COVID 19 pandemic for a long time now and lot of modalities in term of its preventive aspect has been in terms of• Social distancing facial masking and sanitization.• Govt also came up with respective lock downs.Still lot of cases of COVID-19 pandemic occurred may were treated and many lost their precious lives however we have now come up with vivid 19 vaccine with the hope to break the chain of COVID-19
361 Refractive Changes in a Recently Diagnosed Diabetic Patient , Esosa Okundaye
AbstractDiabetes mellitus is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. Hyperglycemia is the most significant risk factor for diabetes and fluctuating levels can result in fluctuating vision. Transient refrac-tive changes are well-recognized features of diabetes and these patients may have both short-term as well as permanent refractive alterations. I present a case of a newly diagnosed type 2 diabetic patient who presented with hyperglycemic induced- hypermetropia on initial examination, with variation in refraction one month after.Keywords: Diabetes Mellitus; Hyperglycemia; Refractive Error; Visual Acuity
362 Torpedo Maculopathy Associated with RP1L1 Mutation and Rod-Cone Dystrophy , Manoj Soman1,2, Jay U Sheth1,2*, Asmita Indurkar1,2 and Unnikrishnan Nair1,
AbstractGenetic analysis of patients with Torpedo maculopathy is scarce in literature with only two previously documented cases with genetic analysis. We report a case of Torpedo maculopathy with Rod-Cone dystrophy associated with an RP1L1 mutation. This case highlights the need for genetic testing in this rare retinal pathology as this may give a clue to the presence of other ocular associations and systemic abnormalities. Keywords: Torpedo Maculopathy; RP1L1 Mutation; Rod-Cone Dystrophy; Genetic Testing; Electroretinogram
363 Retinopathy of Prematurity at the University and Departmental Hospital of Borgou-Alibori in 2019 , Assavedo Codjo Rodrigue Abel1*, Alfa Bio A1, Abouki Coa3, Hounwanou A1, Monteiro S1, Kpanidja G2, Agossou J2, Alamou S3, Sounouvou I3, Tchabi Hounnou S3 and Doutetien Gbaguidi C
AbstractIntroduction: Retinopathy of prematurity is one of the leading causes of childhood blindness, which extent should be known in Benin and especially in Parakou. Aim: To study the retinopathy of prematurity in the University Hospital of Borgou-Alibori in 2019.Methods: It was a cross-section, descriptive and analytical study with prospective data collection, over a period of 6 months, from April 2019 to September 2019 including all premature regardless of birth weight, having received or not oxygen and having at least 04 weeks of postnatal life. They were listed exhaustively after informed consent of the parents.Results: Out of a total of 68 identified premature newborn, 36 had been undergone a fundus examination between the 04th and 06th week of postnatal life. The overall frequency of retinopathy of prematurity was 27.78%. The majority of abnormalities were stage 1 and Area 3 in temporal and were found more among males than in females. The oxygen therapy time (p = 0.026), gestational age (p = 0.0003), low birth weight (p = 0.026), the intraventricular hemorrhage (p = 0.015) and the red cell transfusion (p = 0.015) were significantly factors associated with retinopathy of prematurity.Conclusion:The frequency of retinopathy of prematurity in CHUD-B/A at Parakou is relatively high. It would be wise to educate health professionals for a systematic proposal of a fundus examination in all premature infants that may allow to make an early diagnosis of this disease.Keywords: Retinopathy of Prematurity; Blindness; Associated Factors; Parakou
364 Evaluation of Keratoconus Progression after Intrastromal Corneal Ring Segments Implantation , Livia Cristina Rios1*, Aristofanes Canamary Jr1,3, Henrique Figueiredo2, Mariana Amaranto de Souza2, Pablo Felipe Rodrigues3, Rodrigo Teixeira Santos1,3 and Bernardo Kaplan Moscovici1,3
AbstractObjectives: To report the evaluation of keratoconus progression after Ferrara intrastromal corneal ring segment implantation. Materials and Methods: In this retrospective study, we evaluated progression in eyes with keratoconus after intrastromal corneal ring segments implant. It was considered progression when the increase of the maximum keratometry was greater than 1 diopter (D) when comparing the first postoperative exam (6 months), and the last exam.Results: There was no progression after the surgery. when comparing the mean maximum keratometry pre-op (46.75D) and the pos op data (46.01D), with statistically significant (p-value: 0.047). An increase of less than 1 D in these patients was also observed. In a descriptive analysis, 41 eyes were studied: 8 eyes had an increase greater than 1 D, 19 eyes had an increase equal or less than 1 D and 14 eyes maintained the initial D or had decreased within the years. Analyzing patients ≤ 21 years, the variation of maximum keratometry between 6 months postoperatively was higher in this group (1.82 D ± 3.11) than in the group with more than 21 years(0.5 D ± 1.27). This data was not statistically significant (p = 0.148). Conclusion:This study showed an evolution of maximum keratometry in the postoperative period of the intrastromal ring surgery. However, this increase in the stipulated time of the study was less than 1 D in the majority of patients.Keywords: Keratoconus; Corneal Diseases; Corneal Stroma; Cornea; Corneal Topography
365 Analysis of Choroidal Macular Thickness in Early Post-Covid-19 Patients , Jeniffer Domingues de Jesus1*, Raquel J Soares1, Libânia M Dias2, Suzana M Ventura1 and João C Pedro1
AbstractPurpose: Corona Virus Disease 2019 (COVID-19) is considered a critical global health challenge. Several investigations have sug-gested vascular dysfunction caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, but regarding ophthalmic involvement, only few data are available. Our aim was to evaluate the choroidal involvement in post-COVID-19 patients.Methods: 40 eyes from 40 patients with previous SARS-CoV-2 infection and 40 eyes from 40 age matched controls were included. Choroidal measurements were made using Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) at 13 different loca-tions: at central fovea and at intervals of 500μm to 1500μm away from the fovea in the temporal, nasal, superior and inferior regions. Results: Post-COVID-19 patients showed a significant increase in choroidal thickness compared with the control group for all the regions analyzed (all p <0.01). In the Post-COVID-19 group, the choroid is thickest subfoveally and thinnest 1500μm nasal from fovea. In both groups, the superior and temporal macular choroid has been measured thicker than the inferior and nasal macular choroid, respectively. Conclusion: Our results cautiously suggest that post-COVID-19 patients showed an increase in choroidal thickness compared to control groups. This choroidal thickening may reflect the importance of vascular factors in the pathogenesis of SARS-CoV-2 infection. Keywords: Choroid; COVID-19; Hemodynamic Changes; Ocular Circulation; Retina; SARS-CoV-2
366 Psychological First Aid (PFA) in Improving Staff Confidence in an Eye Hospital during Times of Uncertainty from Ensuing Covid19 Pandemic , Kaushik Murali1*, Gokul Ratakonda2 and Geeta Fulari3
AbstractPurpose: To study the effect of using principles ofPsychological First Aid (PFA) in improving healthcare worker (staff) confidence in an eye hospital during times of uncertainty from ensuing COVID19 pandemic.Methods: Patient Health Questionnaire was designed to gather data about the impact of current pandemic on doctors and staff. Data was also gathered through interviewing the staff and the doctors. To address all the concerns, 5 components of Psychological First Aid (PFA) in communication were used, and also in the provisions made at the workplace to help alleviate this impact. PFA is an initial disaster response intervention with the goal to promote safety, stabilize survivors of disasters and connect individuals to help and provide resources. Staff were re-interviewed to assess their confidence levels. Campaign was created to look at other aspects of routine hospital functioning that could impact safety and outcomes beyond COVID19 and report to the Quality Team. Results: The mean PHQ before interventions was 3.98. Post intervention and return to work, the PHQ score in doctors and staff was only 0.94. Survey showed absolutely no signs of any psychological distress amongst staff. Targeted trainings showed 94% response rate. 3% staff opted for sabbatical which was taken as a surrogate for safety. A random survey of 29 staff showed that 48% were con-fident of all tasks adhering to COVID19 protocols, which increased to 96.5% in 3 months. Discussion: Motivation of healthcare workers was seen to be beyond just financial aspects. There was a strong sense of belonging and duty as identified in our survey. This increases the onus on organisations towards addressing the concerns of healthcare workers providing psychological support. PFA is a proven tool that can help reduce distress in a time of fear, anxiety and uncertainty. Though we did not implement the PFA in the manner it is used typically in natural disasters for individuals, implementing a programme, looking at the principles of - feeling safe, connected, efficacious, calm and hopeful for the cohort of health workers, brought down the distress as measured by the PHQ-9 questionnaire from 3.2 to 0.94 and seems to have a value even beyond the pandemic. Conclusion: Implementing targeted interventions based on the principles of psychological first aid can help reduce psychological distress among health care workers in times of uncertainty in an eye hospital.Keywords: COVID-19; PFA (Psychological First Aid); Psychological Distress; Pandemic; PHQ (Patient Health Questionnaire); Coun-selling; SanQALP - Sankara Quality Assurance and Learning Programme
367 Evaluation of Factors Predicting Glaucoma Damage in Patients with Primary Open-angle Glaucoma , Maria Marenco1, Andrea Palamini1, Carlo Alberto Cutolo1, Giulia Agosto1, Antonio Ferreras2, Carlo Enrico Traverso1 and Michele Iester1*
AbstractPurpose:To evaluate factors predicting glaucoma damage in primary open-angle glaucoma (POAG) eyes.Methods:20 POAG patients were examined in this retrospective study. The most affected eye was analyzed. Peripapillary (P) cho-roidal thickness (CT) and macular (M) CT were measured by Swept Source Optical Coherence Tomography. Correlation between CT retinal nerve fiber layer thickness (RNFLT) and ganglion cell-inner plexiform layer thickness (GCIPLT) and various other factors inc-luding mean deviation (MD), pattern standard deviation (PSD), mean superior and inferior hemifield sensitivity was also assessed by Pearson’s r correlation coefficients and linear regression model.Results:Superior and inferior nasal MCT and PCT were significantly correlated with MD (r = 0.509, r = 0.507, r = 0.577, respectively). MD was positively associated with mean GCIPLT (r = 0.517, p = 0.02) and each GCIPLT sector (p < 0.05), except for the nasal sector. A positive relationship was found between RNFL thickness (mean and each sector) and MD (p < 0.05). PSD was negatively correlated to both GCIPLT (r = - 0.695, p = 0.001) and RNFL thickness (p < 0.05). Among mean PCT, mean MCT, RNFL thickness and mean GCIPLT, only RNFL thickness (β = 0.85, p = 0.011) and mean PCT (β = 0.521, p = 0.021) were predictive factors of MD in the linear regression model.Conclusions: RNFL thickness was the most predictive factor of MD, followed by mean PCT. RNFL thickness seems to be the most useful parameter to predict glaucoma damage in clinical practice.Keywords: Glaucoma; Swept Source Optical Coherence Tomography; Choroidal Thickness; Retinal Nerve Fiber Layer
368 Phacomatosis and Ocular Manifestations of Neurofibromatosis , Gowhar Ahmad
Phacomatosis is a group of conditions where their is tumour formation in CNS skin and eye exact cause is not known however genetic predisposition is a strong factor usual onset with life long duration it has got systemic complications treatment is not kind of certainty however laser therapy and removal of growths is ad-vocated.
369 Treatment Update for Dry Eyes and Blepharitis , .Shahid Bashir Ahmad*
These ocular conditions are very common but difficult to treat. Treatment strategy depends upon the severity of signs and symp-toms. Following is a general guideline on the different tools avail-able for managing these poorly-understood and multi-factorial conditions.
370 Digital Eye Strain during Pandemic Covid-19 , Shua Azam*
As we went through high exposure to digital screen during pandemic of Covid 19 and almost every person faced ocular dis-comfort. Disturbance and discomfort related to the use of digital devices which affect ocular system and results from glare, accom-modation disorders, fixation disparity, dryness, fatigue is termed as digital eye strain [1]. There are two types of eye strain. In in-ternal type sensations of strain and pain is felt inside the eye and caused by accommodative and convergence disorders while in an external type dryness and irritation is felt on the front of the eye and caused by changes environmental conditions [2]. Blurred vi-sion, tearing, tired eyes, burning sensation, redness and double vi-sion are common ocular symptoms and stiff neck, general fatigue, headache and backache are non-ocular symptoms associated with eye strain [3-5]. Studies around the world showed that increased use of digital devices correlates with increased symptoms of digi-tal eye strain [6]
371 Evolving Evidence about the Role of Choriocapillaris in Pathogenesis of Uveitis , Hashim Ali Khan1,2* and Smaha Jahangir2
AbstractChoriocapillaris and retinal pigment epithelium maintain as mutualistic metabolic relationship. Insult to either tissue affects the other in number of chorioretinal diseases. Many uveitides have their main activity around retinal pigment epithelium and surround-ing tissue. Optical coherence tomography angiographic (OCTA) studies have demonstrated the involvement of choriocapillaris in acute phases and subsequent disruption and formation of irregular capillaries in multiple studies. OCTA has expanded our abilities to study choriocapillaris with greater detail. This short review summarizes the changes in choriocapillaris in choriocapillaropathies and other uveitides. Keywords: Retinal Pigment Epithelium (RPE); Choriocapillaris (CC); Indocyanine Green Angiography (ICGA); Fundus Fluorescein Angiography (FFA)
372 Comparing and Evaluating Photo Stress Recovery Time in Diabetic and Normal Population , Aakash Shrestha1 and Manish Dahal2*
AbstractBackground:Photo stress recovery time is the time it takes for the macula to come back to its normal function level after exposure to a strong light source. Early diagnosis is well known to be important for effective diabetic retinopathy treatment. In recent years, the focus has been on considering macular recovery after glare as a parameter that is altered not only in manifest retinopathy, but also in the preclinical stage. Method: A cross-sectional study was conducted at ASG Eye Hospital, Nepal. The study population consisted normal, diabetic and diabetic retinopathy patients. The photo stress test was performed on each patient. Statistical analysis was performed using SPSS for windows. Result: Of total 90 subjects, the mean photo stress recovery time (PSRT) of normal patients on right eye and left eye were 7.46 ± 1.87 and 7.5 ± 1.54 sec respectively, mean PSRT of diabetic patients on right eye and left eye were 14.03 ± 2.39 and 14 ± 2.32 sec respec-tively and mean PSRT of diabetic retinopathy patients on right eye and left eye were 55.83 ± 8.26, 57.46 ± 7.76 sec respectively. PSRT obtained from the 3 groups of subjects was statistically different (p < 0.001).Conclusion: PSRT values depend upon the clinical status of the retina. These findings highlight the need and efficacy of simple tech-nique which can be very useful to anticipate diabetic retinopathy from diabetic patients.Keywords: Diabetes; Diabetic Retinopathy; Macular Function; Photo Stress Recovery Time; Retinal Recovery
373 The Effect of Mitomycin-C Application Time on Pterygium Recurrence After Surgical Excision , Pir Salim Mahar1*, Abdul Sami Memon2 and Israr Ahmed Bhutto
AbstractObjective: The purpose of the study was to establish the safest and the most efficacious duration of application of MMC in patients undergoing primary pterygium excision to prevent recurrence. Methods: An interventional study wascarried out at Isra Postgraduate Institute of Ophthalmology/Al-Ibrahim Eye Hospital, Karachi, Pakistan from 2010 till 2017. Patients underwent surgical removal of pterygium using bare sclera method with MMC in concentra-tion of 0.2 mg/ml (0.02%) with variable exposure time of 1 - 5 minutes. Classification of patients was done randomly with MMC ap-plication time ranging from 1 to 5 minutes. Patients were followed at 3, 6, 9 and 12 months postoperatively to record any recurrence. Results: A total 273 eyes of male patients with mean age of 35.9 ± 1.23 years were included in the study. The overall pterygium recur-rence rate at each follow-up was 5.66%, 6.92%, 7.90% and 9.3% at 3rd, 6th, 9th and 12th months respectively. There was a significant decline in recurrence in the number of patients with MMC application time of greater than 3 minutes at all follow-ups. Maximum of recurrence was seen in patients between 31 to 40 years at the final follow-up.Conclusion: These results suggest that a MMC application time of less than 3 minutes increases the chances of pterygium recurrence after surgical excision. MMC application time of greater than 3 minutes is recommended to prevent recurrence of such high risk recurrent pathology. Keywords: Pterygium; Recurrence; Mitomycin-C; Duration
374 Secondary Angle Closure Following Panretinal Yellow PASCAL Laser Photocoagulation , Tatiana Vélez Osorio1*, Nassim Abreu2 and William McCollum
AbstractObjective:To report the case of a patient with severe non-proliferative diabetic retinopathy who developed angle closure after un-dergoing retinal photocoagulation (PRP) with a yellow Pascal 577 nm laser.Observation: 30-year-old male with severe non-proliferative diabetic retinopathy presented with severe ocular painand nausea one day after undergoing laser photocoagulation in the left eye for the treatment of his diabetic retinopathy. His visual acuity was 20/200 and his intraocular pressure (IOP) was 45 in his left eye. It had a shallow anterior chamber that was closed on gonioscopy. Ultrasonic biomicroscopy (UBM) reported an anterior chamber of 1.68 mm with narrow iridocorneal angles. He was managed with medica-tions to reduce IOP, which includedcycloplegics, topical and oral steroids. He was closely followed with serial examination and the intraocular pressure was reduced before developing glaucoma.Conclusion: Patients presenting with ocular pain and increased IOP afterlaser photocoagulation should increase suspicion for angle closure. Limiting the number of laser burns and the amount of retinal area treated can prevent this problem from occurring.Keywords: Secondary Angle Closure; Angle Closure Glaucoma; Retinal Pan-Photocoagulation
375 Retinal and Body’ Stem Cells Reprogramming , Massimo Lombardi*
A new therapeutic method for the Regenerative Ophthalmic and General Medicine.Using an homotoxicological pharmaceutical blend therapy through retrobulbar injections to “reset” the “body’ programma-tion” deteriorated by environmental life’ conditions completely and worsly changed from the first “original programmation” in the legendary “Eden” where through the “environmental con-ditions”, in which life is then started and “humans” have been originally created and programmated, that were completely dif-ferent from to day environmental planet-earth conditions com-pletely deteriorated, reason for which the human autologous stem cells, to day, do not work any more completely, automati-cally repairing and regenerating damaged tissues and organs as should be by their original programmation and mission because practically now we are subjected to completely modified and de-teriorated biological situations
376 Disabling Cataract in Swat; How Big is the Problem? , Yasir Iqbal Malik1*, Aqsa Malik2 and Waqas Ahmad3
AbstractBackground: Visual impairment caused by cataract is a major cause of treatable blindness. Vision 2021: the Right to Sight, a global initiative launched by a coalition of non-government organization and the World health Organization (WHO), is to eliminate avoid-able visual impairment and blindness on a global scale. In order to accomplish this goal it is important to know the prevalence of disabling cataract in community, especially in developing countries. Objective: To estimate the prevalence of disabling cataract in Swat who need surgery.Settings: Conducted at free eye camps in seven Tehsils of Swat, KPK. Duration: 4 months from September 2018 to January 2019.Materials and Methods: It was a descriptive study using convenient sampling method for sample collection. The selection criteria was patients having cataract of any age and of any gender. The exclusion criteria was no perception of light in the eye, mental retarda-tion, psychiatric illness and physically handicap or too young patients unable to undergo slit lamp examination. Retro illumination technique was adopted on the slit lamp to detect presence and type of cataract according to Lens Opacity Classification System III (LOCS III). Demographic data and ocular examination were recorded on a proforma and was analyzed using SPSS version 22. Results: The disabling cataract was estimated to be 17.5% in patients with a mean age of 62.28 ± 9.10 years. The most common type of cataract was found to be nuclear followed by posterior sub capsular. Bilateral cataract was found in 31.3% of the females.Conclusion: The prevalence of disabling cataract in swat region is high leading to high rate of reversible blindness in the region. Specific measures should be taken by the health authorities to address the problem.Keywords: Cataract; Swat; Blindness
377 Corneal Epithelial Toxicity Following Intraoperative Use of Mitomycin C during Trabeculectomy - A Case Report , Lalitha KJ1*, Meena Gopinath Menon1 and Pallavi Joshi2
AbstractWe report a case of post-operative corneal epithelial toxicity following intra operative subconjunctival use of Mitomycin C for 1.5 minutes in twin site phacoemulsification and Trabeculectomy. Patient was doing well till 15 days after the surgery with the clear cornea and 20/20 vision. Then he noticed diminution of vision and cornea showed multiple punctate corneal erosion. On persistence of the lesion till five weeks after the surgery corneal scraping was done and sent for histopathological examination which showed Mitomycin related toxicity. With proper diagnosis and treatment patient improved well with a central clear cornea and vision 20/30. With guarded use and keen eye for possible complications in the follow-up visits one can avoid the undesirable and hazardous effects of MMC.Keywords: Corneal Epithelial Toxicity; Mitomycin C; Trabeculectomy
378 A New Insight into Ophthalmology: Calculation of Choroidal Vascularity Index , Cihan Buyukavsar*
The significance of the choroid in ophthalmology is increasing day by day. The unknowns about the choroid continue to be elu-cidated in light of many studies in the literature thanks to the de-velopment of optical coherence tomography (OCT) technology and the use of enhanced depth imaging (EDI) features. The primary function of the choroidal layer, which is mainly composed of blood vessels, is to provide blood supply to the outer retina. Interstitial stroma containing melanocytes and connective tissue are other structures that make up the choroid along with blood vessels [1]. Today, the choroidal layer has at least three other main functions, which are thermoregulation, adjustment of retinal position by choroidal thickness change and secretion of growth factors. Any defect that may occur in the choroidal layer may lead to degeneration, neovascularization, myopia, or hyperopia due to impaired emmetropization and possibly the initiation of various pathological processes that would be revealed through further studies [2]. The choroid plays a crucial role not only in choroidal inflammation but also in retinochoroidal diseases, which are com-mon in populations, such as diabetic retinopathy (DRP) and age-related macular degeneration (AMD) [
379 Some of Ocular Side Effects of D M and Obesity , Gowhar Ahmad
The incidence and prevalence of DM I has shown a great spike and it is a kind of global.Disease which is now attributed to the life style pattern so many factors are responsible for its hike.Genetic sedentary life style lack of regular exercises over eat-ing family history of DCM smoking CVS ailments stress strain in obesity.
380 Analysis of Vitamin D Levels in Children with Progressive Myopia , Sowmya Raveendra Murthy1* and Nitya Raghu2
AbstractBackground: The increasing prevalence of myopia in children today deserves more exploration into the causes and possible modifi-able factors. With the growing prevalence of vitamin D deficiency in India, and its effect on numerous body systems, we attempted to find a possible association between vitamin D deficiency and progressive myopia. Aim: To analyse the vitamin D levels in children with progressive myopia.Methods: This is a pilot study. Children with progressive myopia on treatment with low dose atropine showing progression (> 0.5D increase in last 6 months) were included to be a part of the study. Few of these children showed progression despite being on low dose atropine which prompted us to search further. Serum levels of vitamin D3 levels were ordered and analyzed.Results: Total of 20 children, 9 boys and 11 girls, were included, all in the age group of 11 to 17 years. Low dose atropine eye drops were being used for more than a year in 17 children and rest for past 5 months. Serum vitamin D 3 levels were noted to be deficient (< 20 ng/ml) in 15 patients and insufficient (20 - 30 ng/ml) in 3 cases. Only 2 patients were noted to have normal levels above 30 ng/ml. Conclusion: Our pilot study throws light on possibly using vitamin D 3 levels in our protocols in treating children with progressive myopia.Keywords: Progressive Myopia; Vitamin D Deficiency; Atropine Eye Drops
381 Orbital Lymphoma and Spontaneous Gastric Perforation, Rare and Fatal Complication , Juan-Edrick Gonzalez-Mondragon1, Luis Renato Vidaña Torres1, Adriana Dávila Camargo2*
AbstractOrbital lymphomas represent 1% of non-Hodgkin lymphomas. Spontaneous bowel lymphoma perforation is rare and mostly asso-ciated with aggressive behavior. Diffuse large B-cell lymphoma is the most common lymphoma associated with intestinal perforation. We present a case report of a 56 years old patient who presented to our Oculoplastics department with a history of rapidly progres-sive proptosis and severe visual loss. After orbital lymphoma suspicion, a biopsy was conducted. During the post-operative period, the patient began with acute abdomen symptoms that required exploratory laparotomy. Multiple intestinal perforations were found through the surgery. Unfortunately, our patient evolved torpidly, presenting as well SARS-COVID 19 infection, perishing in the next days. In conclusion, even though a primary orbital lymphoma is suspected, we recommend deliberate systemic evaluation at the time of diagnosis and remembering COVID pandemic can worsen any hospitalized patient's prognosis.Keywords: Orbit; Orbital Lymphoma; SARS CoV-2; Orbital Tumor; Gastric Perforation
382 Corneo-Uveal-Retinal Adverse Effects after Single Course of Targeted Anti-Cancer Therapy: Case Report and Review of Literature , Maaly Abdel Halim Abdel Fattah1,2,3*, Tariq Abdulmohsen Al-Anazi2, Sara Sohail Kayali3, Yasser Saleh Almuzaini4 and Faisal Mesfer AlQahtani
AbstractOral anti vascular endothelial growth factors therapeutic agents have been evolving rapidly over the last past decades and became one of the great contributors to advancement of cancer therapy and increasing survival rate of the treated patients.Sorafenib is FDA approved medications for the treatment of solid tumors.In this article, we reported the clinical features of the first Saudi patient presenting with corneo-uveal retinal adverse effects with subsequent bilateral irreversible blindness.Keywords: Hepatocellular Carcinoma; Targeted Anti-Cancer Therapy; Sorafenib; Oral Anti-Vascular Endothelial Growth Factor; Ocular Toxicity; Irreversible Blindness
383 Analysis of Visual Function and the Effectiveness of Assistive Devices in a Glaucoma Cohort at a Tertiary Eye Hospital , Meena G Menon*
AbstractBackground: Since quality of life depends fairly on individual ability to perform everyday tasks, a better understanding of the dif-ferent types of visual disability that patients with glaucoma encounter, becomes almost imperative to the clinician in tailoring their approach to delivering superior visual care. Aims: To analyse effect of glaucoma on parameters of visual function, across 3 grades of disease severity and to evaluate efficacy of assistive devices in functionally rehabilitating these individuals. Settings and Design: Observational 3 group cohort clinical assessment study of 120 eyes of 60 patients diagnosed with glaucoma, between August 2017 and January 2018. Materials and Methods: The disease severity of these eyes were graded. Visual function was subjectively assessed with a question-naire and objectively by colour vision, contrast sensitivity, visual field, binocular function. Data thus obtained was analysed against each grade of disease severity. Based on subjective assessment; assistive devices (magnifying spectacles, magnifiers, illumination devices, Fresnel prisms) were tried and their effectiveness analysed. Statistical Analysis: Paired and unpaired t test and ANOVA. Results: 61 patients (40 males and 21 females), with mean age of 60.43 years were enrolled. Majority (69.16%) had Primary open angle glaucoma. Most of them had moderate to severe (29.6%) and severe (27.7%) glaucoma. While there was no significant dif-ference among groups in terms of colour vision loss, significant loss of contrast sensitivity in 65.7% and stereoacuity in 66.6% was observed. Of the 19 eyes evaluated for low vision, 14 of them were given trial of magnifiers and illumination devices for reading difficulty, other 5 were given trial of Fresnel prism. All of them improved with the respective devices. Conclusion: Glaucoma affects colour vision, contrast sensitivity and stereopsis, in addition to visual field and acuity, thus contribut-ing to poor quality of vision. One cannot ignore the possibility of including evaluation of these parameters of visual function as part of the routine glaucoma work-up, for a holistic approach to visual care Fresnel prism as a potential visual aid, subject to further study.Keywords: Visual Function; Fresnel Prism; Assistive Devices; QoL
384 Macular Thickness Changes in Normal and Glaucomatous Eyes , Mona Abdelkader*
AbstractPurpose: To evaluate macular nerve fiber layer thickness (NFL) in glaucoma patients by optical coherence tomography, to correlate between total macular thickness, macular NFL thickness and peripapillary NFL thickness and to correlate between macular thick-ness and peripapillary NFL thickness and visual field changes. Participants: Total "60" subjects (110 eyes) were studied including: 30 normal subjects (60 eyes) and 30 glaucoma patients (50 eyes).Methods: Optical coherence tomography (OCT) was used to measure macular NFL thickness, total macular thickness and peripapil-lary NFL thickness in each diagnostic group. Main Outcome Measures:Measurements of macular NFL thickness, total macular thickness, peripapillary NFL thickness in total mean, (4) quadrants and (12) clock hours.Results: A significant difference in macular NFL thickness between normal and glaucoma patients was observed. Mean macular NFL thickness demonstrated a stronger correlation with visual function than mean total macular thickness (R = 0.7, P =0.02 versus R = 0.45, P = 0.05). Inner ring, outer ring, mean macular thickness were found to be significantly different between normal and glaucoma patients.Conclusion: Thinning of both macular NFL and peripapillary NFL in glaucoma suggested that retinal ganglion cells of both the macu-lar and peripheral retina are involved in the degenerative process of glaucoma. Macular NFL is a better surrogate marker for glaucomatous damage than total macular thickness. Peripapillary NFL may be the most useful clinical marker in diagnosing and monitoring glaucomatous damages among all three measurements. Keywords: Macular Nerve Fiber Layer Thickness; Glaucoma; Optical Coherence Tomography
385 Efficacy and Safety of Corneal Collagen Crosslinking in Treatment of Progressive Keratoconus with Consideration to the Long-Term Results , Solodkova EG, Fokin VP, Balalin SV* and Melikhova IA
AbstractPurpose: To evaluate the efficacy and safety of a modified technique of corneal collagen crosslinking (CXL) versus standard protocol basing on changes of clinical and morphological characteristics of the cornea in the early and late postoperative period.Materials and Methods: Two groups of patients were examined: group I (25 persons/25 eyes) consisted of patients treated for progressive keratoconus in accordance with a standard protocol of corneal collagen crosslinking, group II comprised those, who underwent crosslinking, performed in a modified technique - 36 persons (36 eyes). Prior to and after the procedure (1, 3, 6 and 12 months postoperatively), all patients had an extensive eye examination, including optical coherence tomography (OCT) of the cornea (OCT RS-3000, Nidek, Japan), confocal microscopy (Confoscan4, Nidek, Japan).Results: Faster re-epithelialization of the cornea occurred in the 2nd group. In both groups there was observed a significant increase of UCVA (from 0,15 ± 0,12 to 0,35 ± 0,14 in the first group and from 0,13 ± 0,11 to 0,33 ± 0,14 in the second) and BCVA (from 0,3 ± 0,18 to 0,05 ± 0,12 in the first group and from 0,4 ± 0,16 to 0,6 ± 0,18 in the second group) at 6 and 12 months follow-ups. One month postoperatively a well-defined rear stromal haze or "demarcation line" was confirmed by OCT and microscopy in all the treated eyes. By that time the depth of "demarcation line" location averaged 262 ± 15,0 μm in the 1st group and 255 ± 10,0 μm in the 2nd. The confocal microscopy revealed that histomorphologic changes were more pronounced in the first group within the whole follow-up period. Starting from the third month of observation a statistically significant downtrend in the rating of all the studied symptoms, with persistence of that tendency in the time that followed - at 6 and 12 months check-ups, was registered in the 2nd group of patients, which pointed at milder and faster corneal recovery after CXL performed in accordance with the modified technique. Endothelial cell density (ECD) remained unchanged in all the cases in both groups within the whole follow-up period. Conclusion: 1. Positive dynamics in postoperative UCVA and BCVA values, inalterability of ECD in all the cases allowed considering both op-tions of corneal collagen crosslinking safe, with comparable clinical efficacy.2. However, in view of more evident increase of BCVA in the second group, milder recovery in the early postoperative period and achievement of adequate and safe level of histomorphologic corneal changes after CXL, the modified technique of progressive keratoconus treatment seemed to be more advantageous.Keywords: Keratoconus; Crosslinking; Modified Technique
386 Catcher Pole Scleral Fixation for Repositioning of Dislocated IOL in Vitreous Chamber , A Scupola1,3, Maria Ludovica Ruggeri1*, A Savastano2,3, MA Blasi1,3 and S Rizzo2,
AbstractPurpose:To describe a new surgical instrument for IOL repositioning in scleral fixation procedures designed to help the surgeon to catch the haptics of the dislocated IOL and then handle them to scleral fixation. Methodology: Twenty-one eyes of 21 patients who underwent IOL repositioning procedure through the handling of this new surgi-cal tool were enrolled in this observational study. The instrument is a flute needle with several side slits that allow the passage of a looped suture (10-0 polypropylene ethicon Prolene EH7896) in order to obtain a tool similar to a catcher pole to engage the haptics and ease the handling during scleral fixation procedure.Results: This procedure has shown to be effective in terms of optic rehabilitation and surgical outcomes.Conclusion: The use of this tool simplifies IOL repositioning during sutured scleral fixation technique representing a valuable help for the surgeon in obtaining satisfying anatomical and visual outcomes.Keywords: Intraocular Lens Dislocation; Intraocular Lens Repositioning; Personalized Medicine; Innovative Biotechnologies; Scleral Fixation; Vitrectomy
387 Women in Ophthalmology , Sirisha Vinzamuri*
Let’s peep into history and see where it all started.In Washington, DC, Isabel Hayes Chapin Barrows inserted her calling card into the Daily Morning Chronicle in 1871, becoming the first “lady oculist” in the United States. She established a list of firsts during her career: first woman admitted to the University of Vienna in Austria to study ophthalmology, first woman employed with regular pay as stenographer for the US congressional com-mittees and privately for Secretary of State William H. Seward, first woman appointed to the faculty of Freedman’s Hospital and How-ard University in Washington, DC, and the first woman to make indi gent care a part of her ophthalmic practice. Isabel Barrows also financed her husband’s schooling and raised 2 children while fulfilling other roles as missionary, editor, reporter, prison reform-er and ambassador.
388 Slit Lamp Exophthalmometry, An Alternate for Hertel Exophthalmometry , Diwakar Rao1*, Tirtha Acharya2 and Basanta Singh2
AbstractPurpose: To compare the value of slit lamp exophthalmometry with Hertel exophthalmometry in normal subject. Methods: A prospective study was performed using 200 subjects. Prior permission was taken from each individuals and consent form was signed by all subjects after informing about tests used in the study. Brief medical and ocular history was taken from the subjects and slit lamp examination was done. Exophthalmometry reading was taken from both Hertel and Slit lamp exophthalmometer and values were analysed.Results: The exophthalmometry value measured from Hertel and Slit lamp Exophthalmometer were similar with ICC of 0.828 and 0.807 for OD and OS respectively. The mean value of OD with Hertel and Slit lamp were 17.81 ± 0.948 and 17.82 ± 1.066 respectively and for OS were 17.94 ± 0.935 and 17.80 ± 0.956 respectively. The exophthalmometry values of males were greater than the females using both techniques. The exophthalmometry value between OD and OS were similar using both techniques. Conclusion: Slit-lamp exophthalmometry offers a simple, easily available, and reliable non-touch technique that does not require an exophthalmometer. Thus, slit lamp exophthalmometry can be Alternative for Hertel exophthalmometer. Keywords: Exophthalmometry; Slit Lamp; Hertel; Exophthalmometer
389 Combination of Collagen Cross Linking with INTACS for Treatment of Advanced Keratoconus CXL Plus INTACS for Keratoconus , Indra P Sharma*
AbstractKeratoconus is a chronic corneal disease that could lead to severe visual impairment or even blindness if left untreated. Advanced keratoconus is rare but difficult to manage. In this report, we present a case of an advanced keratoconus and its management with a combination of Collagen Cross linking with intra-corneal ring segments (INTACS). It summarizes how a rare condition could be halted progression and rehabilitate vision.Keywords: Intra-Corneal Ring Segments (INTACS); Keratoconus; Collagen Cross Linking
390 Virtual Conversation with Hippocrates Spirit , Edward A Skoufis
Main Text Wherever the art of Medicine is loved, there is also a love of Hu-manity. HippocratesWithout romanticism and humanism the medicine will be a “surrealistic picture without spirit and colors”. EDASK The greatest medicine of all is teaching people how not to need it. HippocratesTake a different approach to health and wellness that utilizes the armor of preventive medicine and principles of its lifestyle. EDASKIf someone wishes for good health, one must first ask one-self if he is ready to do away with the reasons for his illness. Hippocrates
391 Spontaneous Suprachoroidal Hemorrhage: A Rare and Devastating Injury , A Manton*, W Saldana and F Peck
AbstractA male 86 year old pseudophakic patient with a poorly controlled end stage primary open angle glaucoma presented to the emer-gency department with an unprovoked, spontaneous expulsive suprachoroidal hemorrhage. An evisceration was conducted under general anaesthetic with a good surgical outcome. Keywords: Glaucoma; Spontaneous Suprachoroidal Hemorrhage; Bacterial Keratitis; Evisceration
392 Ocular Morbidity from Trauma; A One Year Survey , Shah Md Rajibul Islam1*, Omar Jafarullah2, Golam Rabbani3 and Shah Md Bulbul Islam4
AbstractIntroduction: Trauma is one of the leading cause of ocular morbidity worldwide. More common in young male. This study aims to outline the seriousness of the condition.Methods: This cross sectional observational study was done from the imaging room (B Scan USG) of all the patients with ocular trauma that had been advised for a BScan USG. It was done from July 2019 up to June 2020. Age and sex was noted, causative agent was identified, BScan USG findings were noted.Results: Out of 2653 patients, 82% were male. Mean age was 29 ± 10.4 (06 - 72) years. 68% were open globe injury and 32% were closed globe. High speed projectile was the highest 30% followed by blunt trauma 20%, Sharp kitchen objects 18%, RTA 10%, toy 12%, Stationary 5%, Fight 3% and Vegetative trauma 2%. Traumatic cataract resulted in 42% followed by vitreous hemorrhage 38%, endophthalmitis 18%, retinal detachment and lens dislocation 12% and hyphema 10%.Conclusion: A large number ocular trauma can be avoided if proper safety equipment is used and precautions taken. Large number of ocular morbidity occurs in young males every year resulting in socio-economic burden. We as clinicians should advocate strong legislation to prevent work related ocular injury.Keywords: Ocular Trauma; B Scan USG; Work Related Ocular Injury
393 The Effect of Sustained Eye Rotation Upon Central and Peripheral Refraction in Young, Adult Myopic Subjects , Saleh A AlKhaldi1*, Ajay Kumar2 and Lyle S Gray3
AbstractAim: To determine whether ocular movement can affect the shape of the globe and lead to measurable refractive change as the rigid-ity of myopic eyes are lower than emmetropic and hyperopic eyes. Methods: Twenty three healthy subjects aged 18 to 30 years old participated in the experiment, and all mean spherical equivalent of refraction (MSE) was ≤-1.00DS with central cylindrical refraction < -1.25 DC. One drop of tropicamide hydrochloride 1% was instilled 20 minutes prior to measurement to induce mydriasis and mild cycloplegia. Central and peripheral refraction (20 degrees temporal retina) was measured using a hand held infrared auto-refractor (Grand Seiko FR-5000) with a minimum of ten static mea-surements being averaged to give the MSE at each location.Results: There was no significant variation in central and temporal MSE with ocular rotation, even after 10 minutes of off-axis fixa-tion. Considerable inter-subject variation was observed in this effect. Ten minutes of eye rotation caused a further increase in myopia at the temporal location in a sub-group.Conclusion: The action of the extraocular muscles on the globe has a measurable effect upon the retinal shape assessed by off-axis refraction in myopic subjects, although it is not statistically significant. The effect appears to be restricted to peripheral retinal loca-tions. The effect of the extraocular muscles upon retinal shape shows considerable inter-subject variability, which requires further investigation.Keywords: Eye Rotation; Eye Shape; Central Refraction; Peripheral Refraction; Myopia; Shin-Nippon Autorefractor
394 Teleophthalmology Implementation during COVID-19 Pandemic: Experience in Mexico City , Samuel J Avalos-Lara1, Bani Antonio-Aguirre2, Edgar N Vázquez-Quezadas3, Alberto Güijosa4, Ana Maria Jakubczyk-Lopez1, Eric López-Lesama1, Andric C Perez-Ortiz5 and Claudia Palacio-Pastrana1*
AbstractBackground: Teleophthalmology (TO) is a fundamental tool to continue eye care delivery during the COVID-19 pandemic. TO pro-grams allow follow-up of patients with chronic eye conditions, postoperative follow-up, triage, and referral of emergency conditions. Given the high risk of infection associated with ophthalmic examinations, TO enables safe and satisfactory interactions between patients and health care providers. Methods: We conducted a cross-sectional study to evaluate a TO program implemented in Mexico City, between April 1st, 2020, and June 15th, 2020. TO consults were offered via telephone and video visits. The program included tele-triage and follow-up consul-tations. Patients meeting referral criteria for emergency face-to-face (EFTF) evaluation were scheduled for in-person evaluation. Demographic clinical and ophthalmological information, as well as the Net Promoter Score (NPS) for assessing the general patient satisfaction, were obtained. Results: A total of 1,242 teleconsultations were conducted, including 1,159 first assessment consults and 78 follow-ups. The mean age of patients was 59 ± 18.6 years, most were females (57.5%) and had previous eye conditions (65.5%). The most frequent ocular condition presumed during teleconsultation was dry eye syndrome. The prevalence of ocular emergencies requiring EFTF assess-ment was 12.4%, with a 26.8% no-show rate and a positive predictive value of 51.9%. Patients reported high satisfaction with TO services (NPS = 86.9). Conclusion: TO stands as a viable alternative to limit COVID-19 transmission. Teleconsultation satisfaction rates are high, and most cases will not require immediate referral. Thus, TO programs may serve as a safe response to alleviate healthcare systems, while meeting patients needs during the pandemic.Keywords: COVID-19; Teleophthalmology (TO); Emergency Face-to-Face (EFTF); Net Promoter Score (NPS)
395 Role of Microperimetry in Observation and Treatment in Patients with Macular Holes , AS Zotov, AS Balalin*, SV Balalin, AM Marukhnenko, TG Efremova, SM Purshak and IA Melikhova
AbstractPurpose: To assess the role of microperimetry in follow-up and treatment of patients with macular holes. Materials and Methods: Retrospective study of the minimally invasive vitrectomy results using 25G or 27G technologies in 59 patients (59 eyes) with idiopathic macular holes (IMH) was performed. The examination included the determination of the best corrected visual acuity (BCVA), tonometry, perimetry, ultrasound biometry, optical coherence tomography, fundus photography, mi-croperimetry. Results: After surgical treatment all patients showed a significant improvement in BCVA and retinal photosensitivity (p < 0.05). A formula was derived for the dependence of BCVA after treatment on the initial retinal photosensitivity and the maximal IMH size, which can be applied to predict the results of surgical treatment. Conclusion: Microperimetry is a modern non-invasive examination method that allows with a higher density and resolution to local-ize central defects of the visual field and to carry out thorough monitoring before and after surgical treatment. The study of the retinal photosensitivity in the macular region and the maximal IMH size before treatment allow to predict BCVA in the postoperative period.Keywords: Idiopathic Macular Holes; Microperimetry; Minimally Invasive Vitrectomy; Optical Coherence Tomography
396 Reactivation of Herpes Zoster after First and Second Dose of Covid-19 Vaccine , Jéssica Feiroza Corrêa1*, Rebeca Santa Barbara Costa1, Renata Ferreira Barbosa Sugai1, Nelson Chamma Chapelanes1,2, Pablo Felipe Rodrigues1 and Bernardo Kaplan Moscovici1
Abstract We describe a case of Herpes Zoster ophthalmicus that showed reactivation after the first and second dose of covid 19 (Coronavac) inactive vaccine.Keywords: COVID-19; Sars-Cov-2; Herpes Zoster, Herpes Zoster Ophthalmicus, Covid-19 Vaccines
397 Diffuse Lamellar Keratitis After Laser In Situ Keratomileusis , Jayalekshmi Nithin* and Anwar
AbstractTo examine the incidence of diffuse lamellar keratitis after LASIK. We report 2 cases of DLK appearing after the immediate post-operative period of LASIK. We have observed that the astigmatic shift may be assorted with the occurrence of this DLK. Our 2 cases of DLK was following myopic Lasik. The sterile infiltrates resolved over a period of 4-8 weeks on topical steroid therapy. Keywords: Diffuse Lamellar Keratitis (DLK); Laser In Situ Keratomileusis (LASIK); Sands of the Sahara Syndrome
398 Effect of Accommodation on Intra Ocular Pressure in Stable Myopes and Emmetropes , Rahat ul Ain, Tahira Kalsoom, Rubina Kousar and Samia Iqbal*
AbstractKeywords: Accommodation; Intraocular Pressure (IOP); Myopes; EmmetropesPurpose: To compare the changes in intraocular pressure (IOP) of Emmetropes and Stable Myopes before and after accommodation.Materials and Methods: A total of 53 subjects were included in this study after approval from ethical review board/committee. In-clusion criteria for this study was Twenty three Emmetropes (without any refractive error), and thirty Myopes out of which Twenty were low Myopes (-1.00 to -2.75) and Ten were moderate Myopes (-3.00D to -6.00D). While subjects with accommodation spasm, accommodation insufficiency, cataract, aphakia, Pseudophakia and any disease affecting accommodative ability were excluded from study. Informed consent of the patient was taken prior to their inclusion in the study. Results: Mean age of 53 subjects included in this study was 20.69 years. 23 were Emmetropes and 30 were Myopes. Out of 30 Myopes, 20 showed significant raised IOP after induced accommodation. Cylindrical value did not exceed 1.50D. Mean increase in IOP (represented by plus sign) was +1.425 ± 0.90 mmHg in stable Myopes. While mean decrease in IOP of -1.476 mmHg was seen in Emmetropes after induced accommodation. When Pearson Chi Square test was applied it showed significant association of refractive status and changes in IOP with P value of 0.018 after induced accommodation. Conclusion: There was significant increase in Intraocular Pressure (IOP) in Myopes
399 Brief Scenario of Sone of the Indications of Hydroxychloroquine , Gowhar Ahmad*
Hydroxychloroquine belong to 4 aminoquinoline group and are basically have many uses which are mostly antimalarial, antiamoe-bic, analgesic, antipyretic, antiviral, antifungal, anti collagen used in r arthritis used in q fever HIV programs syndrome Whipple's disease it has got immunotherapeutic effect so at present era of global pandemic covid 19 his drug has been used as a prophylaxis for covid due to its immunotherapeutic action patients who are on this drug need regular ophthalmic examination due to its ocular side effects which are 1Corneal keratopathy 2Retinal maculopathy which have various stages Like:a.Premaculopathy b.Well established maculopathy c.Bullous eye maculopathy d.Severe maculopathy e.End stage maculopathy.
400 Manifestations of Ocular Injuries in Road Traffic Accidents , D Chandrakanth Reddy1*, T Himaja2, G Vasavi2 and T Rajeevi Teja
AbstractAim:To study the effects of ocular injuries due to road traffic accidents (RTA) and factors associated with it.Materials and Methods: 50 cases that came as outpatients were included. Time, location, type and mechanism of injury were noted. Vision via Snellen chart, eye examination under slit lamp was done. Any other diagnostic tests, medical and surgical treatment were recorded. X-rays, ultrasonography, CT-scan were done when necessary. The 50 patients were followed for 6 months.Inclusion Criteria: 1. Patients who suffered road traffic accidents with ocular injuries presenting within a week of injuries. 2. Age group between 10 to 60 yrs. 3. Minimum follow-up is for 6 months.Exclusion Criteria: 1. Ocular trauma not due to RTA. 2. Age < 10yrs and > 60 yrs. 3. Previous history of head injuries. 4. Poor follow up < than 6 months.Results: About 88% patients were males. Mostly 2 wheelers were involved in the accidents and 77% of them were not wearing hel-mets. 54% of patients were under the influence of alcohol. Lateral wall fractures were more in 2 wheelers riders not wearing helmets. Various anterior segment findings and posterior segment findings were noted in them. About 12% had vision less than 6/18.Conclusion: Ocular injuries due to RTA have increased with increase in vehicular traffic. Young males, driving at night, alcohol abuse and not following safety precautions are certain risk factors that are associated with RTA and ocular injury. 2 wheeler riders were prone to orbital fractures in RTA.Keywords: Ocular Injury; Road Traffic Accidents
401 Management of Retinoblastoma Associated with Persistent Fetal Vasculature: Case Report , Sophia El Hamichi1*, Estephania Feria Anzaldo1,2, Aaron Gold1 and Timothy Murray
Purpose: To report the challenging diagnosis, treatment, and follow-up of a patient with persistent fetal vasculature (PFV) and reti-noblastoma (RB). Case Report: A 22-month-old male was referred to our clinic for a white retinal lesion in the right eye (OD) to rule out retinoblas-toma versus persistent fetal vasculature. In the examination under anesthesia (EUA), the anterior segment showed lenticular cata-ract both eyes (OU), more prominent OD. Fundus examination of OD revealed an optic nerve calcification mass with vitreous seeding overlying a transvitreal stalk. Vascular ectasia was present with a retina fold and a tractional retinal detachment. Fundus examination of the left eye (OS) showed an attached retina without mass lesion. The patient was diagnosed with unilateral RB stage Vb and PFV OD. The patient started treatment with systemic chemotherapy with 2 drugs and transpupillary laser ablation OD. On subsequent fundoscopic examination OD revealed a completely RB regression type 1 of the primary tumor mass overlying the optic nerve head. A magnetic resonance imaging (MRI) of orbits, neuroimaging and a high-resolution ultrasound was repeated every 6 months without evidence of progressive disease. Two years after the las systemic chemotherapy treatment, MRI showed increased signal intensity with progressive optic nerve enhancement and cannot exclude intraneural malignancy, due to this diagnosis the enucleation of OD was decided. Histopathologic review showed no residual active malignancy in the enucleated globe. Conclusion: It is crucial to do a thorough clinical examination and use B-scan ultrasound as an important ancillary test to rule out RB before any surgery, to avoid the dissemination of malignant RB cells and this case also highlights the importance of regular follow-ups after tumor regression with full ophthalmological examination, B-scan, FA and periodical MRI. Keywords: Retinoblastoma; Persistent Fetal Vasculature; Retinoblastoma Mimickers; Pseudoretinoblastoma; Systemic Chemother-apy; Laser Ablation Therapy
402 Incidental Corneal Pigmentation Following Cosmetic Permanent Eyelid Tattooing , Mohammad-Mehdi Sadoughi1,2, Kiana Hassanpour1,2*, Iman Ansari1and Mehrnoush Lack1
A 36-year-old woman presented to the ophthalmic emergency department complaining of ocular discomfort started 2 hours after eyeliner tattooing. The patient did not complain of any blurry vi-sion, glare, or halo. On external examination, mild eyelid erythema and mild conjunctival injection were present in the left eye. Ocular movements were normal. A relative afferent pupillary defect was absent. The best-corrected visual acuity was 20/20. Slit-lamp bio-microscopy revealed a row of corneal pigmentations in the para-central and central zone of the cornea. The pigmentations con-sisted of a similar pattern repeated approximately 15 times. Each pigmented area was 0.1 mm wide, and 0.3 mm long diffusing for 4 clock-hours in the paracentral and central zone. There was a clear zone between every spot. The black material seemed to be diluted approaching the center of the cornea (Figure 1). Indeed, the pig-ments penetrated the anterior stroma to the approximate depth of 100 microns.
403 Cornea Ulcer Caused by Corynebacterium Sp-Case Report , Vinicius Cidral Correa1*, Renan Akira Miyashiro1, Lucas Moraes Nunes Martins1, Cinthya Laysa Gehrke2, Bernardo Kaplan Moscovici1,2and Nelson Chamma Capelanes1,2
Corneal ulcer represents an ophthalmological problem of great importance given its possible causes, therapeutic challenges and repercussions. As a definition, a corneal ulcer is a solution for discontinuity of the Korean epithelium associated with variable involvement of the underlying stroma. Corynebacterium sp represents an optional, non-mobile, commensal gram-positive, aerobic or anaerobic bacterium. In this way, its pathogenic power is linked to predisposing corneal factors and the virulence of the pathogen to result in corneal damage. This case report a male patient, 74 years old, diagnosed corneal lesion during the COVID- 19 pandemic season. Because of the above, it is concluded that there is a need for early intervention with the use of adequate propaedeutic with the identification of the causative agent, despite the prolonged empirical treatment, associated with a follow-up with a maximum of 48 hours between visits. Keywords: Cornea; Ulcer; Corynebacterium sp
404 Intravitreal Injection Bevacizumab: Main Indications , Babita Gurung, Eliya Shrestha, Hara Maya Gurung, Hari Bikram Adhikari, Anju Gurung, Krishna Gurung and Pawan Baral*
Purpose: To study the main indications of intravitreal injection Bevacizumab in Himalaya Eye Hospital, Pokhara, Nepal.Methods: A retrospective study of the patients who received intravitreal injection Bevacizumab (IVB) from July 2019 to December 2020 was carried out at Himalaya Eye Hospital, Pokhara, Nepal. Patients who received only IVB were included in the study. Patients who received IVB along with other intraocular surgery were excluded from the study.Results: 468 patients received IVB during this study period. 281 were males and 187 were females. Diabetic retinopathy was found to be the most common indication for IVB followed by branch retinal vein occlusion, age related macular degeneration, central retinal vein occlusion and others. There was no recorded complications of IVB during this period.Conclusion: Diabetic retinopathy is the most common indication for IVB followed by branch retinal vein occlusion. The technique of intravitreal injection is considered safe.Keywords: Bevacizumab; Indication; Diabetic Retinopathy; Safe; Nepalb
405 Ocular Trauma during Covid-19 Lockdown 2020 at Himalaya Eye Hospital , Babita Gurung, Anju Gurung, Hara Maya Gurung, Eliya Shrestha, Hari Bikram Adhikari, Krishna Gurung and Pawan Baral*
Purpose: To access the impact the COVID-19 lockdown had on the incidence of sight-threatening ocular trauma at Himalaya Eye Hospital, Nepal.Methods: A retrospective study of all patients who underwent primary repair surgery for serious ocular trauma during the CO-VID-19 lockdown periods at Himalaya eye Hospital was performed. Data on demography of the patient, date of presentation, type of ocular trauma, laterality of the eye and surgical repair were collected. This process was repeated for the same dates in the previous year for comparison.Results: Out of total 55 cases of ocular trauma requiring primary repair surgery at the main operating theatre, 12 cases were seen during the lockdown period. The mean age of patients with ocular trauma during the lockdown period was 40.5 ± 5.54 years. Fifty five cases of ocular trauma were also seen in the previous year while 16 cases of such ocular trauma were seen between dates 24thMarch and 21st July 2019. The mean age of patients with ocular trauma during this time was 29.06 ± 3.48 years.Conclusion: During the COVID-19 lockdown, the number of serious ocular trauma cases was less than the previous year. This de-crease is partially due to less outdoor injuries as people stayed at home due to lockdown.Keywords: COVID Lockdown; Ocular Trauma; Primary Repair Surgery
406 Kent, Surrey and Sussex Ophthalmology Network Survey and Audit into Trainee and Deanery Temporal Artery Biopsy Practice , Christopher Ashton*, Stephen Sweetman, George Murphy, Jamal Dirie, Laura Drayer-Turner, Francis Carr, Eilidh Yardy and Simerdip Kaur
As part of the Curriculum of Ophthalmic Specialist Training all ophthalmology trainees must perform a minimum of two Tempo-ral Artery Biopsies (TABs), learning outcome SS11 TAB, in order to achieve a certificate of completed training (CCT) by the end of their seventh year. However, ophthalmology is not the only special-ity that perform TABs with general surgeons, plastic surgeons and vascular surgeons with the skill set [1]. Our aim was to explore whether trainees found it difficult to attain the learning outcome sign off for temporal artery biopsy with the competition between specialities and to conduct an audit of TAB practice within the Kent, Surrey and Sussex (KSS) deanery.
407 Clinical Classification of Glaucoma , Gowhar Ahmad*
Glaucoma is a common ocular disorder kind of visual threaten-ing disease. If not diagnosed and managed properly and in time problem with this disease is whatever vision is lost can’t be re-stored back. However whatever vision is left has to be maintained either by drugs or laser or open. Glaucoma surgery however we are in the era of ophthalmic subspecialities and presence of glaucoma expert modern anti-glaucoma medication has made prognosis of glaucoma much better.
408 Combined Central Retinal Vein and Cilioretinal Artery Occlusion in Pregnancy treated with Intravitreal Triamcinolone Acetonide , Minakshi Sheokand1*, Dhir Pushkar2, Bajaj Piyush2 and Dhir Parikshit
Pregnancy represents hypercoagulable state with increased risk for thrombotic events. There are few reports of pregnancy-relat-ed retinal vein occlusion cases. We report a case of 7 month pregnant female presented with a loss of vision in her right eye with prior history of pre-eclampsia in her first pregnancy. Vision in the affected eye was 6/24. Complete ophthalmic examination revealed com-bined central retinal vein and cilioretinal artery occlusion. Optical coherence tomography, low dose angiography and carotid doppler study was done along with complete thrombophilic screening. She was treated with anterior chamber paracentesis and topical e/d dorzolamide. After detailed counseling and an informed consent, intravitreal triamcinolone was given. Six weeks post intervention there was complete resolution of edema with best corrected visual acuity (BCVA) of 6/9. No adverse outcomes for either mother or fetus were noted. We report this case to highlight pregnancy as risk factor for combined vascular occlusion and role of intra-vitreal steroid in treatment.Keywords: Pregnancy; Combined Vascular Occlusion; Intravitreal; Triamcinolone Acetonide
409 Macular Damage by Mobile Phones , Shahzad Waseem* and Muhammad Ali
In this small article, you will be reading my opinion as an eye specialist about the damage to eyes by mobile phones, especially in the days when people, especially children have access to these devices 24/7.Its a well known fact that solar eclipse causes macular damage. But the misunderstanding is that eclipse itself doesn’t damage the retina. But it’s the curiosity to see the eclipse which forces people to stare at the sun and they might get macular burn.
410 Endophthalmitis Following Intravitreal Injection Bevacizumab in an Operation Room Setting of Nepal , Hara Maya Gurung, Eliya Shrestha, Babita Gurung, Hari Bikram Adhikari and Pawan Baral*
Purpose:Intravitreal injection Bevacizumab (IVB) has become an important tool in the armamentarium of retina specialists. Though it is considered safe, it is not completely free from causing endophthalmitis, a devastating ocular inflammation which leads to loss of vision. The purpose of this study is to find the prevalence of endophthalmitis following IVB in the operation room of Himalaya Eye Hospital (HEH).Methods: A retrospective study of the patients who received IVB in the operation room of HEH from January 2015 to March 2021 was done. During this period, the record of the number of IVB performed and the number of patients who got endophthalmitis post IVB was taken from the database of the operation room and subsequently the details of the endophthalmitis cases were studied. Nepal Health Research Council approved this study (no 3085).Results: A total of 3339 IVB were performed for 2105 eyes from January 2015 to March 2021. An outbreak of a single episode of cluster endophthalmitis, sterile in nature, was observed during this period which accounted to the prevalence of 0.209% of endo-phthalmitis following IVB in our hospital.Conclusion: The prevalence of endophthalmitis following IVB in HEH is low. IVB which is gaining popularity in the treatment of retinal diseases, if performed with caution is safe and beneficial to the patients.Keywords: Bevacizumab; Endophthalmitis; Prevalence; Retinal Diseases; Retina Specialists
411 Quarantine in COVID: A Necessary Public Health Care Measure? , Ranjila Shyangbo1* and Raju Kaiti2
The world is facing an outraging pandemic of COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), first isolated in the Chinese province of Wuhan, which now has spread across 220 countries and territories resulting about 163,179,059 confirmed cases [1] with 3,383,606 deaths [1] and this number continues to change with progression of pandemic. What led to the pandemic nature of COVID 19 is its ideal attribute of high transmissibility, both via symptomatic and asymptomatic carrier. COVID-19 outbreak was declared as a Public Health Emer-gency of International Concern [2] (PHEIC) on 30 January 2020. Following the uncontrolled and explosive nature of the disease, the World Health Organization (WHO) has declared the outbreak of COVID-19 as a pandemic on 11 March 2020 [3]. So far there is no proven pharmacological treatment and vaccine for COVID-19. This necessitates to explore other options of decelerating the spread of pandemic. Of the many non-pharmacological public health con-trolling measures, isolation, physical distancing and quarantine have been imposed and are found to be one of the effective ways to respond to the outbreak.
412 Diabetic Retinopathy Prevalence in High Income and Low Middle-Income Countries , Raba Thapa*
Diabetes Mellitus (DM) is emerging as a major public health problem globally. DM has been the leading cause of mortality and various morbidities including blindness both in high income and in low and middle-income countries. In recent report of Interna-tional Diabetes Federation (IDF), 463 million adults aged 20 - 79 years worldwide (9.3% of all adults in this age group) have diabe-tes in 2019 and this number is projected to be 478 million by 2030 and 700 million by 2045 globally [1]. Almost four fifth (79.4%) of people with diabetes live in low and middle-income countries. The burden of diabetes has overwhelmed many healthcare systems, es-pecially those of low and middle-income countries [1].
413 Retinopathy of Prematurity in Babies Born of Infertility Treatment- Cradle ROP Experience , Manoj Soman, Sameer I*, Anshuman Gahlot, Sheera K R, Abdul Nizar A P and Unnikrishnan Nair R
Purpose:To examine the incidence of Retinopathy of Prematurity (ROP) in children conceived through assisted reproductive tech-niques (ART) and to analyze whether the severity of ROP varied with babies born through natural conception. Methods: This was a retrospective chart analysis of the CRADLE ROP data between September 2018 and April 2020 and included a multicentric NICU based neonatal screening for Retinopathy of Prematurity using the mobile Retcam Imaging system. Birth weight, gestational age, time of first examination, presence or absence of any stage of ROP, severity of the disease especially APROP and treat-ment were analyzed. Babies born through natural conception were compared with ART born babies.Results: 492 Neonates were examined during this period. ROP was detected in 22.7% and treatment for ROP was advised in 21.4% neonates who developed ROP. 34 infants (6.9%) were born through assisted conception. Infants born through assisted conception ac-counted for 25% of all those infants requiring treatment. Out of those born through natural conception 22% (101 babies) developed ROP and 17.8% of these needed treatment. 32% (11 babies) of ART born babies developed ROP and 54% (6 babies) of these needed treatment. Bilateral APROP requiring anti-VEGF treatment was seen in 9% babies in the ART group compared to 1.9% in the other group. ROP that developed in ART babies were more in need of treatment than natural conception [OR - 5.33 (95% CI: 1.54, 18.47) with p-value < 0.05].Conclusion: ART born babies make up a considerable proportion of the ROP babies who need treatment. Therefore, increased vigi-lance is required when screening babies conceived by assisted conception. With the demand for infertility treatment and use of as-sisted conception increasing, it can only be expected that this number will increase in future.Keywords: Retinopathy of Prematurity (ROP); Assisted Reproductive Techniques (ART)
414 Transforming Healthcare through Telehealth with Retcam by Increasing Procedural Safety for Early Screening of Retinopathy of Prematurity , Melissa Rice*
Objective:The purpose of this study is to evaluate non-sedation protocols for eye screenings of premature infants with Retcam 3 to early screen and detect Retinopathy of Prematurity (ROP) and decrease timings to decrease adverse events. Study Design: In a retrospective study of nurse driven teams with small sample size n = 20 at a Level III NICU August-December 2017 were analyzed to improve safety by decreased timings and non-sedation protocols to prevent adverse events providing a comfortable procedure. A general linear regression model were used to calculate effect with 95 % confidence intervals. Results: Total patients N = 20 were reduction in timings by 20% with non-sedation protocols. P <. 05. Conclusion: This study found that Retcam 3 could be an effective tool via telehealth to early screen and detect (ROP) in premature infants safely and effectively with decreased timings on non-sedation protocols. Keywords: Retinopathy of Prematurity (ROP); Information Systems (IS); ATA (American Telemedicine Association)
415 Visual Outcome with Irrigation of the Interface in Small-Incision Lenticule Extraction , Andrew Yazji*, Joseph Ling, William F Wiley, Shamik Bafna, Ashraf Ahmad and Jeffrey Augustine
Purpose:To compare the refractive and visual outcomes after Small-Incision Lenticule Extraction (SMILE) in patients receiving ir-rigation of the stromal interface versus no irrigation in the United States based on FDA-approved parameters.Methods: In this US-based, single-center, consecutive, retrospective case series, patients undergoing SMILE received irrigation in one eye versus no irrigation in the other eye. Primary outcome measures included uncorrected visual acuity (UCVA) post-op day 1, post-op week 1, and post-op month 1, mean manifest refraction spherical equivalent (MRSE), and the number of patients within ±0.5 D and ±1.0 D of refractive target. Same-day post-op pachymetry and anterior-segment OCT were also obtained. Safety was assessed by noting the incidence of complications and need for additional surgery.Results: 32 patients were included in the study, with 32 eyes in both the irrigated and non-irrigated groups. All patients were tar-geted for plano refraction. UCVA on POM1 was 0.0038 ± 0.164 D for irrigated eyes and -0.0154 ± 0.141 D for non-irrigated eyes (P = 0.40). The MRSE on POM1 was -0.232 ± 0.483 D for irrigated eyes and -0.274 ± 0.539 D for non-irrigated eyes. In the irrigated eyes group on POM1, 21 of 21 patients were within ±1.0 D of refractive target compared to 18 of 21 in the non-irrigated group. Adjusting for expected pachymetry, irrigated eyes had an average of 15.406 ± 0.347 microns thicker post-operative pachymetry readings com-pared to the non-irrigated eyes (P = 0.006).Conclusion: Irrigated eyes had better UCVA, lower MRSE, and deviated less from their refractive target compared to non-irrigated eyes. Irrigated eyes had a significant increase in corneal pachymetry measured immediately postoperatively compared to non-irri-gated eyes, however its effect on visual outcome was not significant.Keywords: SMILE; Refractive Surgery; Ophthalmic Surgery
416 Acute Retinal Necrosis Misdiagnosed as Toxoplasma - Case Report , Priyanka1*, Sunita Sabarwal2 and Amber Kumar3
Acute retinal necrosis syndrome (ARN) is a rare necrotizing, fulminant retinopathy caused by one of the members of the herpes group of viruses with poor visual outcome if not diagnosed and treated timely. The condition occurs typically in healthy person but may occur in immunocompromised also.We report a rare case of ARN misdiagnosed as toxoplasma but timely diagnosis and treat-ment results in good visual outcome. Keywords: Acute Retinal Necrosis; Acyclovir; Polymerase Chain Reaction
417 A Case Report of Lamellar Ichthyosis , Deepthi Ramesh, Sirisha Vinzamuri*, Ksheeraja Harshvardhan, Anusha Aynala and Sirisha Vinzamuri
Ichthyosis is an inherited skin disorder (also called disorders of keratinization) is characterized by hyperproliferation of cells and thus an abnormal physical barrier and manifests as dry, scaly and thickened skin. Lamellar ichthyosis (LI) is one of the subtypes and has an autosomal recessive inheritance. It is a rare condition where babies present with shedding of skin and is usually generalized. They are also called as “collodion babies” as they are said to have a shiny armor of shed skin [1]. Here we present a case of a newborn baby diagnosed with LI and bilateral ectropion which spontaneously reduced after topical treatment such as lubricants and antibiot-ics were started. We are reporting this case as LI is considered to be a rare inherited disorder and the bilateral ectropion was found to reduce spontaneously without any invasive interventions.Keywords: Lamellar Ichthyosis; Bilateral Ectropion
418 The Magnitude of Refractive Error , Gaurav Dubey1, Dr Kamal Pant1*, Vibha Kumar2, Jamshed Ali3, Ragni Kumari4 and Dr Mahesh Chandra5
Refractive errors affecta largerproportion of the world’s pop-ulation, regardless of age, ethnicity, or ethnic group. Globally, 2.3 billion individuals are known to have refractive errors, with (1.8) billion. having access to. appropriate eye. exams and. inexpensive corrections, and (500 million) have uncorrected errors that cause blindness or impaired vision (mostly in developing nations) [1]. They are a significant cause of poor vision and even blindness, if not corrected. However, they can be easily detected, measured, and corrected with spectacles and other refractive corrections [2]. An uncorrected refractive error has been identified as the leading cause of visual impairment in Asian school-aged populations [3-6] {Hispanic and European} [7,8]. The prevalence of vision loss due to refractive error was reported to be as high as 0.36 percent in India for all age groups in a population considered together, with blindness. characterized as presenting. length visual acuity {< 3/60 in the better eye} [9]. Refractive error is the second most common eye problem in Indian school-going children. The most common cause. of defective vision in. school children is refractive errors. Children younger than 15 years. make up. about 42% of the popu-lation. in India. The fact is that 30 percent of kids lose their eyesight before 20 years of age. Uncorrected refractive error in children and its consequences profoundly impact their overall develop-ment, particularly on educational and developing health
419 Hypothesis on Pathophysiologic Mechanisms in COVID-19 Rare Ophthalmic Presentations; A Review , Sasan Jafari1, Masood Bagheri2* and Ahad Jafari1
In late 2019, the world encountered the novel coronavirus severe acute respiratory syndrome (COVID-19) pandemic. Ophthal-mic findings in COVID-19 patients were mainly ocular surface initially. Over time, different ocular involvements were reported in this pandemic. The aim of this study was to review the variety of possible ocular involvements with underlying pathophysiologic hypotheses in COVID-19. This study demonstrates the variety of suspicious ocular involvements in COVID-19 from ocular irritation to visual loss in three different categories: direct infectious ocular involvement, indirect ophthalmic complications and therapeutic-prophylactic options ocular side effects.This review represents a panoramic spectra of COVID-19 ophthalmic symptomatology with possible underlying pathophysiology.Keywords: Coronavirus; 2019-nCoV; COVID19; SARS-CoV-2; Epidemic; Pandemic; Ophthalmology
420 Squint Causes Types Management and Role of Parents in Mobile Abuse by Children , Gowhar Ahmad*
Squint also termed as strabismus is a kind of common ocular condition characterized by abnormal ocular deviation with ab- sence of normal ocular paralism and paucity of binocular vision which is of 3 types: • Simultaneous perception • Simultaneous fusion and • Stereopsis main aim of squint management is not only to correct the nor- mal angle of deviation but to ensure normal status of vision for this early diagnosis and management by proper squint expert is very important so it is very important for every parent to seek the advice of paediatric ophthalmologist if they observe any sort of abnormal ocular deviation in their children with better awareness and education prognosis of squint is far better than before.
421 Case Report- A Case of Tuberous Sclerosis , Anusha Ayanala, Sirisha Vinzamuri* and Ksheeraja Harshvardhan
Introduction: Tuberous sclerosis complex (TSC) is an autosomal dominant phakomatosis. Tuberous sclerosis is a disorder charac- terized by the growth of numerous benign tumours in many parts of the body caused by mutations of TSC1 and TSC2 genes. This rare genetic disorder is usually associated with a triad of seizures, mental retardation and cutaneous lesions [1]. Case Description: The case of a 11 year old male presenting with loss of consciousness 1 month back. On examination he was diagnosed to be a case of tuberous sclerosis. Over the skin of the face there was adenoma sebaceum. There was a hypo pigmented patch present over the left lumbar region, face, fore limb. There was a shagreen patch over the back. Fundus examination showed hamartomas with mild exudation in the right eye. This case report emphasizes the importance of complete evaluation of a case pre- senting with loss of consciousness. TSC should be considered in children presenting with seizures, developmental delay and mental retardation. Conclusion: Adenoma sebaceum and retinal hamartomas are very common ocular manifestations of Tuberous Sclerosis. Majority of the retinal hamartomas are non-progressive but lesions with sub retinal fluid and progression to total exudative detachment are reported. So, all cases of tuberous sclerosis must be evaluated at an ophthalmic setup [2]. Keywords: Tuberous Sclerosis Complex (TSC); TSC1 and TSC2 Genes
422 Exopthalmometry-A Review , Sirisha Vinzamuri* and Ksheeraja Harshvardhan
Exophthalmometry is a test that’s routinely done in the evaluation and measurement of proptosis. In this article various methods of performing this test are described and the practical nuances of Hertels exopthalmometry are detailed upon. Keywords: Exophthalmometry; Hertels Exopthalmometry
423 Misconception on Mechanism of Damage to Macula by Solar Eclipse , Shahzad Waseem*
In almost all the Ophthalmology books and perhaps most of the ophthalmologist agree that solar eclipse causes damage to the macula and may cause permanent visual loss if sun is seen for a long time. In our observation, we have found that, at the day of solar eclipse, people are very excited and curious to see the eclipse. As we know that cosmology tells us that in solar eclipse, moon comes in front of the sun. And from earth we can easily stair at the sun, which is not possible in normal days.
424 Eyelid Reconstruction Using Nasal Septal Chondromucosal Graft in Eyelid Sebaceous Gland Carcinoma Revisited , Rajan Sharma1*, Mahesh A2, Rani Sujatha3, KS Nagaraja4, Abid Maqbool1 and Yash Oza1
Sebaceous gland carcinoma (SGC) of the eyelids is a rare malignancy. Most cases require excision followed by eyelid reconstruc- tion. Reconstruction of the eyelids after tumor removal remains one of the most challenging tasks. We report a case who developed tumor from the Meibomian glands of the upper eyelid. Excision of the tumor was done and reconstruction was done using a chon- dromucosal septal graft. The graft was procured and sutured in the place of excised tarsal plate on the upper eyelid. Anterior lamella of the eyelid was intact. We did not encounter flap necrosis, dehiscence, infection, ectropion, recurrence or irregular eyelid margins. Various techniques of eyelid reconstruction, their advantages and disadvantages have been reviewed. Keywords: Eyelid; Sebaceous Gland Carcinoma; Meibomian Glands; Chondromucosal Septal Graft
425 Presumed Viral Retinitis , Priyanka1*, Mihika Dube2 and Amber Kumar3
Viral retinitis is an important infectious disease of the retina occuring in both healthy as well as immunocompromised persons. Although viral retinitis usually can be diagnosed by the fundus picture but in case of diagnostic dilemma for suspected viral retinitis, aqueous and vitreous specimens have greater diagnostic value as compared to serologic studies. Here, we report a case of presumed viral retinitis with negative PCR but responded well with timely antiviral therapy with good visual outcome. Keywords: Viral Retinitis; Valacyclovir; Polymerase Chain Reaction
426 Visual Outcome after Cataract Surgery at Bhaktapur Eye Centre , Kripa Joshi1*, Sushma Duwal2, Jamuna Gurung3, Yogita Rajbhandari4, Aye Myat Mon5 and Manish Poudel6
Objective: The aim of the study is to evaluate the visual outcome after cataract surgery at Bhaktapur eye centre. Methodology: This was the retrospective study that included 161 eyes of 159 patients fulfilling the inclusion criteria who underwent cataract surgery either phacoemusification or manual small incision cataract surgery from September 2019 to November 2020 in Bhaktapur eye centre secondary level provided with permanent infrastructure to deliver outpatient and operation theatre services. The preoperative details, type of cataract surgery performed, intraoperative and postoperative complications and visual acuity at first day, first week and sixth to eighth postoperative week were retrieved. Results: Maximum cases that underwent surgery were between 65 - 75 years followed by 75 - 85 years. The mean age was 67.7 ± 10.36 years and the male to female ratio was 0.51:1, 55 males and 106 females. 21.38% cases had associated comorbid diseases. Phacoemusification was performed in 67.8% and manual small-incision cataract surgery in 32.2%. At presentation, more than half that is 52.7% had best corrected visual acuity BCVA of less than 3/60. Intraoperative complications were found in 3.1% and corneal edema was the most common among postoperative complications. At 6 - 8 weeks follow up after surgery, 88.81% had BCVA 6/6- 6/18, 9.93% had BCVA of 6/18-6/60. Conclusion: This study showed that cataract surgery whether manual small incision cataract surgery or phacoemulsification offered good visual rehabilitation in maximum number of patients. Proper and timely management of complications and provision of refrac- tion facility postoperatively would be a good way to improve visual outcome. Keywords: Cataract Surgery; Visual Outcome; Cataract
427 Prevalence and Associated Factors of Ametropia among Schoolchildren Aged at Least 6 Years in North Benin , Codjo Rodrigue Abel Assavedo*, Amadou Issifou Alfa Bio and Saadiath Hada
Introduction: Ametropias are the first reason for ophthalmological consultations of school children. It is a public health problem and one of the main causes of visual impairment in the world. Purpose: To study the prevalence and associated factors of ametropias among primary school children aged 6 years old and over in the commune of Parakou in 2020. Patients and Methods: This was a cross-sectional, descriptive and analytical study that took place from july 1st to 30 th september 2020. It involved school children aged at least of 6 years old, residing in the commune of Parakou and enrolled in the various elemen- tary school in this commune for the 2019 - 2020 school year. Results: A total of 810 children aged 6 - 15 years old had participated to the study. The prevalence of ametropias was 19.87%. The 6 - 7-years-old age group had the most ametropia (34.40%). A female predominance had been objectified (52.23%). Hyperopia was the most represented refractive abnormally (42.68%), followed by astigmatism (39.49%) and myopia (22.93%). Ocular pruritus (p = 0.000) and studying with poor luminosity (p = 0.001) were statistically significantly associated with ametropia. Age (p = 0.0164), sex (p = 0.0095), father's socioeconomic status index (p = 0.0002), mother's socioeconomic status index (p = 0.013), and parental history of wearing corrective lenses (p = 0.0178) were statistically significantly associated with hyperopia. On the other hand, history of pre- maturity (p = 0.0428) and malnutrition (p = 0.000) were statistically significantly associated with astigmatism and only malnutrition (p = 0.0001) was statistically associated with myopia. However, 3.82% of ametropes were amblyopic. Conclusion: Ametropia still be a major concern in the children school setting because of its significant prevalence (19.87%) and its complications, which are preventable with early diagnosis and management. Keywords: Ametropia; Prevalence; Associated Factors; Schoolchildren; Parakou
428 The Incidence of Consecutive Exotropia Following Surgical Correction of Childhood Esotropia, and Associated Risk Factors in St John Eye Hospital , Habes Batta1, Mohammad Daraghmeh1, Mohammad Abu Safyia1, Abdalrahman Assaassa2, Abdallah Hamayel2, Serin Moghrabi2, Jamal Qadomi2 and Salam Iriqat1*
Background/Aims: Consecutive exotropia is a manifest that develops in a formerly esotropic patient either spontaneously or after optical or surgical treatment for esotropia. It has been reported in 3-29% of patients. Consecutive deviations are generally consid- ered as complications of strabismus surgery. The purpose of this study is to determine the incidence of consecutive exotropia follow- ing successful surgical correction of childhood esotropia and identify factors associated with its development. Methods: A descriptive, retrospective study was carried out through review of 117 cases (55 males, 62 females) having age variation from 1-18 years, who were operated on for congenital esotropia between March 2010 and November 2017 and had follow-up for a period of 3 years. Variables used were: age at surgery, patient sex, bilateral medial rectus recession, length of recession, degree of preoperative deviation, presence of inferior oblique over-action and post-op assessments. Result: The Incidence of Consecutive Exotropia following surgical correction of childhood Esotropia was found to be 13.7 (16/117), which is correlated with previous studies. Among risk factors, the Length was the only significant factor that decreased the risk of developing consecutive Exotropia by 0.254 (P = 0.017). Age at surgery, Pre-operation Angle and Bilateral IO recession didn’t show any association with the risk of developing consecutive Exotropia. Conclusion: There was a statistical significance of consecutive exotropia development in patients in regard to length of medial rectus muscle recession, while age at surgery, gender, preop angle prism diopter and inferior oblique overaction had no role in affecting the occurrence of consecutive exotropia. Keywords: Consecutive Exotropia; Infantile Esotropia; BMR
429 Tear Gas Related Health Issues Concerned among Protesters in Myanmar , Aye Myat Mon*
Currently in Myanmar, countrywide mass protest is going on due to the military coup on February 1st 2021. Police are using violent and non-violent ways to crackdown the crowd of peaceful protesters. Among them, firing tear gas bombs is one of the daily encountering dangers for protesters in Myanmar.
430 The Myopia Impact , Ali Nouraeinejad*
The prevalence of myopia and high myopia is rising worldwide at an alarming pace [1,2]. This is in an order or sequence of pro- cesses linked to significant increases in the risk of vision impair- ment from pathological conditions associated with high myopia, including retinal damage, cataract, and glaucoma [1,2]. Regrettably, the issue of vision impairment associated with myopia receives limited attention from a public health viewpoint in terms of assessment of prevalence, protective interventions, and possible treatment selections [1,2].
431 Post-COVID Visual Hallucination , Abhidnya Surve1*, Ranjana Deshmukh2, Mallika Buche3 and Govind Deshmukh1
A 52-year-old male with a history of diabetes mellitus and hy- pertension for 10 years presented with complaints of visualization of colored sparks and absurd figures in the left eye (LE) for the last 3 days. These were very disturbing for the patient. He had his- tory of mild headache but no complaints of giddiness or vomiting. There was no history of trauma or any medication intake other than that for diabetes and hypertension. He had suffered COVID in- fection 30 days back (RTPCR positive) for which he received treat- ment outside (oral azathioprine, hydroxychloroquine, steroids and favipiravir).