International Scientific Indexing (ISI)

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, AkÄ±n 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 8âˆ† exophoria to 11âˆ† exophoria and after vergence therapy it had a range of 6âˆ† to 4âˆ†. 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 14âˆ† to 30âˆ† 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 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.
195 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
196 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
197 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
198 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
199 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
200 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
201 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)
202 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
203 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
204 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
205 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
206 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.
207 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
208 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
209 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.
210 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
211 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
212 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
213 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.
214 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.
215 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
216 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.
217 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
218 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.
219 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].
220 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)
221 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)
222 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
223 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
224 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
225 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
226 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
227 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.
228 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
229 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
230 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.
231 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
232 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
233 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
234 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
235 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
236 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.
237 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].
238 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).
239 The Coronavirus Disease 2019 and Myopia , Ali Nouraeinejad* The coronavirus disease 2019 (COVID-19) pandemic has glob - ally stricken millions of people [1]. As the global health burden of COVID-19 continues to boost, it is also showing to impose enor - mous costs on people, communities, health care systems, and economies [1]
240 Phone Triage System is an Effective and Safe Way to Manage Patients in Eye Casualty during the COVID-19 Lockdown , Ricardo De Sousa Peixoto1*, Bansri K Lakhani2, Yuanchao Xue3, Anthony J King2, Harminder S Dua2 and Dalia G Said2 The recent COVID-19 pandemic led the UK government to issue guidelines on social distancing and home confinement. In accor- dance with the Royal College of Ophthalmologists guidance on the management of services during the pandemic [1], our unit halted all routine clinical activity and restricted emergency access ser - vices. Nottingham University Hospitals trust (NUH) has the largest tertiary walk in eye casualty centre in the East Midlands with 24 hour on-call cover. Following lockdown, all walk-ins to eye casualty were stopped and patients were encouraged to self-refer via a new phone triage system aiming to prioritise patients with acute symp- toms who needed face to face review and providing verbal advice over the telephone where possible. Walk-in patients were triaged in the same manner and only selected patients were admitted to the department. Both phone and presential triage were carried out following an existing risk assessment triage tool developed for eye casualty.
241 Results of Combined Small Incision Cataract Surgery and Cyclodialysis in Low Income Patients with Glaucoma and Cataract , Mario Renato Papa-Vettorazzi1*, Claudia María Lopez-Villeda1, José Benjamín Cruz-Rordriguez2, Gladys Lucía Silva-Linares1 and Mariano Yee-Melgar1 Purpose: To assess the short and long term effect of combined cataract and glaucoma surgery (Small Incision Cataract Surgery [SICS] plus cyclodialysis) in a low income population. Study design: Retrospective. Materials and methods: We performed a retrospective analysis of 355 SICS plus cyclodialysis procedures all performed by experi- enced surgeons. Evaluations at day one, 1 week, 1, 3, 6 and 12 months. At every visit, the evaluation included: intra ocular pressure (IOP) measurement, glaucoma medication requirements and corrected distance visual acuity (CDVA). We also evaluated complica- tions and re interventions. Results: The median preoperative IOP was 18 mmHg (15-24), it decreased to 12 mmHg (10-14) at the 7 days, 1, 3, 6 and 12 month assessments (p < 0.01). Mean number of glaucoma medications decreased from 1.55 preoperatively to 0.96 postoperatively (mean decrease 0.58, 95% CI-0.84 to -0.32, p < 0.01). At three months median CDVA improved from 0.69 logMar (0.47-1.8) (20/100 Snellen) to 0.3 logMar (0.17-0.51) (20/40 Snellen) (p < 0.01). Complication rate was 9%, the most frequent was posterior capsule rupture (PCR). Re intervention rate was 10% mostly because of not achieving IOP control. Conclusions: Combining SICS plus cyclodialysis is effective, it shows a short and long term reduction in IOP, a decrease in glaucoma medication requirements and an improvement in CDVA all comparable to the reports of phacoemulsification plus trabeculectomy. Keywords: Combined Surgery; Cyclodialysis; Glaucoma Surgery; SICS
242 Acute Posterior Multifocal Placoid Pigment Epitheliopathy Following COVID-19 Vaccination , MZ Kanaan* A 41 year-old patient presented with left paracentral scotoma with initial visual acuity of 6/6 in the affected eye. Review in the clinic few days later showed deterioration of left eye vision to 6/36 and examination revealed deep retinal lesions in the posterior pole with foveal center involvement and serous retinal detachments. A diagnosis of acute posterior multifocal placoid pigment epi- theliopathy (APMPPE) was made. Detailed medical history unveiled COVID-19 vaccination 6 days prior to the visual symptoms. Keywords: Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE); COVID-19 Vaccination
243 Retinal Detachment Surgery...Past to Future - A Review , Shalin Shah* The term retinal detachment is used to describe a separation of neurosensory retina from retinal pigment epithelium (RPE). This review article describes past incorrect theories and attempt of treatment and newer advancement in rhegmatogenous retinal detach- ment surgery. Keywords: Retinal Pigment Epithelium (RPE); Retinal Detachment Surgery; Neurosensory Retina
244 Future Prospect of Antimicrobial Contact Lens Cases , Gaurav Kumar Bharadwaj1 and Joydeep Dutta2* Contact lenses are worn by 145 million persons worldwide as a mode of vision correction. Although using contact lenses is typi- cally safe but it can cause eye irritation and infection. In addition, microbes can contaminate contact lenses during their use leading to the development of microbial keratitis and corneal infiltrates. Microorganisms such as coagulase negative staphylococci found on the skin of eyelids as well as conjunctiva are the most prevalent microbes that infect lenses. Most studies estimate that 40-50 per- cent of lenses based on hydrogel or silicon hydrogels are contami- nated, with minimal variation in rates reported from different geo- graphical regions including Australia, India, and USA.
245 Prevalence of Conjunctivitis in Low Developing Countries: The Case in University Teaching Hospital of Kara in Togo , Kokou Messan Amedome1, Codjo Rodrigue Assavedo2*, Chakiratou Abouki3, Koffi Didier4 and Komi Balo5 Introduction: Conjunctivitis is an inflammation of the conjunctival mucosa regardless of the cause. It is the most common cause of “red eye”. The aim of this study was to determine the prevalence of conjunctivitis at Kara University Teaching Hospital. Methods: We carried out a retrospective and descriptive study on the files of patients who consulted in the ophthalmology depart- ment of the Kara University Teaching Hospital and whose diagnosis of conjunctivitis was retained over the period from January 1, 2017 to December 31, 2019, i.e. a period 03 years old. Results: Our target population was 550 patients from which we had collected a total of 248 cases of conjunctivitis, i.e. a hospital prevalence of 45.09%. The average age of the respondents was 30.20 years with extremes of 6 months and 78 years. The median was 26.50 years. The age group [0-40] years was the most represented. There was a female predominance with an F/M ratio of 1.53. Pu- pils, students (34.90%) and civil servants (22.30%) were the most affected. Pain, pruritus, visual impairment, and eye redness were the most frequent reasons for consultation. Conclusion: Conjunctivitis is a frequent condition in our community and it uses statistical and epidemiological data to better equip itself in the fight against this pathology. Keywords: Prevalence; Conjunctivitis; Kara
246 Conjunctivochalasis , Isha Sharma* In most ophthalmology practices, we come across patients who are senile, as senile cataract is the among the common causes of visual impairment in the adult population. It is imperative that we give due importance to the ocular surface in these patients while treating the patients as postoperatively, they may not be satisfied if the ocular surface is not healthy despite best possible correction. Conjunctivochalasis is one such entity that is often too may a times ignored and untreated. The ophthalmologists should be aware of this condition and manage it appropriately. Keywords: Ophthalmology; Conjunctivochalasis; Eye Syndrome
247 Comparison of Two surgical treatments for Rhegmatogenous Retinal Detachment , Tal Yahalomi *, Idan Hecht2,3, Michal Lifshitz1, Roee Arnon1, Halit Winter1 and Joseph Pikkel1 Purpose: To compare the success rate of pars plana vitrectomy (PPV) and scleral buckling in terms of visual outcomes, repeated surgeries and postoperative complications for the treatment of rhegmatogenous retinal detachment. Methods: We collected data of all patients operated in one tertiary medical center in Israel during the year 2019. Patient over the age of 18 years with at least one year of follow-up were included. Retinal attachment rate, visual outcomes and postoperative complica- tions were compared. Results: Included were 30 patients that underwent posterior vitrectomy and 36 that underwent scleral buckling. All patients were operated by the same surgeon. Success rate of retina re-attachment were almost the same in both groups (86.7% vs 86.1 for vitrecto- my and scleral buckle respectively, p = 0.948). In both groups there was a significant improvement of the final visual acuity compared to the pre-operative visual acuity (0.146 ± 0.1 vs 0.149 ± 0.1 Log MAR improvement for vitrectomy and scleral buckle respectively, p = 0.411). A strong correlation existed between the number of operations to reattachments -any additional surgery drops the chance of reattachment by 2.4% (odds ratio: 0.024, 95% CI 0.003 - 0.208, p ≤ 0.001). Conclusion: Among a modern cohort of patients with retinal detachment, no differences were seen in success rates or visual out- comes between patients treated with posterior vitrectomies compared to scleral buckling. Keywords: Pars Plana Vitrectomy; PPV; Scleral Buckling; SB; Rhegmatogenous Retinal Detachment; RRD
248 Predictors of Sight Threatening ROP in a Tertiary Care Hospital of Himachal Pradesh , Praveen Kumar Panwar1*, Deepti Parmar2, Champa Panwar3 and Vibham Giulati4 Purpose: To study the incidence, patterns and risk factors of sight threatening ROP. Methods: A hospital based prospective observational study was conducted from January 2019 to December 2019 at Indira Gandhi Medical College Shimla. 250 babies who fulfilled inclusion criteria’s were examined by an ophthalmologist at 3 weeks postnatal age. Baseline factors, systemic risk factors, and pattern of ROP were noted. Factors associated with sight threatening ROP including Type- 1 ROP, Stage IV and V, were analyzed. Results: Out of 250 babies screened 13.6% babies developed any type of ROP. The incidence of sight threatening ROP was 9.2%.Out of 23 babies with ST- ROP Type -1 ROP was seen in 20 (86.95%) and advanced ROP (stage IV and V) in 3(13%). Mean gestational age, birth weight and duration of oxygen exposure for sight threatening ROP were 29.9 weeks and 1.23 kg, 23.83 ± 9.722 days respec- tively. Septicemia and respiratory Distress Syndrome found to be significant risk factors associated with ST- ROP. Late presentation was main cause of stage 4 and 5 disease. Conclusion: Low birth weight, lower gestational age and duration of oxygen used were basic factors associated with development of ROP but risk factors like RDS and sepsis were found to be significant and independent risk factors for ST-ROP. These risk factors should be prevented or babies having these risk factors should be followed up regularly and treated effectively to stop the progres - sion of disease. Keywords: Sight Threatening-ROP; Respiratory Distress Syndrome; Septicemia
249 UBM in Lens Particle Glaucoma Due to Penetrating Injury: A Case Report , Pablo Andrés Grigera*, Rocío Márcico and Héctor Javier Fontana Lens particle glaucoma after penetrating ocular trauma is secondary to lens capsular rupture by a sharp element. The resulting glaucoma depends on the amount of lens fragments released into the anterior chamber, the inflammatory response, and the ability of the trabecular meshwork to clear the material. The purpose of this article is to report a lens particle glaucoma case of a patient with 3-months history of penetrating eye injury. Although the medical treatment for glaucoma and inflammation should be established initially in this entity, the definitive treatment is by means of the extraction of the lens and its fragments. When patients delays in at- tending, peripheral anterior synechiae and serious glaucomatous damage may be found. If significative goniosynechiae develop, a fil- tering surgery may be required. In this case, ultrasound biomicroscopy served as a complementary aid to diagnosis and surgical plan. Keywords: Ultrasound Biomicroscopy; Lens-Induced Glaucoma; Penetrating Injury; Eye Trauma
250 A Simplified Classification of Ocular Trauma , B Shukla*, P Bhasin and D Shukla Classification of a disease is meant for understanding a disease in its manifold expressions. It is also necessary to compare and contrast our work with fellow colleagues. A very simple type of classification is easy to follow but usually it is not scientifically very adequate. Similarly a detailed classification may theoretically be easy to follow but is it is difficult and time taking to carry out in practice. Thus a middle type may be quite useful particularly if large number of volunteers and studies are not available. Kuhn’s clas- sification is very simple and very popular but misses many things. Shukla et al made a better classification but made it a little long and hence could not become very popular. The present classification is an attempted answer to the above problem. Keywords: Ocular Trauma; ophthalmology; Eye Ball
251 Bisphosphonates and Ocular Inflammation , Ali Nouraeinejad1,2* Osteoporosis, as a musculoskeletal disease, is assigned by low bone mass and degradation of bone microarchitecture, culminat- ing in an escalation in bone weakness and propensity to fracture [1,2]. When the cumulative effect of bone resorption is in excess of bone formation, osteoporosis is induced [1]. Osteoporotic fractures are linked to substantial morbidity, mortality, and high healthcare expenses [1].
252 Prevalence of Ocular Diseases at University Teaching Hospital of Kara in Togo , Kokou Messan Amedome1, Codjo Rodrigue Abel Assavedo2*, Kokou Vonor3, Nidain Maneh4, Didier Koffi Ayena5 and Komi Balo6 Purpose: The aim of our study was to list the common eye conditions encountered in hospital practice at CHU Kara in order to de- termine their prevalence. Patients and Methods: This was a retrospective and descriptive study based on the files of patients who consulted in the ophthal- mology department of CHU Kara from January 1, 2017 to December 31, 2019. From a target population of 550 patients, we retained 248 selected cases of conjunctivitis who underwent a complete ophthalmologic examination. The parameters studied were age, sex, profession, reason for consultation and diagnosis. Results: The sample consisted of 550 patients. The average age was 34.63 years +/- 19.68. The 50 and over age group accounted for 40.55%. The sex ratio was 1.07. The visual loss represented 25.55% of the reasons for consultation. The eye conditions commonly encountered were conjunctivitis followed by ametropia then cataracts and glaucoma, ie 45.09% respectively; 28.18%; 15.63% and 9.45%. Retinal conditions such as retinal detachment accounted for 0.55% of all conditions encountered. Conclusion: Our study confirms the predominance of conjunctivitis in hospital practice in our context. However, other ailments should not be neglected since they are sources of visual impairment that can impact the development of our societies. Keywords: Prevalence; Eye Conditions; Conjunctivitis; Ametropia
253 A Plethora of Actions of Curcumin - A Magical Agent for Treatment of Wide Range of Diseases Varying from Neuroinflammatory Disease (AD, PD)-IBD to DM and CVD, NAFLD, NASH Along with Various Cancers - A Systematic Review , Kulvinder Kochar Kaur1*, Gautam Allahbadia2 and Mandeep Singh3 Curcumin represents a yellow polyphenolic pigment derived from the plant Curcuma longa (turmeric) rhizome that has been put in utilization over centuries for cuisine art besides coloring of foods, as a constituent of separate medicinal formulations that has been used over and over in Ayurveda along with Chinese medicine. In the current decades it has been exhaustively evaluated for its biological actions. Thus here we conducted a systematic review with the utilization of search engines like pubmed, google scholar, web of science, Cochrane library from 1900 till date with the utilization of MeSH terms Curcumin; Neuroinflammation; Alzheimer’s disease (AD); parkinson’s disease (PD); antioxidant actions; other anti-inflammatory actions; cardio protection; hepatoprotection in liver fibrosia; non alcoholic fatty liver disease (NAFLD); non alcoholic steatohepatitis (NASH); Anti cancer actions. We observed a total of over 3000 articles but selected only 53 articles for this review with the journals constraints of up to 50 references. No meta- analysis was done. Here we have reviewed in detail the mechanism of action of Curcumin in various above mentioned diseases along with transcription factors involved. Recently even in COVID its use has got documented. Although use in Alzheimer’s disease studied extensively human studies are still battling to get a concrete answer. In case of cancers, usually it is a good coagent with other chemo- therapeutic drugs, might hamper human papilloma virus (HPV) infection as well as avoid cancer cervix generation. In case of NASH, or liver cirrhosis its use with beta blockers might aid in conversion back towards normalcy. Keywords: Curcumin; Anti Inflammatory; Anti Oxidant; Neuro Shielding; Cardio Shielding; Hepatoprotection; Anti Cancer Actions
254 How SARS CoV-2 Affected Our Lives , Shivam Bajoria In September 2019 a data with 31% patients out of 38 are showing an onset of symptoms of infection through Corona virus in their eye. Serotypes 1-11 and 18, where corneal development is not known. As COVID-19 pandemic has proven to be quite an alarming con- dition for our society and the world as being a global crisis.
255 Perioperative Posterior Ischemic Optic Neuropathy: A Case Report , Mohamed M Khodeiry1* and Menna M Khodeiry2 Perioperative posterior ischemic optic neuropathy (PION) is a drastic complication for patients when they notice vision loss after recovering from anesthesia and this might have some medicolegal implications. Here, we report a 51-year-old male with bilateral vision loss due to PION after multiple laparotomies to control intrabdominal bleeding. Keywords: Optic Nerve; Perioperative; Posterior Ischemic Optic Neuropathy
256 Bilateral Metastatic Acute Lymphoblastic Leukaemia Presenting as Hypopyon: A Case Report , Asmita Indurkar, Manoj Soman, Sameer Iqbal*, Sumita Phatak and Unnikrishnan Nair R Here we report a case of a 32-year-old male patient with bilateral haemorrhagic hypopyon as an unusual presenting feature of acute lymphoblastic leukaemia (ALL). Cytology of anterior chamber tap was suggestive of leukemic infiltration of the anterior chamber of the eyes, a sign of metastatic acute lymphoblastic leukemia. He was conservatively managed with topical steroids and cycloplegics. Patient was already initiated with chemotherapy under the care of an oncologist. A leukemic hypopyon is considered as an early sign of central nervous system involvement or systemic relapse. A finding of clinical significance, it should be immediately reported to the oncologist to urgently rule out CNS involvement and for aggressive management. Keywords: Acute Lymphoblastic Leukaemia; Hypopyon; Acute Myeloblastic Leukemia
257 Effect of Jaw Movement in Blink Rate and Tear Volume , Premnath Krishnasamy1, Hari R1*, Sumanth Kumar H S2 and Pooja Anemath2 Aim: To find the effect of blink rate and tear volume during jaw movement Methodology: There are 50 subjects which were included in the study that are based on inclusion and exclusion criteria. First, we recorded Non-invasive breakup time, tear meniscus height, and Schirmer’s test, that are followed by blink rate and inter blink in- terval which was recorded in video. Lastly, the parameters were taken without jaw movement and during jaw movement hence the results were compared. Results: The report results were compared based on normal, reflex, and basal secretion with and without jaw movement and all of them are correlated. There was a significant reduction in blink rate during jaw movement in all three conditions with which show 24.1 ± 10.33, 31.72 ± 13.9, 24.0 ± 12.97 respectively in without jaw movement to 17.5 ± 8.34, 25.72 ± 13.28, 18.46 ± 11.12 respectively during jaw move- ment. There was a notable increase in inter blink interval values during jaw movement in all three conditions from 3.02 ± 1.33 sec, 2.3 ± 1.21 sec, 3.59 ± 2.93 sec respectively in without jaw movement to 4.32 ± 2.52 sec, 3.04 ± 1.68 sec, 3.59 ± 2.93 sec respectively during jaw movement. There was a slight reduction in non-invasive tear break up time during jaw movement in all three conditions which appear to be 7.97 ± 1.38 sec, 6.76 ± 1.12 sec, 7.23 ± 1.31 sec respectively in without jaw movement and 6.06 ± 0.89 sec, 4.5 ± 1.23 sec, 5.84 ± 1.34 sec respectively during jaw movement. There was pointless reduction in tear meniscus height during jaw movement in all three conditions with 0.34 ± 0.06 mm, 0.37 ± 0.08 mm, 0.35 ± 0.07 mm respectively in without jaw movement to 0.33 ± 0.06 mm, 0.35 ± 0.08 mm, 0.34 ± 0.08 mm respectively in during jaw movement. Conclusion: From above data, we can conclude that there was remarkable reduction in blink rate, tear stability, tear secretion during jaw movement where as slightly increased inter-blink interval. Likewise, there were no change in TMH during jaw movement. Keywords: Schirmer Strips; Non-invasive Tear Break Up Time; Tear Meniscus Height; Proparacaine 0.5%; Mastication
258 Accommodative Spasm on Teenage , Hari R* A 16 year old girl complaint of severe headache especially in occipital area since 2 weeks. History of long hours of computer usage more than 6 hours a day. No any ocular trauma or any head injury, or any significant medical history. On examination her unaided visual acuity was found to be 6/6 monocularly and on slit lamp examination anterior segment was within the normal limit. Then dry auto refraction value was taken which was RE: -6.50 dsp/-0.75 dcyl at 31 and LE: -3.50 dsp/-0.50 dcyl at 4. Near point of convergence was measured by help of RAF ruler and it was 6cm. Also near point of accommodation was mea- sured by help of RAF ruler and it was RE: 20D, LE: 6D and Binocularly 20D. Subjective refraction was done and she didn’t accept any power her BCVA for distance was 6/6 and near was n6 (blur) monocularly and. Then cycloplegic refraction was advised for her and cyclopentolate drops was used to rule out accommodative spasm and after that wet auto refraction value was taken which was RE: +0.50 dsp/-0.50 dcyl at 14 and LE: +0.75 dsp/-0.75 dcyl at 4 which show that the patients had accommodative spasm. Keywords: Accommodative Spasm; Hypermetropia; Headache
259 Burkholderia Postoperative Endophthalmitis and an Outbreak Including Bilateral Simultaneous Postoperative Endophthalmitis , Mike Yuan Chen1, Susan Ruyu Qi2, Jens Kratholm3 and Steve Arshinoff1,4* Purpose: To describe a single-center series of the first Burkholderia contaminans postoperative endophthalmitis (POE) cases and the first suspected Burkholderia cepacia complex (Bcc) bilateral simultaneous postoperative endophthalmitis (BSPOE) in the context of Burkholderia bacteria and systemic Burkholderia infections. Setting: The Narvik Eye Clinic, Narvik, Norway. Design: Retrospective study of all 5 unilaterally and one bilaterally infected patients, the surgical environment, Burkholderia bacteriol- ogy and the likely cause of the infections. Methods: Meticulous review of the case series occurring during unusual winter weather in arctic Norway in January 2019, detailed examination of the surgical clinic, dismantled for this assessment, followed by detailed review of the biology of Bcc species and the infections it can cause. Results: Six patients developed postoperative Bcc endophthalmitis within 4 months postoperatively, with one case suffering BSPOE. All cases, except one eye of the BSPOE patient, were vitreous-culture positive for B. contaminans. The Bcc strain was genetically identi- cal to the ones later cultured from the surgical center’s ventilation system. All patients recovered visual acuity of 20/25 or better after aggressive treatment. Conclusions: Bcc-induced postoperative endophthalmitis is rare and can occur if operating room ventilation is tampered with. It is challenging to treat with generally poor outcomes prior to the current series, in which all cases did well. Keywords: Endophthalmitis; Postoperative Endophthalmitis; Bilateral Endophthalmitis; Bilateral Simultaneous Postoperative En- dophthalmitis; Bilateral Postoperative Endophthalmitis; Operating Room Ventilation; Burkholderia; Burkholderia Endophthalmitis
260 Subjective Refractions Determined by Dyop® and Snellen Chart as Optotypes , Isiaka Sanni Oluwasegun* Purpose: Compare subjective refractive error and visual acuity measurement by Dyop® acuity chart and Snellen chart. Methods: Forty subjects aged 24.48 ± 2.01 years with visual acuity better than 6/12 were recruited at University of Benin Optom- etry Clinic. Refractive error and corrected visual acuity were measured by subjective refraction method with Dyop® acuity chart and Snellen chart. The assessment sequence between the two acuity charts formats was alternated for every other patients to reduce potential refractionist bias. The duration of measurements was compared. Thibo’s notation was used to represent the refractive er- ror findings to enhance easy analysis. Results: There was no significant difference in terms of spherical equivalent (M), component J0 and J45 measured by Dyop® acuity chart and Snellen chart (even with age and gender consideration) for the subjective refractive error assessments but there was dis- parity in the mean acuity of about 0.25 diopters with Dyop (1.17 ± 0.14 decimal units) and Snellen chart (1.60 ± 0.21 decimal units). The subjective refraction measurement with Dyop (339 ± 122 seconds) took half the duration for Snellen’s (680 ± 281 seconds). Conclusions: Subjective refractive error measurements by a Dyop® was comparable with Snellen chart. Dyop® subjective refractive error assessment was twice as efficient, with a narrower variance in visual acuity measurements, compared to the subjective refrac- tion done with Snellen charts as optotype. Keywords: Dyop®; Snellen Chart; Subjective Refraction; Visual Acuity
261 Regenerative Corneal Prosthesis as an Alternative to Human Donor Cornea for Transplantation to Treat Blindness , Shivam Bajoria* An alternative to human donor cornea is needed as the availability of limited good quality tissue, with this condition potentially worsening in many countries as the population is progressively ageing. Corneal equivalent develop by numerous attempts as an alternative to human corneas donated as well as prosthesis. In this review the efforts in bioengineering implants has been focus that are described include biomaterials that allow for partial regeneration of corneal tissue, self-assembled cornea constructs and cell free. Cornea implants that promoted regeneration when evaluated in clinical trials. Keywords: Cornea; Biomaterials; Prostheses; Regeneration; Self Assembly; Implants; Clinical Studies
262 Surgical Outcomes of Late Surgery in Uncomplicated Infantile Exotropia , Soveeta Rath1*, Jinal Gore2 and Suma Ganesh1 The purpose of our study is to determine the motor and sensory outcomes in children undergoing surgery for infantile exotropia after age of 2 years and to review the association of pre-operative variables with surgical outcomes. In this retrospective study, we included patients who were diagnosed as infantile exotropia with a deviation of > 25 Prism diopters (PD) before 12 months age and subsequently underwent strabismus surgery at a single centre from 2014 to 2019. Postoperative motor alignment was assessed at 6 weeks and binocular sensory status was assessed using Worth 4-Dot (WFDT) and Titmus stereoacuity tests at 6 months follow up. A total of 30 patients were analysed. At 6 weeks post-op, motor success was seen in 24 patients (80%), whereas 6 patients (20%) con- stituted failure group which included 5 patients (17%) with a recurrence and 1 (3%) with an overcorrection. At 6 months post-op, measurable stereopsis was present in 15 patients (50%) with a stereopsis better than 400 sec of arc in 12 patients (40%), binocular single vision was present in 6 patients (20%) on WFDT. Smaller pre-operative angle of deviation was significantly associated with motor success for distance (p = 0.009) and near (p = 0.020). Smaller pre-operative angle for distance was associated with better sen- sory outcomes (p = 0.041). Pre-operative vision, age at surgery and duration of misalignment did not show statistically significant association with motor and sensory outcomes. Thus we conclude, smaller pre-operative angle of deviation for distance and near are associated with good motor and sensory outcomes. Older age at surgery in this study had outcomes comparable to younger age group reported in previous studies. The association of surgical outcomes with pre-operative vision and duration of misalignment could not be proven by this study. Keywords: Strabismus; Exotropia; Infantile; Surgery; Binocularity; Outcomes; Intermittent Exotropia
263 Tips to Increase Knowledge Generation Through Research, During the Ophthalmology Residency , Fernando José Macouzet-Romero and Virgilio Lima-Gómez* A goal of the Ophthalmology residency is to develop research, but few specialists perform this activity during their professional practice. One of the reasons is that the training of the specialist seeks to get clinical-surgical skills and uses research as a tool to improve them. In residency programs that require a thesis to ob- tain the degree of specialist, the deadlines needed to graduate may sometimes interrupt projects; this prevents completing the stud- ies and the resources invested in them are lost, which generates frustration both in the student and in the educational institution.
264 How Digitalization is Advancing Ophthalmology , Mukesh Sinha* Down the years of ophthalmology, research scientists, techni- cians have always tried to come up with advanced and effective ways to diagnose, treat and even sustain the healthy state of hu- man eyes. Though the field has seen some incredible techniques to help humans, in times like these, when digitalization is approach- ing its heights, it’s been prevalent how digitalization can advance ophthalmology.
265 Effect of Caffeine (Coffee) on Blink Rates of Adults During Conversation , Anonaba Chimeremeze Alozie*, Ubani Udo Ahanna, Ihesiulor Grand Chikezie, Ikesinachi Ubah Samuel and Freeman Odionyenfe Ifeanyi Purpose: To determine the effect of caffeine on blink rate of adults Method: A total of 100 subjects aged 18 - 50 years participated in the study. The subjects were allowed to rest for 5 minutes and then conversed for 1 minute during which the subjects talked with the researcher on general issues to make for relaxation. The number of blinks per minute was noted and recorded. After which the subjects were given 1.5 grams of Nescafe coffee powder, mixed with 50 millilitres of water, under room temperature. Each subject drank the coffee drink comfortably and the exact time of coffee intake noted. Number of blinks at 15 minutes was taken after each subject consumed Nescafe coffee. Blink rate was taken for each subject at 30, 45 and 60, minutes after coffee consumption. Results: Mean baseline blink rate was 16.17 blink/min. 15 minutes post consumption of coffee, mean blink rate decreased to 14.00 blink/min. 30 minutes post consumption of coffee, mean blink rate decreased to 12.89 blink/min. 45 minutes post consumption of coffee, mean blink rate further decreased to 11.03 blink/min. Mean blink rate at 60 minutes post consumption of coffee was 14.84 blink/min. Conclusion: This study showed that caffeine significantly decreased blink rate during conversation. Blink rate at 60 minutes was noted to be gradually returning to baseline blink rate. This suggests that the effects if caffeine on blink rate in adults may last for an hour before it gradually diminishes. This study also compared the effect of caffeine based on gender and found no significant differ- ence between blink rate in both sexes. However, there was an effect in respect to age. Older people had a significantly decreased blink rate after consumption of coffee with respect to time. Keywords: Caffeine; Adults; Blink Rate
266 Solar Retinopathy Secondary to Solar Eclipse Gazing: A Case Report from Nepal , Keshav Acharya 1 * and Janak Poudel 2 Solar retinopathy is a photochemical damage to the retina, generally due to direct or indirect solar observation or during eclipse. We document the case of a solar retinopathy in a 19-year-old male who presented with the complaint of blurring of central vision in both eyes since a day after the solar eclipse dated 26th December 2019 (Annular Eclipse). He had a history of gazing solar eclipse through the reflecting plain mirror for about one minute. During examination, his visual acuity was reduced to 6/12 bilaterally and the fundus examination revealed discrete yellow lesions at each maculae. Optical Coherence Tomography (OCT) shows RPE defects at both fovea, which shows the signs of improvement and only a few changes to normal after a certain month. The symptoms were reduced and patient had no complaints when he appeared to our clinic one month later. Thus, we should make everyone aware about using goggles/ eye protection during sun exposure to reduce the risk which is highly susceptible to retinal damage, which turned into probably the case for this patient. Keywords: Visual Acuity (VA); Optical Coherence Tomography (OCT); Retinal Pigment Epithelium (RPE); Solar Retinopathy
267 The Chronicle of Dislocated ICL V4c- A Case Report and Review of Literature , Venugopal Anitha*, Meenakshi Ravindran and Aditya Ghorpade To report a case of traumatic repetitious anterior Phakic Intraocular Lens (ICL) dislocation and its review of Literature. Following Blunt trauma in a 31-year-old male, partial, anterior, nasal dislocation of ICL was noted after two years of implantation. Immediately after reposition, spontaneous repeated dislocation was noted during the first postoperative day. The ICL was reposited twice in our patient. The reasons for the repetitious prolapse of the haptics of ICL were discussed in detail with reference to the review of Litera- ture. The most common complications following ICL implantation are cataracts and Glaucoma, which could be prevented by accurate sizing of the lenses. In addition to wrong sizing, spontaneous ICL dislocations occur due to other factors such as abnormal positioning of ICL in the sulcus, and the size of the pupil during the immediate postoperative period. Keywords: The Chronicle; Dislocated ICL V4c; Review of Literature
268 Ocular Phenotypic Features of Adult-Onset Primary Open Angle Glaucoma in A Tertiary Hospital in Southern Nigeria , Onua AA and Ordinioha B* Background/Objective: This was a prospective study of patients diagnosed with adult-onset Primary Open Angle Glaucoma (POAG) at the Glaucoma Clinic at the University of Port Harcourt Teaching Hospital, Nigeria. The objective of the study was to determine the ocular phenotypic features of patients with adult-onset glaucoma. Materials and Methods: Clinical assessment of patients combined with findings from clinical records and interviewer administered semi-structured questionnaire were used to obtain data from the respondents between January and December 2021. Results: One thousand two hundred (n = 1200) adult POAG patients aged ≥ 40 years were recruited. The mean age of the subjects was 56.5 ± SD 22.3 years. Male-female ratio was 2.9:1. The mean central corneal thickness (CCT) was 532 ± SD 8.6 μm and average intraocular pres- sure (IOP) was 31.3 ± SD 11.2 mmHg. Nine hundred and three subjects (n = 903;75.3%) had high intraocular pressure (≥ 22 mmHg). Over 25% had poor ocular perfusion pressure (≤ 40mmHg). Six hundred and forty-seven (n = 647; 53.9%) had positive family history of glaucoma (first degree relatives) while 234 (19.5%) had positive family history of glaucoma (second degree relatives). Eight hun- dred and twenty (n = 820; 68.3%) subjects had cupping of the optic disc (VCDR ≥ 0.7). All the study participants had II to IV degree of open drainage angle on gonioscopy. Conclusion: Thin CCT, high IOP, large VCDR poor OPP, and open drainage angle are noticeable ocular phenotypic features of adult- onset primary open angle glaucoma. Early detection through community-based case detection using these parameters could help in reducing the scourge from POAG. Keywords: Adult-Onset Primary Open Angle Glaucoma; Phenotypic Features; Southern Nigeria
269 Pre-eclampsia Associated Bilateral Serous Retinal Detachment: A Case Report , Saley Hamidou Idrissa*, Maha omari betahi, Ahmed Bennis, Nouhou Diori Adam, Fouad Chraibi, Meriem Abdellaoui, Yacoubou Soumana and Benatiya Andaloussi Idriss Serous retinal detachment is a rare complication of pre-eclampsia. We report the case of a 20-year-old patient with a 28-week pregnancy who was referred from the obstetric emergency department for a sudden decrease in visual acuity in both eyes. The ge- neral examination revealed high blood pressure with massive proteinuria and the ophthalmological examination showed extensive bilateral retinal serous detachment. In view of this clinical picture, blood pressure was balanced with antihypertensive therapy and the retina reapplied totally after 2 months. Keywords: Pre-eclampsia (PE); Serous Retinal Detachment (SRD); High Blood Pressure, Proteinuria
270 A Case Report of Extensive Cerebral Venous Sinus Thrombosis in a Patient with Behçet's Disease Revealed by Binocular Diplopia , Maha Omari Betahi*, Saley Hamidou Idrissa, Ahmed Bennis, Fouad Chraibi, Meriem Abdellaoui, Idriss Benatiya Andaloussi A 34 year-old patient was admitted in our department for diplopia associated with headache. In his background, he was fol- lowed in the Internal Medicine Department for Behçet’s disease manifested by bipolar aphtosis and deep vein thrombosis (DVT) of the lower extremities. Ophthalmological examination revealed a VA of 10/10 with a grade III papilledema. The CT scan showed a filling defect of the lateral sinus and superior longitudinal sinus with a “delta” sign in favour of dural venous sinus thrombosis leading to for the diagnosis of cerebral angio-Behçet. MRI confirmed the diagnosis by demonstrating extensive cerebral venous sinus thrombosis (CVST) of the superior longitudinal sinus, sinus rectus, lateral sinus, left sigmoid sinus, and left internal jugular vein. The treatment was based on the corticosteroid (methylprénisolone) with anticoagulant (Low molecular weight heparin and antivitamine K) and colchicine. The outcome was favorable with an easing of the headache and diplopia. Keywords: Behçet’s Disease; Vasculitis; Cerebral Venous Thrombosis; Diplopia
271 Ocular Injuries Caused by Intimate Partner Violence Using an Emergency Room Database - A Gender - Based Analysis , Radhika Malhotra, Yash S Shah, Paul D Langer and Neelakshi Bhagat* Objective: Intimate partner violence (IPV) has increased since the start of the COVID-19 pandemic. Ophthalmologists and emer- gency department (ED) physicians should be vigilant in assessing patients with ocular injuries for a history of IPV. Our study is aimed to describe the epidemiology of patients presenting to the emergency department with ocular injuries secondary to IPV. Methods: We conducted a retrospective study using the National Electronic Injury Surveillance System-All Injury Program (NEISS- AIP) from 2006 to 2016 in 60 emergency departments across the United States. 25,541 ED patients with an ocular injury due to IPV were analyzed. Main outcomes included race, hospital size, incident location, reason for assault, precipitating cause of injury, and medical diagnosis. Results: IPV-related ocular injuries were more commonly noted in women compared to men (73.8% vs 26.2%). Most patients were in the young adult group (21-30 years old). Men and women were primarily Black in majority. In males, the precipitating cause of injury was either being struck by an object or injury by fire (struck 66.1%, fire 30.6%), whereas females were overwhelming injured by a striking injury (90.4%). The most common diagnosis was an ocular contusion or abrasion (males 43.4% vs females 53.4%). Conclusion and Relevance: IPV results in significant ocular trauma that presents to the ED, and is more commonly see in women, black race, and young adults. However, men can also be victims of IPV and should be equally evaluated. Assessment of IPV is impor- tant in ocular injury seen in the ED. Keywords: Intimate Partner Violence; IPV; Ocular Injuries; Eye Traum
272 Comparative Effectiveness of Hyperbaric Oxygen Therapy Versus Bevacizumab Therapy in Patients with Vascular Obstructions of the Retina , Lic Rodrigo Ojeda Salamanca 1 , Lic Cristopher Campos Cifuentes1 and Mg Hugo Berríos Arvey2 * Aim: To compare the evidence of primary studies on the effectiveness of hyperbaric oxygen therapy and Bevacizumab in patients with retinal vascular obstructions. Materials and methods: A systematic review was carried out without meta-analysis of 123 primary studies, 98 of which were excluded due to exclusion criteria, the remaining 25 studies were submitted to internal and external validity criteria, leaving 20 for research use. Results: No significant differences were observed between the efficacy of hyperbaric oxygen therapy and Bevacizumab (0.73 and 0.78), respectively. In contrast, the cost of both benefits had a significant variation between both therapies ($20.70 and $475.42 dol- lars approximately). Conclusions: Although both therapies have demonstrated efficacy in retinal vascular obstructions, the cost per individual benefit makes hyperbaric oxygen therapy more convenient and at the same time less invasive than other ophthalmologic treatments indi- cated for these pathologies. Keywords: Hyperbaric Oxygen Therapy; Bevacizumab; Retinal Vascular Obstruction; Hyperbaric Chamber; RVCO; CRAO
273 A Prospective Study on Visual Outcomes of Cataract Surgery after Phacoemulsification with Foldable vs Non Foldable Intraocular Lenses , Shavina Garg 1 , Harsimran Singh1 , Rajinder Khalsa 1 , Usha Aggarwal 2 , Anand Aggarwal 1 *, Indu Khosa1 , Kamlinder Kaur 1 and Shubham Mittal Purpose: To compare the visual outcomes of cataract surgery with foldable vs non foldable Intraocular lenses after phacoemulsifica- tion, at a tertiary Eye centre in Department of Ophthalmology, Government Medical College, Patiala. Methods: In a prospective, comparative, randomized clinical trial of phacoemulsification cataract surgery, 200 patients received hydrophilic foldable intraocular lenses through 2.8mm clear corneal incision and 100 patients received non foldable Polymethyl Methacrylate (PMMA) intraocular lenses through 5.25mm clear corneal incision. Preoperative and postoperative visual acuity, Penta- cam based analysis of astigmatism, dry eye changes and IOP measurements at day 7, 1 month, 3 month and 6 month follow up visits were analysed. Results: A total of 300 people were enrolled in the trial, 200 were randomly allocated to receive a hydrophilic foldable lens and 100 to receive a non foldable PMMA lens. At 6 months after surgery, 194 out of 200 patients (97%) had best corrected visual acuity of 6/9 or better in foldable group (group I) and 95 out of 100 (95%) in the non foldable group (Group II). Visual acuity of 6/12 - 6/18 was observed in 3% of foldable and 5% of non foldable group (p value - 0.385). None of the cases in both group I and II had best corrected visual acuity worse than 6/18 at the end of 1 month. Vision stabilized in both groups after first month postoperatively. Surgically induced astigmatism was 0.47 0.39 D in group I and 1.03 0.48 D in group 2 at the end of 6 months as compared to baseline. The dif- ference in SIA between both groups was statistically significant (p value < 0.001). Dry eye changes were more in group 2 as compared to group 1 but the difference was not significant. As far as IOP changes were concerned, both the groups didn’t have any significant difference, though the decrease in IOP was significant in each group after 6 months of cataract surgery (p value < 0.05). Conclusion: Phacoemulsification with implantation of a foldable IOL through a 2.8mm incision leads to less post operative astigma- tism as compared to phacoemulsification with implantation of a non foldable IOL through 5.25mm incision. The main concern of pa- tients is final visual outcome, which remains the same with both foldable and non foldable IOLs. Therefore, phacoemulsification with either implantation of a foldable or an inexpensive rigid PMMA IOL gives excellent results in hands of experienced cataract surgeons. Keywords: Cataract; Phacoemulsification; Intraocular lenses; Visual Acuity; Surgically Induced Astigmatism; Intraocular pressure
274 Effect of Anisometropic Correction on Binocularity at Al-Ibrahim Eye Hospital, Karachi , Priyanka1 *, Sadaf Fatima 2 , Savaira Sarwar 2 , Malik Anjum Fayyaz 2 , Manoj Johrani2 and Rabia Akbar Introduction: Anisometropia is a condition in which the two eyes have unequal refractive power one eye may be markedly stronger than the other. Anisometropia affects our binocular vision. Individual with anisometropia typically see one eye larger image in one eye and one smaller image in the other eye. Objective: To determine the effect of anisometropic correction on binocularity in Al-Ibrahim eye hospital, Malir Karachi. Methods: A Cross Sectional Descriptive study was carried out in Al-Ibrahim eye hospital, Malir Karachi from July 2021 to December, 2021. Non-Probability Convenient sampling technique was used. This study involved 52 subjects who diagnosed with different types of Anisometropia of age range 10-30 years, of both genders. Demographic data, history of onset, visual acuity of every subject was checked and recorded separately both for near and distance, with and without glasses and with pin-hole, objective and subjective refraction were performed. Stereopsis was evaluated by Lang I, Lang II and Frisby test. Worth four dots test was also performed to evaluate the binocular single vision. SPSS version 20.0 was used to analyze the data. Results: A total of 52 subjects were included in this study. Out of 52 subjects, 29 were males and 23 were females. Most of the sub- jects showed the degree of anisometropia of range (2.50 -3.00D). Astigmatism was most commonly presented in subjects among other refractive errors. Visual acuity was seen to be better after anisometropic correction showed significant result with p-value 0.000. There was slight change in stereo acuities with Lang I, Lang II and Frisby stereo acuity tests and all the subjects were indicated with normal fusional status by worth four dot test. Conclusion: This study revealed that there was change in stereo acuities among all groups of degrees of anisometropia. There was no any association found between the age and degree of anisometropia on the Stereopsis and binocular single vision. Fusional status was normal showed the normal retinal correspondence. Keywords: Anisometropia; Stereopsis; Lang I; Lang II; Frisby; Worth Four Dot Test
275 Comparing the Effect of Penetrating Canaloplasty and Trabeculectomy in Pseudophakic Chronic Primary Angle Closure Glaucoma Patients , Xiaoyuan Yang, Conghui Ma, Haijun Li, Xin Jin, Jing Ren, Liang Dong, Yangzeng Dong and Zongming Song Background: To compare the efficacy and safety of penetrating canaloplasty with partial Schlemm’s canal excision and retention suture to traditional trabeculectomy in the treatment of chronic primary angle closure glaucoma (PACG) in patients who are pseu- dophakic. Methods : This is a single center prospective comparative cohort study. Eleven consecutive pseudophakic patients (14 eyes) with the diagnosis of chronic primary angle closure glaucoma who were examined at the Henan Eye Institute at Henan Provincial People’s Hospital, between March 2018 and June 2019, were enrolled in the penetrating canaloplasty group. We also retrospectively reviewed the charts of 11 age and gender matched pseudophakic chronic PACG patients (14 eyes) who underwent traditional trabeculectomy the year prior at the same institution. We compared the efficacy and safety between the two surgical intervention groups. The main outcome measure is surgical success defined as IOP ≤21mmHg without topical IOP lowering medications at 6 months post-operatively. Conditional success defined as IOP ≤21mmHg with topical IOP lowering medications at 6 moths post-operatively. Results: Six months after the respective surgeries, patients who underwent PC achieved a complete success rate of 85.7%, versus 42.9% in the trabeculectomy group, which is significantly higher (p=0.018). Conclusion: Compared to traditional trabeculectomy, penetrating canaloplasty with partial SC resection and retention suture might be able to achieve comparable IOP reduction in pseudophakic chronic PACG patients. Keywords: Penetrating Canaloplasty; Chronic Primary Angle Closure Glaucoma; Schlemm’s Canal Glaucoma Procedures; Pseudo- phakic
276 Complications and Management of the Excessive Fibrin Glue in Anterior Chamber: Case Report , Ozlem Barut Selver 1 , Ilayda Korkmaz 1 and Melis Palamar 2 * A 36 year-old 9-week pregnant female presented with redness, pain and photophobia in the left eye. Best corrected visual acuity (BCVA) was 20/33. Slit-lamp examination revealed a 1.5 mm perforation area in the paracentral cornea. Fibrin glue was placed in the corneal perforation area for sealing and secured with bandage contact lenses. During the procedure, an excessive amount of fibrin glue was mistakenly injected into the anterior chamber (AC). On the postoperative first day, there was moderate AC reaction with raised intraocular pressure (IOP). Topical steroid and anti-glaucomatous treatment were administered. During the follow-up, com- plete dissolution of fibrin glue and regression of AC reaction was observed, and IOP went back to normal. Two weeks after fibrin glue injection, corneal integrity has achived and AC depth was normal with residual fibrin glue particles. BCVA increased to 20/25. Ocular findings remained stable during the follow-up for 18 months. Clinicians should be aware of the possible side effects of fibrin glue application. Careful observation and accurate management of the secondary complications are crucial to prevent further damage. Keywords: Corneal Perforation; Fibrin Tissue Adhesive; Anterior Chamber; Intraocular Pressure
277 Noncompliance with Prescribed Eye Drops is to be Addressed in Patients Undergoing Cataract Surgery , Ali Nouraeinejad; Cataract is the leading cause of blindness worldwide [1-6]. Cat- aract surgery is one of the most common surgeries in the world [2] so that cataract surgery is the commonest single surgical proce- dure carried out in the developed world [7].
278 Effect of Caffeine (Coffee) on Blink Rates of Adults During Conversation , Anonaba Chimeremeze Alozie*, Ubani Udo Ahanna, Ihesiulor Grand Chikezie, Ikesinachi Ubah Samuel and Freeman Odionyenfe Ifeanyi Purpose: To determine the effect of caffeine on blink rate of adults Method: A total of 100 subjects aged 18 - 50 years participated in the study. The subjects were allowed to rest for 5 minutes and then conversed for 1 minute during which the subjects talked with the researcher on general issues to make for relaxation. The number of blinks per minute was noted and recorded. After which the subjects were given 1.5 grams of Nescafe coffee powder, mixed with 50 millilitres of water, under room temperature. Each subject drank the coffee drink comfortably and the exact time of coffee intake noted. Number of blinks at 15 minutes was taken after each subject consumed Nescafe coffee. Blink rate was taken for each subject at 30, 45 and 60, minutes after coffee consumption. Results: Mean baseline blink rate was 16.17 blink/min. 15 minutes post consumption of coffee, mean blink rate decreased to 14.00 blink/min. 30 minutes post consumption of coffee, mean blink rate decreased to 12.89 blink/min. 45 minutes post consumption of coffee, mean blink rate further decreased to 11.03 blink/min. Mean blink rate at 60 minutes post consumption of coffee was 14.84 blink/min. Conclusion: This study showed that caffeine significantly decreased blink rate during conversation. Blink rate at 60 minutes was noted to be gradually returning to baseline blink rate. This suggests that the effects if caffeine on blink rate in adults may last for an hour before it gradually diminishes. This study also compared the effect of caffeine based on gender and found no significant differ- ence between blink rate in both sexes. However, there was an effect in respect to age. Older people had a significantly decreased blink rate after consumption of coffee with respect to time. Keywords: Caffeine; Adults; Blink Rate
279 Delta and Omicron Variants , Isiaka Sanni Oluwasegun* The purpose of this paper is to review recent studies on Delta and Omicron variants of SARS-CoV-2 as to their symptoms, disease presentation and diagnosis, how they are affecting us and how ocular exposure routes influence disease presentation. Delta and Omicron have similar symptoms that sufferers present with, but shortness of breath is peculiar to the Delta variant and sneezing is not a symptom of Delta but of the Omicron variant infection. PCR and Antigen tests are usually done to diagnose SARS-CoV-2 if the disease is suspected but genomic sequencing (an expensive diagnostic test) is required to diagnose the Delta, Omicron, or the exact SARS-CoV-2 variant. The Delta variant (B.1.617.2) had invaded over 163 nations as of August, 2021 after it was discovered in India in late 2020. The Omicron SARS-CoV-2 variant may be more transmissible but less severe than the Delta variant form. The Delta VOC mostly endangers those who are unvaccinated or just partially vaccinated but the Omicron variant may be associated with increased risk of reinfection. In South Africa, the base of the Omicron variant, children seem to have been affected more with increase in num- ber of hospitalizations among those children under age 5. A few cases of Delta variant infections reported had ocular manifestation including red bloodshot eye and conjunctivitis, but there may be a connection between chronic yet SARS-CoV-2 (Omicron variant) and neuroparalytic keratitis. Further studies into the ocular manifestation of these two VOCs and the susceptibility of the ocular surface as a route of entry may revolutionize our understanding of the two VOCs. Keywords: SARS-CoV-2; Delta Variant; Omicron Variant; Ocular Surface
280 A Comparative Study between Sutureless, Glue-less Conjunctival Autograft vs Sutured Limbal Conjunctival Autograft for Primary Pterygium , Mandeep Singh Rai 1 , Neenu Kalra 2 , Anand Aggarwal 1 *, Rajinder Khalsa1 , Divjot Kaur 1 , Indu Khosa1 , Ravneet Kaur 1 and Surmila Meena Purpose: To compare and evaluate efficacy of two surgical techniques for management of primary pterygium in terms of post- operative signs, symptoms and complications. Design: This was a comparative, prospective, randomized, open labelled parallel study. Setting: Department of Ophthalmology, Government Medical College, Patiala, Punjab. Methods: The study included 60 patients with primary pterygium. The mean age was 42 ± 10 years (range 22-62 years). Simple exci- sion under local anaesthesia was performed followed by closure of the bare sclera by suture less and glue free conjunctival autograft in 30 patients (Group I), versus conventional method of a sutured conjunctival autograft in 30 patients (Group II). Results: At Visit 1, 6 patients (20%) of Group I had Graft edema in comparison to 5 patients (16.67%) in Group II. Subcutaneous haemorrhage was noted in 6 (20%) patients in both the groups. Graft retraction was noticed in 4 patients (13.33%) in Group I and in 2 patients (6.66%) in Group II. Graft dislodgement was observed in 1 patient (3.33%) in Group I. One (3.33%) case of recurrence was reported at 6 months in Group I whereas 2 (6.67%) cases were reported in Group II. One case of Granuloma was reported in Group II. There were significantly lower post-operative signs and symptoms in group I as compared to group II in the first post-operative week and the difference between the two groups was statistically significant (p value < 0.05) at visit 1 and visit 2. The satisfaction survey revealed higher overall satisfaction score for group I as compared to group II. Conclusion: Sutureless technique may be considered as a viable alternative to sutured technique in terms of surgical outcomes. It scores better in terms of post-operative symptoms when compared to sutures. Keywords: Pterygium Surgery; Sutureless Glue Free Conjunctival Autograft; Conjunctival Autograft
281 Sarcomatoid Carcinoma of the Orbit: A Rare Case Report , El Houssaine Boudra 1 *, Hajar Hanguir 1 , Imane Gouzi 2 , Ahmed Bennis1 , Nawal Hammas 2 , Fouad Chraibi 1 , Meriem Abdellaoui 1 and Idriss Benatiya Andaloussi 1 Sarcomatoid carcinomas (SCs) are a variant of squamous cell carcinomas. They are extremely uncommon in the orbit. In the English literature, we reported Only 9 cases with orbital origin of this tumors. The prognosis of sarcomatoid carcinoma is extremely poor and the disease is usually clinically advanced at presentation. Currently, there is no consensus for the treatment of this variant malignant neoplasm. The treatment should be aggressive, and frequently yield poor results. We present a case of 42 years old male with orbital sarcomatoid carcinoma. Keywords: Orbital; Sarcomatoid; Carcinoma; Case Report; Spindle Cell
282 Anterior Herpetic Uveitis, About a Clinical Case , Danny Silva Cevallos 1 *, Juan Carlos Salazar Flores2, Diana Salazar Flores3 , Fernando Silva Michalón 4 , Jhuleydi Chuncho Romero 5 and Gabriela Flores Moscoso 6 Next, a report is made of a clinical case of a male patient who was admitted to our institution with a suspected diagnosis of a transient cerebrovascular event together with visual disorders that, upon detailed examination, revealed damage to the anterior chamber of the eye, giving as a diagnosis Uveitis being the same an ophthalmological pathology of meticulous treatment and delicate progression to blindness if it is not treated properly. Additionally, its etiology could be determined as a viral whose causative agent was Herpes Virus 1. This case is presented as the objective of the appropriate determination of ophthalmological pathology, always seeking in this way more detail to the physical examination and the anamnesis around patients suffering from other pathologies and the aforementioned diagnosis goes unnoticed. Keywords: Uveitis; Eye; Anterior Chamber; Blindness; Ophthalmologic
283 How to Reduce the Risk of Cataract , Ali Nouraeinejad* Cataract is currently the leading cause of blindness in the world [1-3]. Contributing risk factors for the development of cataract in- clude older age, sunlight exposure, certain types of chronic health diseases, a secondary (complicated) cataract developing as a re- sult of other primary ocular diseases, secondary to the medication (e.g., systemic corticosteroids), ocular trauma, radiation, smoking, alcohol use, obesity, nutritional deficiency, family history, and pre- vious eye surgery [1,2].
284 Post-operative Complications of Silicone Oil Removal , Maha Omari Betahi*, Saley Hamidou Idrissa, Ahmed Bennis, Fouad Chraibi, Meriem Abdellaoui and Idriss Benatiya Andaloussi Purpose: To outline the features, results and associated complications following the removal of silicone oil from the eyes. Methods: This is a retrospective study of eyes treated for silicone oil removal between 2017 and 2021. Visual acuity (VA), intraocular pressure (IOP) and rates of retinal re-detachment, hypotony, ocular hypertension, corneal complications, cystoid macular oedema (CMO) and cataract progression were evaluated. Several variables were analysed, including preoperative and postoperative visual acuity (VA) (at 1 month, 3 months and 6 months), preoperative and postoperative intraocular pressure (IOP) (at 1 month,3monthsand6months),andtheprevalenceofcomplicationsaftersiliconeoilremoval.Thecomplicationsinvestigatedweremainly retinal re-detachment, ocular hypotony, ocular hypertension, corneal complications, cystoid macular oedema (CMO), macular hole and cataract progression. Results: Totally, 59 eyes of 59 patients (83% male, average age 42.9 years) were identified. Silicone oil tamponade had been used for retinal detachment (RD) surgery as a tamponade agent in all eyes, including two that had also had surgery for an open globe injury. Salt solution (BSS) or air were chosen as vitreous substitutes in the majority of eyes (85%) after removal of the oil. The average duration of SO tamponade was 16.1 months. The average logMAR VA before oil removal was 1.55. which improved to an averageof1post-operatively.TheaverageIOPpre-operativelywas18.9mmHg,whichreducedby4.6mmHgaftersurgery.Complications following SO removal were: retinal re-detachment (12%), CMO (8%), ocular hypertension (7%), hypotony (5%), cataract progression (5%), macular hole (5%), corneal complications (3%), and epiretinal membrane (3%). Conclusion: Following SO removal, as shown in this study, VA has significantly improved overall and IOP has been reduced. In this study, the two most prominent complications encountered were Re-detachment and ocular hypertension. Keywords: Silicone Oil; Silicone Oil Removal; Complications; Re-detachment; Visual Prognosis; Hypotony; Ocular Hypertension
285 The Pit Stuff: Surgical Management of Optic Disc Pit Maculopathy with Autologous Free ILM Flap , Anju Gupta, Shams Tabrez and Dhaivat Shah* Optic disc pit (ODP) is a rare congenital abnormality described under congenital cavitary anomalies of the optic disc which may be accompanied by serous macular detachment with the development of schisis leading to gradual loss of vision. Several invasive and non-invasive methods have been identified in literature with several different modifications including laser photocoagulation, intravitreal gas injection and pars plana vitrectomy with internal limiting membrane (ILM) peeling. The report describes a 42 year old man with a unilateral optic disc pit consistent with serous macular detachment in the left eye which was successfully treated with vitrectomy, ILM peeling and stuffing the autologous free flap into the pit. Keywords: Congenital Anomaly; Maculopathy; Optic Disc Pit; ILM Peeling; Autologous Free ILM Flap
286 Pulled in Two Syndrome (PITS), a Serious Strabismus Surgery Complication , Karim Gaballah 1 and Dalal Shawky2 * Aim of the Study: To consider an important and rare complication that can happen during strabismus surgery, to identify the causes, the warning signs, the risk factors so as to prevent it from happening. Subjects and Methods: This is a retrospective study, studying the files of operated cases of strabismus, and available photos, during the period from January 2010 till January 2021, searching cases of Pulled In Two Syndrome, reporting what happened and cases were this complication could be avoided. The study included the files of 1610 patients operated by the authors from strabismus in one of the centers of Alexandria, where the details of surgery and complications are monitored, and where most of them had photos for documentation. Results: Cases of pulled in two syndrome were six cases. This complication was shown in long standing strabismus, specially in adults, where the muscle to be operated was fibrotic, and the minimal pull of the muscle during hooking caused the muscle to be cut spontaneously at the junction of the belly and tendon of insertion. In the earlier cases, the muscle was torn, starting at one edge, and rapidly completely cut in two when pulled with the hook. Conclusion: This complication should be considered when operating long standing strabismus, restrictive strabismus, Congenital fibrosis of extraocular muscles, and strabismus operated in older age. Keywords: Pulled in Two Syndrome (PITS); Restrictive Strabismus; Congenital Fibrosis of Extraocular Muscles (CFEOM)
287 Twisted Tale of a Barbed Fish Hook! , Aditya Ghorpade* and Anitha Venugopal Ocular fish hook injuries should be treated judiciously in view of the damage to the ocular structures because of the barbed tip and chances of the infection due to the bait. Surgical management has to be planned based on the hook type and the area of involvement. If treated in time, visual prognosis can be excellent. We present a case of an accidental fish hook ocular injury to the child, managed by ‘cut it out technique’ with excellent post operative outcome. Early commencement of medical management, planned surgical approach and vigilant post operative outlook are the keys to success. Keywords: Round Bend Barbed Fish Hook; Cut it Out Technique; Fishing; Penetrating Ocular Injury; Corneal Foreign Body
288 Bilateral, Spontaneous, None-traumatic Dislocation of Posterior Chamber Intraocular Lens in a Patient with Retinitis Pigmentosa: A Case Report , Anas L Yasin 1 *, Mohammad T Akkawi 2 , Mohamed Magdy Khodeiry 1 , Mohammad M Shehadeh 2 and Abdel Rahman S Musameh A 39-year-old man with retinitis pigmentosa (RP), who had undergone uneventful bilateral phacoemulsification ten years previously, had spontaneously dislocated intraocular lenses (IOL) within the capsular bag in both eyes two years apart. We removed the dislocated IOLs, and performed parsplanavitrectomy for the left eye, anterior vitrectomy for the right eye, and finally scleral fixation of the new IOLs. Mild of the capsular bags contraction and uneven distribution of the zonular clumps along the equator of the capsules were noted in both eyes. To our knowledge, this is the first case report of bilateral spontaneous dislocation of IOLs within the capsular bag of an RP patient in Palestine. This event raises the issue of possible IOL dislocation in RP patients, a complication that could extend to a decade after the initial operation. Keywords: Retinitis Pigmentosa; Phacoemulsification; Intraocular Lens Dislocation; Zonular Weakness; Capsular Bags Contraction
289 Outcome of Epithelium-on Versus Epithelium-off Corneal Collagen Cross-linkin in Keratoconus , Shaikh Jannatul Kabir 1 , Md Sharfuddin Ahmed 2 , Md Showkat Kabir 3 , Mohammad Shish Rahman 4 , Nirupam Chowdhury 4 , Mohammed Moinul Hoque 4 and Nawreen Binte Anwar 5 * Purpose: To compare and measure the epithelium on versus epithelium off corneal collagen cross linking in the treatment of keratoconus. Methods: This interventional study was conducted in the Department of Community Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh and Green Eye Hospital, Dhanmondi, Dhaka, from January 2020 to September 2021. Forty patients with keratoconus were randomly selected to one of the two treatment groups. Twenty patients treated with epithelium on CXL were considered Group I (n = 20), and the other 20 patients treated with epithelium off CXL were considered Group II. Results: The mean age was 21.95 ± 4.19 years in group I and 20.9 ± 3.35 years in group II. The mean BCVA was 0.48 ± 0.42 logMAR unit in group I and 0.45 ± 0.27 logMAR unit in group II. Keratometry values remain unchanged in both groups except the mean simulated maximum keratometry readings. The simulated maximum keratometry in postoperative day-15 was 52.68 ± 4.02 diopters in group I and 56.51 ± 5.21 diopters in group II. The mean simulated maximum keratometry postoperative day-30 was 52.96 ± 4.02 diopters in group I and 56.6 ± 5.31 diopters in group II. The mean corneal thickness preoperatively was 450.5 ± 38.4 μm in group I and 445.5 ± 33.89 μm in group II. The mean postoperative corneal thickness on day-15 and 30 was 451.85+-38.22 and 451.6 ± 38.43 μm in group I and 437.9+31.38 μm and 438.5 ± 33.51 μm in group II respectively. The mean OSDI preoperative was 16.3 ± 2.23 in group I and 15.2 ± 2.07 in group II. The mean OSDI on postoperative day-1 was 17.15 ± 2.21 in group I and 15.75 ± 2.07 in group II. The mean OSDI on postoperative day-30 was 15.4 ± 2.11 in group I and 15.9 ± 2.38 in group II. The improvement was not statistically significant. Conclusion: Both procedures can halt the progression of keratoconus. In terms of results and related complications, both treatment procedures are equivalent. Keywords: Corneal Collagen Cross-linking; Epithelium-Off; Epithelium-on; Keratoconus
290 The Sore Excrescences-inflammatory Papillary Hyperplasia , Anubha Bajaj* Inflammatory papillary hyperplasia is a benign, predominantly inflammatory lesion incriminating the oral mucosa. Inflammatory papillary hyperplasia is engendered secondary to chronic trauma and lesions are commonly discerned within the hard palate. Inflammatory papillary hyperplasia usually arises due to employment of dentures and is categorized as type III denture stomatitis. The essentially benign inflammatory papillary hyperplasia may be misinterpreted as a potentially malignant disorder [1].
291 Co-existing Unilateral Optic Disc Pit and Choroidal Colobomas , Sashwanthi Mohan*, Madhuvanthi Mohan, Sujatha Mohan and Mohan Rajan A 15-year-old boy came for a regular ophthalmic check-up. His best corrected visual acuity was 6/6, N6 in both the eyes. Anterior segment of both the eyes was within normal limits. Fundus examination of the right eye was within normal limits. The fundus of the left eye revealed the presence of an optic disc pit on the inferonasal aspect of the optic disc and two choroidal colobomas independent of the disc located inferiorly.
292 Covid-19 - Traditional Medicine Can Contribute: Need of Assimilation , Ved Prakaash Banga 1 * and Suneera Banga Still World is fighting with the Covid-19 pandemic, Importance of time when first patient of COVID appeared is important. Shortly we’ll analyze this. Very recent upsurge of Corona virus patients in China and Brazil is an eye opener, we need a more broad view in understanding this epidemic
293 Bilateral Endophthalmitis After Immediately Sequential Bilateral Cataract Surgery (ISBCS) in an Immunodeficient Patient , Susan Ruyu Qi 1,2 *, Mélanie Hébert 1,2 , Mike Yuan Chen3 , Steve A Arshinoff 3,4 and Eric Tourville 1,2 Introduction: Bilateral simultaneous postoperative endophthalmitis (BSPOE) is a rare but potentially devastating complication fol- lowing immediately sequential bilateral cataract surgery (ISBCS). We present a case of BSPOE in an immunocompromised patient to suggest actionable precautions in this patient population. Patient and clinical findings: A 79-year-old male with specific pneumococcal antibody deficiency underwent uneventful ISBCS with prophylactic intracameral 0.1 mL undiluted moxifloxacin 0.5%. The patient returned with decreased visual acuities of light percep- tion in the right eye (OD) at 5 days and count fingers in the left eye (OS) at 7 days postoperatively with severe anterior chamber inflammation in each eye. Diagnosis, Intervention, and Outcomes: The patient was diagnosed with BSPOE. Tap-and-inject was performed emergently on day 5 OD and day 7 OS with intravitreal vancomycin 1 mg/0.1 mL, dexamethasone 0.4 mg/0.1 mL, and ceftazidime 2.25 mg/0.1 mL. Cultures done OD were positive for methicillin-resistant coagulase-negative Staphylococcus epidermidis. The patient later underwent an anterior chamber washout, pars plana vitrectomy, and intravitreal injections of vancomycin 1 mg/0.1 mL and dexamethasone 0.04 mg/0.1 mL OU and recovered 20/20 visual acuity OU at 6 weeks postoperatively. Conclusions: This case raises critical issues about the adequacy of intracameral prophylaxis methods for immunosuppressed pa- tients. Keywords: Vancomycin; Bilateral Simultaneous Postoperative Endophthalmitis (BSPOE); Immediately Sequential Bilateral Cataract Surgery (ISBCS)
294 Impact of COVID-19 Lockdown in Ophthalmologic Care and Subsequent Restoration of Clinical and Surgical Activity , Lucia Gonzalez-Buendia 1 , Jorge Ruiz-Medrano 1 , María García-Zamora 1 , Ignacio Flores-Moreno1 and José M Ruiz-Moreno1,2 * Purpose: To evaluate the impact of coronavirus disease 2019 (COVID-19) lockdown on ophthalmology practice and evaluate the recovery of activity after this period. Methods: This cross-sectional study was performed with data collected from Puerta de Hierro- Majadahonda University Hospital administrative services. Number of outpatient visits, emergency room (ER) visits, surgeries and intravitreal injections were analyzed. Results: Total number of outpatient visits, retina visits and ER visits fell significantly during the lockdown compared with prepandemic data (P = 0.0007, P = 0.0009 and P < 0.0001, respectively), but no significant differences were observed after this period compared to prepandemic data. Similarly, a significant decline in total number of surgeries was observed during the lockdown (P = 0.0005) but after no differences were found. Number of retina surgeries dropped during the lockdown (P = 0.0021) and remained low after (P = 0.0056). We found no significant differences in number of weekly intravitreal injections throughout the pandemic. Conclusion: A reduction on number of visits and surgeries was observed during the lockdown, but after this period there were no differences compared to prepandemic data. Remarkably, although reduced, no statistically significant differences were found regarding number of intravitreal injections during the lockdown. Keywords: COVID-19; Pandemic; Lockdown; Retina; Medical Practice; Intravitreal Injection
295 Pattern of Ocular Morbidity and Visual Disability in Children Attending Eye Out Patient Department in Gwalior, Madhya Pradesh , Ankita Aishwarya1*, Devendra Kumar Shakya2 and Prabha Gupta3 Purpose: This study aims to evaluate the pattern of ocular morbidity in children less than 18 years. Methods: An out patient (OPD) department based prospective observational and interventional study was done from July 2016 to June 2018. Results: A total of 5000 children out of which 2960 (59.2%) were males and 2040 (40.8%) were females. These children were di- vided into groups based on age: 0-3 years, >3-7 years, > 7-11 years, >11-15 years, >15-18 years. Maximum number of children who attended OPD were from age group >7-11years and >11-15 years which was 1100 (22%). The most common cause of ocular morbid- ity was refractive error (34.4%) followed by ocular injury (12.2%), Vitamin A deficiency and conjunctivitis (6.8%), squint without amblyopia (5.6%), corneal opacity (4.8%), blepharitis (4.4%), squint with amblyopia (4.2%)and cataract (4.2%) and so on. Children under low vision category were 740 (14.8%), with economic blindness were 425 (8.5%), with social blindness were 122 (2.4%), manifest blindness were seen in 64 (1.2%) and absolute blindness were seen in 39 (0.78%).Overall 27.8% (1390) children were in category of blindness. In 190 (3.8%) children vision was indeterminable due to newborns, uncooperativeness, mentally handicapped or semi-conscious state. Conclusion: This study revealed that the most common cause of ocular morbidity was refractive error. Most of the studies included school screening method but this can miss congenital malformations as most of these children don’t go to school. Most common cause of absolute blindness was developmental followed by ocular trauma which in most cases can be preventable. Small awareness among parents can prevent devastating change in their child life.. Keywords: Ocular Morbidity; Epidemiology; Refractive Error; Strabismus; Visual Impairment in Children
296 Type 2 Diabetes Mellitus and Dyslipidemia , Maria Arif* and Asifa Majeed Poor lipoprotein synthesis and clearance is one of the meta- bolic problems associated with diabetes. Genetic and epigenetic factors play a key role in lipid homeostasis by influencing the regu- lation of cell surface receptors.The metabolic syndrome is a collec- tion of metabolic dysfunctions, it is also known as type 2 diabetes mellitus. Insulin resistance, inflammation, dyslipidemia, obesity, hypertension, atherosclerosis, and endothelial dysfunction are all cardiovascular risk factors.
297 Targeting of Signal Transduction Pathway Components to Mitigate Selected Ocular Disorders , Najam A Sharif 1-7 * Coordinated communication between and within cells forms the basis for life in health and disease of all tissues and organs. Such relaying of information is mediated by neurotransmitters, hormones, bacteria, viruses, steroids and a host of cyto- and chemokines via specific receptors, ion-channels, and transporters located in cellular membranes and on intracellular organelles including the nuclear membrane and within the nucleus itself. Activation of such transmembrane components generates intracellular second messengers such as cAMP, cGMP, inositol phosphates, diacyl glycerol, Ca 2+ , and gaseous transmitters such as nitric oxide, carbon monoxide and hydrogen sulfide that modulate activity of cytoplasmic proteins, lipids and other substances via phosphorylation, dephosphorylation, glycation, and acetylation. Additional communication is achieved by modulation of genetic machinery, via transcription factors, various chaperones, and through secretome/exosome-mediated release of growth factors, microRNAs, and via direct transfer of many of the afore-mentioned chemicals between neighboring cells down nanotunnels. Dysfunctions within any component of this signal transduction machinery, whether in excess or deficiency or by mutation, results in some form of disease and thus represent targets for intervention by small molecule drugs, peptides, antibodies, genetic manipulation and/or via cell- replacement therapeutics. A brief outline of some of these elements will be discussed. Keywords: Receptors; Signal Transduction; Ion-channels; GPCRs; Enzyme; Agonist; Antagonist; Inhibitor
298 Compare the Result between Non Mydriatic Fundus Camera and Slit Lamp Biomicroscope in Diabetic Patients , Mehak Nazir 1 *, Muhammad Asif 2 , Abdul Hameed Talpur 3 and Imdad Memon 4 Objective: To compare the result of non-mydriatic fundus camera with slit lamp biomicroscope in patients having diabetic mellitus according to age and gender distribution at AIEH. Methodology: A proforma was designed in which all Variables were listed; to make sure to select the appropriate patient and not to miss out any details. Variables were selected in accordance with the aims and objectives of the study. Results: On the bases of Sensitivity (for confirmation), Specificity (not confirmation), Positive predictive value (actually have a disease) and Negative predictive value (actually does not have a disease), the Optometrist 97.06% sure that the patient has Diabetic Retinopathy, 81.58% does not have Diabetic Retinopathy, 93.04%, if the test is positive that the patients actually have Diabetic Retinopathy, and there is 91.08% chance, if the test is negative means the patient does not have Diabetic Retinopathy however there is still 8.82% chance of false negative (patient do not have Diabetic Retinopathy) in Right eye. 99.04% sure that the person has disease, 85.71% is confirmed that the person doesn’t have Diabetic Retinopathy, 95.41%, if the test is positive that the patients actually have Diabetic Retinopathy there is 96.77% chance, if the test is negative means the patient does not have Diabetic Retinopathy however there is still 3.22% chance of false negative (Patient do not have Diabetic Retinopathy) in Left eye. Conclusion: Concluded that slit lamp biomicroscope is a standard test to detect the Diabetic Retinopathy. Keywords: Diabetic Retinopathy; Nonmydriatic Fundus Camera; Slit Lamp Biomicroscope
299 Are Anti-vascular Endothelial Growth Factor Biosimilars Applicable for Treating Diabetic Macular Edema? , Avinoam Ophir* FDA: Food and Drug Administration; DME: Diabetic Macular Edema; DDME: Diffuse DME; nAMD: Neovascular Age-related Macular Degeneration; VA: Visual Acuity; BCVA: Best-corrected Visual Acuity; mGLP: Modified Grid Laser Photocoagulation; OCT: Optical Coherence Tomography; SD-OCT: Spectral-domain OCT; PPV: Pars Plana Vitrectomy; VFT: Vitreofoveal Traction; ERM: Epiretinal Membrane; -VEGF: -Vascular Endothelial Growth Factor; DRCR.net: Diabetic Retinopathy Clinical Research Network; CMT: Central Macular Thickness; PVD: Posterior Vitreous Detachment.
300 Visual Evoked Potential in Myopia , Mona Abdelkader* and Ayman Fawzy Purpose: To determine how the magnitude of myopia influences the parameters of pattern visual evoked potential (VEP) and multifocal visual evoked potential (MVEP). Subjects and Methods: One hundred and eighty eyes of 180 normal volunteers with good visual acuity and without glaucoma were included in the study. The subjects were divided into four groups. The groups were emmetropia with refractive error (±0.25D), low myopia (-0.25D to -4.00D), Moderate myopia (-4.2SD to -8.00D) and high myopia (>-8.00D). All subjects were tested on flash VEP, pattern VEP, multifocal visual evoked potential (M-VEP) and static automated perimetry (SAP). M-VEP positive peak wave (p) amplitude and latency were measured for all groups. Also,P100 amplitude and latency of PVEP were detected. Mean deviations (MD) and Corrected pattern standard deviation (CPSD) of SAP were determined. The relationship between refractive error, PVEP, M-VEP parameters and SAP values were assessed. Results: For low myopia, there were no significant correlation between SAP values and spherical equivalent. For moderate and high myopia, there were decrease in mean sensitivity and mean deviation as degree of myopia increase. While both PVEP and M-VEP amplitudes and latencies in mild and moderate myopia were similar to emmetropia, in high myopia, P wave amplitude decreased and P wave latency increased slightly. Conclusion: Low and moderate myopia does not alter the visual field obtained by M-VEP or parameters of PVEP with slight affection of VEP parameters in high myopia. Keyword: Myopia; Multifocal Visual Evoked Potential; PVEP; SAP
301 Sam's Technique of Cone-shaped Orbital Implant , Sameera Irfan* Purpose: To study the effectiveness of a Cone-shaped orbital implant either as a primary or a secondary procedure. Primary Surgical Outcome: To achieve satisfactory cosmetic appearance with a reasonable symmetry between the two eyes, good implant motility, and prosthesis worn comfortably. Methods: A prospective, interventional study of 261 consecutive cases who had orbital implant surgery at a tertiary care centre, from Jan 2009 to Jan 2021. There were 146 males and 115 females between the age 17-62 years (median age 23 years). 218 cases had an enucleation with a primary orbital implant. 43 cases had a secondary implant for an empty socket (26 cases), exposed, or posteriorly migrated implant (17 cases) that was removed and replaced by a secondary orbital implant. The indications, surgical technique, post-operative complications, and longterm aesthetic outcome are discussed in detail. The limitations and risks of the procedure were fully explained to the patients. Patients and their attendants were counselled regarding the fitting of final prosthesis, its care and the need for regular follow-up visits. All cases were followed up for a minimum period of 12 months while 50% cases visited had an average follow-up of 7 ± 3 years. Results: The most serious complication was post-operative infection; despite a meticulous surgical technique, it occurred in 14 cases (6.42%) in the primary implant group and 6 cases (13.95%) of the secondary group. It was managed conservatively in all cases. However, recurrent purulent discharge, wound dehiscence, and implant exposure necessitated the removal of implant in 2 primary cases (0.91%). Conjunctival scarring due to previous surgeries resulted in 3 mm wound dehiscence and implant exposure in 3 cases (6.97%) of the secondary group. A mucus membrane graft was needed to cover the defect. A lid tightening procedure was needed in 12 cases (27.90%) in the secondary implant group who had worn prosthesis in an empty socket prior to the secondary implant surgery. Good implant motility was noted in all primary cases due to the fully-integrated nature of the implant. It was good in only 11 cases (25.59%) where all rectus muscles were attached to the implant and fair in 14 cases (44.18%) where a few muscles could be salvaged. Motility was absent in 13 secondary cases (30.23%) where no muscles could be found. All primary cases had a good cosmesis and 100 % patient satisfaction. Conclusion: The technique described here is simple, with a short learning curve. It is an inexpensive option amongst a vast array of costly fully-integrated orbital implants that are commercially available. It offers good cosmetic results with minimal post-operative complications. Keywords: Enucleation; Evisceration; Orbital Implant; Post-enucleation Socket Syndrome; Implant Wrappings; Integrated Orbital Implant
302 Strabismus in Pediatric Patients , Sunakshi Anand Strabismus, also known as crossed eyes, is a common eye condition among children of all ages. It is when the eyes are not lined up properly and they point in different directions, also considered misaligned. One eye may look straight ahead while the other eye will turn in, out, up, or down. It is not necessary for the misalignment to occur in one eye more than the other and can shift between the eyes.
303 A Comparative Study of Conjunctival Autografting after Pterygium Excision with Autologous Blood Coagulum and Sutures , Aswathy Vijayan*, Vijayalakshmi MS, Leila Mohan and M Nivean Purpose: To compare autologous blood coagulum versus sutures for attaching limbal conjunctival autografts in patients undergoing primary pterygium excision. To compare graft stability, postoperative pain and discomfort, and recurrence rate in the two groups. Methods: Prospective cohort study of patients undergoing surgery for pterygium from Comtrust Eye Hospital, Calicut, Kerala during for 1 year,6 months, where sutures or autologous blood coagulum was used for graft adhesion.154 patients who underwent pterygium excision with limbal conjunctival autografting were selected into 2 groups. Group A: Autografts attached by sutures (77 cases). Group B: Autografts attached by autologous blood coagulum (77 cases). Results: 1 case (1.3%) showed graft displacement in group A. In group B, 6 cases (7.8%) showed graft displacement and 2 cases (2.6%) showed graft loss. Thus a total of 8 cases (10.6%) showed graft instability. At the end of 6 months post operatively, recurrence was found to be equal 4 cases (5.2%) in both the groups. Post operative pain at the end of 1st week was found in 21 cases (27.3%) in the group A as compared to 4 cases (5.2%) in the group B. Foreign body sensation was present at the end of 1 week in 29 cases (37.7%) in the group A compared to 2 cases (2.6%) in the group B. Conclusion: The postoperative discomfort was high in group A but subsided in 4 weeks. Graft stability is higher in the suture group. Both groups had equal number of recurrences. Keywords: Conjunctiva; Autograft; Autologous Blood Coagulum; Suture; Pterygium
304 Ophthalmology Consultations in a Large Specialist Hospital , Maaly Abdel Halim Abdel Fattah1,2,3*, Abdalla Abuzubida3 and Faisal Mesfer AlQahtani2 The objective of this article is to describe the patterns of ophthalmic referrals in a tertiary hospital. Materials and Methods: This prospective descriptive design was conducted among all age group patients who were referred to ophthalmology department during the period of September 2014 till March 2015. The researchers designed data collection sheet that comprised patients’ personal characteristics, service requesting consult, reason for consult, type of consultation (screen, rule out, request for ophthalmic investigation – such as visual fields) primary ophthalmic complaint, versus follow-up one, final diagnosis and action required. Results: 519 in-patient and ER consultations were included in this study, Screening and rule out were the most common type of con- sultations accounting for 71.7% in which CMV retinitis rule out (232 patients) constituted the biggest portion. The top common pri- mary ophthalmological diagnoses were, Exposure keratopathy (129 patients), Refractive errors (88 patients), Diabetic retinopathy (53 patients), and Conjunctivitis (48 patients). Optic neuropathy was the most secondary ocular diagnosis detected in 201 patients Conclusion: Our hospital is considered the first hospital in publishing such data in Saudi Arabia. Analyzing in-patient ophthalmology consultations can be crucial for redistribution of hospital resources to effectively manage In-patients with eye diseases. Keywords: In Patients; Consultations; Ophthalmic Referrals; Saudi Arabia; Screening; Tertiary Hospital
305 Spontaneous Retrohyaloid Hemorrhage Revealing Immune Thrombocytopenic Purpura: A Case Report , El Kaissoumi Loubna*, Mrini Basma, Boutimzine Nourredine and Cherkaoui L Ouafae Retrohyaloidal, or pre-retinal hemorrhage is a localized collection of blood most often between the posterior hyaloid and the internal limiting membrane. It is a frequent complication of various retinal pathologies such as proliferative diabetic retinopathy, retinal arterial macroaneu- rysms, and may be more rarely secondary to a Valsalva or spontaneous maneuver. We report the case of a 34-year-old female patient consulting in the ophthalmological emergency room for a sudden, painless drop in visual acuity in the right eye in which the examination finds a retro-hyaloid hemorrhage and a general clinical anemic syndrome. The objective of our work is to underline the semiological importance of a unilateral decrease of visual acuity in the context of a hemorrhagic syndrome. The occurrence of retro-hyaloid hemorrhage should suggest a syndrome hemorrhagic, which is most often associated with severe anemia. This must lead to an emergency etiological assessment, which can allow the diagnosis of a immunological thrombocytopenic purpura. Keywords: Anemia; Diagnosis; Thrombocytopenic Purpura
306 Optic Disc Pit Treated with Human Amniotic Membrane: Is it a Lasting Solution? , Agostino Salvatore Vaiano, Antonio Greco and Andrea Greco* Purpose: To analyze long term results of a novel surgical technique implicating the use of a human amniotic membrane patch (hAM) to settle a serous macular detachment in an optic nerve head pit. Methods: We describe a case a 42 years old male affected by macular serous detachment associated with optic disk pit (OPD) treated with vitrectomy and intravitreal apposition of Human Amniotic Membrane Results: Postoperative period recorded no complications; CDVA improved from 1.5 to 0.5 logMAR and OCT scan shows reduced se- rous macular detachment in the first year, unfortunately at 18 months an unexpected relapse occurred. Conclusion: Considering the follow up, our case could open a debate for the long term effects of HAM apposition. Further case and additional techniques, or even a clinical trial may be necessary to additionally prove the full efficacy of this technique. Keywords: Optic Disc Pit Treatment; Amniotic Membrane; Optic Disc Pit Maculopathy; Vitrectomy
307 Orthokeratology for Myopia Control , Tsering Lamu Shongmu Purpose: Orthokeratology is a technique of temporarily correcting myopia and slowing its progression by gently flattening the central cornea [7-9]. The goal of this article is to analyze the Ortho-k evolution, parameters selection, designs, and fitting of ortho-k lenses, the role of Ortho-k as well as its influence on the corneal surface, to temporarily correct myopia and slow its advancement. Keywords: Orthokeratology; Corneal Refractive Therapy (CRT); Vision Shaping Treatment (VST)
308 Glaucoma Drugs Don’t Work in Patients Who Don’t Take them , Isiaka Sanni Oluwasegun* I was stunned when one of my patients said to me, in secret, “none of my eye doctors adequately explain what to do with the eyedrops prescribed, since I was diagnosed with glaucoma, let alone care to know if I did or how I administered the drops before my next visit. I liked the way you educated me on this, and I now know the effect of non-adherence to my glaucoma medication as well as why my vision has deteriorated”.
309 Brief Scenario of Phacomatosis , Gowhar Ahmad* Phacomatosis is a group of Conditions. where their is tumour formation in c n s and other parts of BRAINE in ophthalmology it involves optic nerve head and retina various conditions under phacomatosis are as follows
310 Complete Closure of a Full-thickness Macular Hole Associated with Diabetic Macular Edema and Vitreo-retinal Adhesion During Treatment with Bevacizumab and Hemodialysis - A Case Report , Sahar Khayat 1 * and Basel Alahmar Idiopathic full-thickness macular hole closure is a well-documented observation. Total posterior vitreous detachment is what presumed to lead to the macular hole closure. Diabetic retinopathy is known to worsen the prognosis of FTMH compared to that of an idiopathic etiology. We report a case of a 60-year-old male with severe non proliferative diabetic retinopathy, diabetic macular edema and epi-retinal membrane who developed a full-thickness macular hole. The patient had spontaneous closure of the macular hole during treatment with anti- vascular endothelial growth factor bevacizumab regular injections almost 6 months after starting 3 weekly hemodialysis for kidney failure. Keywords: Macular Edema; Case Report; Hemodialysis; Diabetic Retinopathy; Retina
311 Ophthalmologic Manifestations in Schizophrenic Patients: A Review of the Literature , Marina Maria Gonzaga Moreira 1 *, Letícia Brandão Barbosa de Oliveira 1 , Carlos Eduardo Ximenes da Cunha1 , Marina Viegas Moura Rezende Ribeiro 2 and Allan Maia Andrade de Souza 3 Introduction: Schizophrenia is a severe psychiatric disorder characterized by various psychotic manifestations. The relationship between this disorder and ophthalmologic dysfunctions is well described in the literature. Examples of this are the numerous retinal alterations in schizophrenics and the deficits in visual perception. In addition, chronic use of antipsychotics can lead to several ophthalmologic manifestations. Objective: To identify and explain the main ophthalmologic manifestations caused by schizophrenia and antipsychotic treatment. Methods: This is an integrative literature review, using papers published in the last 20 years in the LILACS, SCIELO, PUBMED, Psycoinfo, Scopus and Google Schoolar databases. The review was produced in January 2021 using 18 scientific articles. Results and Discussion: Based on the analysis of the data, the main findings were the changes in the retina, eye movement and visual perception in schizophrenic patients. The effects of antipsychotics on vision were also noted. It was observed that excessive dopaminergic activity generates hypersensitivity to color and compromises synaptic transmission in the retina. Antipsychotics, in chronic use, are able to generate damage and atrophy of the retinal pigment epithelium and elevate intraocular pressure (IOP). Moreover, it was noted characteristic abnormalities in eye movements and visual perception in schizophrenics. Conclusion: Ophthalmologic involvement is one of the most important features of schizophrenia. Despite the existence of studies that prove the relationship between vision problems and schizophrenia, there is still a need for further research for a better understanding of the ophthalmologic consequences in these patients Keywords: Schizophrenia; Ophthalmology; Retina; Distortion of Perception; Antipsychotics
312 Conjunctival Closure in Strabismus Surgery with ‘Tent-up’ Technique , Mayank Jain*, Roshani Desai, Simranjeet Aulakh and Hiruni Wijesinghe Closure of the conjunctiva during strabismus surgery can be expedited with the help of a pair of Moody curved fixation forceps. Fixing the forceps at the edges of the conjunctival incision creates tenting of the conjunctiva which ensures a tenon-free closure. Not only is this technique time-saving, but it can be done without the additional need for an assistant. Strabismus surgeons can adopt this simple and effective technique to reduce the surgical time and provide optimum healing of conjunctiva. Keywords: Conjunctival Closure; Strabismus Surgery; Tent-up Technique; Surgical Technique; Surgical Instruments; Moody Curved Fixation Forceps
313 Evaluate Contrast Sensitivity in Glaucoma Patients from 16 - 80 Years , Muhammad Asif Memon 1 *, Mehak Nazir 2 , Samina Qamar 3 , Sadaf Fatima 3 , Sawera 3 and Beenish Atif 4 Purpose: To measure the contrast sensitivity in different types of glaucoma patients. Material and Method: An observational and non-probability convenient sampling study from February to August 2020, using lea contrast sensitivity, Snellen visual acuity charts, trial box and occlude. Result: Out of 60 patients 37 were males and 23 were females. Mean onset age was 38.4 years between 16-80 years. 33 (55%) patients were diagnosed with Primary Open Angle Glaucoma, 17 (28.3%) patients with Primary Close Angle Glaucoma, 7 (11.7%) patients with Acute Closure Glaucoma and 3 (5%) patients with Secondary Glaucoma. Similar with Glasses 46 (76.7%) patients had visual acuity 6/6 to 6/12, 11 (81.3%) patients had 6/18 to 6/36 and 3 (5%) patients had 6/60. According to contrast sensitivity 30 (50%) patients had 1.25% (80%), 21 had 2.50% (40%) and 9 had 5% (20%). 15 subjects had 1.25% (80%), 13 subjects had 2.5% (40%) and 5 subjects had 5% contrast sensitivity in POAG. 11 subjects had 1.25% (80%), 4 subjects had 2.5% (40%) and 2 subjects had 5% contrast sensitivity in PCAG. 3 subjects had 1.25% (80%). 3 subjects had 2.5% (40) and 2 subjects had 5% contrast sensitivity in ACG. Conclusion: There is reduction in contrast visual acuity with and without refraction most of patients had variation at level of Contrast Visual Acuity in Primary Open Angle Glaucoma. Keywords: Contrast Sensitivity; Open Angle; Close Angle; Acute Closure; Glaucoma; Optic Nerve; Intraocular Pressure; Periphery Vision
314 Evaluate the Awareness of an Eye (Cornea) Donation in Patients , Muhammad Asif Memon 1 *, Hajira 2 , Mehak Nazir 3 , Samreen2 , Nabila Noor 2 and Abdul Hameed Talpur 4 Purpose: To evaluate the awareness of an eye (cornea) donation in patients attending Al-Ibrahim Eye Hospital. Methods: A descriptive hospital based and non-probability convenience sampling study from May to November 2019. Total 200 patients were enrolled according to inclusion and exclusion criteria and those who gave consent. Results: 200 participated were given consent, high percentage of age 83 (41%) between 34 to 54 years and mean age 40.84. 47 (23.5%) were willing to donate their eyes, 82 (41.0%) were denied and 71 (35.5%) had don’t know on religious believe, however 84 (42.0%) of participated were found to be willing to donate, 100 were not and 16 had no knowledge. Furthermore 9 (4.5%) were willing, 150 (75.0%) were not and 41 (20.5%) were no idea to donate for money. The most common source of information regarding eye donation in respondents was 72 (36.0%) electronic media followed by information by friends and family 31 (15.5%) and other 88 (44.0%) was unaware of information abbot eye donation. Conclusion: There is a need for regular eye donation awareness programs not only in the community but even for the college students, staff in hospitals and in government sector. Keywords: Donation; Transplant; Awareness; Survey
315 An Ophthalmologic Nightmare: Traumatic Enucleation , Onur Furundaoturan1 , Mehmet Hasta 1, Kadri Emre Çalışkan2, Cenk Eraslan 3 and Ozlem Barut Selver 1 * A 42-year-old head trauma patient was referred after a motorcycle accident. The right globe was subluxated laterally with avulsed optic nerve. Following an urgent neurosurgery, removal of the enucleated globe and closure of other tissues were done. After the need for intensive care patient was discharged with topical medication and waiting for the recovery of the tissues for the prosthesis. Keywords: Ocular Trauma; Traumatic Enucleation; Optic Nerve Avulsion
316 Ocular Morbidities in Indoor Pediatric Patients in the Ophthalmology Ward at a Tertiary Care Hospital , Maheshwari Dhwani R1 *, Juneja Stuti 2 and Ganvit Shankar S 3 Introduction: Childhood blindness has nabbed 1.4 million children in the world. Africa and Asia have 1.3 blind million children. Two lakh blind children reside in India. The atrocities of the blindness of the child are magnified by the number of children affected and the number of years the child has to live with blindness. Preventable causes of blindness make up less than 50% of the causes. In developing nations, every minute a child goes blind. Aims: A study was undertaken to identify the pattern of pediatric ophthalmic disorders in patients being admitted to Ophthalmology Department at a tertiary care hospital in Gujarat. Settings and Design: Prospective observational design Methods and Material: Children in the pediatric age group, from birth till 18 years visiting the outpatient clinic of the department of ophthalmology and being admitted for further management comprised the population selected for study, over one year, from 1st August 2019 to 31st July 2020. ICD classification was used. Statistical Analysis Used: Frequency and percentage. Results: The predominant subset of pediatric patients admitted were in the age group of 3-6 years of which male patients were 20% and female patients, 35%.The most common anatomical ocular structure involved was the cornea (54%). Most of the patients belonged to the trauma subgroup with a total of 36 patients (72%) and mainly had penetrating injuries. Conclusions: With proper measures, preventable blindness can be avoided. Young children are susceptible to injuries while playing with fireworks, hence we suggest parents supervise their children. Keywords: Ocular Complications; Visual Acuity; Ophthalmology; Children; Public Health; Ocular Trauma
317 Congenital Bilateral Cataract: Lamellar, Perinuclear and Sutural Components , Irving A Domínguez Varela1 *, Raúl Hernán Barceló Cantón1 , Andrea Rangel Padilla 1,2 , Yolanda Macías Rodríguez 1 and Sara González Godínez 1, Lens sutures are formed by the interdigitation of the anterior and posterior tips of the spindle-shaped fibers of the fetal nucleus. When this sutures opacify known as “sutural cataracts” cause minimal visual disturbance and usually do not require surgical intervention, until the cataract increases and visual acuity progressively decreases [1,2]
318 Validation of a New Meibomian Gland Dysfunction (MGD) Grading Scale for Rapid Assessment of MGD in Clinical Practice , Fahad Salem Alshahrani*1 , Fiona Stapleton2 , Blanka Golebiowski 3 , Emma Gibson 4 and Archana Boga 3 Meibomian gland dysfunction is an abnormality of meibomian glands and their secretions, resulting in poor quality of tears. Purpose: To validate the MGD grading combination of telangiectasia plus expressibility against the MGD14 questionnaire and against meibography (measured using the Oculus Keratograph). In addition, the sub-aims of this study are to validate the MGD14 questionnaire against meibography and against OSDI questionnaire. Methods: Study design is an observational, cross-sectional, single visit study. Twenty participants were enrolled into this study, including non-contact lens wearers (14 males and 6 females; mean age ± SD, 30.8 ± 3.5 years). Ocular comfort symptoms were examined using MGD14 and OSDI questionnaires. Telangiectasia, expressibility, meibography and Marx line were each graded from 0 to 3, pouting, orifice plugging and irregular lid margins were scored as present or absent while the number of capped glands and the number of expressible glands were counted. Results: There was no significant correlation between MGD14 score and TE combination, (Spearman’s correlation r = 0.37; p > 0.05). Meibography scores didn’t show correlation with TE combination (Spearman’s correlation r = 0.17; p > 0.05). In addition, the results showed that there was no association between meibography and MGD14 score (Spearman’s correlation r = 0.21; p > 0.05). A strong positive correlation was found between MGD14 scores and OSDI scores (Pearson correlation r = 0.68; p < 0.05). Conclusion: This is the first study to validate the combination of TE for evaluating MGD. This study didn’t show correlations between TE combination against MGD14 and against meibography. In addition, there was no correlation between meibography and MGD14. Overall, this study displayed poor relationship between symptoms and signs of dry eye, however, these results need to be confirmed in a large sample size with more participants displaying MGD. Keywords: Meibomian Gland Dysfunction; Abnormality; Meibography
319 A Study to Assess the Pattern of Diabetic Macular Edema Using Optical Coherence Tomography (OCT) and to Evaluate the Relevant Risk Factors , Sandeep Singh1 , Balbir Singh2 , Ashok Aggarwal 3 , Paavan Kalra4 , Harwinder Nagpal 1 , Anand Aggarwal 1 *, Shubham Mittal 1 , Surmila Meena1 and Divya Tara Purpose: To assess the pattern of diabetic macular edema using optical coherence tomography and to evaluate relevant risk factors. Design: This was a cross sectional, open labelled observational study. Setting: Outpatient Department of Ophthalmology, Government Medical College, Patiala. Materials and Methods: 100 patients above 18 years of age diagnosed with diabetic macular edema (DME) were enrolled in the study. Only one eye of one patient with worse visual acuity was considered in this study. Eye with good visual acuity was excluded from study. After ocular examination, Optical Coherence Tomography was performed on patients. Using the retinal thickness map analysis protocol, macular thickness was determined and compared with normative data. Statistical Analysis: The data was collected from patients using a proforma. Data was compiled in excel format. Data was subjected to statistical analysis using SPSS version 22 (SPSS Inc., Chicago, Illinois, USA).Pearson Chi Square test and ANOVA Analysis was used for assessment of level of significance. p value of less than 0.05 was taken as significant. Results: Majority of the patients in our study had spongy DME (47%) followed by cystoid (39%), Serous Macular Detachment (9%), Mixed (5%). Among 9 patients of serous macular detachment (SMD) 7 were males. Maximum mean Cental Macular Thickness (CMT) was observed in Cystoid (523.82 μm) followed by Mixed (496.4 μm, SMD (380.22 μm), and spongy (328.91 μm) variants. Maximum mean Central Macular Volume (CMV) was observed in mixed (0.49 mm3 ) followed by cystoid (0.45 mm3 ), SMD (0.41 mm3 ), and spongy (0.36 mm3 ) variants. Low visual acuity was observed in Cystoid macular edema and serous macular detachment while patients having spongy macular edema had relatively good vision. On comparison of mean age, duration of diabetes mellitus, CMV and CMT in different patterns of macular edema a statistically significant difference was found. Highest mean age (77.67 years), highest mean duration of DM (14.56 years), highest FBS level (198.89 mg/dl), highest triglyceride level (257.00 mg/dl) was observed in SMD. Highest mean hba1c level was observed in cystoid (9.32%) followed by SMD (9.22%). Cystoid macular edema was more common in females and spongy macular edema was more common in males. Spongy macular edema (78.12%) was predominantly present in patients with duration of diabetes mellitus ≤5 years while in patients with duration of diabetes mellitus between 5-10 years cystoid macular edema (53.19%) was predominantly present. Proportion of cystoid macular edema (50.90%) was more in patients having hba1c >8.5% while proportion of spongy macular edema (62.22%) was more in patients having HbA1c <8.5%. Among 9 patients of Serous Macular Detachment 7 patients had hba1c>8.5%. Proportion of cystoid macular edema (44.28%) was more in patients having Fasting Blood Sugar (FBS) >125 mg/dl while spongy macular edema (63.33%) was more in patients having FBS < 125 mg/ dl. In patients having triglyceride >200 mg/dl major proportion of patients had cystoid macular edema (49.02%) while in patients having triglyceride level <150 mg/dl major proportion of patients have spongy macular edema (72.22%). Statistically the difference in distribution of macular edema with respect to gender, habit of smoking, duration of diabetes mellitus, treatment of DM, visual acuity, grading of diabetic retinopathy, FBS and HbA1c and Triglyceride was significant with p value = 0.016, 0.02, 0.02, 0.02, 0.01, 0.018, 0.004, 0.01 and 0.03 respectively. A significant negative correlation of visual acuity was present with grading of DR, CMT, CMV, HbA1c, FBS. The correlation between age, alcohol consumption, type of DM, Family history of DM, IOP, SBP, DBP, BMI, statin use, Cerebro Vascular Disease (CVD), LDL, HDL with pattern of DME was not statistically significant (p value = 0.87, 0.95, 0.12, 0.85, 0.17, 0.004, 0.779, 0.243, 0.46, 0.30, 0.179 and 0.21 respectively). Conclusion: The pathophysiology of DME remains unknown and different patterns of DME can be caused by different ocular or systemic risk factors. The patients with chronic hyperglycemia, hyperlipidemia have more proportion of cystoid macular edema which leads to worsening of visual acuity. The foundation of treatment and prevention of DME progression lies in the strict control of chronic hyperglycemia, hypertension and hyperlipidemia. Keywords: DR; DME; OCT; Cystoid Macular Edema; Spongy Macular Edema; Mixed Macular Edema; Serous Macular Detachment.
320 Incomplete Third Cranial Nerve Palsy Presenting with Binocular Diplopia and Strabismus in a Patient with COVID-19 , Júlia N Widmer-Pintos1*, Sofía del-Pozo-Lérida1, Consuelo Arnaldos-López1, Noelia Barriga-Barrios1, Laura Sararols-Ramsay1, Hugo Gonzalez-Valdivia2 and Mercè Guarro-Miralles1 Purpose: This paper aims to raise suspicion in clinicians for COVID-19 infection in the setting of a third nerve palsy of unknown origin. Case Report: We report the case of a previously healthy 46-year-old male presenting with an acute onset of binocular diplopia, right eye strabismus, and right eye ptosis 1 day before being tested positive on an antigen test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Outcome: The patient successfully recovered 1 week after oral corticosteroid treatment. Conclusion: Our patient’s case, together with other reported cases, adds evidence suggesting a correlation between SARS-CoV-2 infection and III cranial nerve palsy. Keywords: COVID-19; SARS-CoV-2; Diplopia; III Cranial Nerve Palsy; Strabismus
321 Efficacy and Safety of Opposite Clear Corneal Incision to Reduce Pre-existing Astigmatism After Phacoemulsification - A Prospective Study , Shavina Garg 1 , Balbir Singh2 , PL Jindal 3 , YN Mathur 4 , Anand Aggarwal 1 *, Kamlinder Kaur 1 , Indu Khosa1 and Ravneet Pannu1 Design: This was a comparative, prospective, randomized study. Setting: Department of Ophthalmology, Government Medical College, Patiala, Punjab. Purpose: To compare the efficacy and safety of Opposite Clear Corneal Incision to reduce pre-existing astigmatism after phacoemulsification in tertiary Eye Care centre of India. In this prospective, comparative study 160 patients planned for phacoemulsification were divided into 2 groups. Group A received a foldable IOL through 3.2 mm clear corneal incision made on the steeper meridian along with a 3.2 mm opposite clear corneal incision in an attempt to reduce pre-existing astigmatism. Group B received a foldable IOL through a single clear corneal incision made on the steeper meridian. The preoperative and postoperative data at day 7, 1 month, 3 months and 6 months, on UCVA, BCVA, astigmatism was compared between the groups. Results: A total of 160 patients were enrolled in the study. These patients were divided into 2 groups with 80 patients in each group. The mean preoperative astigmatism was 1.40 +/- 0.31 in group A which reduced to 0.61 +/- 0.14 D after 6 months. The mean preoperative astigmatism was 1.34 +/- 0.26 D in group B, which reduced to 0.98 +/- 0.18 D after 6 months of follow up. The average mean astigmatic reduction in group A and B was 0.79 D and 0.30 D respectively. There was a significant difference in mean astigmatism between both the groups after 6 months of follow up (p Value < 0.05). 95% of patients had uncorrected visual acuity between 6/6 - 6/9 in group A whereas 55% patients had UCVA between 6/6 - 6/9 after 6 months (p Value < 0.05). None of the patients had UCVA less than 6/18 in both groups. The BCVA was between 6/6 - 6/9 in 97.5% and 95% of patients in group A and group B respectively, which showed no significant difference in terms of BCVA. Conclusion: Being an advancement in refractive lenticular surgery, Opposite Clear Corneal Incision is a safe and cost effective procedure in reducing mild to moderate preexisting corneal astigmatism if reliable preoperative corneal topography readings using pentacam are available. They may be employed during phacoemulsification surgery to further enhance visual outcomes and patient satisfaction. Keywords: Cataract; Phacoemulsification; Opposite Clear Corneal Incision (OCCI); Clear Corneal Incision (CCI); Astigmatism; Visual Acuity
322 Remote Patient Monitoring of Central Retinal Function with MACUSTAT®: A Multi-modal Macular Function Scan , Earnest Chen1 , Michael Mills 2 , Tara Gallagher3 , Andrew Polis 3 , Peter Pham5 , Jasper April 5 , Ranya Habash 6 , Ronald C Gentile 4 and Sean Ianchulev4 * Introduction: There is significant unmet need for remote monitoring of visual function with home-based, patient-centric technologies for chronic retinal diseases, especially during times of crisis such as the COVID-19 pandemic. The Macustat® central retinal function scan is a novel on-demand cloud-based digital health application for home monitoring that can be accessed on any smart phone, tablet, laptop or desktop. The aim of this study is to assess the efficacy of the Macustat® compared to traditional in-office retinal evaluations. Materials and Methods: Retina practice patients with underlying macular pathology underwent office-based retinal examination, OCT macula imaging and best-corrected visual acuity assessment using the Snellen chart test followed by remote tele-monitoring assessment with the Macustat foveal function multi-modal scan. The self-administered home test was accessed on a cross-platform device-agnostic screen of a smart phone, tablet, laptop, desktop or other consumer peripherals with internet access. Central visual function was assessed with the multi-modal Macustat test using dynamic virtual Amsler grid testing, hyperacuity perimetry and visual acuity testing, all delivered via remote telehealth interface. The results were compared to the findings of the in-office comprehensive retina exam and OCT evaluation. In the subgroup of eyes with exudative AMD, Macustat foveal function scans were compared to OCT findings. Results: A total of 50 eyes were enrolled, 64% of subjects were female, and the mean age was 69.2 years. Macular diagnoses included AMD and diabetic retinopathy. All patients were literate and had an educational level of high school or above. The foveal acuity potential registered with the Macustat test showed high correlation with the office Snellen acuity potential (logMAR Macustat 0.14 ± 0.17 vs 0.15 ± 0.17 Snellen Office) with 96% of eyes registered Macustat acuity within 0.2 LogMAR of office acuity measurement. In Wet AMD eyes with CNV pathology documented on OCT, the Macustat foveal function scan showed a corresponding abnormality in 89% (8/9) of any CNV eyes and 100% of all visually significant CNV. In normal eyes without any visually significant edema or CNV, more than 92% showed corresponding normal retinal function scan. Conclusion: The Macustat test of central retinal function delivered via a telemedicine platform demonstrates high concordance with clinical findings in the office using traditional diagnostic devices. Home monitoring with the Macustat test may offer complementary clinical utility as a telehealth tool for the assessment of visual acuity and macular function in patients at high risk for macular disease and possible progression. Keywords: Telemedicine; Remote Monitoring; Ophthalmology; Retina; Macustat
323 Surge of Complications in Corneal Transplant Patients Presenting After COVID-19 Lockdown , Jigyasa Sahu 1 * and Parul Jain Postoperative complications after corneal transplantation are quite common and pose a substantial risk to the probability of graft survival, particularly if they are not promptly identified and treated. Timely follow up and compliance to therapy is mandatory for improving outcomes. Poor adherence to treatment regimens poses a significant problem after corneal grafts and substantially contributes to increased chances of graft failure, culminating in rising health care costs [1]. Missed appointments are also an important cause of inefficiency in health care delivery and are associated with substantial monetary costs.
324 Facilities for Visually Impaired Students that are Available in University of Hyderabad Campus , Gavini Sahithi* Objective: To evaluate if visually impaired students are aware of the facilities provided to them by the University of Hyderabad and make them aware if they are not aware. To evaluate if visually impaired students are utilizing and satisfied with those facilities and to know if they seek improvement in any facility or require any new facility Methods: This study was done on 30 visually impaired students in School of Medical Sciences, University of Hyderabad campus. BCVA was recorded using standard log MAR chart and the data was collected through a questionnaire. Results: More than 80% subjects are aware of all facilities. Only few subjects i.e. less than 23% using braille books transport facility. More than 65% utilizing remaining all facilities. Majority of subjects has shown dissatisfaction for transport and braille books. The problems stated by more percentage of subjects are - no enough PCs, need other device to work on computer, no special transport, no all-time care takers, and no subject related braille books. Conclusion: Majority of subjects are utilizing and satisfied with all facilities except transport and braille books. This study evaluated the problems, investigated the improvements and new facilities that are required and they need to be rectified by the concerned authorities Keywords: Visual Impairment; Blindness; Low Vision
325 The First Results of the Complex Laser Surgery Technology Application for Primary Open-angle Glaucoma , Balalin AS 1 *, Fokin VP 1 , Balalin SV 1,2 and Dzhashi BG 1 Examination and treatment of 50 patients (50 eyes) with the early stage of primary open angle glaucoma before and after application of complex laser surgery technology was carried out. Selective laser trabeculoplasty in combination with YAG-laser trabeculostomy was performed in the projection of the outflow meshwork. Hypotensive effect was 31.1% of the initial intraocular pressure level on the 1st post-op day and remained for a month after the surgery due to the outflow improvement of the intraocular fluid by 62.5%. The YAG-laser and OCT data allow optimization of YAG trabeculostomy, providing an alternative noninvasive laser treatment for patients with primary open angle glaucoma. Keywords: Primary Open Angle Glaucoma; Selective Laser Trabeculoplasty; YAG Laser Trabeculostomy
326 Acute Bilateral Uveitis Following COVID-19 Vaccination: Case Reports , Catarina Pestana Aguiar*, Lígia Figueiredo, João Costa, Maria João Matias, Vítor Miranda, João Chibante-Pedro and Miguel Ruão Introduction: The development of the COVID-19 vaccines occurred promptly, and we are still learning about their side effects. Therefore, it is important to report possible medical associations to them. Case 1: A 21-year-old female, with no significant medical history for this event, diagnosed with bilateral acute anterior uveitis three days after receiving the Pfizer-Biontech COVID-19 vaccine. An aggravation of the disease was observed after the administration of the second dose. Case 2: A 70-year-old male, with no relevant medical history, presenting with a bilateral anterior uveitis after receiving the Pfizer- Biontech COVID-19 vaccine 3 to 4 weeks before. A macular edema of the right eye developed later in the course of the disease. Discussion: Vaccines can induce uveitis and other ocular inflammatory conditions through different possible mechanisms. In both cases we reported here, the temporal relationship between the onset of the symptoms and the administration of the vaccines makes this medication a possible cause for the ocular manifestation. Keywords: Uveitis; COVID-19; Vaccination; Adverse Drug Reaction; Ocular Inflammation
327 Why it's Essential to Schedule an Eye Exam for Your Child , Larry Jerge* Today, most children receive preventive medical care in the form of vaccines and early wellness visits. They also get preventive dental care with early dental exams before a toothache occurs. Unfortunately, most kids go to the eye doctor only after they have struggled to see for months—or even years—and have already lost 20/20 vision.
328 Reliability of Monocular Estimation Method and Objective Convergence Test in Assessment of Non Strabismic Binocular Vision Anomalies , Mousumi Saikia 1 , Kamal Pant2 and Joydeep Dutta 3 * Purpose: To know the reliability of monocular estimation methodand objective convergence measurement as an alternative protocol for screening nonstrabismic binocular vision anomalies. Design: a cross-sectional descriptive observational prospective study. Methods and Materials: 40 subjects; 26 females and 14 males; mean age (20.31 ± 1.92 ) were evaluated for accommodative facility and accommodative status with the help of monocular estimation method (dynamic retinoscopy). Objective near point of convergence was assessed with red filter and penlight target. All the tests were done with best corrected visual acuity after refractive error correction. Further these findings were correlated with routine orthoptic work up to know whether these tests alone can be an alternate screening method of nonstrabismic binocular vision anomalies or not. Results: 27.5% of the subjects were found to have Non Strabismic binocular vision anomalies in relation to conventional routine orthoptic work up showed 32.5% of prevalence. A strong level of agreement (kappa value 0.88) was found, showed statistical significant p < 0.001. Conclusions: Objective assessment of accommodative facility, status of accommodation and near point of convergence can be alternative protocol for screening nonstrabismic binocular vision anomalies in community set up. Keywords: Accommodative Facility; Status of Accommodation; Non strabismic Binocular Vision Anomalies; Accommodative and Vergence Anomalies; Monocular Estimation Method
329 Co-relation Between Myopia and Age, Sex, Axial Length, Pachymetry and Anterior Chamber Depth in Young Adults , Prabhav Bansal 1 *, Shatakshi Jindal 2 , Brig Sagarika Patyal 1 , Col Anirudh Singh1 , Ashutosh Gupta 1 , Kapil Shahare1 and Deepak Kumar Deepak3 To find the correlation between myopia and age, sex, axial length, pachymetry and anterior chamber depth in young adults. Keywords: Myopia; Axial Length; Pachymetry
330 Ocular Presentation of Monkey Pox: A Brief Review , Somsri Wiwanitkit 1 and Viroj Wiwanitkit 2 * Monkey pox can be presented through the eyes, and this could be the first time. Due to the probability of a widespread epidemic at this time, practitioners must be aware of the possibility of ocular problems in monkeypox. Monkey pox has spread across Europe, creating a significant public health risk [2]. The authors review the ocular manifestation of monkey pox in this brief essay. Keywords: Monkeypox; Ocular; Presentation
331 Photo Stress Recovery Time Variations in Common Posterior Segment Ocular Diseases , Udo Ahanna Ubani, Chikezie Grand Ihesiulor*, Nnamdi Elem Okore, Andrew Uma Omaka, Samuel Ononuju Ndukuba, Theocracy Uchechukwu Okechukwu, Izuchukwu Confidence Benjamin, Chiemeka Bright Ukoh, Daniel Chukwudi Oti, Freeman Odionyenfe Ifeanyi Purpose: The aim of this study was to determine the photostress recovery time (PSRT) of subjects with posterior segment ocular anomalies such as dry AMD, diabetic retinopathy, hypertensive retinopathy, and glaucoma. Methods: This hospital-based study was carried out and PSRT evaluated for the fellow eyes of randomly selected 200 subjects. After a 10-second-bleaching of the retina, the subjects were directed to read from the line above best visual acuity (VA). Time taken to read the VA line was recorded. The data was presented and analyzed in table and the hypotheses tested at a given level of significance. Using Greenhouse-Geisser correction and Sphericity Assumed (0.000 < 0.05), observations were assessed for different ages and sexes. Results: PSRT increased significantly in the above mentioned posterior segment ocular anomalies compared to the controls. Hence photostress recovery time test is recommended for diabetic retinopathy, hypertensive retinopathy, glaucoma and dry age related macular degeneration patients. Conclusion: These findings show that PSRT increases in subjects with glaucoma, ARMD, hypertensive and diabetic retinopathy, mostly in older patients. Keywords: ARMD; Diabetic Retinopathy; Glaucoma; Hypertensive Retinopathy; Photostress
332 Artificial Eye - Boost to Life , Nitu Dubey1 , Ajeet Kumar Dwivedi 2 * and Ranjeet Kumar 3 A Contracted socket is a complication of an Anophthalmic socket which results in the inability to support prosthesis. Contracted socket defines absence of functional eyeball from orbit. In most of cases, its presence take a lot on person’s confidence and make oneself very difficult to come out of psychological trauma and stress associated with it. Rehabilitation of these patients is of utmost importance to provide positivity and self confidence in these scenarios. Artificial Eye (Customized Ocular Prosthesis) acceptance is dependent on individual persona and multiple sitting approaches to satisfy the individual need. There are occasions to modify the socket by surgical intervention to fit the artificial prosthesis. This article was written to create basic understanding of artificial eye and its various steps of manufacturing and dispensing. Keywords: Artificial Eye; Fornix Reconstruction; Customised Prosthesis; Evisceration; Enucleation
333 Changes in Accommodative Parameters After E-reading , Afrah Atif Ur Rahman 1 , Thrupthi K 1 , Kamal Thakur 1 *, Rahul Roy1 and Savitha Arun 2 Background and Objectives: The purpose of the study was to determine changes in accommodative parameters after constant reading from digital print (Kindle and MacBook) and hard print (Novel). Methods: A total of 30 subjects were enrolled in the study with the age group between 18 to 30 years (21.4 ± 1.5) years. A complete eye examination was performed on all subjects including the assessment of accommodative parameters. Subjects were made to read a novel for 30 minutes after which an assessment of accommodate parameters was done again, A break of 2 hours subjects were made to read from kindle for 30 minutes followed by an assessment of accommodative parameters. Again, a break of 2 hours was given, followed by reading on MacBook and, an assessment of accommodative parameters was done post-reading. Results: There was a significant decrease in the Negative Relative Accommodation (NRA) and binocular Accommodative Facility (AF) while using the MacBook in comparison with the other devices mentioned. There were no significant changes in the other Accommodation parameters i.e., Near Point of Accommodation (NPA), Positive Relative Accommodation (PRA), Monocular Estimation Method (MEM), and uniocular Accommodative facility. Conclusion: Reading from MacBook induce slight increase in accommodative parameters, while Kindle can be used for reading with minimal effects on accommodative parameters as compared to traditional books. Keywords: Accommodation; Kindle; MacBook; VDU; Reading; Hard Print; Softcopy
334 Superpositions of Quanta Measuring Bases , Gudrun Kalmbach HE* In earlier publications the author has mentioned superpositions of the measuring Gleason frame base triples. The study can be a theme for a research student or project. Some results are collected in this article as possibilities. Equations are added to such superpositions and spaces like the oriented Riemannian sphere S2 , a projective plane P 2 or of R3 . Different kinds of generating physical equations are listed. One popular method is to use the real or complex cross product, measuring the area spanned by a 2. dimensional pair of vectors. For higher real or complex dimensions the same method applies. Keywords: Fano Memo; Angular Momentum; Physical Equations
335 Management of Color Blindness with Contact Lens: A Case Study , Sebin C Sebastian* and Mohammad Nooruz Zaman Color vision deficiency is mostly inherited and occurs due to mutation of the X chromosome. It is the reason why men are most commonly affected. A case of color vision deficiency was for a 21-year-old male who had come for a routine eye evaluation. Colour vision was managed with X chrome contact lens. Subject was fitted with X chrome contact lens in non-dominant eye and color vision test was revaluated after adaptation of 15 min, 1 hour, and 2 hours. The improvement in color vision on Ishihara color plates was noticed on follow-up. It was concluded that X-chrome lenses help to improve the color vision deficiency and it is one of the management for color vision deficiency. Thus, early diagnosis is indicated for timely intervention and better results, especially in children. Keywords: Color Vision (CV); Contact Lens (CL); X Chrome Lens and Ishihara Plates
336 Stereopsis and Color Vision in Children of Al-Ibrahim Eye Hospital, Malir, Karachi , Muhammad Asif Memon 1 *, Samreen Baloch2 , Fazila Shah 2 , Ahmed Hafeez 2 , Ayaz Ali 2 , Kiran2 , Mehak Nazir 3 , Muhammad Atif Nisar 4 and Beenish Atif 5 Purpose: To determine effect of refractive error and color vision on Stereopsis and evaluate the frequency in children. Methods: The hospital based; descriptive, cross-sectional study was conducted at paediatric department from July to December 2020. Results: 29 (51.8%) out of 56 found myopic, 12 (21.4%) hypermetropia and 15 (26.8) astigmatism in right eye and 30 (53.6%) found myopic, 13 (23.2%) hypermetropia and 13 (23.2%) astigmatism in left eye. 21 had normal or 55 sec of arc, 6 have mild 170 sec of arc and only 2 patients had weak 340 sec of arc.12 hypermetropia patient 10 have normal or 55 sec of arc and 2 have mild 170 sec of arc.15 astigmatism patient 6 had normal or 55 sec of arc of stereopsis, 6 have mild 170 sec of arc of stereopsis and 3 patient had weak 340 sec of arc Stereopsis without refractive correction. With refractive correction on Frisby test, 56 (100%) patients had normal or 55 second of arc stereopsis. Out of 56 of patients, 52 (92.9%) patients had normal color vision (Trichromats) and only 4 (7.1%) patients found with blue-yellow color vision defect (Tritan). Tritan color vision anomaly found in 3 females out of 20 and out of 32 male 1 had found with tritan color vision anomaly. Conclusion: Improvement of stereopsis after correction and no effect of color vision on stereopsis. Tritan (Blue) color vision anomaly was higher in female as compare to male. Keywords: Stereopsis; Color Vision; Anomaly
337 Role of Parents in Mobile Data Abuse by Children, Gowhar Ahmad* At present we are in the era of mobiles laptop and I pass which is need of the hour. However it’s abuse is being done by children in age groups of 5 to 7 years or more also now due to present era of COVID 19 pandemic children have on line classes so it is adding more insult. Children for hours are playing games on mobiles. Gaxing at a psrivukar game or different games thus putting lot of strain on eyes so they present with symptoms of eye STRIAN eye ache head ache irritability change in behaviour abdominal pain fainting even delayed Mike stones and epileptic like attacks have been reported with blued vision diplopia and squint.
338 A Case Report of Recurrent Episodes of Periorbital Cellulitis (RPOC) and Facial Inflammation on a Background Of 1E Nasal Extranodal NKT Cell Lymphoma in Remission, Anna Gkountelia* and Wessam Mina Recurrent periorbital cellulitis is a rare complication of sinus disease. To discuss the cause and management of recurrent periorbital cellulitis (RPOC) in a 53-year-old male patient with a medical history of stage 1E nasal extra nodal NKT cell lymphoma in remission (hard palate mass and left nasal cavity involvement) treated in the past with chemoradiotherapy, consolidative therapy and multiple sinus surgeries. Although periorbital cellulitis is a commonly encountered and treatable condition, recurrent periorbital cellulitis is rare and may be challenging to manage [1-5]. In our experience, the causes of recurrence vary, but resolution in this case was achieved by identifying the underlying cause through continuous clinical reassessment and by appropriate medical or surgical management. Keywords: Periorbital Cellulitis; Surgery; Recurrent Periorbital Cellulitis (RPOC)
339 Acupuncture Channels and Points Around Eyes, Ved Prakaash Banga* Recently treatment of Eye diseases with Traditional Chinese Medicine or TCM has been slowly gaining momentum. When I started Ophthalmology practice with Acupuncture there was no internet, you can not approach patient suffering from eye ailments where we can provide a solution, definitely Media remained very helpful in my early days. There were many committed Journalists, I always remember.
340 Lower Eyelid Conjunctival Amyloidosis: A Case Report, Anna Gkountelia* and Wessam Mina Amyloidosis is characterized by extracellular deposition of protein amyloid fibrils in tissues, including conjunctiva, which are insoluble in proteolytic proteins. Conjunctival amyloidosis specifically in the palpebral conjunctiva is a rare finding in clinical practice [1,4,5,7,10]. The authors described the case of a 37-year-old Bangladeshi origin female patient, with lesion located in the lower eyelid conjunctiva, elevated, well-defined, yellowish. Incisional biopsy of the lesion was performed, and the histological examination confirmed conjunctival amyloidosis. Conjunctival amyloidosis is a rare finding in the literature. The management of conjunctival amyloidosis depends on the extent of local involvement and patient’s general health status, varying from symptomatic, with use of ocular lubricants, to surgical, by removing the lesions. Keywords: Conjunctival Amyloidosis; Eyelid; Amyloid Fibrils
341 A Case of Bacterial Meningitis and Pneumo-orbit, on a Background of Previous Orbital Fracture Repair with Titanium Plate, Anna Gkountelia*, R Scawn, W Grant and Wessam Mina Blunt trauma to the orbital rim is a frequent cause of both orbital fractures and damage to the surrounding facial bones and soft tissues. Many surgical specialties, including ophthalmologists, otolaryngologists, maxillofacial specialists, neurosurgeons, and plastic surgeons, evaluate and treat orbital fractures Restoration of orbital volume after internal orbital fractures can prevent enophthalmos. A variety of high strength materials/allografts are commonly used that boast low postoperative complication rates, including titanium mesh with and without porous polyethylene coating. Some controversy exists over the use of uncoated titanium mesh in the orbit. Newer products contoured to the three dimensional orbital anatomy aim to improve reestablishment of the complex orbital shape [1-4]. There is no previous bibliography available to support a plate is a source of meningitis. We report a case of bacterial meningitis and pneumo-orbit, on a background of previous orbital fracture repair with titanium plate, and our management technique. Keywords: Blunt Trauma; Orbital Fracture; Ophthalmology
342 Bilateral Orbital-cranio NF Type I: 2 Rare Cases Presentation, Anna Gkountelia*, Richard Scawn and Wessam Mina Introduction: Neurofibromatosis type I (NFI) is a fairly frequent (1 in 3000 live births), autosomal dominant, neurocutaneous disorder that has considerable clinical variability. In orbitocranio NFI (OCNF), which occurs in 1–22% of patients, NFs may cause progressive, disfiguring tumours of the orbital, facial, and temporal areas [1,2,4-8]. In this presentation, we report the experience with clinical observation and surgical management of rare bilateral OCNF, in two patients (2:162) seen at Chelsea and Westminster Hospital. Method: Patients diagnosed with NFI were identified and medical records reviewed for demographic data, ophthalmologic examinations, surgical interventions and procedure outcome to create a retrospective, non-comparative case series of patients with bilateral OCNF seen at one medical centre over a 10-year period. Result: Two patients with bilateral OCNF have been identified in a total of 162 cases with NFI. A 33yo man with extensive soft tissue infiltration (mass lesions) involving the face and anterior-superior scalp and neck, (Figure 1) ovoid mass posterior to the spinous process of C2, infiltration of the para pharyngeal spaces partially compressing the oropharynx, bilateral orbital involvement with small calcified globe on the left side and sphenoid wing dysplasia, asymmetry of the skull vault with relative thinning on the left hemisphere (Figure 2). He had several previous surgeries on both his eyelids, as far as cataract surgery and NF debulking from forehead and orbits. His current visual acuity is 6/18 in the right eye and no perception of light in the left. Keywords: OCNF; Neurofibromatosis Type I (NFI); Tumour
343 Management of Ciliary Staphyloma as a Complication of Silicone Oil Infusion During Retinal Detachment Surgery - A Case Report, Amita Yadav*, Ashok Pathak and Kavin Bhogar Silicone oil infusion is a frequently used modality for intraocular tamponade in various vitreoretinal surgeries. This surgical tool is by and large safe and effective but is associated with various complications like raised intraocular pressure (IOP), cataract, deterioration of vision due to emulsification of oil etc. especially if retained for longer periods. We would like to report a case of a young male who underwent surgery for retinal detachment with silicone oil used as endo-tamponade, who presented with a painful blind right eye due to a rare complication of ciliary staphyloma secondary to raised IOP after being lost to follow up with silicone oil in situ due to COVID 19 pandemic. We present an unconventional approach of managing this complication by opting for filtering surgeries to lower IOP before going for more destructive procedures. Keywords: Silicone Oil Infusion; Complications; Staphyloma; Trabeculectomy; Retinal Detachment
344 Improvement of Photoreceptor Function Following Transplantation of NS-Derived RPE Cells into the Subretinal Space of an Animal (Rat) Model of Retinal Degeneration, Hamid Aboutaleb Kadkhodaeian 1,2 , Taki Tiraihi 1 *, Hamid Ahmadieh3 , Hossein Ziaei 3 , Narsis Daftarian 4 and Taher Taheri 5 Purpose: To investigate transplantation of retinal pigment epithelium (RPE) antigen (PSRA)-expressing pigmented spheres in an animal (rat) model of age-related macular degeneration (AMD) using sodium iodate to rescue and improve (i) a- and b-wave activities, (ii) alter outer nuclear layer thickness, and (iii) enhance cell number. Materials and Methods: Mal e hooded rats (n = 65) were divided into five groups, two of which received sodium iodate and three of which did not. AMD was induced using retro-orbital sodium iodate injection. After 30 days, cells were injected into the subretinal space using a trans-scleral approach. For cell transplantation, rat bone marrow stromal stem cells were differentiated into neurospheres (NSs) and, after 7 days, into RPE cells. For tracking, differentiated cells were labeled with BrdU and then transplanted into the subretinal space. Photoreceptor function was evaluated by full-field electroretinography over the course of 7-90 days. The effects of transplanted cells on neurosensory retina and RPE layer were assessed using immunohistochemistry and cresyl violet staining at corresponding time points. Results: Both the scotopic b-wave at an intensity of 0.01 cd.s/m 2 and photopic a-wave at an intensity of 3.0 cd.s/m 2 were affected. Significant differences between the test groups and relevant controls appeared at 60 days, but only for the scotopic assay and, at 90 days, for the photopic assay. Seven days after injection, light microscopy of IHC on paraffin sections in the transplanted group showed that PSRA cells had migrated and integrated into the host RPE layers. Further investigation using specific RPE cell protein RPE65 and ZO-1 revealed that these cells were able to express specific proteins as well. There was a statistically significant difference between the numbers of outer nuclear layer (ONL) cells and thicknesses in transplanted group. Significant differences between the test group and relevant controls appeared throughout the 7-90 day course in ONL cell count and through 14-90 days in ONL thickness. Ninety
345 Subhyaloid Haemorrhage: A Case Report, Santosh Subedi and Sujan Rijal* Introduction: Intraocular collection of blood, usually between posterior limiting layer of the vitreous and retina is subhyaloid haemorrhage. Case Presentation: Unilateral subhyaloid haemorrhage with history of trauma in 30 years male is the case that we present. Laboratory tests was done and it is within the normal. Conclusion: Our case decorate an fascinating presentation of unilateral subhyaloid haemorrhage, where history of trauma was the risk factor. Keywords: Trauma; Subhyaloid Haemorrhage; Rapti Eye Hospital
346 Assessment of Pain and Anxiety Related to Cataract Surgery, Kokou Vonor 1,2 *, Fabrice Bagna 3 , Yaovi Tété3 , Yawa Nagbé 3, Koffi D Ayéna3,4 and Komi P Balo 3 Purpose: List and analyze the factors related to anxiety and pain related to cataract surgery under loco regional anesthesia in Lomé. Methods: We carried out a cross-sectional study, over a period of 7 months from January to July 2020, on patients undergoing cataract surgery. The Amsterdam preoperative anxiety and information scale (APAIS from 6 to 30) assessed preoperative anxiety before each intervention. The visual analogic scale (VAS from 0 to 10) measured the Postoperative pain. Results: We considered 105 patients, including 50 men and 55 women, i.e. a sex ratio (M/F) of 0.91. The mean age was 61.71 ± 14.14 [22-88] years. The average duration of surgery was 22.52 ± 6.73 minutes. The mean global preoperative anxiety score was 7.22 ± 3.14. Women had an average global anxiety score of 8.04 versus 6.32 for men. The mean global preoperative anxiety score for the first eye was 6.75 versus 8.72 for the second eye. The most anxiety-provoking preoperative factor was the feeling of postoperative pain (19.05%) followed by probable losing of the operated eye (9.52%). Over 105 patients, 5 (4.76%), reported immediate postoperative pain equal to 4 according to the VAS for the first eye versus 8 (10.26%) for the second eye. Immediate postoperative period revealed 12.73% of women expressing pain at 4 according to the VAS compared to 12% of men. Conclusion: The management of anxiety and pain related to cataract surgery involves informing the patient about anesthesia, surgery, postoperative follow-up, and the expected visual result. The contribution of music to the theater in reducing preoperative anxiety needs exploring in a subsequent study. Keywords: Anxiety; Pain; Cataract Surgery; Lomé
347 Differentiation and Structural Investigation of Bone Marrow Stem Cell-derived Retinal Pigment Epithelium Cells, Zahra Hajiha 1 , Hamid Aboutaleb Kadkhodaeian 1,2 *, Hamidreza Sameni1,2 , Mona Farhadi 3 and Sam Zarbakhsh Background: To investigate the ultrastructure of retinal pigment epithelium (RPE) derived from rat bone marrow stromal stem cells (BMSCs). Materials and methods: In this study, mesenchymal stem cells were extracted from the bone marrow of rats. They were then cultured in Transwell plate containing RPE differentiation cocktail and cultured for sixty days. Immunocytochemistry investigation was performed on the bone marrow cells and RPE cells. To evaluate the melanin pigment as well as the apical microvilli, tight junction of differentiated RPE cells, hematoxylin and Eosin staining, scanning and transmission electron microscopy were performed. Results: Immunocytochemistry investigation of the bone marrow cells indicated that more than 90% of these cells showed mesenchymal stem cells markers. The results also showed that 76.52% of RPE cells indicated RPE65 specific protein, and 62.06% of them revealed tight junction protein (ZO-1). Furthermore, optical microscopy findings indicated that these cells were single-layer with apical villi on top of them. The results of scanning and transmission electron microscopy showed that these cells after 60 days had melanin pigment and apical microvilli as well as tight junction between the cells. Conclusion: We found that BMSCs can be differentiated into RPE cells and express the specific markers of these cells. We also indicated that the differentiated cells in comparison to normal cells had apical microvilli as well as melanin granules, and there was also cell junction between cells. Keywords: Bone Marrow Stem Cells; Retinal Pigmented Epithelium; Apical Microvilli; Tight Junction; Melanin; Electron Microscopy
348 Reliability of GR-2100 Autorefractometer in Nepalese Population, Kishor Sapkota 1,2 * and Jorge Manuel Martins Jorge1 Objectives: The aim of this study was to determine the reliability of GR-2100 Autorefractometer in measuring refractive error in Nepalese population. Methods: It was a cross-sectional study. Refractive error of right eyes of 595 subjects was determined by GR-2100 Autorefractometer and conventional method (retinoscopy followed by subjective refining) in Nepal Eye Hospital during one-year period. The variation of mean spherical equivalent (M) and J0 and J45 components of Jackson Cross Cylinder (in eyes with astigmatism) between two methods was determined. Effect of age on the variation between two methods was also analyzed. Results: Out of the total participants, 54% (321) were female. The mean age of the subjects was 32.5 ± 19.9 years. Forty-five percent of the subjects were in the age group 16 to 30 years. Average M measured by the conventional method was -2.16 ± 3.39D with range -17.63D to +8.50D. Autorefractometer overestimated M (-0.33 ± 0.92, p < 0.001) and J0 (0.02 ± 0.24D, p = 0.021) and the difference was associated with age of the subjects (p < 0.05). However, there was no difference in J45 component of the refractive error within two methods (p = 0.178). The highest percentage of agreement (62%) was found in axis followed by cylinder component (59%) of the refractive error. Conclusion: GR-2100 Autorefractometer overestimates refractive error. Percentage of agreement was higher with axis and cylindrical components of the refractive error. Only this autorefractometer cannot be used for the prescription, however, it can be used in the screening program. Keywords: Myopia; Autorefractometer; Spherical Equivalent; Overcorrection; Nepal
349 An Internationally Validated Direct Observation of Clinical Skills Rubric for Subjective Refraction, Amy V Jost 1 , Heather Connor 2 , Aaron V Shukla 3 , Sophia Y Fang4 , Pádraig J Mulholland 5,6 , Shailaja P Reddy7 and Karl C Golnik 8 * Background: Globally, refractive error is the most common cause of correctable vision impairment. Refractometry is a skill that is difficult for beginners to learn and challenging for the evaluators to assess. A well-constructed rubric can provide guidance as a teaching tool to the novice refractionist and as an assessment tool to the instructor. Purpose: A new rubric was created to provide clinical educators with an internationally valid and standardized method to teach and assess competency in subjective refractometry. Methods: A panel of seven international content experts participated in a qualitative research study to create a distance vision subjective manifest refractometry rubric by identifying the key steps of the procedure, determining performance levels of competency, and creating behavioral descriptors for each procedural step and level of competency. The rubric was reviewed by a total of 34 international subject-matter experts from 18 countries and from various roles, to ensure content validity. Results: A 15-step rubric for subjective refraction was created. Levels of competency were defined as novice, beginner, advanced beginner and competent. Precise descriptions of performance were determined for each step at each performance level. Content validity was achieved by incorporating reviewer’s comments. Conclusions: This internationally valid and standardized rubric is an assessment tool that can be applied globally to teach and assess distance vision manifest subjective refraction. Keywords: Subjective Refraction; Refraction; Rubric; Refractive Error; Refractionist
350 Red Eye in Children Aged 0 to 15 Years at the Cades/O of the Donka National Hospital in Conakry, Balde Abdoul Karim 1,2 *, Sovogui DM 1-3 , Bah TM 1,2 , Gninou ESO 1 , Magassouba A 1 , Hann F2 and Diane S General Objective: To study the red eye in children from 0 to 15 years old at CADES/O. The Application Centre for the Diploma of Specialized Studies in Ophthalmology (CADES/O) served as a framework for the realization of this study. This was a prospective study of descriptive type of a duration of 5 months from March 22 to August 22, 2021. Results: During our study period, we received in consultation 719 children, those who consultedfor a red eye represented 502 cases or 69.8% of cases and 217 children or 30.2% consulted forother pathologies. The age group from 1 to 5 years was the most affected with 178 cases or 35.5%. The average age was 7.5 years with extremes of 14 days and 15 years. According to the reason for consultation, pruritus and eye redness were the master symptoms, 337 (67.1%) and 302 (60.2%) respectively, followed by lacrimation to 117 cases (23.3%) and secretions to 61 cases (12.2%). After treatment, the evolution was favorable in 413 cases or 82.3% marked by a regression of the symptomatology and a renewed visual acuity. In 17.7% of cases, we observed recurrences. Keywords: Red Eye; Child; Conjunctiva; Conakry
351 Stem Cell Technology for Eye Disorders, PD Gupta* The eye is the most important sensory organ in humans. Many of the conventional treatments are ineffective for certain ocular disorders. For example, there’s no cure for the age-related macular degeneration (AMD). It is estimated that over 300 genes have been implicated in retinal degenerations. There is no way to regulate that many genes to correct ADM. The earlier management methods for AMD were cumbersome and not much effective; the advanced methods such as, gene therapy, artificial retina involving genetic engineering technology, using optical or laser switches to excite neurons (optogenetics) and advanced biological techniques such as transplanting stem cells has better scope for management of macular degeneration. Stem cells can act as a source of new, healthy specialized cells and may provide a way to replace damaged cells in the eye.
352 Treatment of Retinal Folds Using Different Approaches for Unfolding After Retinal Detachment Surgery, Xavier Valldeperas-Belmonte1 , Pablo Diaz-Aljaro*1 , Laura Broc-Iturralde1 , Adriá Sanchez-Fortuny Sanchez1 , Nevena Romanic- Bubalo 1 , Sandra Gómez- Sanchez1 Susana Ruiz - Bilbao 1 , and Antonio Sabala- Llopart 1 Purpose: To present two different surgical procedures for the treatment of retinal folds after retinal reattachment surgery. Methods: Two different surgical techniques on two cases of retinal folds depending on their presentation time and position on the posterior pole. Results: Case one and two had retinal folds involving macula, both required surgeries, on the first case injection of subretinal fluid (BSS) was used for unfolding, and in the second case, peripheric retinectomy and redetachment of the retina was performed. Visual symptoms resolution and flattening of the retina was achieved in both cases after follow-up period. Conclusion: Surgical treatment of retinal folds involving macula must be addressed promptly to avoid visual impairment, conversely, extrafoveal folds can be appropriately managed with a conservative approach if visual acuity is correct. Keywords: Retinal Folds; Unfolding; Buckle
353 Knowledge, Attitudes and Practices Related to Primary Open Angle Glaucoma in the Adult Population at the Donka National Hospital CADES/O, Baldé Abdoul Karim*, Madjimta k F, Diane S, Sovogui DM, Magassouba A, Barry A K, Bah T M Introduction: Primary open-angle glaucoma (POAG) is a chronic progressive optic neuropathy corresponding to a progressive loss of retinal ganglion cells characterised by anexcavation of the optic nerve head (or papilla) associated with a typical visual field deficit The aim of this study was to describe the knowledge, attitudes and practices of adultglaucoma patients with respect to CAPM. Methodology: This was a prospective and descriptive study based on the census of alladult patients suffering from CAPM at the CADES/O of the Donka National Hospital for a period of 4 months from 1er September to 31 December 2020. Results: During our study we counted 172 patients with a male predominance of 105(61%) against 67 (39%) in women, i.e. a sex ratio M/F = 1.54 Of the 172 patients, 67.4% thought that GPAO could be cured with medication, 94.8% knew that the treatment of GPAO is lifelong, 75% had come to the hospital directly when they had vision problems, 97.7% were not insured, 51.7% found the cost of the treatment quite expensive, 65,7% did not take the medication at the prescribed times, 58.7% complied with the prescribed doses of medication, 58.1% were satisfied with the treatment they received, 55.2% of the patients kept appointments, 75.6% were informed about their disease (the natureof the disease, its consequences, the hereditary nature, the life-long treatment). The main personal medical history was hypertension. Conclusion: Medical treatment prescribed in the first instance is not always well followed up because of the very high cost of the drugs in relation to the patients’ income. Keywords: Conduct; Attitudes; Practices; Primitive Open Angle Glaucoma
354 The Epidemiology of Low Vision in North West Bank Population: A Hospital-based Study, Anas L Yasin 1 *, Mohammad M Shehadeh 2 , Mohamed M Khodeiry 1 , Mohammad T Akkawi 2 , Ammar Aghbar 2 , Abdul-Raheem Abu Shanab 2 , Haneen Nueirat 2 and Menatalla M Khodeiry 3 Aim: To assess the magnitude of low vision (LV) among ophthalmic patients of North West Bank (NWB) discrete. Methods: Institution based cross section study was performed at An-Najah National University Hospital which is a large tertiary hospital serving NWB. A total of 3000 patients who were more than 18 years old were selected between June 2018 - June 2019. Comprehensive ophthalmic exam was done and patients with LV (best corrected visual acuity after any possible treatment < 6/18 (0.33) to >= LP) were studied. Results: A total of 106 (3.5%) were having LV. 48 patients (45.3%) were males and 58 (54.7%) were females. Average age of LV patients was 67 years. Most LV patients had VA less than 0.05 (decimal) (3/60 Snellen). Diabetic retinopathy (DR) was the leading cause of LV and retina related causes compromised the vast majority of cases. Conclusion: The magnitude of LV is high but most of its association are either avoidable or treatable. The role of screening and counseling programs and early diagnosis and treatment should be emphasized along with increase awareness of LV services and their importance to visually impaired persons. Keywords: Low Vision; North West Bank; Cross Section Study; Diabetic Retinopathy
355 C. burnetii Chorioretinitis: A Case Report, Paolo Amato*, Matteo Forlini and Alessandro Mularoni Q fever chorioretinitis The Q-Fever is a disease caused by Coxiella burnetii, infrequent zoonosis which rarely involve the ocular structures. C. burnetii is vehiculated by a organic/inorganic particles dispersed in the air (droplets). For this reason the primary site of infections is the respiratory tract. Clinically the Q-Fever may be misdiagnosed for a common flu also because of its self-limiting nature. The acute stage may be followed by the chronic phase in 5% of cases in which can be involved the cardiac and hepatic district [1,2]. The early diagnosis can permit the reduction of chronicity index and therefore the tissue damage and related organ failure, thanks to the use of doxicicline as first line therapy. A great variety of chorioretinal findings was described related to infections of R. conorii, but very poor data was reported in literature concerning ocular findings in C. burnetii infection [3,4]. Keywords: C. burnetiid; Fever; Chorioretinitis
356 Urrets Zavalia Syndrome and Cataract After Implantable Collamer Lens Implant in Previous Posner-Schlossman Syndrome, Alfonso Savastano 1,2 , Davide Brando 2 *, Umberto De Vico 1 , Gloria Gambini 1 and Stanislao Rizzo 1,2 Introduction: Implantable collamer lens (ICL) implantation is a predictable type of refractive surgery to moderate to high refractive errors. Urrets-Zavalia Syndrome (UZS), first described as a fixed and dilated pupil following penetrating keratoplasty in patient receiving atropine, is now considered a complication of any surgical manipulation of anterior segment. Patient and Clinical Findings: We reported a case of a female patient affected by bilateral high myopia, who developed UZS and subcapsular cataract after ICL implant in her left eye (LE). This last suffered of Posner-Schlossman syndrome (PS) 6 years before without sequelae. Diagnosis, Intervention, and Outcomes: A fixed dilated pupil not responsive to dapiprazol was noted in absence of corneal edema or rise of IOP in LE after uncomplicated ICL implant; UZS was therefore diagnosed. Two months later, a second surgery for ICL removal, phacoemulsification and artificial intraocular lens implant was performed for cortical cataract development. The uncorrected distance visual acuity (UDVA) one month after surgery was of 20/20. Conclusions: Very few cases of UZS have been described after ICL implantation. We supposed a mechanism of a suffering iris tissue from the previous PS and inflammatory reaction to the intraoperative fluid exchange which lead to cataract development as well. Keywords: Urrets-Zavalia Syndrome; Posner-Schlossman Syndrome; Implantable Collamer Lens; Refractive Surgery; Cataract Surgery
357 SQUINT Types Causes Management and Role of Parents in Mobile Data Abuse by Children, Gowhar Ahmad 1 * and Ali Hussain Mir 2 Squint is a kind of common ocular condition characterized by abnormal ocular deviations with absence of normal ocular paramecium and paucity of binocular vision which is kind of Simultaneous perception, Simultaneous fusion and stereopsis.
358 A Study on the Preoperative Anxiety Levels Among Cataract Patients from Community Camps, Shreya Kumari 1 , Surabhi Basu Roy Sarkar 1 , Gajendra Shah 1 , Arun Thakur 1 , Ruchi Patial 1 , Anish Thakur 1 , Debashish Das1 , Amrit Singal 1 , Aditya Goyal2 , Mohammad Nooruz Zaman 2 , Saitirumaladev Kalicheti 2 *, Mittapalli Priyanka2 , Sebin C Sebastian 2 and Renu Thakur 3 Background: It is crucial to assess pre-operative anxiety levels for to mitigate any negative outcomes. Previous studies showed that preoperative anxiety before cataract surgery is very much expected in patients up to 80% and no studies are done on community patients up to our knowledge. Aim: The purpose of this study is to find anxiety levels among unprivileged patients undergoing cataract surgery preoperatively using Hamilton anxiety rating scale questionnaire. Methods: A set of 14 questions from Hamilton anxiety rating scale was administrated by to 385 patients between 30-90 years of age undergoing cataract surgery in community care at Sankara eye hospital, Ludhiana. A 14-item standard questionnaire for the Hamilton anxiety rating scale was administered. Each item is assessed on a zero-to-four-point scale. Results: We observed that 325 (84 percent) Patients having Mild Anxiety, 36 (9 percent) Patients having Moderate Anxiety, 24 (6 percent) Patients having Severe Anxiety. Conclusion: It is expected that preoperative anxiety is very much prominent in individuals getting cataract surgery. But with right amount of counseling and taking preoperative care the community patients at Sankara Eye Hospital, Ludhiana have least anxiety levels, they are confident and have conviction that they are supplied with good quality of eye care service. Keywords: Hamilton Anxiety Rating Scale; Anxiety; Cataract Surgery; Community Eye Care
359 Tests to Diagnose Ocular Myasthenia Gravis, Madhuvanthi Mohan, Sashwanthi Mohan*, Sujatha Mohan and Mohan Rajan Myasthenia gravis is an autoimmune, neuromuscular junction disorder causing fatiguability and weakness of the muscles • Ocular myasthenia gravis (OMG) is where weakness is isolated to the periocular muscles, namely, extraocular muscles, levator palpebrae superioris and orbicularis oculi [2].
360 Low Vision in Children: Adaptation Versus Prescribing Devices, Devanshi M Dalal 1 and Dhaivat Shah 2 * Low vision in children is a major issue creating havoc in normal child growth. It needs to be understood in detail in order to be managed. The present article discusses various conditions causing low vision in children, the prevalence of visual impairment, adaptation to low vision, clinical objectives of low vision care, low vision aid according to life stages, and rehabilitation. Keywords: Low Vision; Paediatric; Adaptation; Devices; Vision Rehabilitation
361 Mapping the Tendency Oriented Perimetry (TOP) and Normal Threshold Strategies, MD Bahauddin Molla 1 *, Tariq Reza Ali 2 and MD Showkat Kabir Background: The Tendency Oriented Perimetry (TOP) and Normal Threshold Strategies (NTS) are two widely used procedures of diagnosis in the treatment arena of ophthalmology. But we have not enough data regarding the comparative analysis between these two procedures of TOP and NTS. Aim of the study: The aim of this study was to establish a correlation between Tendency Oriented Perimetry (TOP) and Normal Threshold Strategies (NTS) by OCTOPUS automated visual field analyzer in diagnosis and monitoring of glaucoma and other neurological lesion. Materials and Methods: This was a prospective observational study. The comparative case study was conducted at the National Institute of Ophthalmology and Hospital (NIO and H), Dhaka, Bangladesh during the period from January 2003 to December 2004. At the first screening glaucoma suspect patients, established glaucoma and neuro-ophthalmological patients attended at the outdoor of NIO and H were selected for this study. Finally, forty-five eyes of twenty-five subjects were defined in this study for analysis. Data were collected by predesigned questioner and analyzed by SPSS latest version. Results: The mean time required for test in Tendency Oriented Perimetry (TOP) was 3.01 ± 0.40 minutes and in Normal Threshold (32) was 15.87 ± 2.02 minutes. In our study the comparison of mean sensitivity in tested eye by TOP and NTS (32) strategies were prepared. The mean sensitivity in TOP was 21.07 ± 7.60 and in NTS (32) was 20.01 ± 6.95. The mean defect in TOP was 7.92 ± 7.24 and in NTS (32) was 8.46 ± 7.09 and the mean difference was statistically not significant (p > 0.05). Conclusion: The study concludes that Tendency Oriented Perimetry (TOP) is an alternative to Normal threshold (32) perimetric technique in the assessment of visual field. Furthermore, TOP strategy is very much time saving and has less fatigue effects both to the patients and perimetrists. So, in screening purpose we can use TOP strategy instead of NTS (32) strategy. Keywords: Ophthalmology; Tendency Oriented Perimetry TOP; Normal Threshold Strategies
362 Ocular Involvement as the Only Manifestation in Paracoccidioidomycosis, Juliana Bisco Ferreira da Silveira e Freitas1*, Giovana de Figueiredo Godoy2 and Victoria Walters3 Introduction: Paracoccidioidomycosis is a systemic infection caused by Paracoccidioides Brasiliensis fungus that primarily affects the lungs. Ocular involvement is rare, in most cases having a secondary manifestation typically found in the eyelid and conjunctiva. Patient and Clinical Findings: We reported a case of paracoccidioidomycosis in a female patient with a localized ocular manifesta- tion. Conclusions: This case shows the importance of including paracoccidioidomycosis as a differential diagnostic hypothesis in patients with only ocular manifestations that display tumors characterized by eyelid thickening. Keywords: Conjunctival Infection; Conjunctival Melting; Paracoccidiodomycosis; Scleral Melting; Systemic Disease; Paracoccidioides brasiliensis
363 An Unusual Case of Peripheral Retinoschisis Complicated by Vascular Malformations: A Case Report, Manoj S, Sameer I*, Mancy Mathew and Unnikrishnan Nair Senile retinoschisis (SR) is an uncommon condition in which the neurosensory retinal layers abnormally separate, usually at the level of outer plexiform layer. Here, we report a rare case of bilateral senile retinoschisis with aneurysmal vascular lesions in the schitic region that led to intraschitic bleeding and later vitreous haemorrhage. We discuss the possible nature of the disease and the management course. Keywords: Peripheral Retinoschisis; Vitreous Haemorrhage; Retinal Detachment
364 A Step Towards Reducing Global Glaucoma Blindness - How does Gonioscopy Help?, Shajitha Parveen H* Glaucoma is a leading cause of irreversible blindness worldwide. It has been estimated that 76 million people would have developed glaucoma in 2020 and the number is likely to reach 111.8 million by 2040 [1]. Asia accounts for more than half of the world’s overall glaucoma burden and more than three-quarters of the global Primary Angle Closure Glaucoma (PACG) population [1,2]. A recent systemic review and meta-analysis of population-based studies reported that 64.7% of PACG cases were previously undetected in Asia [3]. Although Primary Open Angle Glaucoma (POAG) is the most common subtype of glaucoma, the increased propensity of PACG to cause permanent blindness makes it a pressing public health issue, especially in Asia [4,5]. It is reported that angle closure glaucoma is associated with a three-fold increased risk of bilateral visual impairment [6].
365 Knowledge About Various Aspects of Refractive Error in Patients, Muhammad Asif Memon 1 *, Zainab Ranjhani 2 , Mehak Nazir 3 , Muhammad Qasim 4 , Noorul Huda 5 , Andleeb Abid 6 , Abdul Hameed 7 , Sadia Bukhari 8 , Muhammad Atif Nisar 9 , Beenish Atif 10 and Muhammad Karim 1 Object: To determine the knowledge regarding refractive errors among outdoor patients. Methodology: A descriptive hospital based and non-probability convenience sampling study. Total 200 patients were enrolled according to inclusion and exclusion criteria and those who gave consent. Researcher asked all the questions given in the structured questionnaire and administered the answers as given by individuals. Results: The females were 59.5% and male were 40.5%, the maximum age were 51 and mostly were house wife a 34%. Refractive error was 66 about distance blur vision had 57% and they thoughts the blur vision occurs due to watching tv and mobile phones as 19%. Conclusion: We observed that only a few of the patients shared a little knowledge regarding refractive errors, which reflected their poor awareness about the subject. Moreover, a majority of the participants were known of the fact that a poor knowledge of the refractive error can have a significant impact on vision and lack of knowledge may leads to the blindness. Keywords: Refractive Error; Awareness; Outcomes; Sign and Symptoms; Causes and Occupation
366 A Contact Lens in the Management of Corneal Opacity: A Case Study, Mohammad Nooruz Zaman 1 *, Bhupesh2 and Sebin C Sebastian Purpose: To manage the corneal opacity with corneal scleral lens. Case Report: A 26-year old female came to an eye hospital with a complaint of diminished of vision, glare and redness in both eyes for 10years The unaided visual acuity was finger counting (FC) @ 2 meter with no improvement with pinhole in right eye and count- ing finger closed to face (CFCF) with no improvement with pinhole in left eye and near
367 Squint Types Causes Management and Role of Parents in Mobile Data Abuse by Children, Gowhar Ahmad* quint is a kind of common disorder characterized by abnormal occular deviation with absence of normal occular parallelism and paucity of binocular vision which is kind of simultaneous perception, simultaneous fusion and stereopsis, main sim of squint management is not inly to correct the normal angle of deviation by to endure normal status of vision for this early prompt treatment by squint expert is very important, so it is very important for every parent to dark the advice of pediatric ophthalmologist if they observe any kind of abnormal occular deviation of their kids.
368 Scenario of Various Ophthalmic Rings, Gowhar Ahmad* We have kind of different ophthalmic rings which once a while comes to the notice of an ophthalmologist so one has to understand the pathophysiology and importance of these ophthalmic rings.
369 Bacterial Spectrum and Antibiotic Sensitivity in Patients with Chronic Dacryocystitis Attending at a Tertiary Hospital in Dhaka, Nirupam Chowdhury 1 *, Md Sharfuddin Ahmed 2 , Md. Showkat Kabir 3 , Chandan Kumar Roy4 , Md Moinul Hoque 5 , Subarna Saha6 , Mohammad Shish Rahman7 and Nawreen Binte Anwar 8 Purpose: The purpose of the study was to assess the bacterial spectrum in patients with chronic dacryocystitis and their antibiotic sensitivity pattern. Methods: This cross-sectional observational study was carried out in the Department of Ophthalmology, Department of Community Ophthalmology and Department of Microbiology and Immunology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from March 2017 to August 2019. A total of 50 patients of 19 years and above with clinically diagnosed cases of chronic dacryocystitis were enrolled in this study. Results: Most of the patients belonged to 46-55 years of age and male to female ratio was 1:2.8. About 60.0% of the female population were housewives followed by 8 (16.0%) service holders and 7 (14.0%) businesswomen. More than one third (34.0%) of the patients were culture positive and 66.0% were culture negative. Four cases had Gram positive bacteria; among them 3 (75%) were Staphylococcus aureus. Thirteen patients had Gram negative bacteria, among which Klebsiella spp was found in 9 (69.2%). The most common isolated bacterial organisms were Klebsiella spp 9(52.9%) followed by Staphylococcus aureus 3(17.6%) and
370 A Clinical Study of Ocular Trauma: Etiology, Pattern, Management and Visual Outcome, Bhim B Rai 1 *, Anshu Sahai 2 , Winnie Gangwal 3 , Monisha Sahai 2 and Ted Maddess Purpose: To understand the profile of ocular trauma presenting to a tertiary hospital in Rajasthan, India. Study Design: Prospective, case-series study. Methods: We included ocular injury patients attending Sahai Hospital and Research Centre. Questionnaires based on India Eye Injury Registry were used. Mechanical and chemical injuries were classified as per Ocular Trauma Classification Group (OTCG), and Ropar-Hall Classification, respectively. Results: Of 405 patients (411 eyes), majority were male (77.9%). None of the patients was using eye protective device (EPD). The most commonly affected group was aged 21-30 years, farmers (25.3%), and rural patients (51.1%). More urban patients presented within 12 hours, 29.9% c. f. 6.2%. Presentation after 24 hours had poorer best corrected visual acuity (BCVA) (p = 0.001), and it declined with increasing interval (p = 0.001). Majority of injuries were mechanical (395, 96.1%) with hammer-chisel works (20.4%). Close-globe injury (CGI) out-numbered open globe injury (OGI) (306,74.4% c. f. 89, 21.6%). Contusion in CGI (52.9%), and penetrating injury in OGI (61.8%) were the most common types. Cornea was the most common tissue injured (69.6%) and corneal opacity the most common complication. In CGI, zone of injury was the single most important visual prognostic factor (p = 0.001). In OGI, type (p = 0.002), grades (p = 0.004), and zones (p = 0.004) of injury determined visual prognosis. Conclusions: Patients presenting within 24 hours had good prognosis. In OGI, higher grade and more posterior entry site had poor prognosis. In CGI, zone was the only significant prognostic factor. Most of the injuries were avoidable. We recommend compulsory use of EPDs while on work. Keywords: Eye Injury; Golden Hour; Mechanical Injury; Ocular Trauma; OTCG
371 Special Considerations in Cataract Surgery for Uveitis Patient, Mohamed Almousa* When it comes to cataract surgery in a patient with a coexisting disease, uveitis poses a particular challenge. “The most critical thing to recognize is that the uveitis patient should not be treated as a usual cataract patient, “Failure to take precautions to prevent the uveitis from flaring up due to the trauma of cataract surgery is asking for complications”.
372 Knowledge About Various Aspects of Refractive Error in Patients, Muhammad Asif Memon 1 *, Mazar-ul-Hasan 2 , Mehak Nazir 3 , Izmal Urooj 4 and Madhiha Jawaid 5 Object: To determine the knowledge regarding refractive errors among outdoor patients. Methodology: A descriptive hospital based and non-probability convenience sampling study. Total 200 patients were enrolled according to inclusion and exclusion criteria and those who gave consent. Researcher asked all the questions given in the structured questionnaire and administered the answers as given by individuals. Results: The females were 59.5% and male were 40.5%, the maximum age were 51 and mostly were house wife a 34%. Refractive error was 66 about distance blur vision had 57% and they thoughts the blur vision occurs due to watching tv and mobile phones as 19%. Conclusion: We observed that only a few of the patients shared a little knowledge regarding refractive errors, which reflected their poor awareness about the subject. Moreover, a majority of the participants were known of the fact that a poor knowledge of the refractive error can have a significant impact on vision and lack of knowledge may leads to the blindness. Keywords: Refractive Error; Awareness; Outcomes; Sign and Symptoms; Causes and Occupation
373 Variation of Axis Before and After Cycloplegic Refraction at Peadiatric Department of Al-Ibrahim Eye Hospital, Malir, Karachi, Muhammad Asif Memon 1 *, Asad Iqbal 2 , Mehak Nazir 3 , Saman Hamid 2 , Izmal Urooj 4 , Madhiha Jawaid 5 , Muhammad Atif Nisar 6 and Beenish Atif Purpose: To determine the variation of refractive error and axis before and after cyclorefraction. Methodology: An observational, descriptive study had 426 eye and non-probability sampling technique were used. Patient selection according to inclusion and exclusion criteria. Results: A total of 426 eyes were recruited and examined, who lay in our criteria of age The type of astigmatism has been identified by auto-refractometer both before and after instilling the drops of cyclopentolate, and the comparison has been made on the basis of auto-refractometer readings. Out of these 426 eyes, 238 (55.8%) eyes were of males and 188 (44.1%) eyes were of females. The variation of axis after cyclo refraction out of 426 eyes 293 (68.7%) patients had variation of axis before and after cyclo more than 5 ` degree, among those 293 eyes, 168 (57.3%) were of males and 125 (42.6%) were of females. Conclusion: The study showed significant variation of refractive error and axis before and after cycloplegic refraction which was greater than 5 degrees. The major shift was compound myopic astigmatism into compound hypermetropic astigmatism. Keywords: Refractive Error; Cylindrical Axis; Cycloplegic Drugs; Refraction
374 Retinal Manifestations in Acquired Immuno Deficiency Syndrome: A Clinical Study and their Relationship to CD4 Cell Count, Manoj S, Sameer I*, Sruthi P S and Pasupuleti Venkata Sarath Babu Background: HIV is a multisystem disorder causing a wide spectrum of diseases. Ocular manifestations which occur in 70-80% of HIV patients may be the initial presentation of a systemic infection in an asymptomatic patient. HIV-related ocular symptoms can vary depending on CD4+ T lymphocyte levels. Aim: To analyze the retinal manifestations of HIV/AIDS patients and to evaluate its association with CD4 cell counts. Material and Methods: HIV patients with CD4T cell count < 200 cells/mm3 and WHO stage 4 disease irrespective of CD4 cell count were included in the study. Detailed history and ocular examination were undertaken along with systemic evaluation. Observations: Out of total 306 patients examined, 86 (28%) had retinal manifestations. Majority of patients belonged to age group 20-40 yrs (69%). Most common retinal manifestations were HIV retinopathy (19%), then CMV retinitis (6%). Retinal manifestations were more among those with CD4 count < 50 cells/mm3. In HIV positive patients with retinal manifestations, HIV retinopathy seen as comparatively early manifestation, while CMV retinitis seen as a late manifestation. There is increased risk for CMV retinitis in those with CD4 cell count
375 Pediatric Low Vision Management in Case of Myopic Maculopathy Case Study, Devanshi M Dalal 1 * and Dhaivat Shah 2 A pediatric case of macular myopathy is described. His best corrected visual acuity was -13.50/-1.00 x 40 with vision 6/24 in the right eye while for the left eye subjective acceptance was -12.75/-0.50 x 50, 6/18. Several visual and adaptive aids can help people regain or maintain their independence so that the child can continue integrated education. Pediatric Low Vision Management in case of progressive condition like Myopic Maculopathy should be an integrated approach of low vision aids and rehabilitation including vocational training. Keywords: Myopia; Retinopathy of Prematurity (ROP); Myopic Maculopathy
376 Awareness About Eye Donation Among Urban/Rural Population, Aryantika Sharma*, Pratyaksh Kaistha, Saurav Kumar Singh, Anju Kumari, Debanjali Bhatacharjee, Himanshu Tripathi Aim of Study: To find out the awareness of eye donation in people to find out their knowledge and interest in eye donation with the help of a easy survey questionnaire. Need of Study: Globally 6 to 8 million people out of 45 million population going blind due to correctable ocular problems [1]. To prevent blindness globally eye donation is a hope but due to lack unawareness and myths on eye donation people hesitate to donate eyes and the reality is there is nothing wrong in donating eyes. Eye donation is not a common practice in our population. The eye donation can be done upto 6 hours after death. To increase the awareness regarding eye donation we conducted this survey. In our survey eye donation among the rural as well as urban general population especially younger population was of great importance. Keywords: Eye Donation; Population; Organ
377 Normal Tension Glaucoma (NTG) - A Probationers Perspective, Bhardwaj Kumar Gaurav*, Mondal Animesh, Aggarwal Surbhi and Karmakar Sourav Normal Tension Glaucoma (NTG) is a common type of glaucoma in which the intraocular pressure (IOP) remains normal despite glaucomatous alterations in the optic nerve, optic disc, and visual field loss, and in which age and ethnicity are important factors in diagnosis. The search was conducted using a variety of online database platforms, with recent authentic articles being considered. The goal of this study is to outline every possible aspect of NTG, including pathophysiology, risk factors that contribute to illness progression, research techniques, and differential diagnosis that aids in early detection and treatment. Systemic vascular anomalies that reach the microvascular level at the location where the optic nerve departs for the visual centers in the brain are the most common cause and contributing factors. Because there are various non-glaucomatous neuropathies that can mimic NTG, a physical examination of the optic disc and its morphology is important in order to rule out NTG in terms of clinical inquiry. Treatment and management, such as preventive IOP lowering therapy, visual field testing, and diurnal variation modulation, can halt disease progression in NTG even at an early stage. Keywords: Normal Tension Glaucoma; Intraocular Pressure; Primary Open Angle Glaucoma; Optic Disc
378 Analysis of Corneal Biomechanical Properties Dependence on Topometric and Biometric Parameters, Solodkova EG 1,2 *, Balalin SV 1,2 , Fokin VP 1 , Lobanov EV1 and Balalin AS 1 To assess the dependence of biomechanical parameters on the initial biometric, keratometric and tomographic parameters of the cornea in healthy patients with different refractions, a retrospective study was performed, which included 173 eyes of 173 healthy patients with different refractions. The study analyzed the correlation between indicators of corneal stiffness, biomechanically compensated intraocular pressure, measured using Pentacam HR and Corvis ST (OCULUS Optikgeräte GmbH; Wetzlar, Germany), true keratometry, anteroposterior eyeball size, corneal thickness in the central optical zone and the age of the patient. As a result of the study, a significant direct dependence of the corneal stiffness parameter was noted, first of all, on the corneal thickness in the central optical zone (p = 0.0000), on the level of biomechanically compensated intraocular pressure (p = 0.0056), as well as a reliable inverse dependence on keratometry (p = 0.0465), but there was no influence on the patient’s age (p = 0.382) and the anteroposterior eyeball size (p = 0.851). Keywords: Amplitude of Corneal Deformation; Corneal Stiffness; Corneal Biomechanical Properties
379 Image Processing Based Types of Chronic Ailments of the Human Eyes for Glaucomatic Disease Detection Using KNN Techniques, Mahesh B Neelagar 1 , Balaji KA 2 , Pavithra G 3 and TC Manjunath4 * In this research paper, the Image Processing Based Glaucoma Detection Using KNN Techniques – a prototype is being presented in a nutshell. The human eye is one of the most essential organs in the body. The eye is continuously vital in our daily lives; without them, the world would be dark and doing daily activities would be exceedingly difficult. In the sense that it would be exceedingly difficult for anyone to accomplish any work without sight. The loss of vision/sight in the human eyes can be caused by a number of reasons. As a result, blindness in the human eyes must be avoided, as the most valued human organ is totally responsible for seeing. One of the reasons of blindness and vision loss in the eyes is various types of diseases that develop in the eyes as a consequence of a variety of conditions. A Convolutional Neural Network (CNN) is proposed in this approach for detecting glaucoma using fundus pictures of the eyes. We utilise the Otsu thresholding approach for segmenting, followed by HOG feature extraction techniques and Knn algorithm classification. For training and testing the model, we utilise a Convolution Neural Network. Keywords: Fundus Images; Glaucoma; Retinal Fundus Image; Convolution Neural Network
380 Four in One: Multimodal Imaging of Four Disparate Retinal Pathologies in One Eye, Dhaivat Shah*, Debmalya Das, Subham Sinha Roy and Purna Nangia Diabetic retinopathy, retinal vein occlusion, age related macular degeneration and macular hole are major retinal diseases that can lead to blindness and affect mainly the elderly population. All of them in a nutshell signify a basic underlying ischemic scenario with addition of detrimental effects of ageing. Published English literature does not reveal a case describing coexistence of all these pathologies simultaneously. This is, to our knowledge, is the first report with coexistent presentation of four major retinal abnormalities in a single eye, which are well highlighted on multimodal imaging modalities. Keywords: Eye; Female; Pathologies
381 Why Plus not Minus - A Case Report on Refractive Accommodative Esotropia, Raisul Azam 1 *, Eram Khan2 and Yusra Shuaib 3 Accommodative Esotropia is the type of deviation of eyes or squint which is basically due to accommodation reflex. There are various types of accommodative depending upon different parameter’s such as refractive error, amount and type of squint, age, AC/A ratio and utmost important refraction and vision with follow ups. Considering these factors practitioner can get to the right diagnosis and can start the right treatment having good improvement in vision as well as decrease in the ocular deviations. In Refractive accommodative esotropia giving full cycloplegic treatment is one of the best treatments for better improvements in vision. Follow up of patient can also lead us to the correct diagnosis in early case we can get confused between refractive accommodative esotropia and infantile esotropia, one with a follow ups can lead us if the deviation or the amount of squint decreases or gets ortho with spectacles we can diagnose the case with Refractive accommodative esotropia and if the deviation remains with glasses and without glasses we can diagnose it with infantile esotropia, in which surgery is the only treatment options for that. So a correct and diagnosis and a correct treatment can give a good results. Keywords: Accommodation; Accommodative Esotropia; Refractive Accommodative Esotropia
382 Ophthalmology and Astrology, Dr Sirisha Vinzamuri* He exists in all; he functions through all. He is not only the cosmic man, but the cosmos itself.” This is how the “Purusha Sukta,” a Vedic hymn, explains creation. If contemplated upon, it means that we are in infinite ways mini representations of the universe and if dissected further a parallel correlate can be drawn between us and the cosmos. The moment a living being comes out of its mother’s womb, it is stamped, as it were, by the cosmic influence at that very moment, in much the same way as a photographic film exposed to a flash of light. Thus the being born is imbued or saturated with exactly the same qualities, good, bad or indifferent, as happen to exist in the cosmos with reference to the place in which and the time at which the being is born.
383 Prevalence of Myopia in School Going Children at Rapti Eye Hospital, Suresh Rasaily*, Sujan Rijal, Nita Sunam, Om Prakash Yadav and Manju Bohara Objective: A growing public health concern among school - age children is myopia. Myopia prevalence varies by geographic region, race, ethnic group and socioeconomic status. The purpose of this study was to find out prevalence of myopia in school going children at Rapti Eye Hospital, Tulsipur Dang, Nepal. Only tulsipur city’s schools students were taken for the study. Materials And Methods: A cross-sectional descriptive research was conducted. Vision test was done using snellen’s chart. Refractive error was determined through Retinoscope. Age group was taken between 4-18 years (upto 10th standards). Results: Random students were taken who came at Rapti Eye Hospital for eye check up. Total 200 students from different schools of Tulsipur city were picked up. Out of which 87 were male and 113 were female. The refractive errors were found in 62 students (121 eyes). There were 37 students (72 eyes) who had myopia identified. Compared to male, there were more female than male. Prevalence of myopia in this study was 18.5%. Prevalence of myopia in male was 8.5% and in female 10.0%. Keywords: Rapti Eye Hospital; Myopia; Children
384 Mactel Type 2: Evaluation of Systemic Associations and Imaging Characteristics, Manoj S, Sameer I*, Ravi RV, Mancy Mathew and Narendra Meel Purpose: The purpose of this study was to study the clinico-demographic characteristics of Mactel patients and to correlate its clinical findings with FFA and OCT findings. Methods: This prospective study was conducted in 30 Mactel patients at a tertiary eye care centre in south Kerala between May 2014 and May 2016. Clinical staging of the disease was done based on Gass and Blodi classification. In FFA, disease was classified into those with < 180 degrees leakage, > 180 degrees leakage and CNVM leakage. OCT findings were also noted. Routine blood investigations were carried out in all the patients. These were arbitrarily divided into convenient groups for the statistical analysis. Results: The mean age of MacTel patients was 57 years with a female predominance in study group. Out of this, 86.71% had overt diabetes mellitus, 36.67% had hypertension and 16.7% had familial hypercholesterolemia. Most of the patients had stage 2 disease (48.33%) while none of them had Stage 1 disease. 46.67% in the study had < 180 degrees leakage on FFA while 48.33% had > 180 degrees. 3 eyes (5%) had CNVM type of leakage. Degree of leakage on FFA tended to correlate with the stage of disease. Common OCT findings were normal OCT (43.3%), Inner Lamellar Hole in 23.33%, Outer Lamellar Hole in 15%, full thickness hole in 1.67%, foveal pigmentation in 11.67% and CNVM in 5%. However central foveal thickness did not show a correlation with vision loss. Conclusion: The coexistence of high prevalence of diabetes mellitus and hypertension was suggestive of the fact that the vascular stress in these conditions may add to the pathogenesis of Mactel. Further research is required to establish the significance of the higher prevalence of dyslipidemia in Mactel l patients as found in our study. As the disease progresses, the degree of FFA leakage seems to suggest greater disease severity. OCT characteristics, however, failed to demonstrate such a correlation. Central foveal thickness in OCT may not be a good index to correlate with visual prognosis in these patients. Keywords: Macular Telangiectasia, Mactel; Systemic Associations; Fundus Fluorescein Angiography; Optical Coherence Tomography
385 Evaluation of Tear Secretion with and without Refractive Error Using by Schirmer’s Test in Pediatric Department of AIEH, Karachi, Muhammad Asif Memon 1 *, Sana Naz 2 , Neha Memon 2 , Rimsha 2 , Kainat Sheikh2 , Salman 2 , Mehak Nazir 3 , Nabila Noor 4 and Noor-ul-Huda Purpose: To evaluate the tear secretion in children with and without refractive error from 5 - 15 years. Methodology: A case control, non-probability convenient study was carried out 150 individual patients with and without refractive error divided into two equal groups. Objectively assessment include Schirmer’s test-1 without anesthesia (ST-1) were performed on visit at hospital. Results: Total 150 patients, 111 participant’s age between 10-15 years, and 86 of the participants were female and 64 were male. 75 Emmetropic children’s visual acuity was 6/6 and 75 patients’ vision was 6/9 to 6/60. 75 refractive error 36 (23.6%) myopia, Astigmatism 31 (20.3%) and Hypermetropia 8 (6.1%). Degree of ST-1; normal 26 (76.8%), mild 8 (20.3%), moderate 01 (1.4%) and severe 01 (1.4%) in Myopia, and normal 4 (60.0%), mild 01 (10.3%), moderate 01 (10.3%) and severe 02 (19.4%) in Hypermetropia, finally normal 24 (79.0%), mild 04 (12.0%), moderate 02 (6.0%) and severe 01 (3.0%) in Astigmatism. Degree of ST-1; normal 48 (58.3%), mild 10 (15.0%), moderate 13 (20.3%) and severe 04 (6.4%) in Emmetropia. The P-value between refractive error and without refractive error was 0.005, respectively. Conclusion: Both children (with refractive error and without refractive error) had dry eyes but emmetropic children had greater effect of dryness rather than patients had refractive correction. Whereas in refractive error patients’ myopia had greater effect on dry eye than hypermetropia and astigmatism. Keywords: Refractive Error; Dry Eye Disease; Tear Secretion; Schirmer’s Test-1; Emmetropia; Myopia; Hypermetropia and Astigmatism
386 Bio-Reset and Complete Treatment of Chronic Glaucoma Center for General Informational Regenerative Medicine and Ophthalmology, Massimo Lombardi* Presentation: It is necessary to “Re-Formulate” -in Toto- “the Clinical Perspective of Glaucoma” since it has been focused “mostly” on the “Control of intra-Ocular Pressure Rise” caused by a “Progressive Increasing Resistance to Water Mood’ Outflow” in “Schlemm’s Canal Trabeculate”. A “Reductive and Myopic Vision of the Problem” which, in fact, has allowed “in the last centuries” “superficial and erroneous -Scientific- Thinking” unable to understand the “True Reasons” and not only the “Consequences” of the well known Clinical Phenomenon, that the Progressive Increase in Ocular Pressure inevitably leads to an inexorably worsening of visual functions as the: Visual Field, Visual Ability and Acuity, Color Vision, Contrast Sensitivity and Night Vision, up to a “Progressive Blindness’”. Keywords: Chronic Glaucoma; Collagen; Lamina Cribrosa
387 Analysis of the Factors Influencing Spectacles Non-adaptation in Optical Stores, Saitirumaladev Kalicheti 1 *, Chamundeshwari Talari 2 , Kamurthy Murali Krishna 2 , Arshiya Khatoon 2 , K Mamatha 2 , Mahathi Veerabathini 2 and Bhargavi Theratipally2 “Giving a customer their eyeglasses are not the end of the matter; it may be the beginning of a problem for both the dispenser and the customer,” This statement summarizes the concept of troubleshooting and the significance of a complete quality check prior to dispensing a pair of glasses. This emphasizes the importance of robust after-sales service to provide a patient with a comprehensive eye care experience. Aim: The aim is to investigate potential causes of spectacle non-adaptation and returns in retail optical stores. Methods: Intolerant Patients were requested to provide their concerns, refraction measures, frame type, and any other pertinent information. In addition, retrospective clinical data was collected to assess the quality of the eye exams. Result: The data collected over three months was analyzed using Microsoft Excel. Seven per cent (7%) of customers returned with complaints in total. The ages of the oldest and youngest consumers ranged from 15 to 58, with a mean age of 36.5 years. The bulk of complaints was from individuals who wore progressive single-vision lenses and bifocals. Conclusion: The present study concludes that paying close attention to particulars while dispensing a pair of glasses like lens fitting, anisometropia, aniseikonia, high refractive errors and lens enhancements. Keywords: Non-Adaptation; Spectacles; Vision
388 Laser Surgery for Pigmentary Glaucoma, Fokin VP 1 *, Balalin SV 2 , Sarkisyan AS 3 and Balalin AS Purpose: To analyze the efficacy of a complex technology of laser surgery for pigmentary glaucoma which consists of YAG-laser iridectomy in the first stage followed by multistage selective laser trabeculoplasty to achieve a mild pigmentation degree of the trabecula in 360 0 . Materials and Methods: Laser iridectomy was performed in 19 patients (38 eyes) aged 18 to 54 years old with pigmentary glaucoma after achieving the values of the individual IOP level using drug therapy. Then after 4 weeks SLT was carried out. If an exogenous pigmentation was ≥ 2 st., SLT has been repeated several times every 4-6 months. Observation period: from 4 to 15 years. Results: The glaucoma process stabilization was achieved in all cases. The level of true IOP decreased by 6.6 ± 0.3 mm Hg (-30%, p < 0.05), Becker’s coefficient by 121 ± 4.3 (-60%, p < 0.001), the instillations number by 0.57 ± 0.09 (-70%, p < 0.001). The indicators increased: the average value of the total retinal photosensitivity by 381 ± 4.3 dB (15%, p < 0.001), the average threshold of the retinal photosensitivity by 2.6 ± 0.1 dB (10%, p < 0.001), the intraocular liquid outflow by 0.08 ± 0.013 (72%, p < 0.001). Drug hypotensive therapy was canceled at 16 eyes (42.1%). Conclusion: The complex method of pigmentary glaucoma laser surgery in the form of YAG-laser iridectomy and the multistep SLT is effective and safe. It may be performed for a decrease of increased ophthalmotonus level to the individual IOP against the background of drug treatment. Keywords: Pigmentary Glaucoma; YAG-laser Iridectomy; Selective Laser Trabeculoplasty
389 Improvement in Corneal Assessment by Curved-field OCT, Ali Nouraeinejad* Clinical procedures, such as refractive surgeries, depend on the counts of corneal cells and their nerves placed at en face corneal planes and consequently need en face corneal images with a large field-of-view [1]. However, the field-of-view of current high- resolution clinical methods, such as in vivo confocal microscopy (IVCM) and specular microscopy (SM), is optically restricted to about 0.5 mm [1,2]. Emerging in vivo research instruments derived from conventional Fourier-domain optical coherence tomography (OCT), such as ultrahigh-resolution-OCT (UHR-OCT) [3,4], Gabor- domain optical coherence microscopy (GDOCM) [5], and micro- OCT (μOCT) [6] can amplify the field-of-view up to about 1 mm; however, the cellular mosaics at that level are free of motion artifacts only in anaesthetized humans and animals, immobilized throughout the prolonged laser beam scanning in the en face plane
390 Customised Ocular Prosthesis for Young Adult: A Case Reports, Swastika Adhikari 1 *, Archana Murthy2 and Diwakar Rao The eye is a vital organ not only in terms of vision but also being an important component of facial expression [1]. Loss or absence of a part of the face especially eye can cause severe physical and emotional problems [2]. Loss of eye could be because of different eye diseases, malignancies, congenital defect, trauma, chemical injuries, painful blind eye or sympathetic ophthalmia [3]. Several stock ocular prosthesis are readily available in the market but Custom-made ocular prosthesis has many advantages and looks realistic. The complaint like discharge, itchiness, redness is more in stock eye prosthesis. Cosmetically compromising and movement is less due to improper fitting, shape and size. Impression taking in the custom-made eye prosthesis plays the vital role in shape, size of ocular prosthesis and comfortability of the patient while wearing it. Custom made ocular prosthesis provides better fit and improved exquisite, but they are more time-consuming and needs more patience and expertise [5]. This case report demonstrates innovative technique for fabricating custom ocular prosthesis with manual scleral and iris painting using coloured pigments which provides delicately satisfactory result long lasting with comfortable and better fit. Keywords: Eye; Trauma; Ocular Prosthesis
391 A Prospective Interventional Study on Surgical and Visual Outcomes After 23 Gauge Vitrectomy in a Tertiary Eye Care Centre in South India, M Nivean1 , Sangeetha Sekaran2 , Pratheeba Devi Nivean3 , Sridhar Baratan4 and S Alhana Begum* Since the introduction of pars plana vitrectomy (PPV) in 1971, the most revolutionary development in vitreoretinal surgery in the past few years has been transconjunctival sutureless vitrectomy (TSV). The large number of potential advantages of TSV include reduced surgical trauma, shorter operating time, lesser conjunctival scarring, decreased postoperative inflammation, faster postoperative healing, early visual recovery, improved patient comfort, and reduced postoperative astigmatism when compared to traditional vitrectomy. Fujii., et al. introduced 25-gauge vitrectomy in 2002. It had some inherent problems with the instrument flexibility, lower flow rate, and high incidence of complications. Later, modifications in 25-gauge TSV led to improvement in wound integrity and sterility, potentially decreasing the likelihood of these complications. Eckardt introduced 23-gauge TSV in 2005. It offered improved flow rates and stiffer instrumentation with fewer complications and resolved most of the problems with the 25-gauge system. During the past years, 23-Gauge vitrectomy has evolved as a very popular operating technique in a relatively short period of time. The main reasons for its success are the easier transconjunctival pars plana access with less conjunctival scarring, shorter surgical time, decreased postoperative inflammation, and increased patient’s comfort. The technique resulted as an effective approach for selected diseases of the posterior segment without significant complications. The aim of our study is to report a prospective consecutive interventional study on the safety and efficacy of 23-Gauge transconjunctival sutureless pars plana vitrectomy for a variety of vitreoretinal conditions. The main endpoint of our study was the anatomical success with retinal reattachment. We also analyzed the functional outcome and complications with particular attention to visual acuity, to changes of the intraocular pressure (IOP) and to the depth and inflammatory reaction of the anterior chamber. Keywords: Transconjunvtival; Pars Plana; Vitrectomy; Vitreoretinal; Intraocular Pressure; Inflammation
392 A Case Report on - Congenital Third Nerve Palsy and their associated Findings, Raisul Azam*, Gaurav Kumar Bhardwaj, Sourav Karmakar and Animesh Mondal Abducens nerve or 6th Nerve it is having the longest intracranial course of all the cranial nerves. Any damage to the abducens nerve along its long course may result in a palsy. Congenital 6 th nerve palsy is very rare as against DRS. No study data available on its epidemiology due to its rarity. Congenital 6th nerve palsy is taken as DRS unless proved otherwise. 2 years old female child came to Laxmi Eye Institute with a complain of abnormal turning of both eyes towards nasal side since Childhood. All the clinical examination was performed to get the right diagnosis and to give best treatment and management to patient. As congenital sixth nerve palsy may be confused with Duane’s Retraction Syndrome and Congenital Esotropia. So, A careful clinical evaluation is essential to differentiate between these. Keywords: Abducens Nerve Palsy; Congenital 6 th Nerve Palsy; Duane’s Retraction Syndrome; Congenital Esotropia
393 Rare Case of Bilateral Cong Corneal Dystrophy with Rare Associated Cong Left Eye Ant Staphyloma, Gowhar Ahmad* Corneal Dystrophy is a very rare condition kind of deposition of Amyloid deposition in corneal stroma bilateral exact cause not known however genetic familial Tendency plays an important part to be differentiated from corneal degeneration by the fact which is essentially unilateral of heredofamilial tendency.
394 Community Clinic - A Unique Opportunity for Eye Health Care Referral System in Bangladesh, Nahid Ferdausi* The flagship initiative of the current administration in Bangladesh is Community Clinic (CC), a population-based health care network specifically designed for providing primary health care to people at the grass-roots level. The CC-based PHC concept is a distinctive form of Public-Private Partnership (PPP) since the CCs are built on property contributed by the community and the government provides the medications, staff, and service providers. Each CC serves roughly 6,00 rural residents and is led by a community healthcare provider (CHCP), who works six days a week. A health assistant (HA) and a family welfare assistant (FWA), who alternately work three days a week, also serve as part of the healthcare team. With a focus on prevention and health promotion, CC offers a “one-stop” service outlet for nutrition, family planning, and health. In accordance with the current epidemiological trend of diseases, CC performs Non-Communicable Disease screening, referring urgent cases and complex cases to higher-level institutions for optimal care.
395 Association between Glucose Levels and Intraocular Pressure in Diabetic Patients, Asaad A Ghanem 1 *, Mostafa Amr 2 , Ahmed A Ghanem3 , Lamiaa F Arafa 4 , Kasr Al-Ainy5 and Mahmoud S Madi Purpose: To assess whether high hemoglobin A1c levels influence intraocular pressure in patients with non-proliferative diabetic retinopathy. Methods: A prospective case series study was performed on 75 patients with non-proliferative diabetic retinopathy and 25 healthy control subjects. Ophthalmic examinations included best corrected visual acuity, slit lamp biomicroscopy, and intraocular pressure measurement. A corresponding hemoglobin A1c were measured using capillary glucose testing. Exclusion criteria included a glaucoma or treatment with IOP lowering medications and oral or topical steroids. Multivariable logistic regression models were used after controlling for the same sets of confounders. A value of P < 0.05 was considered significant. Results: There was non-statistically significant difference as regards age, systolic and diastolic systemic hypertension, BCVA, central corneal thickness, while, there was a statistically significant differences as regard body mass index, smoking states, HDL cholesterol, LDL cholesterol, triglyceride, HBA1c, and intraocular pressure (
396 Refractive Errors in Type 2 Diabetic Patients, Ragni Kumari 1 , Kavindra Pratap Singh2 , Salai Dhavamathi Janarthananan3 , Mrinal Ranjan Srivastava 4 *, Pragati Garg5 and Rajiv Janardhanan Purpose: A community-based study was conducted to identify the extent of prevalence of refractive errors among the type 2 diabetic population in Lucknow. Methods: A total of 437 patients (> 40 years old) with type 2 diabetes were examined with a complete eye screening tests including objective auto refraction. Spherical equivalent refractions of both eyes were reported. Data collected include age, gender, general medical information and serum biochemistry. Results: The mean refraction was −0.84 ± 2.59 D. Prevalence rates were determined for astigmatism (63.8%) hyperopia (1.4%) and myopia (0.2%%). 34.6% patients were emmatropic. Age is an important factor for all of the refractive errors. Correlation showed that every increase of one year of age and one percent of HbA1c is associated with 0.05 D (p = 0.003) and 0.14D (p = 0.04) shift in hyperopia, respectively. Conclusions: This study provides epidemiological data on refractive errors in a North indian population in Lucknow, India. The Astigmatism prevalence is higher than the reported rates in the diabetic population compare to hyperopia and myopia. Second major finding was emmatropia. Keywords: Refractive Errors; Type 2 Diabetes; Prevalence; Community-based Study
397 Disorders Encountered Low Vision, Niraj Kafle1 *, Swastika Adhikari 1 and Aparajita Kar 2 In the practice of eye care “LOW VISION” has a specific meaning as defined by WHO”. A person with low vision is one who has impairment of visual functioning even after treatment and/or standard refractive correction, and has a visual acuity of less than 6/18 to light perception, or a visual field of less than 10 degree from the point of fixation, but who uses, or is potentially able to use, vision for planning and/or execution of a task”. Keywords: Low Vision; WHO; Vision Rehabilitation

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