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VISUAL OUTCOME AND PROGNOSTIC FACTORS IN MECHANICAL INJURY OF ANTERIOR SEGMENT OF EYE

Mon, 01 Jul 2024 00:00:00 GMT

Title: VISUAL OUTCOME AND PROGNOSTIC FACTORS IN MECHANICAL INJURY OF ANTERIOR SEGMENT OF EYE Authors: DIVIJA, K Abstract: Background Trauma can result in wide spectrum of eye injury of the globe, optic nerve and adnexa ranging from superficial to vision threatening complication Timely intervention and surgical repair of anterior segment injury and subsequent visual rehabilitation with long term impact is a topic of great significance and challenges to the practicing ophthalmologists. Even though with the advent of new modalities and improved technology, the management of penetrating ocular injuries has changed. We need to prognosticate any patient with ocular trauma before and even after the repair of ocular injury. Objectives : 1. To assess the various factors affecting the final visual outcome in patients with mechanical ocular injury 2. To assess the severity of ocular trauma at the time of presentation Methods This prospective study was conducted on minimum of 72 patients fulfilling the inclusion criteria in the department of Ophthalmology, R. L. Jalappa Hospital and Research centre, Kolar from August 2022 to December 2023, after obtaining ethical clearance from Institutional Ethical Committee of Sri Devaraj Urs Medical College and written informed consent from the subjects. All cases of mechanical ocular injuries involving the anterior segment of eye age more than 5 years were assessed by a detailed history regarding Time of onset an mode of injury ,Mode of Clinical examination including Visual acuity ,Color Vision ,Slit lamp examination , fundus examination , X-ray orbit , B-Scan CT and MRI orbit if needed xiv Results: Among 72 eyes studied, patients' average age (years) was 31.82, and most were 11-30. Around 60% were males. The left eye was implicated among 45.8%, and 9.7% had bilateral eye involvement. Around one-fourth had trauma by RTA, followed by wooden pieces or firecrackers. At the presentation time, 44.4% had Cf 1-meter to Cf 5-meter vision, and 30.6% had 6/60 to 6/24 visual acuity. At one week follow-up, 54.2% had a VA 6/60 to 6/24, 26.4% had 6/18 to 6/6, and 19.4% had Cf 1 meter to Cf 5 meter. At one month follow-up, 25% had a VA 6/60 to 6/24, 73.6% had 6/18 to 6/6, and 1.4% had Cf 1 meter to Cf 5 meter Corneal foreign body with epi defects was the most common complication, followed by Traumatic cataract (9.7%), IOP was high among 13.9% of the patients.11.1% of the patients had wounds involving the pupillary axis. 16.7% of the patients were immunocompromised. Most patients presented within 24 hours (75%), while 16.7% and 8.3% presented within 24- 48 hours and >48 hours, respectively. Conclusion and interpretation This study concluded , most had ocular injury by RTA, . Corneal foreign body with epi defects is the common complications observed upon the presentation Three-fourths of those with ocular injury had good vision by follow-up. A significant association was found between visual acuity and wounds involving the pupillary axis, the immunocompromised status of the patients.

RELATIONSHIP BETWEEN CONTRAST SENSITIVITY AND METABOLIC CONTROL IN DIABETICS WITHOUT RETINOPATHY

Mon, 01 Jul 2024 00:00:00 GMT

Title: RELATIONSHIP BETWEEN CONTRAST SENSITIVITY AND METABOLIC CONTROL IN DIABETICS WITHOUT RETINOPATHY Authors: DEVI SINDHUJA, S Abstract: BACKGROUND: Contrast sensitivity is the capacity to detect minor changes in luminance between regions that do not have distinct borders.However, visual acuity evaluates the sharpness of one's eyes at a specific distance. High contrast optotypes, which consist of black text on a white backdrop, are used to evaluate this. The fact that contrast sensitivity, a measure of visual quality, often decreases at an earlier age than visual acuity does is generally acknowledged. The current diabetes epidemic in India is largely attributable to diabetic retinopathy, a vision-threatening complication of diabetes mellitus. Research suggests that retinal neurodegeneration occurs in the early stages of diabetic retinopathy, despite the fact that the condition is characterised as a microvascular disease.Visual impairments such as reduced contrast sensitivity, changed colour perception, and altered temporal perception can be caused by retinal neurodegeneration. Such deficiencies might manifest prior to alterations in visual acuity and vascular architecture .Detecting early visual functional alterations in lower contrast situations may be beyond the capabilities of the current screening techniques for diabetic retinopathy, which primarily evaluate the morphologic integrity of the retina and retinal circulation. Therefore, the purpose of this study is to ascertain whether metabolic control and contrast sensitivity are associated in Type 2 diabetics who do not have retinopathy. METHODS: From September 2022 to December 2023, a cross-sectional study was carried out on a minimum of 53 patients who met the inclusion criteria at R. L. Jalappa Hospital and xvii Research in Kolar. The study was approved by the Institutional Ethical Committee of Sri Devaraj Urs Medical College, and the subjects were provided written informed consent. The period of diabetes and diabetic control were recorded after collecting a brief history of the patient's eyes and overall health, as well as their treatment for the condition. Visual acuity, anterior and posterior segment evaluation, and demographic data were all part of the clinical examination that each patient underwent. A thorough evaluation of the retina was carried out in order to exclude the possibility of diabetic retinopathy. Exclusion criteria for participation in the study include the presence of intra retinal haemorrhage or microaneurysms, the first sign of diabetic retinopathy seen through ophthalmology.Estimations were made for fasting blood sugar, postprandial blood sugar, and glycated haemoglobin (HbA1C). Using the identical lighting conditions, we measured contrast sensitivity at a distance of 1 metre using a Pelli-Robson chart. Log contrast units are used to quantify contrast sensitivity. The contrast sensitivity is negatively correlated with the score. RESULTS: The present study enrolled 53 patients and their mean age was 60.16±7.80 years and ranged from 40 to 70years.The mean fasting blood glucose was 127.28±40.75 mg/dl and the post prandial blood glucose was 174.37±59.52 mg/dl. The three months glycemic control marker HbA1c was assessed and the mean was 7.72±1.85.The mean duration of diabetes was 7.21±4.37 years The mean contrast sensitivity for right eye was 1.57±0.37 which indicated some visual impairment. Similarly the left eye also showed the same (1.56±0.37). The negative xviii correlation was observed in the present study which indicated that as the duration of diabetes increased with poor glycemic control, the contrast sensitivity decreased on both right eye (r=0.7097; P<0.0001) and left eye (r=-0.6990; P<0.0001) . CONCLUSION: In conclusion, our study highlights the critical interplay between diabetes duration, glycemic control, and visual impairment. As the duration of diabetes increased; contrast sensitivity decreased on both eyes significantly (P<0.0001).Similarly, both eyes contrast sensitivity had a negative correlation with HBA1c levels, which revealed that as the glycemic control progressed to poor control, the contrast sensitivity progressed to visual impairment. The significant correlations found in this study should encourage healthcare providers to focus on comprehensive diabetes management strategies to prevent or delay the onset of visual disabilities in diabetic patients.

A CROSS SECTIONAL STUDY TO ASSESS THE CORRELATION AMONGST VISUAL ACUITY, CONTRAST SENSITIVITY AND VISUAL FIELD ANALYSIS IN PATIENTS WITH GLAUCOMA

Mon, 01 Jul 2024 00:00:00 GMT

Title: A CROSS SECTIONAL STUDY TO ASSESS THE CORRELATION AMONGST VISUAL ACUITY, CONTRAST SENSITIVITY AND VISUAL FIELD ANALYSIS IN PATIENTS WITH GLAUCOMA Authors: SUSMITHA, JOSHY Abstract: PURPOSE Over 80 million individuals worldwide suffer from glaucoma, which is the second most common cause of blindness. It is a group of illnesses which lead to blindness by loss of retinal ganglion cell leading to irreversible optic neuropathy. Therefore, basic approaches for glaucoma early diagnosis and enhanced strategies for stopping the disease's progression are crucial objectives of public health research that would benefit society. Progress in the visual field is an important outcome in determining the progress of glaucoma and modification of treatment. As such, methods for identifying advancement in the visual field have been the subject of research for many years. Contrast Sensitivity Scoring is based on the individual’s ability to delineate between objects based on the slight changes in luminance. Glaucoma can reduce contrast sensitivity for all grating sizes, mostly at the middle spatial frequencies. Visual Acuity testing involves the assessment of central vision hence other modalities of investigation are required in order to identify glaucoma at the earliest and supplement its treatment. METHODS At Sri Devaraj Urs Medical College, 41 patients in the ophthalmology department were evaluated as part of the study. Patients who met the requirements for study had their visual acuity assessed by using Snellens visual acuity chart , the obtained value was converted into a LogMAR value. By using Pelli Robson contrast sensitivity chart, the contrast Sensitivity was measured at a distance of 1 Meter. Goldmann Applanation Tonometry, 4-mirror gonioscopy, and slit-lamp biomicroscopy were xiv used to evaluate the anterior segment. Fundus lens + 90D used for optic disc inspection. After dilating the pupil, slit lamp biomicroscopy using Fundus lens and indirect ophthalmoscopy was used to determine the extent of damage, type and severity of glaucoma .The Humphrey visual field analyzer 24- 2 program was used to plot the patients' visual fields. SITA standard program was used. A measure called mean deviation, or MD, was employed to assess visual field function. A fault is considered early if its mean deviation is less than -6 dB, moderate if it is less than -12 dB, and severe if it is greater than -12 dB. Patients with the typical changes in the visual field and with optic nerve head changes, were diagnosed with glaucoma .If there are questionable optic nerve alterations but no discernible loss in visual field the patient was suspected of having glaucoma; if intraocular pressure (IOP) is 21 mm Hg or higher but there is no discernible loss in visual field or change in the optic nerve head, the patient is suspected of having ocular hypertension. RESULTS: The study in total included 41 people as sample. The age distribution revealed that 51–60 age the group was the most prevalent (48.8%), and that men slightly outnumbered women (56.1% vs. 43.9%). The largest occupational category was made up of clerks (39.0%), followed by tailors (17.1%). There was variation in visual acuity, with the highest acuity of 0.3 in both eyes. Results of the analysis of the anterior segment data were primarily within normal limits (WNL). Normal tension glaucoma (NTG) (22.0%) was the second most frequent type of glaucoma, after primary open-angle glaucoma (46.3%). The mean values of intraocular pressure (IOP) were found to be 24.71 mmHg for the right eye and 17.71 mmHg for the left, and the mean values of the Humphrey Visual Field Analyzer (HFA) mean deviation (MD) - 10.61 dB for the eye right and -8.33 dB for the eye left according to descriptive statistics. xv There is no clear relationship between contrast sensitivity and visual acuity for the right eye. The Pearson correlation coefficient between the CS score and the visual field analysis, a high positive link between the two with a P value of less than 0.001, indicating (HFA MD) is 0.613. Regarding the left eye: There is no direct association seen between the CS score and visual acuity. A statistically significant positive association between the CS score and visual field analysis (HFA MD) in the left eye is provided by the correlation Pearson coefficient of 0.342 and value P of 0.029 between the CS score and HFA MD. In order to minimize the impact of additional variables, the study was restricted to individuals with an excellent visual acuity score of (6/12) or higher. Eye disorders such as cataracts and other ocular conditions such as retinopathy ,age-related and diabetic maculopathy were excluded.

CLINICAL OUTCOME OF MANUAL SMALL INCISION CATARACT SURGERY IN SMALL PUPIL

Mon, 01 Jul 2024 00:00:00 GMT

Title: CLINICAL OUTCOME OF MANUAL SMALL INCISION CATARACT SURGERY IN SMALL PUPIL Authors: SHARADHI, S PETKAR Abstract: Background and Objective Small pupil is one of the most significant risk factors that can lead to a variety of difficulties both during and after the cataract surgery. Poor pupil dilation can be caused by many factors, such as diabetes and the consumption of certain pharmaceutical drugs such as terazocin and doxazocin. Even for an experienced cataract surgeon, the intraoperative small pupil continues to provide a number of obstacles. Preoperative and intraoperative measures, such as 2.5% phenylephrine drops, sphincterotomy, iris hooks, pupil expansion rings can reduce the likelihood of miosis occurring during the surgery. Limited data is available regarding visual outcome and the rates of complications in patients with small pupils undergoing cataract surgery. Therefore we investigated the visual outcome, intraoperative complications and post-operative complications following cataract surgery in small pupils. METHODOLOGY This is hospital-based, cross-sectional study, involving 40 eyes who attended ophthalmology OPD at R.L Jalappa Hospital attached to Sri Devaraj Urs Medical College, Tamaka, Kolar from September 2022 to December 2023. Pupils are measured in mesopic luminance under torch light or slit lamp graticule. Patients with pupil size of less than or equal to 3mm were taken for the study. Following this, the patient was dilated using dilating drop tropicamide(0.8%) +phenylephrine(0.5%) one drop in both eyes every 5-10minutes for 3 times after 15-20minutes see the pupil size if the pupil size of 6mm and less then the patient is considered. On the day of surgery, patient is dilated half an hour before the surgery. And operation is done by single surgeon intraoperative complications while operating like Posterior capsular rent, iris trauma, difficulty in delivering the nucleus are noted. If complications while delivering the nucleus to anterior chamber are anticipated xv phenylephrine(2.5%)is used, if dilation is not adequate 2%viscoelastic is used even after this if pupil fails to expand sphincterotomy is done. Postoperative visual outcome is assessed on the 1st, 7th and 30th postoperative day. RESULTS We examined 40 patients in total who is undergoing MSICS with small pupils. Majority of patients were aged between 61-70 years, comprising 47.5% of the sample, followed by those over 71 years (35.0%), and the smallest group being those aged 50-60 years (17.5%). Gender distribution was fairly even, with 52.5% female and 47.5% male patients. Pre-operative visual acuity varied, with the most common category being counting fingers close to face (CF CF) observed in 27.5% of patients. Other notable pre-operative visual acuities included 1/60-2/60 in 17.5% of patients and counting fingers at 2 meters (CF 2mt) in 15.0% of patients. Regarding pupil size, before dilation, the majority of patients (77.5%) had a pupil size of 3 mm, while 22.5% had a pupil size of 2 mm. Post-dilation, the most common pupil size was 5 mm (47.5%), followed by 4 mm (32.5%), 6 mm (15.0%), and 3 mm (5.0%). Intraoperative complications were notable, with trauma to iris (microbleeds, sphincter tears, iris chafing) occurring in 27.5% of cases and posterior capsule rupture (PC rent) in 28.0% of cases. Difficulty in delivering the nucleus was encountered in 12.5% of surgeries. Postoperative slit lamp examinations on day 1 revealed that 42.5% of patients experienced corneal edema, while Descemet's membrane folds (DM folds) were observed in 27.5% of patients. Anterior chamber (AC) reaction was noted in 10.0%, and 7.5% of patients had clear findings. Visual acuity outcomes showed that on postoperative day 1, the most common uncorrected visual acuity was 6/24 (22.5%), with 15.0% of patients achieving 6/60 and hand movements xvi (HM) vision. On postoperative day 7, 25.0% of patients achieved BCVA of 6/6 vision, followed by 20.0% with 6/12 and 17.5% with 6/18. By postoperative day 30, the most common best corrected visual acuity was 6/6 (30.0%), with 32.5% of patients achieving 6/9 and 25.0% achieving 6/12. Statistical analysis revealed significant associations between intraoperative events, postoperative visual acuity, and pupil size after dilation. Difficulty in delivering the nucleus was significantly associated with smaller pupil sizes (p = 0.03). Furthermore, postoperative visual acuity on day 1 showed a statistically significant association with pupil size after dilation (Chi-Square: 56.42, P Value: 0.007). CONCLUSION AND INTERPRETATION: Small pupil presents significant challenges, particularly in intraoperative complications like PC rent, iris trauma, and many more. Despite these challenges study shows the importance of meticulous surgical technique and careful management which can lead to favourable visual outcomes. There was significant associations found between small pupil size and increased surgical difficulty. Through tailored approach, we were able to reach maximum visual acuity of 6/6 in most of patients.