Gautam Bhaduri

Prospective randomized comparative study of macular thickness following phacoemulsification and manual small incision cataract surgery

Purpose:  To compare macular thickness following uncomplicated phacoemulsification with foldable acrylic lens and manual small incision cataract surgery (MSICS) with non‐foldable polymethyl methacrylate (PMMA) lens implantation.

Ocular surface disorder in pterygium: Role of conjunctival impression cytology

OBJECTIVE To study ocular surface abnormalities in patients with pterygium, conjunctival impression cytology was explored as a tool for the assessment of the cytological changes. MATERIALS AND METHODS A comparative case control study was undertaken to evaluate the ocular surface disorders in pterygium. Fifty cases of pterygium and 50 age and sex-matched controls were analyzed for the presence of local tear film abnormalities as assessed by the tear film break up time and Schirmer test. The spectrum of changes in cytomorphology was studied in detail using conjunctival imprint cytology. RESULTS Tear film break-up time and Schirmers strip wetting were found to be significantly different in study and control groups. Studying the cytomorphology of the conjunctival imprint smears, reduced cellularity and squamous metaplasia of different grades was observed more frequently in patients compared to controls. On overall grading of cytological changes, statistically significant difference was noted between the study and control groups (P value 0.00172). CONCLUSION From the present study we can suggest that aqueous tear film deficiency leading to ocular surface disorder brings about a change at the cytological level, and ocular surface disorders found in pterygium can be interpreted by conjunctival impression cytology.

Visual impairment in urban school children of low-income families in Kolkata, India

To evaluate pattern of visual impairment in school children from low-income families in Kolkata, India, an institutional cross-sectional study was conducted among 2570 children of 10 primary schools. Ocular examination including refraction was done and pattern of visual impairment and refractive error was studied. The age range was 6-14 years. Refractive error was seen in 14.7%. Only 4 children were already wearing correction. Myopia and hypermetropia was present in 307 (11.9%) and 65 (2.5%) children, respectively. Visual acuity of less than 6/12 in better eye was present in 109 (4.2%) and 5 (0.2%) children pre- and post-correction, respectively. Eighteen children had amblyopia. Although prevalence of refractive error in this group is less compared to school children of all income categories reported from other cities of India, it is more compared to school children of all income categories from the same city. Refractive error mostly remains uncorrected in this group.

Central serous chorioretinopathy after dacryocystorhinostomy operation on the same side

A 43-year-old man developed central serous choroidoretinopathy in his left eye following dacryocystorhinostomy operation on the same side. He was using xylometazoline nasal drops in his left nostril. Action of xylometazoline or the stress related to the operation or the effect of both factors played the role in the causation of this ocular condition. Omission of nasal drops or relief from stress resulted in full recovery of vision and complete resolution of symptoms within one month.

The role of fine needle aspiration cytology in the diagnosis of orbital lesions

Context: Fine needle aspiration cytology (FNAC) in orbital lesions has gained importance over the last 3 decades, especially with the advent of imaging studies. Aims: The study was undertaken to evaluate the role of FNAC as a diagnostic tool in patients presenting with orbital mass lesions. Subjects and Methods: Patients of different age groups presenting with orbital lesions were studied over a period of 2 years. The 38 patients selected for this study were evaluated clinically by thorough general and ophthalmological examination, and then were investigated with computed tomography (CT) scanning (both axial and coronal planes). Each patient included in this study was then subjected to FNAC under direct vision or under ultrasonography or CT guidance with a sterile 22 gauge needle without anesthesia. Results: The age of the patients varied from 2 to 72 years. On cytology, four cases were diagnosed as nonneoplastic and the remaining 34 (89.48%) as neoplastic lesions. In the neoplastic group, benign tumors (20; 58.8%) outnumbered malignant (14; 41.2%). The distribution of malignant lesions was more heterogeneous with a predominance of lymphoma involving the orbit. Surgical biopsy was done in 27 cases. Surgical biopsy report correlated with the FNAC report in 23 out of 27 cases. The sensitivity was 86.6%, specificity 100%, and positive predictive value 100%. Conclusion: FNAC is a useful, safe and cost-effective method of diagnosing orbital pathology. Image guidance is helpful especially in deeply situated nonpalpable lesions.

An unusual case of penetrating ocular trauma with metallic spoon.

Ocular trauma is an important cause of vision loss. The agents incriminated in such injuries are diverse. We present a case of ocular trauma with a metallic spoon causing deep laceration of lid and temple region with sclerocorneal laceration. After assessment of the general condition and stabilization of the systemic parameters the operative procedure was undertaken on elective basis. Though the final visual outcome was not rewarding due to the severity of the injury, any potential hemostatic catastrophe was averted.

Idiopathic Intracranial Hypertension in a Child After Hemodialysis

Idiopathic intracranial hypertension remains a disease of unknown etiology. Epidemiology, associations, features, and prognosis in children have changed over the years. The main clinical complaint of pediatric idiopathic intracranial hypertension is headache with visual disturbance. We report on a patient with childhood idiopathic intracranial hypertension, who presented without headache after hemodialysis for acute renal failure. Idiopathic intracranial hypertension without headache is believed to have a poor prognosis. However, this child demonstrated a favorable outcome with medical therapy. The child was followed with serial optical coherence tomography of retinal nerve fiber layer thickness around the optic nerve head. In the absence of a reliable procedure to evaluate the therapeutic efficacy in the follow-up of patients with idiopathic intracranial hypertension, the importance of optical coherence tomography, a noninvasive, objective, and reproducible procedure, is highlighted as a useful adjunct in the management of idiopathic intracranial hypertension.

Quantitative analysis of segmented fluorescein angiography images for the follow-up of choroidal neovascular membrane

Purpose: The aim of this study was to evaluate choroidal neovascular (CNV) lesions with fluorescein angiography (FA) and to identify quantitative parameters and correlate these parameters to treatment outcomes. Subjects and Methods: This institution based cross-sectional study evaluated 30 eyes with active sub-foveal predominantly classic CNV treated with bevacizumab. Pre- and post-injection segmented FA images were analyzed. Lesion area and CNV lesion were manually delineated. Outcome measure was the change 1-month after each injection in different intensity values (0-255 divided in eight regions A [lowest intensity] to H [highest intensity] on a linear scale) in lesion area, perimeter, greatest linear dimension (GLD), area, visual acuity (VA) and central macular thickness (CMT). Results: At month 3, statistically significant changes from baseline occurred in VA, CMT, lesion area, GLD and perimeter (P < 0.05 all comparisons). Change in CMT from baseline to 3 months postinjection was correlated with change in VA (P = 0.009, r = 0.469) and intensity regions B (P = 0.001, r = −0.565), D (P = 0.001, r = 0.560), E (P = 0.035, r = 0.386). At month 3, change in intensity values 0-63 (A + B) was negatively correlated with CMT (P = 0.001, r = −0.575) and lesion area (P = 0.019, r = −0.427); change in intensity values 64-223 (C-G) was positively correlated with CMT (P = 0.000, r = 0.636) and lesion area (P = 0.002, r = 0.551). Conclusions: Decrease in area, GLD, perimeter and area with intensity ≥ 64 on segmented FA were associated with a favorable outcome of treatment. These parameters may be useful adjuncts to existing evaluation techniques during follow-up of CNV.

Evaluation of registered visually disabled individuals in a district of west bengal, India.

Objective: To identify the sociodemographic characteristics, degree and cause of visual disability among certified visually disabled individuals in a rural district of West Bengal, India and to identify possible lacunae, if any, in the existing certification system. Materials and Methods: A cross-sectional study by secondary data analysis of medical records of 155 visually disabled individuals and their 310 eyes. Demographical features, diagnosis, percentage of visual disability and work activity status of each individual were analyzed. Results: One hundred and thirty one (84.52%) individuals had 100% disability. The number of males was significantly higher than that of females. Fifty eight (37.42%) individuals were below 21 years of age. Phthisis bulbi was the most common cause followed by microphthalmos. Further, 81.29% patients had the same lesion bilaterally. Conclusion: Patients with higher grades of disability have attended certification boards. A large number of disabled individuals comprised children and young adults. Male gender bias demands concern.