Luxmi Singh

Retinal profile: a clinical indicator of severity in dengue fever in a suburban Indian environment.

Purpose To study the retinal changes in subjects suffering from dengue fever and check if these changes can be taken as sufficient indicator of severity and progression of the disease. Patients/Methods A detailed history was recorded of 118 patients on whom ocular examination, including direct ophthalmoscopy, indirect ophthalmoscopy and coloured fundus photography, was performed. Results Forty-seven percent of patients were found to have posterior segment abnormalities. Retinal vein dilatation or tortuosity was the most common finding followed by changes in the optic disc (8.4% of patients) and background haemorrhage (6.7% of patients). With increasing severity of thrombocytopenia, the proportion of patients with retinal abnormalities increased. In patients with grade I thrombocytopenia, no fundal abnormality was found. In those with grade II thrombocytopenia, fundal abnormality was found in 13.63% patients, whereas in the grade III category it was 27.90%. Conclusions Severity of thrombocytopenia had a significant association with retinal abnormalities. Occurrence of fundus changes increases with an increase in severity of thrombocytopenia. Fundus changes were found in all patients with grade IV thrombocytopenia.

Role of prophylactic use of timolol maleate (0.5%) in preventing rise of intraocular pressure (iop) post Neodymium: Yttrium Aluminum Garnet (Nd: Yag) capsulotomy

Purpose : To evaluate the role of prophylactic use of Timolol maleate (0.5%) eye drop in preventing rise of intraocular pressure (IOP) post Nd: YAG capsulotomy. Materials and Methods: A randomized, single-blinded, parallel group study conducted in 220 eyes, over a period of 18 months. Precapsulotomy baseline IOP, Slitlamp examination and grading of PCO was done. After instilling the test medication Nd: YAG laser capsulotomy performed. Post capsulotomy patients were assessed immediately, after 1 hour and 3 hours for IOP. Result: Precapsulotomy, mean IOP in Group I (use of placebo) was 15.30 ± 2.83 mm Hg as compared to 16.15 ± 2.48 mmHg in Group II (use of Timolol eyedrop), Group II mean IOP was significantly higher (P = 0.019). However, immediately after the procedure mean IOP in Group I was 14.55 ± 2.87 mmHg as compared to 13.16 ± 3.72 mmHg in Group II thus showing mean IOP in Group II to be significantly lower (P = 0.002). One hour and 3 hours after the procedure too, mean IOP in Group II was significantly lower as compared to that in Group I (P < 0.001). With increasing grade of PCO reduction in post-procedure IOP was lower and reduction in IOP was maximum in patients requiring <30 milliJoules of total energy. Conclusion: A judicious control over energy use and post laser IOP monitoring can influence the trend of IOP rise in a positive manner. Whenever anticipated that >60 mJ of laser energy is required as in higher grades and younger age, prophylactically Timolol maleate 0.5% eye drop should be instilled before Nd: YAG capsulotomy while all other patients in which Timolol is not used, should be kept under observation after laser capsulotomy.

DIABETIC MACULAR EDEMA IN ASSOCIATION WITH DIABETIC RETINOPATHY IN PATIENTS OF TYPE 2 DIABETES MELLITUS

Diabetic Retinopathy is an important cause of blindness with diabetic macular edema(DME) affecting 15% of patients 15yrs after diagnosis. The prevalence of diabetes mellitus(DM) is expected to approximately double globally between 2000 and 2030. The burden of DME is likely to increase as prevalence of DM is expected to rise by 50% globally, from 2000 to 2030. Therefore, is a major cause of concern. To study diabetic macular edema prevalence and pattern in association with severity of diabetic retinopathy in patients of type 2 diabetes mellitus. 300 patients with type 2 diabetes mellitus were included in anobservational cross sectional study. Clinical assessment was done by recording Visual acuity by Snellens drum test, slit lamp examination, direct and indirect ophthalmoscope, fundus examination with +90 D lens, Goldman applanation tonometry, gonioscopy, Cirrus SD-OCT macula and fundus photography. Among 600 eyes, prevalence of DME was 14.0% and 24.3% in NPDR and PDR eyes respectively. Statistically, this difference was not significant (p=0.226).Among the categories of diabetic retinopathy, a significant increase in prevalence of DME was observed with increasing severity of NPDR (p<0.001). Among 87 eyes with DME, the pattern of DME was 59.8% with diffuse retinal thickening, 21.8% with cystoids macular edema and 18.4% with serous retinal detachment. Prevalence of DME was more in NPDR group increasing with severity of NPDR. The prevalence of DME pattern of diffused retinal thickening was most followed by cystoid macular edema and serous retinal detachment among those with diabetic retinopathy. Luxmi Singh, Lubna Ahmed, Swati Yadav, Pragati Garg, B.B Lal Department of Ophthalmology Era’s Lucknow Medical College & Hospital, Sarfarazganj, Lucknow, U.P, India-226003