Meenakshi Wadhwani

Caregiver Burden Assessment in Primary Congenital Glaucoma

Purpose To assess the magnitude of caregiver burden and depression in primary caregivers of patients with primary congenital glaucoma. Methods Fifty-five primary caregivers of children diagnosed with primary congenital glaucoma were evaluated. The magnitude of burden on caregivers was assessed using a Caregiver Burden Questionnaire (CBQ). The overall aggregate burden and burden across 3 domains—socioeconomic, emotional, and psychological—was evaluated. Depressive symptomatology was evaluated using a Patient Health Questionnaire–9 (PHQ-9) standard questionnaire and graded from mild to severe. Results The mean age of the presenting children was 8.11±46.71 months; all of them were male. The mean age of the study participants was 33.6±8.36 years (53 female, 2 male). Thirty-nine (71%) individuals were identified to have moderate aggregate burden and 3 (5%) had severe aggregate burden. Twelve (22%) subjects were noted to have moderate depression, while 6 of them (11%) had either severe or very severe grades of depression. Conclusions Caregivers of patients with primary congenital glaucoma have significant emotional and psychological burden. Moderate to severe depression may be present in one-third of individuals giving primary care to children with congenital glaucoma.

Test-retest variability of retinal nerve fiber layer thickness and macular ganglion cell-inner plexiform layer thickness measurements using spectral-domain optical coherence tomography.

Purpose:To evaluate the test-retest variability of spectral-domain optical coherence tomography (OCT) in measurement of retinal nerve fiber layer (RNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. Methods:A total of 65 eyes of healthy subjects were enrolled in this observational cross-sectional study. RNFL thickness and GCIPL thickness were measured using the repeat scan optic cube and macular cube protocol using Cirrus HD-OCT (software version 6.0). A single operator obtained 3 measurements during 1 session to determine test-retest variability. Intrasession repeatability was defined by intraclass correlation, limits of agreement, and coefficient of variation. Results:The mean age of patients was 37.89±15.11 years (range, 10 to 70 y). The mean RNFL thickness readings as measured during 3 sessions were 93.89±9.73, 93.63±10.00, and 93.55±9.64 &mgr;m and average GCIPL thickness measurements were 82.90±4.61, 82.98±4.24, and 83.06±4.36 &mgr;m, respectively. Coefficient of variation was 1.2 for average RNFL thickness and 0.82 for average GCIPL thickness. The intraclass correlation coefficient showed a good correlation between repeat measurements for both average RNFL and GCC thicknesses (0.994 and 0.990, respectively). The limits of agreement (95% confidence interval) for the 3 sessions ranged from −3.61 to 4.13 &mgr;m for the average RNFL thickness and −2.55 to 2.40 &mgr;m for GCIPL thickness measurements. Conclusions:In healthy eyes, Cirrus HD-OCT shows excellent intrasession repeatability for RNFL and GCIPL thickness measurements.

Diurnal versus office-hour intraocular pressure fluctuation in primary adult onset glaucoma

PURPOSE To evaluates the role of measuring intraocular pressure (IOP) outside office-hour in primary adult onset glaucoma. METHODS This retrospective study included 100 cases of primary adult onset glaucoma. IOP readings obtained with Goldmann applanation tonometry between 7 am and 10 pm were compared to office-hour readings. RESULTS One hundred patients were enrolled (mean age: 58.64 ± 10.98 years) in the study. Overall, mean diurnal IOP was significantly higher than mean office IOP (p < 0.05). Two-thirds of the patients had peak IOP measurements outside office-hour. Mean diurnal IOP fluctuation (7.03 ± 2.69 mm Hg) was significantly higher than mean office IOP fluctuation (4.31 ± 2.6 mm Hg) (p < 0.003). There was a significant correlation between baseline IOP and fluctuation in IOP (r = 0.61, p<0.001). CONCLUSION The mean diurnal IOP and IOP fluctuations were higher than office-hour readings in patients with primary adult onset glaucoma. Diurnal monitoring may be particularly useful in patients with high baseline IOP.

Outcomes of Trabeculectomy Augmented With Subconjunctival and Subscleral Ologen Implantation in Primary Advanced Glaucoma.

Purpose: To evaluate the efficacy and safety of trabeculectomy with combined subconjunctival and subscleral ologen implant in eyes with advanced glaucomatous optic neuropathy. Design: This is a retrospective, noncomparative case series. Methods: Twenty seven eyes of 23 patients with advanced primary glaucoma who underwent fornix-based trabeculectomy with insertion of ologen both subsclerally and subconjunctivally along with low dose Mitomycin-C (0.1 mg/mL×1 min) were evaluated. Data recorded included a complete history, demographic profile, and ophthalmic examination including gonioscopy and visual fields. Any complications or secondary procedures performed after trabeculectomy were recorded. Complete success was defined as intraocular pressure (IOP) ⩽15 mm Hg without ocular hypotensive medication and qualified success as IOP⩽15 mm Hg with medications. Results: The average age of patients was 46.2±14.8 years. There were 17 males and 6 females. Of these, 7 patients were diagnosed with juvenile open-angle glaucoma, 7 patients with primary open-angle glaucoma and 9 patients with primary angle-closure glaucoma and pseudophakia. The average follow-up time was 23.3±5.6 months, with a minimum of at least 12 months. The mean preoperative IOP was 38.3±6.6 mm Hg. Postoperatively, the IOP at 3 months was 12.5±1.9 mm Hg; 6 months was 12.6±3.9 mm Hg; 12 months was 12.3±2.5 mm Hg; and 24 months was 12.5±1.6 mm Hg (n=17); (P<0.0001). Complete success was noted in 92.6% eyes, qualified success in 3.7% eyes, and failure in 3.7% eyes. The preoperative and postoperative best-corrected visual acuity in logarithm of the minimum angle of resolution was 0.3±0.2 and 0.3±0.1 (P=0.31). The average number of ocular hypotensive medications used preoperatively was 4.2±0.5 (median 4) which decreased to 0.07±0.3 (median 0), (P<0.0001) postoperatively. Conclusions: Trabeculectomy with low dose Mitomycin-C and with implantation of ologen both subsclerally and subconjunctivally, appears to offer encouraging results in achieving a low target IOP in eyes with advanced primary adult glaucoma.

Clinicomicrobiological profile of endophthalmitis: A 10 year experience in a Tertiary Care Center in North India

Purpose: To determine the clinicomicrobiological profile of infectious agents and their antibiotic susceptibility in different type of endophthalmitis. Methods: A retrospective review of clinical and microbiological records from January 2001 to December 2010, was performed in 1110 patients diagnosed with different type of endophthalmitis (postoperative, posttraumatic, endogenous and post keratitis) to record the demographic details, clinical presentations; microbiological agents isolated with their antimicrobial sensitivity pattern. Antimicrobial susceptibility testing for various culture positive isolates (bacterial/fungal) was performed by the disc diffusion technique. Results: Out of the 1110 intra-ocular specimens processed, 384 (34.6%) were positive for bacteria. S epidermidis was the most predominant isolate accounting for 42.7% of all bacteria obtained, followed by Pseudomonas aeruginosa (24.5%). Besides Pseudomonas, Acinetobacter spp. were the next common gram negative bacilli detected (8.3%) followed by Klebsiella, E. coli, Enterobacter and Alkaligenes in 2.6%, 0.8%, 0.8% and 0.5% cases respectively. The predominant fungal species were Aspergillus spp., in 36.1%, followed by Fusarium spp. in 26.4% cases. Overall susceptibility pattern in our study showed that gram positive bacteria were most susceptible to glycopeptides like vancomycin (80-100%) and fluoroquinolones (87-91%). The sensitivity pattern of gram negative organisms like Pseudomonas and Klebsiella towards fluoroquinolones ranged between 61% - 82%. Conclusion: S epidermidis was the most common bacteria isolated in postoperative and posttraumatic endophthalmitis, Pseudomonas aeruginosa was the most common bacterial isolated in posttraumatic endophthalmitisAmongst fungi Aspergillus was the most common organism.

A case of frost branch angitis in pregnancy : an unusual presentation

INTRODUCTION Frosted branch angiitis usually occurs in children and presents with severe sheathing of all retinal vessels mimicking the appearance of frosted branches of a tree. OBJECTIVE To report a case of frosted branch angiitis in a pregnant lady. CASE We, hereby, report a case of a 24-year-old pregnant female who presented to us with the complaints of sudden diminution of vision in the right eye for three days. Fundus examination revealed severe sheathing of all retinal vessels with neurosensory retinal detachment suggestive of frosted branch angiitis. The case was treated with posterior sub-tenon injection of triamcinolone. CONCLUSION Similar to the good prognosis reported earlier in most patients with frosted branch angiitis, the outcome in our patient was satisfactory.

Comparison of Eye Drop Instillation Before and After Use of Drop Application Strips in Glaucoma Patients on Chronic Topical Therapy.

Purpose:To evaluate the impact of using drop application strips on eye drop instillation in glaucoma patients on chronic topical ocular hypotensive therapy. Methods:A total of 72 patients with primary open-angle glaucoma with an uncorrected visual acuity of 3/60 or more, self-administering topical antiglaucoma medication for >1 year were evaluated. One eye of each patient was included in the study. Patients were instructed to instill 0.5% carboxymethyl cellulose drop in 1 eye. They were then instructed to instill the same drop using the drop application strips. Results:Mean age of the patients included in the study was 50.39±12.04 years. Before assistance of drop application strips, 35 (48.61%) patients placed the drop into the eye without any contact of the dropper nozzle, and, after application of the drop application strips, 66 (91.67%) patients placed the drop in the eye without any contact (P=0.025). The number of patients putting the first drop of drug into the eye without spilling over the adenexae increased from 30 (41.67%) to 45 (62.5%) after application of the strip (P<0.001). The mean number of drops instilled to get 1 drop into the eye decreased from 2±0.95 to 1.56±0.78 when the drop application strip was used (P<0.001). Conclusions:Use of a drop application strip causes a significant decrease in contact of the eye drop bottle nozzle with the eyeball and eyelid, decreases the number of drops instilled to get 1 drop into the eye, and is associated with an overall improvement in eye drop instillation.

Evaluation of Physical Properties of Generic and Branded Travoprost Formulations

ABSTRACT Purpose: Comparative evaluation of pharmaceutical characteristics of three marketed generic vs branded travoprost formulations. Materials and methods: Three generic travoprost formulations and one branded (Travatan without benzalkonium chloride) formulation (10 vials each), obtained from authorized agents from the respective companies and having the same batch number, were used. These formulations were coded and labels were removed. At a standardized room temperature of 25°C, the drop size, pH, relative viscosity, and total drops per vial were determined for Travatan (Alcon, Fort Worth, TX, USA) and all the generic formulations. Travoprost concentration in all four brands was estimated by using liquid chromatography-coupled tandem mass spectrometry LCMS. Results: Out of the four formulations, two drugs (TP 1 and TP 4) were found to follow the United States Pharmacopoeia (USP) limits for ophthalmic formulation regarding drug concentration, while the remaining two drugs failed due to the limits being either above 110% (TP 2) or below 90% (TP 3). Two of them (TP 1 and TP 2) had osmolality of 313 and 262 mOsm respectively, which did not comply with the osmolality limits within 300 mOsm (+ 10%). The pH of all the formulations ranged between 4.7 and 5.9, and the mean drop size was 30.23 ± 6.03 uL. The total amount of drug volume in the bottles varied from 2.58 ± 0.15 to 3.38 ± 0.06 mL/bottle. Conclusion: There are wide variations in the physical properties of generic formulations available in India. Although some generic drugs are compliant with the pharmacopeia standards, this study underscores the need for a better quality control in the production of generic travoprost formulations. How to cite this article: Wadhwani M, Mishra SK, Angmo D, Velpandian T, Sihota R, Kotnala A, Bhartiya S, Dada T. Evaluation of Physical Properties of Generic and Branded Travoprost Formulations. J Curr Glaucoma Pract. 2016;10(2):49-55.

Patterns of pseudophakic retinal detachment in a referral tertiary care center and the need for improving cataract surgical training.

Purpose To determine the risk factors associated with development of rhegmatogenous retinal detachment (RRD) in patients undergoing different types of cataract surgery. Methods Records of 200 patients presenting with pseudophakic retinal detachment (PRD) between January 2012 and July 2013 at a tertiary care center were reviewed. Duration and type of cataract surgery (phacoemulsification, extracapsular cataract extraction [ECCE], and small-incision cataract surgery [SICS]) and history of YAG capsulotomy with risk factors were recorded. Presence or absence of these risk factors was analyzed and their association with type of cataract surgery was evaluated. Results Of these 200 patients, 137 were male and 63 were female. The mean age of the patients was 55.19 ± 12.60 years and mean duration of cataract surgery to diagnosis of RRD was 8.64 ± 5.15 months. Most patients underwent phacoemulsification (45%), followed by ECCE (31.5%) and SICS (23.5%). Most of the patients with PRD had complicated cataract surgery with intraocular lens (IOL) in sulcus in 63%, anterior chamber IOL in 3%, and aphakia in 0.5%. There was no difference among the 3 types of surgery performed in mean presenting visual acuity, duration between cataract surgery and YAG capsulotomy, or number of posterior chamber IOLs. Incidence of posterior capsular rent (p = 0.02) and presence of vitreous in anterior chamber (p = 0.01) were significantly higher for patients with retinal detachment (RD) who underwent SICS. Conclusions Many risk factors are associated with RD development after cataract surgery. More stringent efforts at improving the quality of cataract surgical training are likely to help in reducing the risk of PRD.

An unusual case of posterior cerebral artery infarct in otherwise healthy man

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