Neelima Mehrotra

Ocular surface disorders in patients admitted in intensive care unit of a tertiary care hospital

To assess the frequency and to identify the predisposing factors for ocular surface disorders in ICU patients. Prospective observational study of all patients admitted to the ICU complex of SRMSIMS between1st January to 31 st April 2016 for a minimum period of 5 days. Patients will be observed for abnormalities of the lid , conjunctiva, cornea and tear film by diffuse illumination aided by Schirmers Test, corneal and conjunctival staining and conjunctival swab when required. Other factors like consciousness, use of a ventilator, preexisting comorbidities shall also be noted. Patients will be observed on Day1, 5, 6, and so on. 60 eyes of 30 patients were examined . In mechanically ventilated patients , 36 eyes (60%) had conjunctival hyperemia which resolved upon intervention which included antibiotics and lubricants . 18 eyes (9%) had conjunctival discharge which resolved upon intervention. 12 eyes (20%) were stain positive. The critically ill often develop ocular surface disorders, especially when sedated and immobilized. A close relationship was observed between these conditions and the inability to close ones eyes. The presence of ocular surface disease was closely correlated with the degree of lagophthalmos, which in turn was closely related to the depth of sedation or paralysis.

Comparison between topical and peribulbar anesthesia experienced by patients who underwent phacoemulsification surgery

Topical anesthesia has steadily gained popularity due to speed and ease of administration, rapid visual recovery postoperatively and the lack of block-related complications. In this investigation, we attempted to study patient satisfaction subjectively in individuals who underwent phacoemulsification under either topical anaesthesia (augmented by intracameral anaesthesia) or peribulbar block. In our study, patients aged 50–70 years scheduled for phacoemulsification for cataract surgery were enrolled. The study cohort was comprised of 80 patients. Patients were scheduled to undergo phacoemulsification with topical anesthesia or peribulbar block. Patient satisfaction was assessed by one research assistant only, using the Iowa Satisfaction in Anesthesia Scale (ISAS). The Students t-test was used to determine the significance of IOWA score in both groups. The statistical analysis was performed in SPSS Software. Results of the ISAS indicated that there was no difference in satisfaction level with peribulbar anesthesia (was not statistically significant P=0.07) compared to topical anesthesia. Satisfaction scores were studied in patients who underwent phacoemulsification under topical anaesthesia than those who were operated under peribulbar block. However this difference was not found to be statistically significant in our study. Topical anesthesia provides better patient satisfaction as peribulbar anesthesia during cataract surgery.

Clinico-etiological study of infectious keratitis

To study the risk factors of infectious keratitis, identify their causative organisms by clinical examination and laboratory investigations. All patients reporting to SRMS Hospital between 1st Jan 2015 and 30th April 2016 with the features of infectious keratitis were thoroughly examined and investigated. Out of 47 patients most common age group involved was 30–50 years and 48.9% were of fungal etiology, 29.8% were viral keratitis and 21.2% were of bacterial etiology. Trauma is the most common predisposing factor for infectious keratitis. Staphylococcus species are the most common bacterial whereas As per gillus and fusarium species are the most common fungal isolates. Response to treatment is good if diagnosis was made and treatment started early.

Role of intravitreal bevacizumab in diabetic macular edema

To evaluate the role of intravitreal bevacizumab on visual function and retinal thickness in patients with diabetic macular edema (DME). The study was conducted at SRMS IMS, Bareilly, U.P. from 1st January 2015 to 30th December 2015. The study included 37 eyes of 28 patients with DME. Complete ophthalmic examination, including best-corrected visual acuity (BCVA), stereoscopic biomicroscopy, and retinal thickness measurement by optical coherence tomography (OCT), was done at baseline and at each follow-up visit. All patients were treated with 0.05 ml intravitreal injection containing 1.25 mg of bevacizumab. All patients completed 3 months of follow-up. The mean BCVA at baseline was 0.889 ±0.111 logMAR, which significantly improved to 0.176±0.349, 0.088±0.238 and 0.088±0.309logMAR at 1 week, 1 month and 3 months. The mean central retinal thickness was 321±113.46 μm at baseline and decreased to 247±90.73, 235.5±95.452, 230.5±92.543 μm at 1 week, 1 month, and 3 months. No adverse effects were observed. Intravitreal bevacizumab injection resulted in significant improvement in BCVA and central retinal thickness 1 week after injection in patients with DME, and this beneficial effect persisted for up to 3 months.

Comparison between Clear Corneal Incision and Scleral Tunnel Incision in Phacoemulsification on basis of post-surgical outcomes

To compare post-surgical astigmatism induced by phacoemulsification through 2.8mm clear corneal incision at steep axis versus superior scleral tunnel incision. This study was performed on 200 eyes of 198 patients of cataract reporting at Eye Department, SRMSIMS, Bareilly from July 2015 to December 2015. They were randomly assigned to two groups: Group A, 2.8mm clear corneal incision at steep axis group and Group B, the superior scleral tunnel incision group. Induced refractive change caused by corneal incision at steep axis showed an overall improvement in pre-operative astigmatism with minimum level of significance while post-surgical astigmatism induced by scleral tunnel incision was found out to be minimal with a good visual rehabilitation. Corneal incision at steep axis is an effective technique to reduce pre-operative astigmatism while scleral tunnel technique is suitable in cases where minimal change in pre-operative astigmatism is targeted.

Therapeutic effects of tacrolimus eye ointment in refractory allergic conjunctivitis

The objective of this study was to investigate the efficacy of topical 0.1% tacrolimus and 0.03% tacrolimus eye ointment in treating refractory allergic conjunctivitis. This prospective observational study included 30 patients with refractory allergic conjunctivitis whose condition had responded poorly to conventional anti-allergic drugs and/or topical steroids and/or topical cyclosporine. All patients received tacrolimus eye ointment twice daily during the study period. Ten clinical signs and six clinical symptoms were rated on a four-grade scale. The primary endpoint was the change from baseline in total clinical signs and symptoms score at the last observation or following 6 months of treatment. Total signs and symptoms score significantly decreased after 1 month of treatment (p<0.001). Giant Papillae were also reduced by tacrolimus eye ointment use (p<0.001). The drug proved effective in patients whose condition did not respond well to topical cyclosporine. The most common adverse reaction was a transient burning sensation (3.20%). Tacrolimus ointment 0.1% is more effective than 0.03% in treating refractory allergic conjunctivitis and may reduce or replace topical steroid use

Clinico-etiological study of dry eye in hospital based population

The aim of his study was to find out the prevalence of dry eye and evaluate various risk factors attributable to dry eye in hospital based population. In this cross sectional study, 150 patients above 21 years of age are included based on dry eye questionnaire, and various tests including tear breakup time (TBUT), schirmers test, tear meniscus height, lissamine green staining along wih presence of strands/filaments. The prevalence of dry eye was 24.4%. It was significantly higher in females (25.5%) than in males (19.8%) and is more common in rural (23.2%) than in urban population. Excessive wind, smoking, and patients on medications (systemic or topical) are more associated with dry eye. Dry eye is a under diagnosed ocular disorder. Reduction in modifiable risk factors of dry eye is essential to reduce its prevalence.

A study of Macular Ganglion cell inner plexiform layer & peripapillary retinal nerve fiber layer thickness in glaucoma by SD-OCT

A study of Macular Ganglion cell inner plexiform layer & peripapillary retinal nerve fiber layer thickness in glaucoma by SD-OCT. To assess Macular Ganglion inner plexiform layer & peripapillary retinal nerve fiber layer thickness in early & moderate to severe glaucoma by SD-OCT. This case series was conducted at department of ophthalmology at SRMS IMS, Bareilly. The duration of study was 5 months from December 2015 to April 2016. A case control study was conducted. The subjects underwent a full ophthalmic examination, HVF, OCT optic disc & GCA algorithm. Areas under the receiver operating characteristic curves (AUROCs) were calculated & compared. Based on the internal normative database, the sensitivity & specificity for detecting early & moderate to severe glaucoma. There was no statistical difference between the AUROCs for the best OCT parameters. For detecting early glaucoma, the sensitivity of GCIPL parameters ranged from 26.8% to 73.2% and that of RNFL parameters ranged 6.1% to 61.6%. For the early glaucoma group, the best parameter from the GCIPL generally had a higher sensitivity than RNFL. The minimum GCIPL showed better glaucoma diagnostic performance.