Raj Vardhan Azad

Pattern of pediatric ocular trauma in India

Objective : The aim of the study is to identify the causes, demographic and clinical profile and evaluate final visual outcome of pediatric ocular injuries.Methods : Two hundred and four children aged fourteen years or less presenting to the emergency services of a tertiary care centre with ocular injury were included. Demographic data, nature and cause of injury, duration between injury and presentation to an ophthalmologist and the diagnosis were recorded. Evaluation of visual acuity, anterior segment and fundus were done. All patients were appropriately managed and followed up on days 1, 7,1 month, 3 and 6 months.Result : Majority of injuries occurred in children of 5 years and older (87.7%). There were 133 (65.1%) boys and 71 (34.9%) girls. Forty-nine (24%) cases presented within 6 hours of injury while 70 (34.3%) presented after more than 24 hours after trauma. Most common cause of injury was bow and arrow (15.2%) followed by household appliances (14.3%). Closed globe injuries accounted for 42.2% injuries, open globe for 53.9% and 3.9% were chemical injuries. Best corrected visual acuity of 6/12 or better was achieved in 79 eyes (91.86%) in closed globe group. However, only 17 eyes (15.45%) in open globe group could achieve this.Conclusion : Most ocular injuries in children are preventable and occur from unsupervised games like bow and arrow and firecracker, which can lead to significant visual loss.

Long-term anatomical and visual outcome of vitreous surgery for retinal detachment with choroidal coloboma.

CONTEXT Vitreous surgery has been advocated as an alternative treatment of selected retinal detachments with choroidal colobomas. AIM To study the long term anatomical and visual outcome of choroidal coloboma with retinal detachment managed by pars plana vitrectomy with silicone oil tamponade. SETTING AND DESIGN Retrospective study conducted in a tertiary eye care hospital. MATERIALS AND METHODS Fourty two eyes of 40 patients with retinal detachments related to coloboma of the choroid without any peripheral breaks were analyzed. All eyes underwent pars plana vitrectomy with internal tamponade using silicone oil. Endolaser was performed along the coloboma border. Silicone oil was removed in 50% of patients. The main outcome measures were retinal reattachment and visual recovery. SPSS (Statistical Package for the Social Science), version 10.0 was used for analysis. RESULTS The retina in all cases (100%) undergoing vitrectomy were completely reattached intra-operatively. After a mean follow-up of 14 months, 37 (88.1%) eyes had attached retina. The best corrected visual acuity was 10/200 or better in 33 (78.4%) eyes. The best corrected visual acuity improved from a preoperative median of counting fingers (range 20/40 to perception of light) to median best corrected visual acuity of 20/200 (range 20/40 to perception of light) at the end of 6 months. Of the 50% (21) cases that underwent silicone oil removal, two eyes had re-detachment of retina. CONCLUSION Pars plana vitrectomy along with silicone oil tamponade for retinal detachment related to choroidal coloboma improves the long-term anatomical and visual outcome.

Intravitreal Bevacizumab for Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration in an Indian Population

PurposeTo investigate the 6-month safety profile and clinical outcomes of intravitreal bevacizumab for treating subfoveal choroidal neovascularization (CNV) in age-related macular degeneration (AMD).MethodsWe performed a prospective nonrandomized interventional study of 40 consecutive patients (40 eyes) with subfoveal CNV due to AMD. Patients underwent standard ophthalmic examination, optical coherence tomography, and fundus fluorescein angiography. All patients were administered one or more intravitreal injections of bevacizumab (1.25 mg) as primary therapy. Outcomes were also analyzed in subgroups based on lesion type (classic or occult) and lesion size (≤3000 μm or >3000 μm).ResultsAt the 6 months’ follow-up, mean best-corrected visual acuity (BCVA) improved from 20/160 to 20/100 (P = 0.014), and the mean contrast sensitivity improved from 0.38 to 0.62 (P = 0.001). The mean greatest linear diameter and mean central macular thickness significantly decreased from 3.79 mm to 2.4 mm (P = 0.0001) and from 438.5 μm to 363 μm (P = 0.0001), respectively. Visual acuity gain of 15 letters or more was seen in 20% of patients, and the gain was more in the small-lesion subgroup (31.5%) than in the large-lesion subgroup (9.5%). No significant adverse effects were observed.ConclusionIntravitreal bevacizumab is a safe and effective modality for treatment of CNV secondary to AMD. A significant improvement in BCVA with intravitreal bevacizumab was observed for all lesion types.

Role of prophylactic scleral buckling in the management of retained intraocular foreign bodies

Purpose: To evaluate the role of prophylactic scleral buckling procedure with pars plana vitrectomy for the removal of retained intraocular foreign bodies (RIOFB) in the prevention of postoperative retinal detachment.

Contrast sensitivity following focal laser photocoagulation in clinically significant macular oedema due to diabetic retinopathy

Purpose: To evaluate the influence of focal laser photocoagulation on contrast sensitivity in diabetic patients with clinically significant macular oedema (CSMO).

Evaluation of vitreous levels of gatifloxacin after systemic administration in inflamed and non‐inflamed eyes

Purpose:  This study aimed to evaluate the human vitreous penetration of gatifloxacin in inflamed and non‐inflamed eyes after oral administration.

Prospective randomized evaluation of diode-laser and cryotherapy in prethreshold retinopathy of prematurity.

Purpose: To study the efficacy of indirect diode laser photocoagulation and cryotherapy in prethreshold retinopathy of prematurity (ROP).

Case report: bilateral simultaneous central retinal vein occlusion in Waldenström's macroglobulinemia.

BACKGROUND We report a case of bilateral simultaneous central retinal vein occlusion (CRVO) in Waldenströms macroglobulinemia. METHODS We report the case of a 60-year-old woman who presented with decreased vision in both eyes. RESULTS Ophthalmoscopic examination showed scattered retinal hemorrhages and venous tortuosity with macular edema bilaterally. The patient had a history of hypertension and was under investigation for lethargy, recurrent epistaxis, and fainting episodes. Serum protein electrophoresis showed an M-spike in the gamma region. Bone marrow trephine biopsy confirmed the diagnosis of Waldenströms macroglobulinemia. The patient was treated with plasmapheresis and subsequent chemotherapy, resulting in improvement of ocular and systemic symptoms. CONCLUSIONS We report this case to emphasize that in any case of bilateral CRVO, hyperviscosity should be suspected. Serum electrophoresis along with coagulation profiles should be performed as a standard practice in patients with bilateral simultaneous CRVO.

Comparative evaluation of RetCam vs. gonioscopy images in congenital glaucoma

Purpose: To compare clarity, exposure and quality of anterior chamber angle visualization in congenital glaucoma patients, using RetCam and indirect gonioscopy images. Design: Cross-sectional study Participants. Congenital glaucoma patients over age of 5 years. Materials and Methods: A prospective consecutive pilot study was done in congenital glaucoma patients who were older than 5 years. Methods used are indirect gonioscopy and RetCam imaging. Clarity of the image, extent of angle visible and details of angle structures seen were graded for both methods, on digitally recorded images, in each eye, by two masked observers. Outcome Measures: Image clarity, interobserver agreement. Results: 40 eyes of 25 congenital glaucoma patients were studied. RetCam image had excellent clarity in 77.5% of patients versus 47.5% by gonioscopy. The extent of angle seen was similar by both methods. Agreement between RetCam and gonioscopy images regarding details of angle structures was 72.50% by observer 1 and 65.00% by observer 2. Conclusions: There was good agreement between RetCam and indirect gonioscopy images in detecting angle structures of congenital glaucoma patients. However, RetCam provided greater clarity, with better quality, and higher magnification images. RetCam can be a useful alternative to gonioscopy in infants and small children without the need for general anesthesia.

Retinopathy of Prematurity Screening by Non-Retinologists

ObjectiveTo detect the screening efficiency of general ophthalmologists (ophthalmic residents) as well as nonophthalmologists (pediatric residents and nurses posted in neonatal intensive care unit) in screening (ROP) retinopathy of prematurity on the basis of posterior pole vascular changes.MethodsProspective consecutive review in a tertiary care hospital setting. Five groups (each, comprising of one ophthalmic resident, one pediatric resident and a nurse) examined the posterior pole vessels of 200 eyes of ROP with a direct ophthalmoscope and compared with an ROP specialist using indirect ophthalmoscope. SPSS (Statistical Package for the Social Science), version 10.0 was used for the analysis.ResultsResultsOphthalmic residents findings were: (sensitivity 95.68%, specificity 92.85%, positive predictive value 94.81%, negative predictive value 93.97%; pediatric residents findings were: (sensitivity 92.24%, specificity 88.09%, positive predictive value 91.45%, negative predictive value 89.15%); and nurses, finding were: (sensitivity 88.79%, specificity 85.71%, positive predictive value 89.56%, and negative predictive value 84.70%). The results had no statistically significant difference in diagnostic reliability. Kappa agreement analysis was significant for ophthalmic residents (0.887), pediatric residents (0.805) and nurses (0.744) compared with the ROP specialist. None of the children diagnosed with pre-threshold or threshold ROP was thought to have normal posterior pole vessels by the trainees.ConclusionsGiven adequate training, general ophthalmologists and non-ophthalmologists (pediatricians and nurse practitioners) are independently reliable in detecting posterior pole changes in ROP babies using direct ophthalmoscope and can be provided with a screening protocol.