Satish Thomas

Large-Angle Strabismus: Can a Single Surgical Procedure Achieve a Successful Outcome?

Purpose: Large-angle strabismus is a gray zone for surgeons with various advocates for one, two-, three-, or even four-muscle surgeries. Very frequently, reoperations are required in these cases in order to achieve a successful outcome. In this article, the authors evaluate the outcome of concomitant large-angle strabismus after a single surgical procedure. Methods: A retrospective analysis of all operated cases of concomitant large-angle strabismus (50 prism diopters or more) during a 1.5-year period was performed from patient’s case files. A successful outcome of surgery was defined as deviation within 10 prism diopters of orthophoria/tropia for both distance and near. Results: Fifty patients met the inclusion criteria. The overall success rate was 60%, with the esotropia group having a higher success rate (68.75%) than the exotropia group (44.45%). Ten patients underwent recess-resect procedure, 20 had bimedial rectus recession, and 3 had bilateral lateral rectus recession, while 17 patients had surgery on 3 horizontal rectus muscles. Thirty-three patients had two-muscle surgery with a success rate of 57.58%, while 17 patients had three-muscle surgery with a success rate of 64.71%, the difference being statistically insignificant. There was no statistically significant difference between the various age groups analyzed for overall success rate, suggesting that age group is not a factor for positive outcome in large-angle strabismus surgery. A total of 12 patients were amblyopic at the time of strabismus surgery and they had a success rate of 33.33%, which was much poorer than the success rate (68.42%) of the remaining 38 patients who did not have amblyopia at the time of surgery. Conclusions: A good surgical outcome can be obtained in large-angle strabismus with a single surgical procedure, though a randomized controlled study needs to be done to establish whether three-muscle surgeries give better results than two-muscle surgeries.

Ophthalmic manifestations of acute and chronic leukemias presenting to a tertiary care center in India

Context: Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. Aims: This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India. Settings and Design: Subjects of leukemia presenting to a tertiary care center in India. Subjects and Methods: A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia. Statistical Analysis Used: The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA). Results: The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%). Conclusions: Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular changes are often picked up in asymptomatic patients.

Should we start all patients with diabetic retinopathy on fenofibrates

There remains a need for strategies that are effective in preventing diabetic retinopathy (DR) or slowing down its progression, which is safe, well-tolerated, and more effective, have a lower risk profile, easy to perform, have more predictable results with less morbidity than the current regimens. Physicians caring for diabetic patients not only need to maximize glycemic control, but also closely monitor and treat other systemic conditions. The consistency of clinical data from the fenofibrate studies showed consistent beneficial effects with fenofibrate in slowing the progression of DR. They demonstrated significant benefit on micro-vascular (i.e., retinopathy and nephropathy) outcome, possibly independent of lipid levels. Can we combine the effectiveness of the current standard procedures with the prevention and slowing down of progression of DR that fenofibrates can offer? Knowledge of the primary mode of action of fenofibrate will be useful for both physicians and patients in determining how best to use this drug as an adjunct in the management of DR and ultimately facilitating the translation of clinical trial data to clinical practice.

Visual Function and Ocular Status in Children with Disabilities in Special Schools of Northern India

INTRODUCTION Children with disabilities (other than visual impairment) are at a higher risk of visual impairment as compared to normal population. Majority of the ocular disorders, like refractive errors and strabismus, are easily treatable. As these children depend on their visual inputs for social and academic activities, an early detection and prompt treatment of even a minor visual problem is of utmost importance for them. AIM To assess the visual function and ocular status of children with disabilities other than visual impairment and to identify the preventable and treatable causes of visual impairment. MATERIALS AND METHODS The study was conducted on children aged 3-16 years who were studying in special schools/ rehabilitation centers in Ludhiana. After prior permission, detailed ocular examination of all the children was done using standard examination techniques. Cycloplegic retinoscopy and refraction was also done and spectacles were prescribed. Children requiring further evaluation were referred to base hospital. RESULTS A total of 404 children with disabilities (other than visual disabilities) studying in 7 rehabilitation centers/ special schools were enrolled. These included children with Cerebral palsy (12.1%), with Hearing impairment (35.3%), with Attention Deficit Hyperactive Disorder (ADHD) (3.7%), with Autism (8.6%), with Down syndrome (12.8%) and with Mental retardation (27.2%). Ocular disorders were seen in 174(43%) children. The most common ocular disorders seen in these children were refractive errors (23%) and strabismus (18.1%). A total of 93(23%) children were prescribed spectacles and 37(9.2%) children were referred for further evaluation. CONCLUSION Ocular problems are common in children with other disabilities. Delay in the detection and treatment of these disorders compounds the already existing disability in these children. Lack of awareness and sensitization among the parents and teachers is a matter of great concern. Therefore, strategies regarding increasing awareness, mandatory ocular examination in these children and early detection and treatment of the ocular disorders is the need of the hour.