Subhash Dadeya

Levodopa/Carbidopa in the Treatment of Amblyopia

PURPOSE To evaluate the role of levodopa/carbidopa in the treatment of amblyopia. METHODS Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-blind, randomized study. Patients were divided into two groups. Group A received 0.50 mg + 1.25 mg of levodopa/carbidopa per kilogram body weight three times daily after meals, with a protein rich drink, whereas Group B received placebo. Both groups received full-time conventional occlusion until a visual acuity of 6/6 was achieved or for a maximum of 3 months. RESULTS The authors observed more than two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the placebo group (9 of 15) (P < .005). Furthermore, improvement in visual acuity of more than two lines was greater in patients younger than 8 years (100%) than in patients older than 8 years of age (60%) (P = .0026). There was also no significant reversal of the improved visual acuity in up to 6 months of follow-up. CONCLUSION Levodopa/carbidopa improves visual acuity in patients with amblyopia and maintains improved visual acuity, especially in patients younger than 8 years.

Acquired isolated unilateral fourth nerve palsy after ventriculoperitoneal shunt surgery

Ventriculoperitoneal shunt has been the surgical procedure of choice for many years for both communicating and noncommunicating hydrocephalus.(1) High failure rates and complications have been reported, despite major improvements in shunt technology(2); however, fourth (trochlear) nerve palsy has not been reported after this procedure. We describe 2 patients who developed a fourth nerve palsy after shunt surgery. Recovery was incomplete, and strabismus surgery was required.

Television Video Games in the Treatment of Amblyopia in Children Aged 4–7 Years

ABSTRACT Aim: To investigate the role of television video games in childhood amblyopia treatment. Method: This prospective, randomized, interventional study included 40 patients between 4-7 years of age, with unilateral amblyopia (visual acuity in amblyopic eye between 1-0.6 LogMAR equivalents) attending the squint clinic at a tertiary eye hospital. All patients were prescribed optimal spectacle correction and occlusion therapy, i.e. full time patching according to patient’s age, was initiated after six weeks.; full-time patching according to patient’s age was initiated after 6 weeks. Subjects were randomly divided into two groups of 20 each. Patients in the first group, Group A (control), were prescribed patching alone. Patients in the second group, Group B (study), were made to play action video games, with the help of a commercial television set, along with patching. They attended 12 half-hour sessions each, at weekly intervals. Follow-up assessments included best corrected visual acuity (BCVA) (both distance and near) and stereoacuity measurements at 3, 6, 9, and 12 weeks. Results: The mean age of patients was 6.03 ± 1.14 years. The distance BCVA in the amblyopic eye showed a significant improvement at final follow-up (12 weeks) in both groups: from 0.84 ± 0.19 to 0.55 ± 0.21 LogMAReq in Group A and 0.89 ± 0.16 to 0.46 ± 0.22 LogMAReq in Group B. However, improvement in BCVA was significantly better in group B at all visits (P=0.002, 12 weeks). The study group also had a significantly better outcome in terms near visual acuity improvement (P = 0.006, 12 weeks). There was also greater stereoacuity improvement in group B, with 7 patients improving to 100 secs of arc or better. Conclusion: Video games supplemental to occlusion may be considered favorable for visual development in amblyopic children, and the study encourages further research on this subject.

Pattern of intraocular pressure in epidemic dropsy in India.

This study was conducted to report on the intraocular pressure (IOP) pattern in patients with epidemic dropsy. Two hundred and thirty proven cases of epidemic dropsy were sent for ocular examination. We measured IOP by applanation tonometry at different intervals. Patients were followed up until 24 weeks. Intraocular pressure of more than 22 mm of Hg was detected in 10.86% patients at the start of the study. However, at 12 weeks only 0.43% patients needed medication for control of IOP. None required medication for IOP control after 20 weeks. The rise of IOP in this case series of epidemic dropsy appeared to be a transient phenomenon and drugs needed to be titrated on a weekly basis.

Autografting of marginal conjunctiva.

Accessible online at: www.karger.com/oph I read with keen interest the article by Özer et al. [1]. They deserve congratulations for eloquently describing the comparative evaluation of recurrence rates of pterygia following autografting applying a marginal conjunctival technique and a bare sclera technique. We have been using different methods to treat pterygia to prevent recurrence and found a recurrence rate of 6.67% with 0.02% intraoperative daunorubicin [2]. Recurrence remains the most enigmatic complication following pterygium excision. There remains no single accepted adjuvant therapy for pterygium surgery. Conjunctival autografting is the most commonly used adjunctive therapy to prevent recurrence, however most authors have failed to achieve successful results [3, 4]. In my opinion, despite the lower recurrence and minimal complications following conjunctival autografting, the experience demanded by the technique, the extended operating time and the discomfort from multiple sutures remain a hurdle in the acceptance of conjunctival autografting as the treatment of choice. With a surgeon/patient ratio being as low as in India and the backlog in the treatment of cataract-induced blindness, a time-consuming and cumbersome procedure like autografting looses its relevance. Pterygium recurs because of accelerated fibroblast proliferation produced by the trauma of an operation similar to the production of keloid tissue following trauma [5]. Daunorubicin inhibits fibroblast proliferation. I think a single intraoperative application of daunorubicin followed by thorough cleansing of the conjunctival tissue with normal saline prevents the accumulation of the drug in toxic concentrations and subsequent complications, since the surgeon directly controls the medication using the intraoperative route, thus eliminating the risk of overuse. The application of daunorubicin is safe and less time consuming. Its effect is reported to last for 40 days and regrowth of Tenon’s capsule appears normal with daunorubicin. Furthermore, in a retrospective analysis comparing conjunctival autografting and intraoperative daunorubicin, Dadeya et al. [6] concluded that based on observations of similar recurrence and minimal complications with added advantage of less operative time, technically simple surgery and absence of discomfort due to multiple sutures, daunorubicin is an ideal adjuvant therapy following pterygium surgery. References

Comparison of Minimally Invasive Strabismus Surgery (MISS) and Conventional Strabismus Surgery Using the Limbal Approach

PURPOSE To compare minimally invasive strabismus surgery (MISS) with conventional strabismus surgery for horizontal recti in terms of functional outcome and complications. METHODS A total of 40 patients requiring surgery for horizontal recti were divided into two groups: those undergoing MISS and those operated on using the conventional limbal technique. In the MISS group, two small keyhole radial cuts were made superior and inferior to the insertion of the muscle margin. Keyhole cut size was almost 1 mm less than the amount of muscle recessed or resected. RESULTS There were significant differences in conjunctival redness and swelling in both groups on postoperative days 1 and 7 and week 3. However, after the third week, both groups had a similar appearance. Visual acuity was decreased at postoperative day 1 in both groups, but the difference was not significant. No significant differences were found for final alignment, binocular single vision, other visual acuities, refractive changes, or complications. CONCLUSIONS This study shows that this new, small incision, minimal dissection technique is feasible. The MISS technique seems to be superior in the immediate postoperative period because there were fewer conjunctival and eyelid swelling complications. Long-term results did not differ between the two groups. [J Pediatr Ophthalmol Strabismus. 2017;54(4):208-215.].

Filter paper strip kit: a cost-effective transport media

This study was undertaken to discover a feasible transport media for the transportation of ocular microbiological material from the periphery to the central laboratory. A total of 94 cases of ocular infection with clinical diagnosis of conjunctivitis and keratitis were studied. In all cases, two representative microbiological samples were collected, and sent by filter paper strip (FPS) kit as well as by direct culture technique. The isolated organisms by both the methods were analysed. Of the total 94 cases studied, bacteria were isolated in 48 cases by direct culture and in 45 cases by FPS kit, whereas, fungus were isolated in 13 cases by each method. FPS kit appears to be an alternative, feasible, and cost-effective technique for transportation of ocular microbiological material from periphery to the central laboratory.

Conjunctival Rotation Autograft

Accessible online at: www.karger.com/oph I read with keen interest the article by Alp et al. [1]. The authors suggested that a prospective randomized trial comparing conjunctival rotation autograft with other adjunctive procedures is recommended. We conducted a randomized trial comparing safety and efficacy of conjunctival rotation autograft with conjunctival autograft in primary pterygium surgery [2]. We concluded that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce recurrence after pterygium surgery. The recurrence rate in our study was 5.88% after a mean follow-up period of 11 months. Delayed wound healing and persistent congestion were the complications noted by us in 11.76 and 5.88% of the patients, respectively. I am of the opinion that conjunctival rotation autograft can be safely tried in all those situations, where conjunctival autografting is not feasible. References