Intravascular Papillary Endothelial Hyperplasia as an unusual diagnosis for peri-orbital tumour - A case report.

Intravascular papillary endothelial hyperplasia (IPEH) is a rare cause of orbital mass which can affect healthy individuals of any age/sex/race/region. It usually requires a histopathological examination, characterized by the appearance of papillary proliferation of vascular endothelial cells within the lumen of the blood vessel, for the final diagnosis. One should be aware that this is a highly vascular lesion which can cause excessive intraoperative bleeding and incomplete removal can lead to recurrences. IPEH of the orbit/eyelid has been reported in few parts of the world as isolated case reports but none from India so far.

Awareness of Presbyopia among Rural Female Population in North Karnataka.

INTRODUCTION: Presbyopia is an age related loss of lens accommodation resulting in inability to read and/write or to do near work. Though literacy level may be low in rural female population of South India, but household works like sewing, sorting grains and operating mobile phones must be difficult due to presbyopia. AIM: To determine the awareness of presbyopia in rural females; also, to determine the knowledge levels regarding presbyopia, spectacle coverage and reasons for not wearing spectacles. MATERIALS AND METHODS: A hospital based cross-sectional study was conducted at SDM College of Medical Sciences, Dharwad, Karnataka, India, on 1000 female subjects of age group 35 years and above coming from rural area (around Dharwad). They were examined and open-ended questionnaire was used to record subject's awareness and knowledge about presbyopia and their responses were analysed. RESULTS: More than 2/3rd of 1000 (66.7%) subjects were not aware about presbyopia. More than 50% subjects had difficulty in cleaning grains, threading needles and reading fine newspaper print. About 86.5% thought presbyopia is age related and 92.2% thought it could be treated with spectacles. In spite of high prevalence, almost 98% of the population were not willing to wear glasses among which majority (60.2%) felt that spectacles were difficult to be maintained while working. In the present study, no statistical significance between literacy and awareness was noted (p=0.46). CONCLUSION: High prevalence of presbyopia was seen with majority of them uncorrected due to lack of awareness or unwillingness to wear glasses. We need to provide better health education regarding presbyopia among both literate and illiterate individuals. Thus, there is a need to create awareness and to provide affordable, accessible and compatible optical services to the affected population.

A Hospital Based Study Regarding Awareness of Association Between Glycosylated Haemoglobin and Severity of Diabetic Retinopathy in Type 2 Diabetic Individuals.

INTRODUCTION: Diabetic retinopathy is one of the most common microvascular complications seen in diabetic patients after a long term of uncontrolled glycaemic status as assessed by glycosylated Haemoglobin A (HbA1c). Hence awareness of glycaemic control is necessary to prevent vision threatening complications. AIM: To assess the awareness regarding association between glycosylated Haemoglobin (HbA1c) and diabetic retinopathy among diabetic patients and to assess the impact of lack of this knowledge on the severity of diabetic retinopathy (DR). MATERIALS AND METHODS: This hospital based cross-sectional study was conducted in the ophthalmology OPD on 200 adult diabetic patients, between November 2012 and January 2013, who were assessed for their knowledge regarding association between HbA1c and its impact on the progress of DR. The study was done with the help of a semi structured questionnaire which included demographic details, literacy levels, diabetic status and awareness of HbA1c. STATISTICS USED: Cochran Armitage test for trend, Fisher Exact test, chi-square for trend and Student's t test. RESULTS: Among the 200 diabetic individuals attending our OPD, 180 (90%) were aware of the importance of blood sugar levels and its fluctuation in type 2 diabetes. Only 23 (11.5%) were aware of HbA1c whereas 10 (5%) misinterpreted it as levels of haemoglobin, 3 (1.5%) did not completely comprehend. About 164 (82%) patients were not aware of the significance or the terminology of HbA1c. Out of the 200 patients, 58 patients showed presence of some grade of DR. Amongst these 58 patients, 7(12.1%) were aware of HbA1c and all the11 patients with clinically significant macular oedema (CSME) were aware of the risk factors of elevated blood sugar levels but ignorant of HbA1c. Among the remaining 142 individuals who showed no signs of DR, 16 (27.5%) were aware of and comprehended the role of HbA1c. CONCLUSION: Our study highlights the gross ignorance of role of HbA1c in the progress of DR among diabetic individuals. It is a known fact that the risk of DR reduces by 35% for every 1% reduction in HbA1c. Hence a strict control of blood sugar level with regular monitoring of HbA1c can help diabetic individuals in prevention of progress of DR, thus preventing severe vision loss.

Duane retraction syndrome: a rare cause of strabismus.

Duane retraction syndrome (DRS) is a rare cause of strabismus in children. It has a characteristic ocular motility disorder and constitutes approximately 1% of all cases of strabismus. We describe a 9-year-old girl with absent or restricted horizontal eye movement, globe retraction and narrowing of the palpebral fissure on attempted adduction. DRS is classified into three types based on the different restrictions of ocular motility and can be associated with various ocular and systemic anomalies.

Retinal Arterial Obstruction-still Remains an Enigma.

Retinal artery obstruction is an ocular emergency which usually carries a poor visual prognosis. Restoration of fruitful vision depends on the underlying cause and the immediate start of treatment. However, none of the known treatment modalities, have so far, assured positive results consistently. Retinal artery obstructions are forewarners of possible systemic emboli/infarcts. Thus, it is imperative for ophthalmologists to identify the disease and get a thorough systemic examination done, preferably by a cardiologist, so as to prevent serious systemic morbidity. It is to be noted that in our case report, in spite of having delayed presentations, both the patients were subjected to thorough cardiovascular examinations. In clinical practice, patients are not further investigated, once the chances of visual recovery are bleak. Our case report highlights the importance of subjecting these patients to complete cardiovascular work ups, even though a poor visual recovery is expected, which can lead to detection of various cerebrovascular infarcts.