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PURPOSE: To describe the clinical presentation and treatment outcomes of pupillary block glaucoma (PBG) following vitreoretinal surgery (VR surgery). MATERIAL AND METHODS: Retrospective observational study of 6941 patients, who underwent VR surgery at a tertiary eye care centre in South India between January 2015 and December 2019. Amongst them, clinical data of 61 patients who developed PBG were taken for statistical analysis. RESULTS: Mean (SD) age was 53.90 (13.4) years and the incidence of PBG was .87%. Median (IQR) time of onset of PBG following VR surgery was 3.33 (1.1-6.6) months and majority were pseudophakic (75%). PBG resolved with Nd:YAG laser peripheral iridotomy (LPI) alone in 50 (82%) patients, whereas 11(18%) patients required additional interventions like surgical iridectomy, trabeculectomy or diode laser cyclophotocoagulation (CPC) either as a stand-alone procedure or in combination with silicone oil removal (SOR). Mean (SD) intraocular pressure at the onset of PBG was 41.61 (14.5) mmHg, which reduced drastically following LPI to 24.28 (14.9) mmHg which further dropped significantly at 6 months follow up to 20.34 (13.9) mmHg. CONCLUSIONS: Incidence of secondary PBG after VR surgery was .87%, and we observed diabetes mellitus, combined cataract and VR surgery, use of 1000cs SO endotamponade, intraoperative endolaser and multiple VR surgical interventions as common associations. Majority of the patients with PBG after VR procedures resolved with LPI and medical management. Few individuals (18%) required additional laser or surgical intervention for IOP control.
Assuntos
Pressão Intraocular , Cirurgia Vitreorretiniana , Humanos , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Masculino , Pressão Intraocular/fisiologia , Idoso , Resultado do Tratamento , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Fechado/fisiopatologia , Glaucoma de Ângulo Fechado/etiologia , Iridectomia/métodos , Complicações Pós-Operatórias , Incidência , Acuidade Visual/fisiologia , Seguimentos , Fotocoagulação a Laser/métodos , Adulto , Distúrbios Pupilares/etiologia , Distúrbios Pupilares/diagnósticoRESUMO
PURPOSE: To evaluate rural community-based eye care models from the perspective of community ophthalmology experts and suggest sustainable technological solutions for enhancing rural eye care delivery. METHODS: A semi-structured descriptive survey, using close-ended and open-ended questions, was administered to the experts in community ophthalmology sourced through purposive sampling. The survey was self-administered and was facilitated through online platforms or in-person meetings. Uniform questions were presented to all participants, irrespective of their roles. RESULTS: Surveyed participants (n = 22 with 15 from India and 7 from Nepal) in high-volume tertiary eye hospitals faced challenges with resources and rural outreach. Participants had mixed satisfaction with pre-operative screening and theatre resources. Delayed presentations and inexperienced surgeons contributed to the surgery complications. Barriers to rural eye care included resource scarcity, funding disparities, and limited infrastructure. In rural/peri-urban areas 87% of participants agreed with providing primary eye care services, with more than 60% of the experts not in agreement with the makeshift center model of eye care delivery. Key components for an effective eye care model are sustainability, accessibility, affordability, and quality. These can be bolstered through a healthcare management platform and a human-chain supply distribution system. CONCLUSION: Tailored interventions are crucial for rural eye care, emphasizing the need for stronger human resources, optimized funding, and community awareness. Addressing challenges pertinent to delayed presentation and surgical training is vital to minimizing complications, especially with advanced cataracts. Enhancements in rural eye care demand a comprehensive approach prioritizing accessibility, affordability, and consistent quality.
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Atenção à Saúde , Oftalmopatias , Oftalmologia , População Rural , Feminino , Humanos , Masculino , Oftalmopatias/terapia , Acessibilidade aos Serviços de Saúde , Índia/epidemiologia , Nepal , Serviços de Saúde Rural , População do Sudeste Asiático , Inquéritos e QuestionáriosAssuntos
Diabetes Mellitus , Retinopatia Diabética , Edema Macular , Humanos , Edema Macular/diagnóstico , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/tratamento farmacológico , Fotocoagulação a Laser , Inibidores da Angiogênese/uso terapêutico , Tomografia de Coerência Óptica , Estudos Retrospectivos , Injeções IntravítreasRESUMO
PURPOSE: To study the effect of prophylactic intracameral moxifloxacin (ICM) on microbiological profile and antimicrobial sensitivity of culture-proven postoperative endophthalmitis (POE). METHODS: This study evaluated culture-proven POE diagnosed within 6 weeks of cataract surgery over two periods, period-1 (January 2010-March 2015) and period-2 (April 2015-December 2019), before and after introduction of prophylactic ICM, respectively. RESULTS: In period-1, 100 cases of culture-positive POE were reported (1 in 4879, 0.02%), while 20 cases (1 in 24635, 0.004%) were reported in period-2 (5-fold reduction, p < .001). The cumulative culture positivity rate decreased from 27.6% to 17.1% (1.6-fold) . Coagulase-negative Staphylococci (CoNS) were significantly reduced (p = .005). CONCLUSIONS: ICM reduced the incidence of culture-proven POE, CoNS in particular. In future, POE caused by rarer pathogens may become more prevalent due to reduction in the rate of commoner and more virulent pathogens with use of intracameral antibiotics. The moxifloxacin sensitivity of CONS did not show change with the use of ICM. Studies with larger population of POE will be more helpful to understand the trend better.
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Edema Macular , Humanos , Edema Macular/diagnóstico , Edema Macular/etiologia , Edema Macular/cirurgia , Olho , VitrectomiaRESUMO
Retinitis pigmentosa (RP) is the most common inherited cause of blindness in the developed world, characterized by night blindness, reduced central vision and constricted visual field; however, unilateral RP is extremely rare. Macular complications such as cystoid macular oedema (CME), macular holes and vitreoretinal interface alterations, such as epiretinal membranes, have been reported in advanced stages. We describe a patient with unilateral RP presenting with CME, a rare occurrence.
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Edema Macular , Retinose Pigmentar , Humanos , Retinose Pigmentar/complicações , Retinose Pigmentar/diagnóstico , Edema Macular/etiologia , Edema Macular/diagnóstico , Edema Macular/diagnóstico por imagem , Tomografia de Coerência Óptica , Masculino , Adulto , Acuidade Visual , FemininoRESUMO
Phakomatoses are a group of congenital disorders characterised by hamartomatous lesions of the skin as well as the central and peripheral nervous systems. The presence of naevus flammeus or port-wine stain is a characteristic feature of many such disorders including Sturge-Weber syndrome (SWS), Klippel-Trenaunay syndrome (KTS) and Phakomatosis pigmentovascularis (PPV).We describe the ocular findings in a patient with coexisting PPV, SWS and KTS.
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Síndrome de Klippel-Trenaunay-Weber , Síndromes Neurocutâneas , Mancha Vinho do Porto , Síndrome de Sturge-Weber , Humanos , Síndromes Neurocutâneas/complicações , Síndromes Neurocutâneas/diagnóstico , Síndrome de Sturge-Weber/complicações , Síndrome de Sturge-Weber/diagnóstico , Síndrome de Klippel-Trenaunay-Weber/complicações , Mancha Vinho do Porto/complicaçõesAssuntos
Astigmatismo , Extração de Catarata , Catarata , Humanos , Astigmatismo/etiologia , Astigmatismo/cirurgia , Refração OcularRESUMO
INTRODUCTION: This study investigated choroidal structural changes on optical coherence tomography (OCT) using choroidal vascularity index (CVI) and choroidal thickness (CT) in patients with Best vitelliform macular dystrophy (BVMD). METHODS: This retrospective case control study included 78 patients with BVMD of different clinical stages and 242 age- and gender-matched healthy controls. Subfoveal OCT scans were analysed. Total choroidal area (TCA), luminal area (LA) and CT were measured after image segmentation and binarization. CVI, a novel marker for choroidal angioarchitecture, was defined as the ratio of LA to TCA. CVI and CT were compared between BVMD and control group, as well as among the BVMD subgroups. RESULTS: Mean CVI was lower in eyes with BVMD (65.0 ± 3.5%) compared to that in control eyes (67.5 ± 3.9%) and this was statistically significant (p < 0.0001). There was no significant difference in subfoveal CT between BVMD (302.88 ± 81.68 µm) and control (309.31 ± 65.46 µm) eyes (p = 0.4799). In the subgroup analysis, all stages of BVMD showed lower CVI compared to control while SFCT remained similar. Within the BVMD subgroups, CVI and subfoveal CT did not differ significantly and both were not shown to be associated with visual acuity. CONCLUSION: Decreased CVI was shown in eyes with BVMD compared to control eyes, while no significant difference in subfoveal CT was seen. CVI may be helpful in the understanding of choroidal pathology in BVMD.
RESUMO
Pre-macular haemorrhage (PMH) can cause profound visual loss. Some surgeons prefer neodymium-doped yttrium aluminium garnet (Nd:YAG) hyaloidotomy as the first line of treatment due to being an easy technique and having a high success rate. However, the use of high energy close to the fovea can lead to various macular complications. We present a case of a patient who presented with PMH secondary to anaemic retinopathy. He underwent Nd:YAG laser hyaloidotomy, but developed a full-thickness macular hole. He further underwent vitrectomy and a type 1 closure was achieved. However, the visual gain was poor due to the large hole size and the collateral thermal damage. The hole may not close spontaneously, thus requiring surgical intervention. The surgical outcome of these holes depends on the size of the hole and the collateral thermal damage caused during the laser procedure.
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Lasers de Estado Sólido , Perfurações Retinianas , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/cirurgia , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Acuidade Visual , Vitrectomia/métodosRESUMO
Purpose: To conduct a bibliometric analysis of research on genetic retinal diseases (GRD) done in India published from 2011 to 2020 in peer-reviewed journals, and assess the productivity, trends in journal choice, publication types, research funding, and collaborative research. Methods: We searched PubMed for articles indicating both vision-related content and author affiliation with an Indian research center. We identified research collaborations and classified articles as reporting basic science, clinical science, or clinically descriptive research. Impact factors were determined from Journal Citation Reports for 2015. Results: The total number of published articles that were retrieved from 2011 to 2021 was 341. During the 10 years of study, the annual output of research articles has nearly doubled, that is, from 21 in 2011 to 44 in 2021. A total of 298 (87%) articles were published in international journals, and 149 (42%) articles in vision-related journals had an impact factor. A total of 224 (65%) articles came from six major eye hospitals. Clinical science articles were most frequently (86%) published, whereas basic science was the least (14%). The diseases on which the maximum and the minimum number of articles were published were retinoblastoma (n = 82,24%) and Stargardt disease (n = 3, 0.9%), respectively. Conclusion: This bibliometric study provides a broad view of the current status and trends in the research on GRD done in India and may help clinicians, researchers, and policymakers to better understand this research field and predict its dynamic directions.
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Pesquisa Biomédica , Doenças Retinianas , Bibliometria , Humanos , Índia/epidemiologia , Publicações , Doenças Retinianas/genéticaAssuntos
Doenças da Coroide , Efusões Coroides , Glaucoma de Ângulo Fechado , Lúpus Eritematoso Sistêmico , Doenças da Coroide/complicações , Doenças da Coroide/etiologia , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/etiologia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnósticoRESUMO
Congenital retinal macrovessel (CRM) is defined as a large aberrant blood vessel that traverses through the central macula. It can have large tributaries extending on both sides of the horizontal raphe. The condition is typically asymptomatic. However, visual loss may be reported in case of associated branch retinal artery occlusion, cavernous haemangioma, retinal artery macroaneurysm, retinal deep capillary ischaemia, retinal detachment and vitreous haemorrhage. However, association of CRM and foveal hypoplasia has rarely been reported.We report multimodal imaging in a patient who was presented with visual loss due to foveal hypoplasia secondary to CRM.