Agreement between diurnal variations of intraocular pressure by Tono-Pen and Goldmann applanation tonometer in patients on topical anti-glaucoma medication.

To estimate agreement in diurnal variations of intraocular pressure (IOP) by Tono-Pen (TP) and Goldmann applanation tonometer (GAT) in glaucoma patients on topical anti-glaucoma medication(s). IOP was measured at every 3 h from 7 a.m. to 10 a.m. in 50 eyes of glaucoma patients on topical medication(s). Diurnal fluctuation of IOP by each method was calculated as maximum-minimum IOP in a day. Central corneal thickness (CCT) was measured by ultrasonic pachymeter. There was good correlation between TP and GAT at all times during a day, minimum, and maximum IOPs during a day (Correlation coefficient, 0.706 at 7 a.m., 0.624 at 10 a.m., 0.682 at 1 p.m., 0.814 at 4 p.m., 0.652 at 7 p.m., 0.572 at 10 p.m., 0.668 minimum IOP, 0.689 maximum IOP). Mean IOPs by TP were always higher than GAT at all times during a day. Bland-Altman plots suggested a close relationship between the two sets of readings, and that this relationship was consistent at different times in a day, in maximum IOPs, minimum IOPs and also in fluctuation of IOPs. Linear regression analysis between the differences of diurnal fluctuation (diurnal fluctuation by GAT-diurnal fluctuation by TP) and CCT showed strong association (R 2 = 0.857, p < 0.001). The mean change in difference of diurnal fluctuation (GAT-TP) for a 10-micron increase in CCT was 0.69 mmHg. TP can be considered a reliable alternative to GAT in glaucoma patients for knowing the diurnal control of IOP; however these two methods should not be used interchangeably. Difference of diurnal fluctuation between two methods is dependent on CCT.

Corneal changes in childhood glaucoma.

OBJECTIVE: To study the clinical features and topography of the cornea in eyes with childhood glaucoma. DESIGN: Cross-sectional, observational study. PARTICIPANTS: Fifty-eight eyes with childhood glaucoma and 28 eyes of age-matched controls. METHODS: Clinical and topographic corneal changes were evaluated. MAIN OUTCOME MEASURES: Corneal topographic changes were evaluated on Orbscan (Orbscan Topography System II; Bausch & Lomb, Salt Lake City, UT) in eyes with childhood glaucoma and those changes were compared with the control eyes. RESULTS: Fifty-eight eyes with childhood glaucoma and 28 eyes of age-matched controls were evaluated. Thirty-six eyes (62.1%) were classified as having primary childhood glaucoma and 22 eyes (37.94%) as having childhood glaucoma with associated ocular anomalies. The corneas in 18 of 58 eyes (31.0%) with childhood glaucoma were clear, whereas 24.1% of eyes (14/58 eyes) had some corneal opacification. Haab's striae were noted in 44.8% of eyes (26/58 eyes) and were most frequently present between 3 and 5 mm from the optical axis. The mean posterior elevation recorded in eyes with childhood glaucoma controlled with medication or surgery was significantly higher than that in control eyes: 0.043 ± 0.027, 0.042 ± 0.017, and 0.018 ± 0.058 µm, respectively (P < 0.0001). The presence of Haab's striae was correlated significantly with a higher posterior elevation (P = 0.0396) and poor vision. The mean anterior elevation in eyes with childhood glaucoma (0.022 ± 0.015 µm) and in control eyes (0.015 ± 0.078 µm) was comparable (P = 0.08). Corneal astigmatism in eyes with childhood glaucoma was significantly higher and irregular compared with that in control eyes: 2.09 ± 1.40 versus 0.93 ± 0.60 diopter cylinder (P = 0.0001); the irregularity index was 2.8 (range, 1-18.1) and 2.3 (range, 0.6-2.3) at 3 mm (P = 0.0005) and 3.2 (range, 1.4-21.3) and 1.8 (range, 0.5-2.9) at 5 mm, respectively (P = 0.0003). Best-corrected visual acuity correlated significantly with cup-to-disc ratio, axial length, refractive error, astigmatism, and posterior corneal elevation. Multivariate analysis showed a significant correlation only with cup-to-disc ratio and axial length. CONCLUSIONS: Childhood glaucoma causes a significant increase in posterior corneal elevation and irregular astigmatism, which contribute to visual disability in such eyes.

Oral cavity cancer incidence and survival trends: A population-based study.

INTRODUCTION: The present study aimed to calculate the burden of oral cavity cancer (OCC) including incidence, mortality rate, survival rate, and influence of predictive factors such as clinicopathological, demographic findings, and treatment modalities. MATERIALS AND METHODS: Data in this retrospective study were collected from India's population-based cancer registry (PBCR) from 2010 to 2016. A total of 1051 cases of OCC were noted. Incidence and mortality rates were calculated. The cumulative survival outcome was calculated using Kaplan-Meier (KM) method. Prognostic factors were estimated using the Cox proportional hazard regression model. RESULTS: The age-standardized incidence rates (ASR), and mortality rate (ASMR), of overall OCC cases were 10.1 and 8.4 per 100 thousand population, respectively. Five-year overall survival (OS) was 32.3%. Survival outcome was significantly associated with the given treatment (Chi-square value = 58.17, P = 0.0001) and anatomical site (Chi-square value = 26.70, P = 0.0001). 17.6% of cases in males were <39-year age group. The hazard ratio (HR) in the age group of >50 years was 2.065 (95% CI 1.34-3.18, P = 0.001). Combination therapy had an HR of 2.630 (95% CI 1.91-3.63, P value 0.000). Tonsillar carcinoma (C09) (95% CI 1.04-3.12) had 1.8 times more chances of death than lip carcinoma (C00). CONCLUSION: OCC cases are increasing in the younger population, and overall, cases show higher mortality rates with reduced survival outcomes. Prognostic factors such as age >50 years, single modality treatment, and alveolar and tonsillar malignancy are associated with poor survival. OCC robust screening by a trained health professional can improve early detection and increases awareness and lower mortality of the disease.

Modeling hippocampal spatial cells in rodents navigating in 3D environments.

Studies on the neural correlates of navigation in 3D environments are plagued by several issues that need to be solved. For example, experimental studies show markedly different place cell responses in rats and bats, both navigating in 3D environments. In this study, we focus on modelling the spatial cells in rodents in a 3D environment. We propose a deep autoencoder network to model the place and grid cells in a simulated agent navigating in a 3D environment. The input layer to the autoencoder network model is the HD layer, which encodes the agent's HD in terms of azimuth (θ) and pitch angles (ϕ). The output of this layer is given as input to the Path Integration (PI) layer, which computes displacement in all the preferred directions. The bottleneck layer of the autoencoder model encodes the spatial cell-like responses. Both grid cell and place cell-like responses are observed. The proposed model is verified using two experimental studies with two 3D environments. This model paves the way for a holistic approach using deep neural networks to model spatial cells in 3D navigation.

Development and evaluation of Fusarium wilt-resistant and high-yielding chickpea advanced breeding line, KCD 11.

Fusarium wilt (FW) is the most severe soil-borne disease of chickpea that causes yield losses up to 100%. To improve FW resistance in JG 11, a high-yielding variety that became susceptible to FW, we used WR 315 as the donor parent and followed the pedigree breeding method. Based on disease resistance and yield performance, four lines were evaluated in station trials during 2017-2018 and 2018-2019 at Kalaburagi, India. Further, two lines, namely, Kalaburagi chickpea desi 5 (KCD 5) and KCD 11, which possesses the resistance allele for a specific single-nucleotide polymorphism marker linked with FW resistance, were evaluated across six different locations (Bidar, Kalaburagi, Raichur, Siruguppa, Bhimarayanagudi and Hagari) over a span of 3 years (2020-2021, 2021-2022 and 2022-2023). KCD 11 exhibited notable performance, showcasing yield advantages of 8.67%, 11.26% and 23.88% over JG 11, and the regional checks Super Annigeri 1 (SA 1) and Annigeri 1, respectively, with enhanced FW resistance in wilt sick plot. Further, KCD 11 outperformed JG 11, SA 1 and Annigeri 1 in multi-location trials conducted across three seasons in the North Eastern Transition Zone, North Eastern Dry Zone, and North Dry Zones of Karnataka. KCD 11 was also tested in trials conducted by All India Coordinated Research Project on chickpea and was also nominated for state varietal trials for its release as a FW-resistant and high-yielding variety. The selected line is anticipated to cater the needs of chickpea growers with the dual advantage of yield increment and disease resistance.

Metastatic Follicular Thyroid Carcinoma of the Mandible: A Case Report at Tertiary Care Rural Centre.

The most common endocrine cancer is thyroid carcinoma, however it seldom spreads to the oral cavity. Follicular thyroid carcinoma is the second most common type of thyroid cancer after papillary thyroid carcinoma. Thyroid carcinoma-related mandibular metastases is not very common, and there aren't many cases reported in the literature. We are describing a case in which the underlying cancer was diagnosed before the metastatic mandibular lesion was found. Total thyroidectomy and excision of the affected structures, with or without adjuvant therapy, appear to be the most effective treatments.

Choroid plexus papilloma in a mature cystic teratoma of ovary: A rare case report.

Mature cystic teratoma of the ovary is the most common type of germ cell tumor. It constitutes approximately 20% of all ovarian neoplasms. As a rare occurrence, however, several types of benign and malignant tumours developing secondarily in dermoid cysts have been reported. Those of central nervous origin are almost exclusively gliomas of astrocytic, ependymal or oligodendroglial lineage. Choroid plexus tumors are unusual intracranial tumors which comprised of only 0.4-0.6% of all brain tumors. These are neuroectodermal in origin and similar in structure to a normal choroid plexus in the form of multiple papillary fronds mounted on a well vascularized connective tissue stroma. The present case report highlights the presence of a choroid plexus tumor in a mature cystic teratoma of the ovary in a 27-year-old woman who came for safe confinement and cesarean section.

Ovarian cancer: A report from population-based cancer registry at central rural India.

INTRODUCTION: Ovarian neoplasms affect a huge part of the female population and, simultaneously, have the worst prognosis among all gynecological malignancies. In most of the population-based cancer registries (PBCR) in India, ovarian cancer is the third leading site of cancer among women, trailing behind cervix and breast cancer. MATERIALS AND METHODS: In the present study, we have summarized the number of new cases of ovarian malignancy and its profile observed in the PBCR in central India during 7 years. REPORTS: During a 7-year duration (2010-2016), 6,515 cancer patients were recorded at PBCR, and 228 cases were of ovarian malignancy. It was observed that most of the cases in this study were in 41-50 years of life. The age-standardized incidence rate of ovarian cancers in the present study was 4.61 per 100,000, and the crude incidence rate was 5.08 per 100,000. The crude mortality rate and age-standardized mortality rate of ovarian cancer were 2.3 and 2.02 per 100,000, respectively. Serous carcinoma was our study's most common histological subtype (43.75%), followed by mucinous carcinoma. CONCLUSION: A steady increase has been observed in the incidence of ovarian cancer in several registries. A significant goal in managing ovarian cancer is to develop an effective test to detect the disease at its earlier stages, resulting in reduced mortality.

Utility of MOC-31 monoclonal antibody in differentiating metastatic adenocarcinoma cells and reactive mesothelial cells in effusion cytology.

In effusion cytology, a clear distinction between reactive mesothelial cells and metastatic adenocarcinoma cells is sometimes challenging mainly due to similarities in the cytomorphological features. In such cases for definitive diagnosis, paraffin-embedded cell block examination and immunohistochemistry are helpful in making this distinction. MOC-31 is one of the proposed immunomarker for adenocarcinoma cells. We undertook to evaluate the role of MOC-31 as a marker for identifying adenocarcinoma cells in effusion specimen. A total of 185 paraffin-embedded cell blocks of effusion samples were identified, of these 111 cases were of metastatic adenocarcinoma. MOC-31 was positive in 101 of the 111 cases of metastatic adenocarcinoma. Minimal focal cytoplasmic staining was also seen in 7 of the 74 cases of reactive mesothelial cells, but these were taken negative as they did not show membrane positivity. The sensitivity and specificity of MOC-31 for metastatic adenocarcinoma cells were 92.5%, and 100% respectively, positive and negative predictive value (NPV) was 100% and 91.14%, respectively. MOC-31 can be used as a reliable marker in effusions for distinguishing metastatic adenocarcinoma from reactive mesothelial cases.

Unrecognized Prevalence of Macrocytosis among the Patients with First Episode of Psychosis and Depression.

BACKGROUND: Mood disorders and psychosis has been reported among the patients with macrocytosis; however, its prevalence among the first episode of psychosis and depression is unknown. The purpose of the study was to establish the prevalence of macrocytosis among the patients with the first episode of depression and psychosis. MATERIALS AND METHODS: In this cross-sectional study, three groups comprising patients with first episode of depression (n = 100), patients with the first episode of psychosis (n = 100), and healthy controls (n = 100) were included. Blood samples were collected from each participant and analyzed using the automated coulter counter. The hematological variables (e.g., macrocytosis, anemia) in the three groups were compared using the Chi-square and analysis of variance tests. RESULTS: The prevalence of macrocytosis among patients with depression and psychosis was 2.6 (8%) and 3.3 times (11%) higher, respectively than that among the healthy controls (3%). In addition, the hemoglobin concentration, mean corpuscular volume and mean platelet volume in patients with first episodes of psychosis and depression significantly differed from those in healthy controls P < 0.001. CONCLUSION: This study showed that the prevalence of macrocytosis among the first episode of depression and psychosis was higher than healthy controls. Macrocytosis may have etiological and prognostic significance among these patients. Prospective studies are needed to explore the clinical significance of macrocytosis among the patients with depression and psychosis in the clinical practice.

Mean Platelet Volume and Platelet Distribution Width Level in Patients with Panic Disorder.

BACKGROUND: Changes in platelet indices have been reported in patients with panic disorder (PD). However, previous study findings are contradictory and inconclusive. The aim of this study was to evaluate and compare the platelet indices in patients with PD. MATERIALS AND METHODS: Patients with PD (n = 123) and healthy controls (n = 133) were enrolled in this case control study. The platelet indices (mean platelet volume [MPV] and platelet distribution width [PDW]) along with red blood cell (RBC) indices (RBC count and red cell distribution width [RDW]) were compared between the two groups using the unpaired t-test. RESULTS: Patients with PD had lower MPV (7.53 ± 0.93 fL vs. 8.91 ± 1.24 fL, P < 0.0001), higher PDW (16.96 ± 0.85 fL vs. 14.71 ± 2.07 fL, P < 0.0001), and higher platelet count (274.2 ± 80.66 × 109 L-1 vs. 243.1 ± 93.89 × 109 L-1, P < 0.005) than the healthy controls. Furthermore, there were significant differences between patients with PD and healthy controls in terms of their RBC count (4.32 ± 0.56 × 1012 L-1 vs. 4.08 ± 0.80 × 1012 L-1, P = 0.007) and RDW (16.48 ± 2.26 fL vs. 15.01 ± 2.25 fL, P < 0.0001). CONCLUSION: Patients with PD have increased PDW and RDW. The platelet and RBC indices may prove to be useful etiological and prognostic markers in patients with PD.

A novel technique to release sticking haptic of a single-piece hydrophobic acrylic IOL using irrigation-aspiration probe.

PURPOSE: To describe a novel technique to release sticking haptic of a single-piece hydrophobic acrylic intraocular lens (IOL) using irrigation-aspiration (I/A) probe. METHODS: In our technique, the I/A probe is introduced into the anterior chamber on Visco mode. Using the aspiration port of the I/A probe, the sticking haptic is held at its tip and suction force is built up until occlusion is noted. Then the haptic is nudged towards the center of the IOL along its curve. After the haptic is free from optic, the suction is released. RESULTS: Several techniques have been described to release the sticking haptic such as squeezing the haptic at the site where it sticks to the IOL or using Sinskey hook for releasing the adhesion. These techniques require extra manipulation of the IOL by introduction of surgical instruments. In our technique, we used the I/A probe itself for separating the sticky haptic successfully. CONCLUSIONS: This technique allows separation of sticking haptic without any extra instrumentation, thus reducing intraocular maneuvering and total surgery time.

A Unique Case of JOAG With Lamellar Ichthyosis With Rickets: A Case Report and Review of the Literature.

PURPOSE: Ichthyosis is known to have ocular associations such as blepharitis, hypertrophic conjunctivitis, corneal vascularization, ectropion, lagophthalmos, etc. However, no reports of its association with glaucoma are there, to the best of our knowledge. We report a unique case of juvenile open-angle glaucoma (JOAG) with lamellar ichthyosis. METHOD: A 16-year-old male child presented with a gradual, painless progressive diminution of vision in both eyes over a period of 3 years. Systemic examination revealed stunted body growth with knock-knees, suggestive of late-onset rickets. Generalized dry scaly lesions with erythema, along with hyperkeratosis of the palms and the soles, suggestive of lamellar ichthyosis were present. On ocular examination, the intraocular pressure was 36 mm Hg; optic nerve head examination revealed a horizontally oval disc with near total cupping in the right eye and total cupping in the left eye, with extensive neuroretinal rim thinning and pallor. Gonioscopy showed wide open angles with prominent iris processes. Screening of JOAG-associated genes (MYOC, NTF4, WDR36, and CYP1B1) and ichthyosis-associated gene (TGM1) was performed by the direct PCR-sequencing method. RESULTS: A diagnosis of JOAG with advanced glaucomatous optic neuropathy with lamellar ichthyosis and rickets was made. The patient underwent right followed by left eye trabeculectomy with 0.2 mg/dL MMC (for 1 min). Postoperatively, the intraocular pressure was 8 mm Hg at 1 week, and 12 to 14 mm Hg at the 6-week, the 3-month, and the 6-month follow-up, and the visual acuity was maintained in the right eye. No mutations in MYOC, NTF4, WDR36, CYP1B1, and TGM1 were observed in the patient and his family. CONCLUSIONS: An association of glaucoma with ichthyosis should be kept in mind. Therefore, a detailed baseline ocular examination in children with ichthyosis is required, as early detection of glaucoma could prevent irreversible blindness.

Application of HPLC and HPTLC for the simultaneous determination of tizanidine and rofecoxib in pharmaceutical dosage form.

Two methods are described for the simultaneous determination of tizanidine and rofecoxib in binary mixture. The first method was based on HPTLC separation of the two drugs followed by densitometric measurements of their spots at 311 nm. The separation was carried out on Merck HPTLC aluminium sheets of silica gel 60 F254 using toluene:methanol:acetone (7.5:2.5:1.0, v/v/v) as mobile phase. The linear regression analysis data was used for the regression line in the range of 10-100 and 100-1500 ng/spot for tizanidine and rofecoxib, respectively. The second method was based on HPLC separation of the two drugs on the reversed phase kromasil column [C18 (5 microm, 25 cm x 4.6 mm, i.d.)] at ambient temperature using a mobile phase consisting of phosphate buffer pH 5.5 and methanol (45:55, v/v). Flow rate was 1.0 ml/min with an average operating pressure of 180 kg/cm2. Quantitation was achieved with UV detection at 235 nm based on peak area with linear calibration curves at concentration ranges 10-200 and 100-2000 microg/ml for tizanidine and rofecoxib, respectively. Both methods have been successively applied to pharmaceutical formulation. No chromatographic interference from the tablet excipients was found. Both methods were validated in terms of precision, robustness, recovery and limits of detection and quantitation. The analysis of variance (ANOVA) and Student's t-test were applied to correlate the results of tizanidine and rofecoxib determination in dosage form by means of HPTLC and HPLC method.

Application of stability-indicating HPTLC method for quantitative determination of metadoxine in pharmaceutical dosage form.

A sensitive, selective, precise and stability-indicating high-performance thin-layer chromatographic method for analysis of metadoxine both as a bulk drug and in formulations was developed and validated. The method employed TLC aluminium plates precoated with silica gel 60F-254 as the stationary phase. The solvent system consisted of acetone-chloroform-methanol-ammonia (7.0:4.0:3.0:1.2, v/v/v/v). Densitometric analysis of metadoxine was carried out in the absorbance mode at 315 nm. This system was found to give compact spots for metadoxine (Rf value of 0.45+/-0.02, for six replicates). Metadoxine was subjected to acid, alkali and neutral hydrolysis, oxidation, dry and wet heat treatment and photo and UV degradation. The drug undergoes degradation under all stress conditions. Also, the degraded products were well resolved from the pure drug with significantly different Rf values. The method was validated for linearity, precision, robustness, LOD, LOQ, specificity and accuracy. Linearity was found to be in the range of 100-1500 ng/spot with significantly high value of correlation coefficient r2=0.9997+/-1.02. The linear regression analysis data for the calibration plots showed good linear relationship with r2=0.9999+/-0.58 in the working concentration range of 200-700 ng/spot. The mean value of slope and intercept were 0.11+/-0.04 and 18.73+/-1.89, respectively. The limits of detection and quantitation were 50 and 100 ng/spot, respectively. Statistical analysis proves that the method is repeatable and specific for the estimation of the said drug. As the method could effectively separate the drug from its degradation products, it can be employed as a stability-indicating one. Moreover, the proposed HPTLC method was utilized to investigate the kinetics of acid and base degradation process. Arrhenius plot was constructed and activation energy was calculated respectively for acid and base degradation process.

Subperiosteal hematoma from peribulbar block during cataract surgery leading to optic nerve compression in a patient with parahemophilia.

A 17-year-old male presented with gradual painless diminution of vision since childhood. Slit lamp examination revealed both eyes having congenital cataract. Right eye lens aspiration was performed but was uneventful, and he prepared for left eye surgery after 7 days. Immediately after giving a peribulbar block, a complete akinesia, tight eyelids, and stony hard eyeball was noted. An abaxial proptosis of 7 mm was noted. Lateral canthotomy and inferior cantholysis were done and proptosis reduced to 5 mm. Bleeding time-clotting time was normal. Proptosis worsened to 8 mm the next day. Contrast-enhanced computed tomography scan showed inferolateral subperiosteal hematoma, but drainage could not be performed due to prolonged prothrombin time and activated prothrombin time. Fresh frozen plasma was transfused. Tarsorrhaphy was performed for exposure keratopathy after his coagulation profile became normal. Hematology evaluation after 2 weeks detected factor V deficiency, and was diagnosed as Owren's disease or parahemophilia.

Visual field loss in primary congenital glaucoma.

PURPOSE: To assess the visual field defects in primary congenital glaucoma (PCG) and to identify associated risk factors. METHODS: In this cross-sectional study visual fields of consecutive PCG patients were examined using Humphery Field Analyzer (HFA) or Goldmann visual field (GVF). All patients had maintained an intraocular pressure (IOP) ≤14 mm Hg on standard care. Mean deviation, pattern standard deviation (PSD), foveal threshold in HFA, and global visual field extent (degrees) in 24 meridians for targets V4e, I4e, I2e in GVF were recorded and evaluated with respect to baseline IOP and age at detection. Statistical analysis was performed by Kruskal Wallis and Mann-Whitney test. Qualitative analysis of GVF and reliable fields in HFA was performed. RESULTS: A total of 100 eyes of 77 patients were included: 56 eyes of 47 patients were in the HFA group; 44 eyes of 30 patients, in the GVF group. On HFA, mean deviation detected at ≤1 month of age was significantly lower than eyes detected after 1 year (P < 0.001). On GVF, the global visual field extent for target I4e and I2e was significantly lower for PCG detected at ≤1 month of age compared to those seen at >1 year (I4e, P < 0.001; I2e, P = 0.005). Mean deviation, PSD, and foveal threshold were significantly lower in PCG with baseline IOP of >30 mm Hg than with IOP of 20-25 mm Hg (mean deviation, P < 0.001; PSD, P = 0.002; foveal threshold, P = 0.002). Extent for targets V4e and I4e on GVF were significantly lower in patients with baseline IOP of >30 mm Hg compared to those with baseline IOP of 20-25 mm Hg (V4e, P = 0.002; I4e, P = 0.003). Definitive glaucomatous defects were found in 36 eyes (41%), most ommon being arcuate scotoma (19 eyes [22%]). CONCLUSIONS: PCG detected at age ≤1 month and those having a baseline IOP of >30 mm Hg show greater visual field loss.

A safe technique for in-the-bag intraocular lens implantation in pediatric cataract surgery.

PURPOSE: To describe a safe technique for in-the-bag intraocular lens (IOL) implantation in pediatric cataract patients who undergo lens aspiration with primary posterior capsulorhexis and anterior vitrectomy. METHODS: Sixty eyes of 45 consecutive patients with congenital/developmental cataract underwent lens aspiration with primary posterior continuous curvilinear capsulorhexis (PCCC) with anterior vitrectomy and in-the-bag IOL implantation using the described technique of IOL implantation using anterior capsule as support. RESULTS: All eyes had stable IOL at the end of surgery and none of the eyes had lens decentration/dislocation in posterior vitreous. CONCLUSIONS: Implantation of in-the-bag IOL is difficult in children who undergo primary PCCC with anterior vitrectomy. Our technique of implanting IOL by pushing it against the back surface of anterior capsule is a safe method and results in no complications related to faulty IOL implantation.

Bilateral Sturge-Weber and Phakomatosis Pigmentovascularis with Glaucoma, an Overlap Syndrome.

UNLABELLED: Aim. To report a case of bilateral Sturge-Weber and Phakomatosis pigmentovascularis with secondary glaucoma in a child. Method. CASE REPORT: Results. A 4-year-old male child was referred to us for control of intraocular pressure (IOP). Sleeping IOP was 36 mm Hg in right eye and 28 mm Hg in the left eye. The sclera of both the eyes showed bluish black pigmentation-melanosis bulbi. Fundus examination of both eyes showed diffuse choroidal hemangiomas with glaucomatous cupping. Nevus flammeus was present on both sides of face along all the 3 divisions of trigeminal nerve with overlying hypertrophy of skin and on left forearm. Nevus fuscocaeruleus was present on upper trunk. All skin lesions were present since birth and were stationary in nature. CT scan of head revealed left-sided cerebral atrophy. Intraocular pressure was controlled after treatment with topical antiglaucoma medications. Pulsed Dye Laser has been advised by dermatologist for skin lesions. Patient has been advised for regular follow-up. Conclusion. The two overlapping dermatological disorders and their association with glaucoma are a rare entity. Management should be targeted both for dermatological and eye conditions.

Evaluating eye drop instillation technique in glaucoma patients.

AIM: To evaluate the technique of eye drop instillation in glaucoma patients. METHODS: Seventy patients with primary open-angle glaucoma or primary angle-closure glaucoma, self-administering topical antiglaucoma medications for at least 6 months were evaluated. All patients instilled a tear substitute in 1 eye using the same technique they used for instilling antiglaucoma medications at home. The parameters that were recorded included time taken to instill the first drop, number of eye drops instilled, drop contact location, any contact with the tip of the bottle, and closure of the eyelids or tear duct after drop instillation. RESULTS: The mean age of the patients was 54.1±10.0 years. The mean time taken to instill the first drop was 14.8±3.7 seconds (range, 8.7 to 23.5 s). The mean number of drops squeezed from the bottle per instillation was 1.8±1.2 drops (range, 1 to 8 drops). In 22 patients (31.43%), the eye drops fell on the eyelids or cheek. Fifty-three patients (75.7%) touched the tip of the bottle to the globe or periocular tissue. Twenty patients (28.57%) closed eyes after instilling drops and 4 patients (5.7%) occluded the punctum. Only 6 patients (8.57%) were able to correctly instill the eye drops (squeeze out 1 drop and instill it into the conjunctival sac without bottle tip contact). CONCLUSIONS: Nearly, 9 of 10 glaucoma patients were unable to instill eye drops correctly. This may be an important cause of unintentional noncompliance in glaucoma medical therapy.