Prevalence of Refractive Errors and Number Needed to Screen among Rural High School Children in Southern India: A Cross-sectional Study.

INTRODUCTION: Avoidable blindness is mainly due to uncorrected refractive errors (URE). School Eye Screening (SES) can be used as an initiative to address this issue. AIM: To determine prevalence of URE and Number Needed to Screen (NNS) to find one child with low vision or blindness from URE among rural school children. MATERIALS AND METHODS: A cross-sectional study was performed in 22 government schools with sixth to ninth grades in Kaniyambadi block of Vellore District of Tamil Nadu, India. There were 4739 children on the rolls. Among children present, all those identified to have a visual deficit in either eye, using a single line 20/40 Snellen's optotype E chart at 6 m, were referred to the hospital for confirmatory evaluation. Blindness (uncorrected) was defined as inability to see 20/200 in the better eye. In two of these schools, visual deficits were validated through a second school based examination by a clinician. RESULTS: Of the 4739 children on rolls, 601 were absent; all 4138 (87.3%) who were present underwent screening; 2.3% (98) {95% Confidence Interval (CI) 1.8 to 2.8} failed the screening test in at least one eye and were referred for examination. Only 28 (28.6%) of 98 children who were referred came for examination to the hospital. In the 2 of the 22 schools where the visual deficit was validated, there were no false positives. The prevalence of refractive error in these two schools was 2.2% (95% CI 1.7 - 2.7). NNS to detect one child with low vision or blindness from URE was 147. CONCLUSION: Magnitude of refractive error, low NNS, low response to referral necessitates complete care at school and hence a relook at the current SES program.

Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: a cohort study.

PURPOSE: Recent emphasis on eye care in intensive care unit (ICU) patients has translated to eye assessment being part of routine care. In this setting, we determined the incidence, risk factors, and resolution time of exposure keratopathy. METHODS: In this prospective cohort study, 301 patients were examined within 24 hours of ICU admission and subsequently daily by an ophthalmologist till death or discharge. Eyelid position, conjunctival and corneal changes, treatment, and outcome data were collected. RESULTS: Admission diagnoses included febrile illnesses (35.2%) and respiratory failure (32.6%); 84.1% were ventilated. Forty-nine patients had exposure keratopathy (bilateral = 35, unilateral = 14) at admission; 35 patients developed new onset keratopathy (incidence 13.2%) 4.6 ± 2.6 days after ICU admission. In 67 patients, keratopathy was mild (punctate epithelial erosions). Macroepithelial defects (n = 9), stromal whitening with epithelial defect (n = 3), and stromal scar (n = 3) were infrequent. None developed microbial keratitis. On multivariate logistic regression analysis, eyelid position (odds ratio, 2.93; 95% confidence interval, 1.37-6.25), and ventilation duration (odds ratio, 1.11; 95% confidence interval, 1.04-1.19) were strongly associated with the development of keratopathy after ICU admission. Keratopathy resolved in 3.6 ± 4.5 days. CONCLUSIONS: Severe exposure keratopathy is infrequent in a protocolized ICU setting. Eyelid position and duration of ventilation are associated with exposure keratopathy.

Percutaneous sclerotherapy of congenital slow-flow vascular malformations of the orbit.

PURPOSE: This manuscript describes the clinical features, imaging findings, treatment details, and short-term outcomes of a series of congenital slow-flow vascular malformations. METHODS: This was a prospective study of congenital slow-flow vascular malformations involving the orbital region treated at a single institution with percutaneous sclerotherapy. RESULTS: Ten patients presented during the study period, comprising eight venous malformations, one lymphatic malformation, and one veno-lymphatic malformation. Nine patients underwent percutaneous sclerotherapy under digital subtraction angiography guidance, of which three developed marked rise in intraocular pressure requiring lateral canthotomy. The treatments were performed in the presence of an ophthalmologist who measured the intraorbital pressure during and after the procedure. On follow-up, some of the patients required repeat sessions of sclerotherapy. All patients had improvement of symptoms on follow up after the procedure. CONCLUSION: Congenital slow-flow vascular malformations of the orbital region are rare lesions that should be treated using a multidisciplinary approach. Monitoring of the intraorbital pressure is required both during and after the procedure to decide about the need for lateral canthotomy to reduce the transiently increased intraorbital pressure.

Regression of takayasu retinopathy after revascularization of occluded branches of the aortic arch by percutaneous angioplasty.

PURPOSE: To present a patient with decreased vision because of Takayasu retinopathy who had improvement in vision and regression of retinopathy after percutaneous angioplasty of occluded aortic arch vessels. METHODS: Interventional case report. RESULTS: A 37-year-old woman with multiple cerebral infarcts and recurrent seizures was referred with painless progressive reduction in vision in the right eye of few months' duration and left eye for 2 years. Vision was 20/120 in the right eye and perception of light in the left eye. There was mild disk pallor in the right eye, optic atrophy in the left eye, and microaneursyms in both eyes. Angiographic findings were consistent with type I Takayasu arteritis. Angioplasty and stenting was performed initially to the right subclavian and common carotid arteries and to the left subclavian, and left internal carotid arteries 6 weeks later. There was improvement in vision to 20/80 and regression of Takayasu retinopathy in the right eye at 3 months post procedure that improved further to 20/50, 6 months post procedure. Vision, as expected, remained poor in the left eye despite revascularization. CONCLUSION: Restoration of flow in the aortic arch vessels may result in reversal of ischemic retinal changes in patients with Takayasu retinopathy.

Magnetic resonance imaging for the ophthalmologist: a primer.

Magnetic resonance imaging (MRI) and computerized tomography (CT) have added a new dimension in the diagnosis and management of ocular and orbital diseases. Although CT is more widely used, MRI is the modality of choice in select conditions and can be complimentary to CT in certain situations. The diagnostic yield is best when the ophthalmologist and radiologist work together. Ophthalmologists should be able to interpret these complex imaging modalities as better clinical correlation is then possible. In this article, we attempt to describe the basic principles of MRI and its interpretation, avoiding confusing technical terms.

Ocular manifestations of Takayasu arteritis: a cross-sectional study.

PURPOSE: To detail the spectrum of eye manifestations in Takayasu arteritis and factors predisposing to its development. METHODS: In this cross-sectional study, 61 patients with proven Takayasu arteritis who were identified during a 16-month period were evaluated for disease- and treatment-related eye manifestations. A fundus fluorescein angiography examination was performed where indicated and with the patients consent. RESULTS: The mean (±standard deviation) duration of illness before ophthalmic evaluation was 55 ± 69 months. Decreased vision was the most common ocular symptom (30%). Thirty-five patients underwent fundus fluorescein angiography examination. Takayasu retinopathy was seen in 9 (15%), ocular ischemic syndrome in 4 (7%), and hypertensive retinopathy in 10 (16%) patients. The most common treatment-related ocular complication was steroid-induced cataract (23%). Other manifestations included iris neovascularization (n = 3), anterior ischemic optic neuropathy (n = 2), steroid-induced glaucoma (n = 1), neovascular glaucoma (n = 1), and uveitis (n = 1). Those manifesting Takayasu retinopathy and ocular ischemic syndrome had significantly (P < 0.05) lower blood pressure in both upper limbs compared with patients not manifesting ischemic retinopathy. A significant (P < 0.03) proportion of patients with Takayasu retinopathy and ocular ischemic syndrome had a nonrecordable right upper limb blood pressure. CONCLUSION: Disease- and treatment-related ocular complications are not infrequent in Takayasu arteritis. Arteritis involving the aortic arch and its branches favors the development of ischemic ocular complications.

Endothelial cell loss and central corneal thickness in patients with and without diabetes after manual small incision cataract surgery.

PURPOSE: Cataract surgery is known to change the corneal endothelial cell density and morphology. In patients with diabetes, this change is more pronounced. This prospective cohort study was conducted to assess and compare the endothelial cell loss and change in central corneal thickness (CCT) after manual small incision cataract surgery (SICS) in patients with diabetes versus age-matched patients without diabetes. METHODS: Consecutive patients with diabetes (153) in the age group 40-70 years and age-matched patients without diabetes (163) undergoing manual SICS were enrolled. Preoperative and 1 week, 6 weeks, and 3 months postsurgery assessments of corneal endothelial loss and change in CCT were done using specular microscopy and ultrasound pachymetry. RESULTS: There was a steady drop in the endothelial density in both the groups postoperatively, with the percentage of endothelial loss at 6 weeks and 3 months being 9.26 ± 9.55 and 19.24 ± 11.57, respectively, in patients with diabetes and 7.67 ± 9.2 and 16.58 ± 12.9, respectively, in controls. The percentage of loss between 6 weeks and 3 months was found to be of significant difference (P < 0.023). In both the groups, an initial increase in CCT till the second postoperative week was followed by a reduction of CCT in the subsequent follow-up (sixth week) and a further reduction in the last follow-up (3 months). The change in CCT between the second and sixth weeks was significantly higher in the diabetic group (P = 0.045). CONCLUSIONS: The diabetic endothelium was found to be under greater metabolic stress and had less functional reserve after manual SICS than the normal corneal endothelium.

Unusual case of a graphite foreign body in the anterior chamber.

Retained intraocular graphite foreign bodies are uncommon. Although they are generally inert, they have been reported to cause severe inflammatory reaction and progressive damage to intraocular structures. We report a case of a six-year-old girl with a retained intraocular graphite pencil lead foreign body in the anterior chamber of the eye and discuss the various considerations in the management of such cases.

Hypoperfusive and hypertensive ocular manifestations in Takayasu arteritis.

Takayasu arteritis is a relatively rare inflammatory arteritis that can be associated with ocular manifestations. We report four patients with proven Takayasu arteritis; two patients manifested hypoperfusive ocular manifestations of ocular ischemic syndrome and anterior ischemic optic neuropathy whilst two others had exudative retinal detachment and papilledema as a result of severe hypertension. The ischemic ocular manifestations were a result of hypoperfusion of the ocular structures due to occlusive arteritis of the aortic arch and its branches. The exudative retinal detachment and papilledema were manifestations of severe hypertension due to renal arterial involvement. Patients with Takayasu arteritis should be referred for ophthalmic assessment and screening for hypoperfusive and hypertensive manifestations.

Oculocutaneous anthrax: detection and treatment.

Anthrax, a zoonotic disease that primarily affects herbivores, has received recent attention as a potential agent of bioterrorism. We report a patient who presented with a 4-day history of pain, watering and difficulty in opening the left upper and lower eyelids, and fever. Clinical examination revealed brawny nonpitting edema with serosanguinous discharge. The history of the death of his sheep 1 week prior to the illness provided the clue to the diagnosis. Although standard cultures of the blood and the serous fluid from the lesion were negative, probably as a result of prior treatment, the diagnosis of cutaneous anthrax was made by a polymerase chain reaction (PCR) test of the serous fluid. Serial photographs demonstrating resolution of the lesion with appropriate antibiotic therapy are presented.

Amniotic membrane graft in the surgical management of cryptophthalmos.

PURPOSE: To describe a case of cryptophthalmos in which an amniotic membrane graft was used in reconstruction of the upper eyelid and fornix. METHODS: The surgical history of a patient with partial cryptophthalmos is presented. RESULTS: Successful creation of a superior fornix in a case of partial cryptophthalmos was achieved only after an amniotic membrane graft was used. CONCLUSIONS: Amniotic membrane is a useful resource for fornix reconstruction in cryptophthalmos.