Contrast sensitivity and its determinants in people with diabetes: SN-DREAMS-II, Report No 6.

PurposeTo assess contrast sensitivity (CS) and to elucidate the factors associated with CS among subjects with type 2 diabetes in a cross-sectional population-based study.Patients and methodsSubjects were recruited from a follow-up cohort, Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular genetics Study (SN-DREAMS II). Of 958 subjects who were followed up in SN-DREAMS II, a subset of 653 subjects was included in the analysis. All subjects underwent a comprehensive eye examination, which included CS assessment using the Pelli-Robson chart. The cross-sectional association between CS and independent variables was assessed using stepwise linear regression analysis. A P-value of <0.05 was considered statistically significant.ResultsThe mean age of the study sample was 58.7±9.41 (44-87) years. Mean CS of the study sample was 1.32±0.20 (range: 0-1.65) log units. CS was negatively and significantly correlated with age, duration of diabetes, hemoglobin level, vibration perception threshold (VPT) value, albuminuria, best corrected visual acuity (BCVA), refractive error, total error score (TEM) of FM 100 hue test, and mean retinal sensitivity. In multiple regression analysis, after adjusting for all the related factors, CS was significantly associated with BCVA (ß=-0.575; P<0.001), VPT (ß=-0.003; P=0.010), severity of cataract (ß=-0.018; P=0.032), diabetic retinopathy (ß=-0.016; P=0.019), and age (ß=-0.002; P=0.029). These factors explained about 29.3% of the variation in CS.ConclusionAmong the factors evaluated, differences in BCVA were associated with the largest predicted differences in CS. This association of CS with visual acuity highlights the important role of visual assessment in type 2 diabetes.

The prevalence and risk factors for age-related macular degeneration in rural-urban India, Sankara Nethralaya Rural-Urban Age-related Macular degeneration study, Report No. 1.

PurposeTo report the age- and gender-adjusted prevalence rates of early and late age-related maculopathy (ARM) and associated risk factors in rural and urban Indian population.MethodsA population-based cross-sectional study was carried out in South India between 2009 and 2011. Of the 6617 subjects ≥60 years enumerated ones, 5495 (83.04%) participated in the eye examination. A detailed history including data on demographic, socioeconomic, and ocular history was obtained. Participants underwent detailed ophthalmic evaluation including 30° 3-field photograph as per Age-Related Eye Disease Study protocol. The ARM was graded according to the International ARM Epidemiological Study Group.ResultsAge- and gender-adjusted prevalence of early ARM was 20.91% (20.86-20.94) in the rural population and 16.37% (16.32-16.42) in the urban population. Similarly, the prevalence of late ARM was 2.26% (2.24-2.29) and 2.32% (2.29-2.34) in the rural and urban population, respectively. In both rural and urban populations, risk factors that were related to both early and late ARM were age, per year increase (OR, range 1.00-1.08); middle socioeconomic status (OR, range 1.05-1.83); and smokeless tobacco (OR, range 1.11-2.21). Protective factor in both was the presence of diabetes mellitus in all ARM (OR, range 0.34-0.83). Risk factors, only in the rural arm, were female gender (OR, range 1.06-1.64), past smoker (OR, 1.14), and serum low-density lipoprotein cholesterol level (OR, 1.03).ConclusionsThe study reports smokessless tobacco as a risk factor for both early and late ARM and identified a higher prevalence of early ARM in the rural population compared with urban population.

Endophthalmitis caused by Acinetobacter baumanni: a case series.

PURPOSE: To profile the etiology, clinical outcomes and drug sensitivity patterns in endophthalmitis caused by Acinetobacter baumanni. METHODS: Retrospective analysis of all the cases of Acinetobacter baumanni endophthalmitis presenting to tertiary referral care ophthalmic hospital in Eastern India from January 2009 to December 2011 were done. RESULTS: A total of four cases were included in the study. Out of the four cases one was post traumatic and the rest were post cataract surgery. All the cases underwent vitreoretinal surgical intervention followed by intravitreal antibiotics. A. Baumanni was isolated from vitreous in all the cases. Among all the drugs tested bacteria were found sensitive to ciprofloxacin (100 %) whereas all tested resistant to ceftazidime. Out of the four cases one had to be eviscerated, another developed retinal detachment post vitrectomy, one was phthisical at final followup, and only one patient achieved a vision of 20/200 with clear media and attached retina at final visit. CONCLUSION: A. Baumanni is a very rare cause of endophthalmitis with poor visual and anatomical outcomes. Ciprofloxacin should be considered as first the line intravitreal antibiotic.

Is neuronal dysfunction an early sign of diabetic retinopathy? Microperimetry and spectral domain optical coherence tomography (SD-OCT) study in individuals with diabetes, but no diabetic retinopathy.

PURPOSE: To elucidate changes in the neurosensory retina in the macular area, using spectral domain OCT and correlate with functional loss on fundus-related microperimetry, in patients with diabetes and no diabetic retinopathy compared with age-matched healthy volunteers. METHODS: This was a prospective study enrolling 39 patients in each group. All patients underwent comprehensive dilated eye examination. The foveal thickness and the photoreceptor layer thickness at the foveal centre were measured using spectral domain OCT, and the mean retinal sensitivity of central 20 degrees was measured using microperimetry. RESULTS: The mean age of the patients with diabetes was 50.92+/-4.75 years, and of controls, 49.87+/-5.50 years. SD-OCT measured photoreceptor layer thickness (PLT) to be 61.62+/-4.48 microm in cases, and 68.79+/-7.84 microm in controls (P<0.0001); foveal thickness (FT) was 168.64+/-16.46 microm in cases and 177.74+/-14.58 microm in controls (P=0.012). The mean retinal sensitivity (MRS) of the central 20 degrees, measured on microperimetry was 15.74+/-3.74 db in cases and 17.70+/-1.5 db in controls (P<0.003). In cases compared with controls (aged under 50 years) statistically significant differences were noted in all the three outcome variables: FT, P=0.030; PLT, P=0.015; and MRS, P=0.020. The duration of diabetes influenced only the PLT (P=0.017). Statistical analysis was performed with Student's t-test and chi2 test. CONCLUSION: Neuronal damage was observed in those eyes that did not have clinical evidence of diabetic retinopathy.

Risk factors for diabetic retinopathy in self-reported rural population with diabetes.

BACKGROUND: Diabetes and its related microvascular complications like diabetic retinopathy (DR) are showing increased prevalence in India. However, the magnitude of DR in rural population with diabetes needs exploration. AIM: To estimate the prevalence and risk factors for the presence and severity of diabetic retinopathy in the self-reported rural population with diabetes. SETTINGS AND DESIGN: In a cross-sectional study, a total of 26,519 participants (age >or= 30 years) attended 198 diabetic retinopathy screening camps conducted in three southern districts of Tamilnadu, India, between February 2004 and April 2006. MATERIALS AND METHODS: All the participants underwent a dilated eye examination to detect DR by indirect ophthalmoscopy. Systemic and ocular risk factor estimation was done in a comprehensive examination. STATISTICAL ANALYSIS: Univariate and stepwise regression analyses were done to identify the independent risk factors associated with the presence and severity of retinopathy. RESULTS: The prevalence of diabetic retinopathy was 17.6% among the self-reported rural population with diabetes. The prevalence of referable (sight threatening) retinopathy was 5.3%. Risk factors associated with the development of any DR were male gender (OR= 1.37), longer duration of diabetes (per year, OR= 1.07), lean body mass index (OR= 1.30), higher systolic blood pressure (per 10 mm Hg, OR= 1.18), and insulin treatment (OR= 1.34; P P CONCLUSION: The study identified risk factors associated with DR in the rural population with diabetes. The results suggested that there was a need for formulating effective preventive strategies to minimize avoidable blindness due to diabetes, in rural areas.

Psoralen-ultraviolet A therapy vs. psoralen-ultraviolet B therapy in the treatment of plaque-type psoriasis: our experience with fitzpatrick skin type IV.

BACKGROUND: Oral psoralen, when combined with UVB, shows an increased response in psoriasis. In this study, conventional psoralen-UVA (PUVA) therapy was compared with psoralen-UVB (PUVB) therapy in plaque-type psoriasis in patients with Fitzpatrick skin type IV. PATIENTS AND METHODS: Equal numbers of patients with stable, plaque-type psoriasis were treated with either PUVA (n = 22) or PUVB (n = 22), three times weekly until 90% clearance was achieved. A final evaluation was made 3 months later. RESULTS: The two groups showed no significant differences in terms of clearance of disease, mean number of exposures, or the average duration of therapy; however, the cumulative dose of UVB required for clearance was significantly lower than that of UVA. Both groups had a similar acute side-effects' profile. CONCLUSIONS: PUVB therapy is as effective as conventional PUVA in the treatment of stable, plaque-type psoriasis in patients with Fitzpatrick skin type IV. A significantly lower dose of UVB is required for clearance as compared with UVA.

An unusual mechanism of burn injury during defaecation: a case report.

A rare form of burn injury sustained during the process of defaecation is described. The importance of this case, in addition to its unique nature, lies in the fact that it enabled us to create a much greater awareness of burn injuries in the targeted population. The step-by-step analysis of the problem and implementation of health education is described. It has particular relevance in the developing countries.