Measurement of dynamic pupillometry parameters in adult Indian population.

PURPOSE: To determine normative dynamic pupillometry data in healthy Indian adults and to investigate the effect of age on various pupillary parameters. METHODS: Pupillometry measurements were obtained on healthy participants using an automatic dynamic pupillometry device, the NPi-200 (NeurOptics Inc., Irvine, CA, USA). Various measurements, including neurologic pupil index (NPi), resting pupil size (Size), minimum pupil diameter (MIN), percentage change in pupil size (CH), constriction velocity (CV), maximum constriction velocity (MCV), latency (LAT), and dilatation velocity (DV), were obtained in routine clinical settings and analyzed statistically for change with age. RESULTS: A total of 470 participants (470 eyes) were analyzed. Mean NPi was 4.31 ± 0.31, Size was 4.38 ± 0.80 mm, MIN was 2.87 ± 0.49 mm, CH was 34.67 ± 4.15%, CV was 2.74 ± 0.68 mm/s, MCV was 4.16 ± 0.98 mm/s, LAT was 0.23 ± 0.02 s, and DV was 1.13 ± 0.25 mm/s. NPi and LAT were positively correlated (P < 0.01), whereas Size, MIN, CH, CV, MCV, and DV were negatively correlated with age (P < 0.01). No statistically significant difference was observed between males and females. CONCLUSION: The study offers normative data on dynamic pupillometry parameters across various age groups within a healthy Indian population, which would serve as a reference for future studies in diverse clinical scenarios. It also elucidates that age significantly influences values in the NPi algorithm.

Interdevice Agreement between a Smartphone and a Commercial Pupillometer.

Background: The reliability of dynamic pupillometry parameters varies from one pupillometer to another, making it difficult to standardize the values for any particular device. Hence, further studies are required to evaluate the agreement of various pupillometer devices and explore their utility in routine clinical settings. Aim: This study sought to evaluate the agreement between smartphone and commercial pupillometer measurements in routine clinical settings. Methods: The study included pupillary measurements obtained by a single investigator from 100 healthy participants (200 eyes) with each pupillometer. Pupillary measurements taken by a smartphone pupillometry application (reflex pupillary light reflex analyzer by Brightlamp [Indianapolis, IN, USA]) were compared with a commercial pupillometer (neurological pupil index-200, NeurOptics Inc., Irvine, USA). Results: The comparison of descriptive statistics revealed a statistically significant difference between the smartphone and commercial pupillometers for various parameters, including maximum diameter, minimum diameter, constriction velocity (CV), maximum CV, and dilatation velocity (P < 0.05), except for latency (P = 0.36). The intraclass correlation coefficient revealed poor agreement between the two devices (<0.50). Conclusion: The measurements by smartphone pupillometry application were found to be unreliable, indicating that they may not be an ideal substitute for commercial pupillometers in their present form in the Indian population. Further studies with larger sample size as well as improvements in the processing and interpretation of the measurements by the software, are needed to determine its utility in routine clinical settings.

Paediatric cornea crosslinking current strategies: A review.

Background: In the general population, 1 in 2000 people has keratoconus. Indians and other people from Southeast Asia have a higher incidence of keratoconus. Children with keratoconus typically present earlier in life and with a more severe disease. Rubbing the eyes has been identified as a risk factor. Children have a higher incidence and a faster rate of keratoconus progression. Visual rehabilitation in children with keratoconus is challenging. They have a low compliance with contact lens use. Many of these children require penetrating keratoplasty at an early age. Therefore, stopping the progression of keratoconus in children is of paramount importance. Main text: Compared to treatment, keratoconus progression prophylaxis is not only preferable, but also easier. Corneal collagen cross-linking has been shown to be safe and effective in stopping its progression in children. The Dresden protocol, which involves central corneal deepithelization (7-9 â€‹mm), saturation of the stroma with riboflavin (0.25%), and 30 â€‹min UV-A exposure, has proven to be the most successful. Two significant disadvantages of the typical Dresden regimen are the prolonged operating time and the significant post-operative pain. Accelerated-CXL (9 â€‹mW/cm2 x 10 â€‹min) has been studied to reduce operative time and has been shown to be equally effective in some studies. Compared to accelerated CXL or traditional CXL, epi-off procedures, transepithelial treatment without the need for de-epithelialization and without postoperative discomfort, have been shown to be safer but less effective. Corneal crosslinking should only be performed after treating children with active vernal keratoconjunctivitis. Corneal opacity, chronic corneal edema, sterile infiltrates, and microbial keratitis have been reported after cross-linking of corneal collagen. Conclusions: The "Dresden protocol", also known as the conventional corneal cross-linking approach, should be used to halt the progression of keratoconus in young patients. However, if the procedure needs to be completed more rapidly, accelerated corneal crosslinking may be considered. Transepithelial corneal cross-linking has been proven to be less effective at stabilizing keratoconus, although being more safer.

Effect of mydriatic eye drops (combined 0.8% tropicamide and 5% phenylephrine) on the measurements of corneal parameters using Pentacam.

Purpose: The purpose of the study is to investigate the effects of combined 0.8% tropicamide and 5% phenylephrine on the corneal parameters using Pentacam. Methods: The study was performed on 200 eyes of 100 adult patients visiting the ophthalmology clinic for evaluation of refractive errors or cataract screening. Mydriatic drops (Tropifirin; Java, India) containing tropicamide 0.8%, phenylephrine hydrochloride 5%, and chlorbutol 0.5% (as a preservative) were instilled into the eyes of the patients three times every 10 minutes. The Pentacam was repeated after 30 minutes. The measurement data of various corneal parameters from different Pentacam displays (keratometry, pachymetry, densitometry, and Zernike analysis) was manually compiled on an Excel spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) 20 software. Results: Analysis of Pentacam refractive maps revealed a statistically significant increase (P < 0.05) in the values of radius peripheral (cornea front), pupil center Pachymetry, pachymetry apex, thinnest location Pachymetry, and cornea volume. However, pupil dilation did not affect the Q-value (asphericity). Analysis of the densitometry values revealed significant increase in all zones. Aberrations maps revealed statistically significant increase in the value of spherical aberration after the induction of mydriasis, but the values of Trefoil 0º, Trefoil 30º, Koma 90º, and Koma 0º were not affected significantly. We did not observe any untoward effect of the drug, except transient blurring of vision. Conclusion: The current study showed that routine mydriasis in the eye clinics leads to a significant increase in various corneal parameters including corneal pachymetry, cornea densitometry, and spherical aberration as measured by Pentacam, which can influence the decision-making in the management of various corneal diseases. The ophthalmologists should be aware of these issues and make adjustments in their surgical planning accordingly.

Flap motility sign: not diagnostic of posterior extension of anterior capsular tears.

Flap motility sign has been recently described as an aid to guide the surgeons regarding the feasibility of continuing safe phacoemulsification in the presence of peripheral extension of anterior capsular tears. While this sign may seem to provide a safety assurance to the operating surgeon who at such times may be under considerable stress, we believe, this sign may not always hold true and this hypothesis needs further investigation. We present a case in which an everted and fluttering flap was noted in the presence of a complete posterior extension of the anterior capsular tear, thus refuting the accuracy of flap motility sign.

Molecular identification and phylogenetic relationship of Demodex mites based on mitochondrial 16S rDNA.

BACKGROUND AND OBJECTIVE: Demodex mites are tiny parasites that live around hair follicles of mammals. The two main species of Demodex i.e. Demodex folliculorum and Demodex brevis present in humans are found near the hair follicles of eyes. The present study was to understand the presence of Demodex mites in people suffering from blepharitis in Amritsar, Punjab. MATERIAL AND METHODS: Demodex mites samples present in blepharitis patients were isolated from the eyelashes. DNA was isolated from three mites and used for PCR amplification of mitochondrial (mt) 16S rDNA. The amplified PCR product were purified and used for molecular identification. RESULTS: The amplified mt16s rDNA product was sequenced and subjected to BLAST search in the NCBI database for molecular identification. The identified mite belongs to Demodex folliculorum species. The phylogenetic tree constructed by using mt16s rDNA sequence suggests that D. folliculorum is closer to D. canis than to D. brevis. CONCLUSION: All the three isolates belong to D. folliculorum and the mitochondrial DNA 16S rDNA partial sequence is applicable for phylogenetic relationship analysis.

A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study.

BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients' average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients' pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study

ABSTRACT BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients' average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients' pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

Ophthalmic manifestations of Paederus dermatitis.

PURPOSE: To report the pattern of ophthalmic manifestations associated with Paederus dermatitis (PD). SETTING: Department of Ophthalmology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India. DESIGN: Clinic-based retrospective study. METHODS: Medical charts of patients presenting to the eye clinic with clinical features consistent with the diagnosis of PD from May 1, 2014 to April 30, 2016 were retrospectively reviewed. Relevant demographic and clinical data of periocular and ocular findings were collected and analyzed. The patients with a history of chronic skin disorders or allergies were excluded from the study. RESULTS: A total of 56 patients were included in the study, of which 39 (69.6 %) were males. The age range was 4-65 years with a median of 27 years. On presentation, common subjective symptoms were burning sensation in 49 (87.5 %), itching in 37 (66.1 %), watering in 25 (44.6 %), foreign body sensation in 19 (33.9 %), blurring of vision in 17 (30.4 %), and photophobia in 12 (21.4 %) patients. Visual acuity at presentation was 20/20 in 39 (69.6 %) patients, between 20/30 and 20/80 in 9 (16.1 %) patients, and less than 20/80 in 8 (14.3 %) patients. Lid swelling, erythema, crusts, and vesicles were the common periocular findings; and conjunctival hyperemia, discharge, and corneal erosions were the common ocular findings. CONCLUSIONS: The current study shows that PD can cause significant ocular morbidity. Ophthalmologists, especially those who work in endemic areas, should be aware of this entity both in terms of management as well as for educating patients about the preventive measures.

Prevalence of corneal astigmatism before cataract surgery in Indian population.

The purpose of the study was to assess the prevalence of corneal astigmatism before cataract surgery in Indian population. The setting of this study was at the Sant Sarwan Dass Charitable Eye Hospital, Jalandhar, India. This is a clinic-based retrospective study. Charts of patients who underwent cataract surgery over a two-year period were retrospectively reviewed, and preoperative keratometric measurements were collected and analyzed. The mean age of 2316 patients (2502 eyes) was 59.54 ± 10.96 years. The corneal astigmatism was less than 1.0 Dioptre (D) in 796 eyes (59.37 %), 1.0-1.99 D in 716 eyes (28.62 %), 2.0-2.99 D in 187 eyes (7.47 %) and more than 3.0 D in 114 eyes (4.56 %). The mean corneal astigmatism was 1.04 ± 1.04 D and showed a gradual increase with age after the fourth decade. The astigmatism was with-the-rule in 709 (28.34 %), against-the-rule in 1298 (51.88 %), and oblique in 598 (23.9 %) eyes. There was a shift in astigmatism from with-the-rule to against-the-rule with increase in age. Over 40 % of the Indian patients undergoing cataract surgery have more than 1.0 D of corneal astigmatism and may benefit from the use of toric intraocular lenses. These data can be useful in planning to make this technology available for the patients.

Use of an autologous lamellar scleral graft to repair a corneal perforation.

To report the use of an autologous lamellar scleral graft to close a corneal perforation. Our patient was a 55-year-old female who presented with a paracentral 2 × 2 mm perforation in the center of a preexisting corneal opacity. Because of the unavailability of corneal tissue and the failure to seal the perforation with glue, a partial thickness lamellar scleral graft was harvested from the inferotemporal quadrant and used to close the corneal defect. There was gradual adherence and uptake of the scleral tissue into the surrounding cornea along with significant clearing over the next few months. At 9 months, her best-corrected visual acuity was 20/80 with a stable anterior chamber, focal posterior synechiae and early cataract changes. A band of iris tissue was observed within the lens substance extending posterolaterally from 1 to 7 o'clock positions. In the absence of donor corneal tissue and in selective emergency situations, an autologous scleral patch graft can be considered as a viable alternative in the treatment of full-thickness corneal perforations. We also report the presence of a band of iris tissue within the lens, a finding which has not been previously reported.

Features of Urrets-Zavalia syndrome after descemet stripping automated endothelial keratoplasty.

PURPOSE: To report a case series of pupil abnormalities consistent with features of Urrets-Zavalia syndrome (UZS) after Descemet stripping automated endothelial keratoplasty (DSAEK) for corneal edema secondary to corneal endothelial cell dysfunction. METHODS: Retrospective chart analysis of subjects who developed UZS after DSAEK at the University of Texas Southwestern Medical Center. RESULTS: We present a series of 7 eyes with features consistent with UZS, after undergoing DSAEK. Elevated intraocular pressures (IOP) were noted in the early postoperative period in all cases. Five of 7 had graft dislocation in the postoperative period and required rebubbling or repeat DSAEK to obtain a well-apposed graft. Patients were followed for 3 to 14 months and showed improvement in visual acuity and IOP, but fixed dilated pupils persisted. CONCLUSION: A fixed irregular or dilated pupil is a rare complication that can be associated with DSAEK surgery. Patients with an elevated IOP and complicated postoperative course seem to be at greater risk for developing iris ischemia and pupil abnormalities consistent with the diagnosis of UZS.

Acute corneal melt associated with topical bromfenac use.

PURPOSE: To report a case of acute corneal melt associated with use of bromfenac ophthalmic solution. METHODS: Case report. RESULTS: A 61-year-old man developed acute corneal melt 5 days after having combined cataract and pterygium surgery in his left eye. Postoperatively, he had been using bromfenac eyedrops four times daily along with the combination of ofloxacin and dexamethasone six times and timolol eyedrops twice daily. Ocular examination revealed the presence of asymptomatic dry eyes. He was managed conservatively with topical antibiotics, lubricants, and bandage contact lens application. The corneal melt healed completely with best-corrected visual acuity of 20/30 at 4 weeks postoperatively. CONCLUSIONS: The current case suggests that corneal melt can occur as a complication of inadvertent excessive use of topical bromfenac in the presence of preexisting ocular surface disorders. However, good visual outcome can be achieved by prompt conservative treatment if accurate diagnosis is made at an early stage.

Cataract surgery in a patient with unilateral cataracta membranacea.

Cataracta membranacea (CM) is a rare condition characterized by the remnants of lens capsules and fibrous proliferation that develops secondary to lens matter liquefaction and absorption. Although CM is usually bilateral and may be associated with other congenital anomalies and poor visual prognosis; it can rarely be seen in the adults with involvement of only one eye. Reported herein, is a case of 57-year-old man who presented with CM in his right eye and underwent successful in-the-bag intraocular lens implantation with good visual outcome.

A silent nasal mass with ophthalmic presentation.

Nasal chondromesenchymal hamartoma (NCMH) is a rare benign pediatric hamartoma that can simulate malignancy. It is apt to be misdiagnosed because of the overlapping histologic features shared with a number of benign and malignant soft tissue tumors. Here we report a case of this clinical entity in a child of 2.5 years of age. NCMH is histologically characterized by a mixture of various mesenchymal elements, including spindle cells, collagen fibers and irregular islands of osseous and chondroid tissue. The tissue was immunosensitive to SMA and calponin. This tumor has a benign biological behavior, and complete resection is the treatment of choice. Awareness of this clinical entity is essential for correct diagnosis and to avoid potentially harmful therapies.

Corneal power measurement with a rotating Scheimpflug imaging system after Descemet-stripping automated endothelial keratoplasty.

PURPOSE: To evaluate alterations in corneal power parameters after Descemet-stripping automated endothelial keratoplasty (DSAEK) using rotating Scheimpflug imaging. SETTING: University of Texas, Southwestern Medical Center, Dallas, Texas, USA. METHODS: Eyes that had DSAEK were evaluated with a rotating Scheimpflug imaging system (Pentacam). The outcome parameters were mean anterior and posterior keratometry (K), mean anterior radius of curvature and posterior radius of curvature, anterior and posterior astigmatism, central corneal thickness (CCT), true net power, corneal volume, keratometric power deviation, and mean zonal-equivalent K readings. These values were compared with those in a control group of age and sex-matched normal eyes. RESULTS: The DSAEK group comprised 32 eyes (28 patients) and the control group, 32 eyes. The mean anterior K, posterior K, and true net power were 42.53 diopters (D) +/- 1.52 (SD), -6.80 +/- 0.55 D, and 40.55 +/- 1.79 D, respectively, in the DSAEK group and 43.60 +/- 1.62 D, -6.20 +/- 0.31 D, and 42.49 +/- 1.57 D, respectively, in the control group. The posterior radius of curvature, anterior and posterior K values, and true net power were statistically significantly lower in DSAEK eyes than in control eyes (P<.01). The equivalent K readings were significantly lower in all zones in DSAEK eyes than in control eyes (P<.01). The mean CCT was significantly higher in DSAEK eyes than in control eyes (628 +/- 46 mum versus 553 +/- 35 mum) (P<.01). CONCLUSION: The true net power of the cornea decreased significantly after DSAEK, mainly because of an increase in posterior curvature. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Corneal higher-order aberrations after Descemet's stripping automated endothelial keratoplasty.

PURPOSE: To compare the corneal higher-order aberration (HOA) after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PKP), and in age-matched controls. DESIGN: Cross-sectional, non-comparative interventional case series. PARTICIPANTS: Thirty-one eyes of 28 patients who underwent DSAEK, 20 eyes of 16 patients who underwent PKP, and 31 eyes of 31 control patients. INTERVENTION: The corneal topography and HOAs of the central 4- and 6-mm zones from anterior and posterior corneal surfaces were evaluated postoperatively with the Scheimpflug rotating imaging system (Oculus Gmbh, Wetzlar, Germany). MAIN OUTCOME MEASURES: Anterior and posterior corneal HOAs. RESULTS: The mean anterior corneal total HOAs of the central 4 and 6 mm were 0.599+/-0.288 microm and 1.215+/-0.496 microm, respectively, in eyes that underwent DSAEK; 1.730+/-0.826 microm and 3.349+/-1.490 microm, respectively, in eyes that underwent PKP; and 0.439+/-0.163 microm and 0.921+/-0.300 microm, respectively, in controls. Although the mean anterior corneal total HOAs of the central 4 and 6 mm were significantly higher in eyes that underwent PKP than in eyes that underwent DSAEK and in controls (P<0.01), there was no significant difference in anterior corneal total HOAs of the central 4 and 6 mm between eyes that underwent DSAEK and controls. The mean posterior corneal total HOAs of the central 4 and 6 mm were 3.680+/-1.586 microm and 7.142+/-3.011 microm, respectively, in eyes that underwent DSAEK; 2.957+/-1.238 microm and 5.314+/-2.095 microm, respectively, in eyes that underwent PKP; and 0.818+/-0.193 microm and 1.609+/-0.344 microm, respectively, in controls. Although there was no significant difference in posterior corneal total HOAs of the central 4 mm between the DSAEK group and the PKP group, the posterior corneal HOAs of the central 6 mm were significantly higher in the DSAEK group than in the PKP group (P<0.01). CONCLUSIONS: Although posterior corneal HOAs are significantly higher in eyes that underwent DSAEK, anterior corneal HOAs are not significantly different in eyes that underwent DSAEK than those of age-matched controls.