A questionnaire-based survey of dry eye disease among leather tannery workers in Kanpur, India: a case-control study.

CONTEXT: Kanpur is a major leather processing center in India, where a large number of tanneries are situated. During tanning process, workers are constantly exposed to heat, leather dust produced in buffering operations and a wide range of chemicals. All these factors are known to cause dry eye. Being ophthalmologists of a tertiary health care center in Kanpur, we used to notice over a period of time that a considerable number of patients with dry eye symptoms, attending our out-patient department, were related to leather tanning industries. But, no published data is available on the prevalence of and risk factors for dry eye disorders among tannery worker. OBJECTIVE: To estimate the prevalence of dry eye problem and its severity among the workers of leather tanneries in the industrial belt of Kanpur and to evaluate various risk factors related to it. METHODS: In this cross-sectional case-control study, Ocular Surface Disease Index (OSDI) Questionnaire was presented to randomly selected tannery workers and control group. OSDI score was calculated based on subjects' response, and was evaluated with OSDI chart to assess the magnitude of dry eye symptoms and to grade its severity. RESULTS were analyzed statistically to evaluate the significance level. RESULTS: A total of 800 workers were selected by simple random sampling, out of which 72 workers were excluded from the study. Thus the questionnaire was presented to a total of 728 workers, while control group included 260 individuals. All the workers as well as controls were male with age ranging from 20 to 59 years. The mean age for tannery workers was 34.05 ± 8.96 years and that for control group was 32.97 ± 10.59 years (p = 0.14). The tannery workers had mean duration of work at tanneries for 6.99 ± 4.86 years. The prevalence of dry eye symptoms among tannery workers was 33.79% (95% CI: 30.35-37.24), while that in control group was 15.77% (95% CI: 11.31-20.23) (p < 0.0001). Among symptomatic workers, 47.96% (95% CI: 41.68-54.26) workers had mild, 36.99% (95% CI: 30.91-43.07) workers had moderate and 15.04% (95% CI: 10.54-19.54) workers had severe dry eye symptoms. Severe symptoms were more prevalent among symptomatic workers of age ≥ 40 years in comparison to those <40 years (34.72% versus 6.90%, p < 0.0001). With increase in duration of work (1-5, 6-15 and 16-25 years), both prevalence and severity of dry eye symptoms increased significantly (p = 0.036 and <0.0001, respectively). CONCLUSION: Dry eye is a significantly prevalent occupational hazard among tannery workers, severity of which increases with the age and the duration of work in tannery. Chemical exposure in hot and dusty working environment of a tannery may have a causative role. Tannery workers should be motivated to use various preventive measures to reduce chemical and dust exposure such as wearing protective glasses, and their ocular health should be monitored periodically for adequate and timely treatment, if required.

Role of multilayered amniotic membrane transplantation for the treatment of resistant corneal ulcers in North India.

To study the role of multilayer amniotic membrane transplantation (AMT) in the treatment of non-healing corneal ulcers. This study included 28 patients with non-healing bacterial corneal ulcers. AMT was performed using the 'overlay on-inlay' technique'. The outcome was assessed in terms of best corrected visual acuity (BCVA), corneal re-epithelization, graft/tissue edema and vascularity, graft melting, graft retraction, infection of graft and surface necrosis. The success rate of ulcer healing was 82.1 % (23 patients) 1 month after surgery, 78.5 % (22 patients) after 3 months and 75 % (21 patients) after 6 months. In the early post-operative period, BCVA deteriorated in all patients (perception of light to hand movement) but improved later. In 26 of the 28 patients (92.8 %) graft retraction occurred after 1 month and neovascularization was seen in 17 of the 28 patients (60.7 %). Multilayer AMT using an overlay on-inlay graft in non-healing bacterial corneal ulcers is a good option in terms of ulcer healing and symptomatic improvement.

Efficacy, Safety and Immunogenicity of Sun's Ranibizumab Biosimilar in Neovascular Age-Related Macular Degeneration: A Phase 3, Double-Blind Comparative Study.

INTRODUCTION: The study aimed to evaluate comparability in terms of efficacy, safety and immunogenicity of Sun's ranibizumab biosimilar with reference ranibizumab in patients with neovascular age-related macular degeneration (nAMD). METHODS: This prospective, randomised, double-blind, two-group, parallel-arm, multicentre, phase 3 comparative study included patients with nAMD ≥ 50 years, randomised (in a 2:1 ratio) in a double-blind manner to receive 0.5 mg (0.05 mL) intravitreal injection of either Sun's ranibizumab or reference ranibizumab in the study eye every 4 weeks until week 16 (total of four doses). RESULTS: Primary endpoint results demonstrated equivalence in the proportion of patients who lost fewer than 15 letters from baseline best-corrected visual acuity (BCVA) to the end of week 16 (99% of patients in Sun's ranibizumab and 100% in reference ranibizumab; p > 0.9999), with the proportional difference (90% confidence interval) at -1% (-2.51, +0.61) lying within a pre-specified equivalence margin. Visual acuity improved by 15 or more letters in 43% of Sun's ranibizumab group and 37% of the reference ranibizumab group (p = 0.4267). The mean increase in BCVA was 15.7 letters in Sun's ranibizumab group and 14.6 letters in the reference ranibizumab group (p < 0.001 within both groups and p = 0.5275 between groups). The mean change in central macular thickness was comparable between groups (p = 0.7946). Anti-ranibizumab antibodies were found in one patient of the reference ranibizumab group, while neutralising antibodies were not found in any patients. Both products were well tolerated. CONCLUSION: Sun's ranibizumab biosimilar is found to be therapeutically equivalent to reference ranibizumab in patients with nAMD. There were no additional safety or immunogenicity concerns. TRIAL REGISTRATION: CTRI/2020/09/027629, registered on 07 September 2020.

Electrophysiological and Visual Parameter Changes in Retinitis Pigmentosa Patients undergoing Autologous Platelet-Rich Plasma Therapy: A Randomized Control Trial.

Purpose: To assess the efficacy of autologous platelet-rich plasma (PRP) injections in suprachoroidal space and subtenon space in cases of retinitis pigmentosa, which is a genetic disease, leading to gradual loss of vision. Till date, no treatment is available. Methods: Seventy-eight eyes of 39 patients of retinitis pigmentosa having visual acuity ranging from reading of Early Treatment Diabetic Retinopathy Study (ETDRS) chart from 1 m onward to patients who were not able to read the ETDRS chart but whose visual acuity ranged from finger count close to face to <1 m were included in the study. The left and right eyes of each patient were randomized as the intervention eye and control eye. 0.2 mL of autologous PRP was injected in suprachoroidal space and 0.5 mL of PRP was injected in subtenon space of the intervention eye taking aseptic precautions. Injections were repeated at 15-day intervals up to 3 injections. Results: Majority of patients were in the age group of 18-30 years (20 cases) followed by 31-45 years (13 cases) and more than 45 years (6 cases). Intervention eyes showed a statistically significant improvement in visual acuity and multifocal electroretinography (mfERG). Improvement was noted in amplitude density latency and in ring ratio of mfERG. There was a significant improvement in best-corrected visual acuity (BCVA). However, no improvement in mfERG or BCVA was observed in the control group. Conclusions: Gene therapy may be the ultimate cure for retinitis pigmentosa, but it is unaffordable for many patients due to its high cost. PRP may be recognized as a modality to improve vision and stop further deterioration, especially in cases where functional vision is preserved. Negligible treatment costs and affordability will give power to economically disadvantaged patients.

Study to Evaluate Stress Among Ophthalmic Surgeons with Different Levels of Surgical Experience.

AIM: To assess and quantify the stress in two different groups of ophthalmic surgeons while performing cataract surgery. MATERIALS AND METHODS: This is a prospective observational institutional study. Healthy ophthalmic surgeons (4 trainee surgeons and 4 consultants) and 4 OT assistants without any history of systemic illness were studied while performing uncomplicated and uneventful cataract surgery. Resting state and post-operative (immediately after surgery) systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), and oxygen saturation (SPO2) were measured by a Comen C80 multi-parameter monitor. Blood cortisol levels were measured by chemiluminescent assay (CLIA) and urine catecholamines levels (adrenaline, nor-adrenaline and dopamine) were measured by high performance liquid chromatography (HPLC). For assessment of stress among one group, paired t-test is used and for comparison of stress levels between trainee surgeons and consultants unpaired t-test is used. RESULTS: Consultants performed phacoemulsification and trainee surgeons performed small incision cataract surgery. In both the groups, the post-operative values of SBP, DBP, PR, blood cortisol, and urine catecholamines were significantly higher than the pre-operative values. This difference was statistically significant. There was a significantly higher increase in SBP, DBP, PR, blood cortisol, urine adrenaline, and urine dopamine in trainee surgeons as compared to consultants whereas there was a significantly higher increase in urine nor-adrenaline in consultants as compared to trainee surgeons. CONCLUSION: Our study reveals that every surgeon is under stress irrespective of experience though the level of stress is different among surgeons.

Warthin-like variant of Papillary thyroid carcinoma-Case report of an uncommon tumour with review of literature.

BACKGROUND: Warthin-like variant of Papillary thyroid carcinoma (WLPTC) is an uncommon variant of PTC. They resemble Warthin tumour of salivary gland. Microscopically the tumour shows presence of papillae lined by oncocytic cells with typical nuclear features of PTC. The stalks of papillae were filled up with lymphoplasmacytic cells. WLPTC have good prognosis. CASE REPORT: A 45-year-old lady presented with thyromegaly. She underwent total thyroidectomy with bilateral selective neck dissection (level II - level VI). Her final histopathology report was WLPTC, Right lobe with lymph nodal metastasis. Post-operatively, she received I131 radio-iodine therapy. She is under follow-up for last four years and is doing well. CONCLUSION: Diagnosing WLPTC, a rare variant of PTC can be challenging. Definitive diagnosis helps in management.

Central serous chorioretinopathy secondary to tuberculosis: cause or coincidence.

32-year-old male with diagnosis of central serous chorioretinopathy (CSCR) in both eyes and negative history of administration of any medicine was treated with bilateral focal laser at leakage point, with visual recovery. Recurrence occurred after 2 years in right eye and was treated successfully with acetazolamide. Second recurrence occurred after 1 year. Acetazolamide was restarted, but no improvement was noted. Thorough re-evaluation of the patient revealed a family history of tuberculosis. Ancillary investigations rendered the presumptive diagnosis of tuberculosis, and antituberculosis treatment led to visual recovery with no recurrences. Present case poses two dilemmas: whether CSCR was secondary to tuberculosis or was it an incidental association in tuberculosis endemic population and second whether resolution occurred due to the treatment of tuberculosis or due to mineralo-corticoid antagonism action of rifampicin. Significance of patient's history, clinical observation and angiographic studies in the diagnosis of idiopathic and recurrent CSCR is reiterated.

Scleral buckling-induced ocular parameter changes in different age group patients of rhegmatogenous retinal detachment.

PURPOSE: This study was aimed to evaluate the difference in the ocular parameter changes following scleral buckling (SB) for rhegmatogenous retinal detachment (RRD) in different age group patients. MATERIALS AND METHODS: This prospective study included 26 eyes of 26 patients who underwent SB for uncomplicated RRD. The patients were divided into three age groups: 16-30 years (Group I), 31-45 years (Group II), and 46-60 years (Group III). Axial length (AL), anterior chamber depth (ACD), and corneal curvatures were measured preoperatively and postoperatively at 1 week, 1 month, and 3-month. The postoperative change and progression of these parameters were evaluated and compared between three age groups using nonparametric Wilcoxon signed-rank test and Kruskal-Wallis test. RESULTS: At 3-month follow-up, a statistically significant postoperative AL increase, ACD decrease, and surgically induced astigmatism (SIA) were observed in all groups (Group I - 0.75 ± 0.32 mm, 0.21 ± 0.21 mm, and 1.5 ± 0.48 D, respectively; Group II - 0.79 ± 0.41 mm, 0.14 ± 0.04 mm, and 2.07 ± 1.18 D, respectively; Group III - 0.86 ± 0.33 mm, 0.16 ± 0.05 mm, and 1.56 ± 1.19 D, respectively). However, surgery-induced change for any parameter was not significantly different between the groups (P for AL [0.7955]; ACD [0.8805]; and SIA [0.5485]). Progression in postoperative changes in AL and ACD was insignificant during three follow-up examinations in all the groups. However, SIA of Group I continued to change significantly up to 3 months but stopped to change at 1 month only in Group II and III. CONCLUSION: Age-related change in physical properties of ocular tissue does not have any major additional effect on the results of SB except that the postsurgical change in corneal curvature stops earlier in older patients compared to that in younger patients.

Cluster endophthalmitis following multiple intravitreal bevacizumab injections from a single use vial.

The risk of endophthalmitis is always a concern when an intraocular procedure is performed. Intravitreal injection is a frequently used method for therapeutic management of many diseases, affecting the posterior segment of the eye. Hence, it is important to assess the risk of complications, especially endophthalmitis. Most studies conducted concentrate on risk assessment from single use from single drug vial. The present article reports the occurrence of cluster endophthalmitis following multiple intravitreal bevacizumab injections from a single vial. Intravitreal injection of bevacizumab was administered to eight eyes of eight patients. Administered dose was prepared from single 4-ml vial of bevacizumab and was injected in the eye, after patient preparation and under aseptic conditions. The procedure was repeated for the remaining patients, thereby imparting multiple pricks in the same vial. Four of the eight patients reported to the hospital on the 3rd day after injection with complaints of pain, watering, and diminution of vision. Two patients reported the following day with similar complaints. Two patients who did not report by the 4th day were contacted and recalled for an examination. All the patients were thoroughly examined using slit lamp biomicroscopy and indirect ophthalmoscopy. Six out of eight were clinically diagnosed to have endophthalmitis and were administered intravitreal antibiotics. The present report highlights possibility of microbial contamination of the drug vial or during compounding process. However, from the present incident, we are encouraged to stay vigilant and wary of contamination.

Clinical Objective Dry Eye Tests in a Population of Tannery Workers in North India.

PURPOSE: To analyze the correlation between subjective symptoms and clinical signs of dry eye among tannery workers. METHODS: In this cross-sectional study, three classic clinical tests, namely the fluorescein tear film break-up time (FTBUT) test, the fluorescein staining (FS) test, and the Schirmer test (ST), were performed to assess the clinical signs of dry eye disease in 246 tanners who were found symptomatic for dry eye in a prior ocular surface disease index survey. RESULTS: All workers were male with a mean age of 35 ± 9 years, and the mean duration of work at tanneries was 8 ± 5 years. Among 246 symptomatic subjects, the FTBUT test, the FS test and the ST were positive in 63.8%, 30.9% and 41.9% workers, respectively. Mean FTBUT and ST scores were 10.6 ± 4.2 seconds and 10.1 ± 7.7mm, respectively. Mean FTBUT for mild, moderate and severe symptom categories differed significantly. Mean ST scores for the mild symptom group were significantly higher than that of the moderate group (p < 0.0001). The FTBUT and ST score showed a strong negative correlation with severity of symptoms (p < 0.0001). A moderate positive correlation was observed between FS positivity and increasing symptom severity (p < 0.0001). The effect of age was insignificant for FTBUT (p = 0.10), while significant for ST score (p < 0.001). The effect of duration of tannery work was significant for both FTBUT and ST scores (p < 0.0001). CONCLUSION: Clinical tests correlated well with symptom severity among tanners, and a multifactorial etiology is suggested for dry eye diseases.

An unusual case of bilateral multifocal retinal pigment epithelial detachment with methanol-induced optic neuritis.

PURPOSE: To describe an unusual case of methanol-induced optic neuritis with bilateral multifocal extrafoveal serous retinal pigment epithelial (RPE) detachment. METHODS: Single case report. CASE REPORT: A 40-year-old male presented with acute bilateral loss of vision and history of consumption of adulterated alcohol. On examination, his vision was perception of light in the right eye and finger counting at 1-ft distance in the left eye. Pupillary reactions were sluggish. The optic discs were normal. An elevated lesion with subretinal serous fluid was present over macula adjacent to superior major vessel arcade in the right eye, which was confirmed as a large extrafoveal RPE detachment on fluorescein angiography. There were two more small RPE detachments in the right eye as well as in the left eye. All RPE detachments were extrafoveal in location. The patient was managed medically with intravenous methylprednisolone (1 g) in 500 ml of ringer lactate for three consecutive days. After three doses, visual acuity of both eyes was recorded as 20/20. CONCLUSION: We herein report an unusual case of bilateral multifocal extrafoveal serous RPE detachment in a patient of methanol-induced optic neuritis. RPE detachments may be due to the toxic effect of methanol metabolites.