Ocular manifestations in renal diseases.

The eyes and kidneys are the targets for end-organ damage in multiple pathologies. Both these organs develop during the same embryonic stage around the fourth to sixth week of gestation, thus sharing a strong correlation between both eye and kidney diseases. Both the eyes and kidneys can be the target of the systemic disease process; however, the eyes can also be affected as a consequence of renal disease or its treatment. Risk factors such as diabetes, hypertension, and smoking are commonly shared between kidney and eye diseases. Ocular manifestations can be predictive of renal disease, and/or patients with renal disease are at higher risk for developing ocular manifestations. Various congenital anomalies of the eyes and kidneys can also present as an oculorenal syndrome. This article summarizes the ocular pathology, which can be seen in renal diseases.

Preliminary results from the comparison of simple limbal epithelial transplantation with conjunctival limbal autologous transplantation in severe unilateral chronic ocular burns.

PURPOSE: To compare the safety, efficacy, and clinical outcomes of simple limbal epithelial transplantation (SLET) with conjunctival-limbal autologous transplantation (CLAU) in severe unilateral ocular chemical burns. MATERIALS AND METHODS: Twenty patients of unilateral chronic ocular burns with more than 270° limbal stem cell deficiency and a healthy fellow eye were divided into two groups - ten patients of Group A underwent SLET while ten patients of Group B were operated for CLAU. Patients were followed up for 6 months and assessed for a stable epithelialized ocular surface, extent of reduction in vascularization and forniceal reconstruction, improvement in corneal clarity and visual acuity. RESULTS: A stable epithelialized corneal surface was obtained in all patients, with a significant reduction in the mean clock hours of vascularization in both the groups (P < 0.001). The mean symblepharon score showed a statistically significant reduction from 1.80 ± 1.14 to 0.30 ± 0.63 in Group A and 1.70 ± 1.06 to 0.15 ± 0.24 in Group B at 6 months. Corneal clarity, as well as best-corrected visual acuity, showed a statistically significant improvement in both the groups. CONCLUSION: Both the procedures, SLET and CLAU, were equally effective in achieving a stable ocular surface, forniceal reconstruction, and regression of corneal vascularization. The requirement of minimal donor tissue in SLET makes it a preferred option over CLAU in cases of uniocular chronic ocular burns.

Evaluation of pattern electroretinogram in retinal vein occlusion treated with intravitreal triamcinolone acetonide.

PURPOSE: To evaluate pattern electroretinogram (pattern ERG) and anatomical changes in optical coherence tomography (OCT) in acute retinal vein occlusion with macular oedema after intravitreal triamcinolone acetonide (IVTA) injection. METHODS: In this prospective interventional study, 20 patients with acute retinal vein occlusion (branch and central) of less than 1 month duration were evaluated for pattern ERG, best-corrected visual acuity (BCVA), central macular thickness on OCT, and contrast sensitivity (CS) before and 1, 6 and 12 weeks after 1 mg IVTA injection. RESULTS: The amplitude of P50 wave (pattern ERG) improved from 3.01 ± 1.22 to 3.56 ± 1.29 µv, mean logMAR BCVA improved from 1.10 ± 0.60 to 0.69 ± 0.45, and CS improved from 0.45 ± 0.41 to 0.79 ± 0.29; mean central macular thickness (CMT) decreased from 515.35 ± 202.83 to 358.35 ± 135.4µ at 12 weeks. All the values were statistically significant (p value < 0.001). CONCLUSION: IVTA injection in acute retinal vein occlusion with macular oedema results in electrophysiological (pattern ERG) improvement in addition to anatomical (OCT) improvement.

Refractive outcome of wavefront guided laser in situ keratomileusis and wavefront guided photorefractive keratectomy in high pre-existing higher order aberration.

PURPOSE: To compare visual outcome and higher order aberrations (HOA) between wavefront-guided LASIK (WF-LASIK) and wavefront guided PRK (WF-PRK) in patients with high preoperative HOA. METHODS: Randomized prospective interventional study. Conducted at Guru Nanak Eye Centre, Maulana Azad Medical College, Delhi, India. Eighty myopic eyes of forty patients were included. INCLUSION CRITERIA: age more than 21 years, best corrected visual acuity of 20/20 or better, a stable refraction, to be off soft contact lens for minimum 14 days prior to preoperative examination, preoperative RMS HOA more than 0.35 µ, preoperative central corneal thickness at least 500 µm, estimated residual stromal bed thickness of at least 275 µm in patients undergoing WF-LASIK and 350 µm in patients undergoing WF-PRK. Exclusion criteria were severe dry eye, blepharitis, corneal disease and warpage, uveitis, posterior segment abnormalities involving the macula or optic nerve and systemic diseases. Patients were randomly divided into two groups. They underwent either WF-LASIK (group A) or WF-PRK (group B) over 2 years (40 eyes each). Patients were followed up for 6 months. Main outcome measures were efficacy, safety, stability, predictability and HOA. RESULTS: At 6 months mean uncorrected visual acuity (logMAR) in group A was -0.01 ± 0.04 and group B was 0.00 ± 0.07 (P = 0.23). HOA RMS (6mm pupil) in group A was 0.61 ± 0.24 µm and group B was 0.55 ± 0.25 µm. The increase was statistically significant in both the groups (P < 0.05). Both the groups showed similar efficacy, predictability and safety. CONCLUSION: WF-LASIK and WF-PRK have similar efficacy, safety and predictability, though WF-PRK induces less HOA.

Comparative evaluation of higher-order aberrations and corneal asphericity between wavefront-guided and aspheric LASIK for myopia.

PURPOSE: To compare visual outcome, higher-order aberrations, and corneal asphericity (Q value) between wavefront-guided and aspheric LASIK for myopia and myopic astigmatism. METHODS: Forty patients were randomly selected to receive wavefront-guided LASIK (wavefront-guided group) or aspheric LASIK (aspheric group) (40 eyes of 20 patients in each group) using the Technolas 217z excimer laser platform (Bausch & Lomb, Rochester, NY). Flaps were created using the Zyoptix XP microkeratome (Bausch & Lomb). Preoperative and postoperative evaluation included uncorrected distance visual acuity (UDVA), corneal topography, wavefront aberrometry, and contrast sensitivity. Minimum follow-up period was 6 months. RESULTS: At 6 months postoperatively, the aspheric group had significantly better UDVA (logMAR 0.04 ± 0.04 [Snellen 20/16] [range: -0.079 to 0.000]) and lower mean residual spherical error (+0.10 ± 0.52 diopters [D] [range: -1.12 to 1.25 D]) than the wavefront-guided group (logMAR UDVA 0.00 ± 0.07 [range: -0.079 to 0.176]; MRSE -0.35 ± 0.47 D [range: -1.5 to 0.62 D]) (P = .003 and < .001, respectively). Mean change in higher-order aberration root mean square at 6 months postoperatively (6-mm pupil) was 0.16 ± 0.17 µm after aspheric LASIK and 0.27 ± 0.28 µm after wavefront-guided LASIK (P = .02). Aspheric LASIK induced minimal change in spherical aberrations postoperatively (0.03 ± 0.12 µm, P = .09), unlike wavefront-guided LASIK (0.23 ± 0.17 µm, P < .01). Change in Q value was significantly less in the aspheric group (0.53 ± 0.31) than the wavefront-guided group (0.91 ± 0.30) (P < .01). The aspheric group had significant improvement in contrast sensitivity at all spatial frequencies (P < .01), whereas the wavefront-guided group showed a slight decrease at higher spatial frequency (18 cycles per degree). CONCLUSIONS: Aspheric LASIK induced significantly less change in higher-order aberrations and maintained corneal asphericity better than wavefront-guided LASIK. The visual outcome and contrast sensitivity was better in the aspheric group at 6 months postoperatively.

Congenital accessory palpebral aperture--an addition to the spectrum of Delleman syndrome.

Delleman syndrome (oculocerebrocutaneous syndrome, MIM 164180) is characterized by orbital cysts, microphthalmia/anophthalmia, focal skin defects, skin appendages and multiple cerebral malformations. We herein describe a case of an 8-month-old male child with features suggestive of Delleman syndrome along with a rare congenital lid anomaly - an accessory palpebral aperture, not reported so far to the best of our knowledge.

Results of corneal collagen cross-linking in pediatric patients.

PURPOSE: To evaluate the safety and efficacy of corneal collagen cross-linking (CXL) in the treatment of keratoconus in pediatric patients. METHODS: Epithelium-off CXL using the standard protocol was performed in 15 eyes from 15 patients (age range: 10 to 15 years) with moderate keratoconus in 1 eye and advanced disease in the fellow eye. Principal outcomes included uncorrected and corrected distance visual acuity (CDVA), refraction, and topography-derived outcomes of maximum and average keratometry (K). RESULTS: Mean uncorrected distance visual acuity improved significantly from 1.00 ± 0.30 (20/200) to 0.72 ± 0.29 (20/100) logMAR (P=.035) and mean CDVA from 0.56 ± 0.21 (20/70) to 0.30 ± 0.15 (20/40) logMAR (P=.003) at the end of 12 months. Mean change in apical K (1.01 ± 2.40 diopters) was also significant (P=.004). No significant complications were noted. CONCLUSIONS: Corneal collagen CXL was found to be safe and effective in the first 12 months for keratoconus in children with similar initial efficacy as in adults in terms of improvement in visual and topographic outcomes.