Telemedicine in diabetic retinopathy screening in India.

With ever-growing prevalence of diabetes mellitus and its most common microvascular complication diabetic retinopathy (DR) in Indian population, screening for DR early for prevention of development of vision-threatening stages of the disease is becoming increasingly important. Most of the programs in India for DR screening are opportunistic and a universal screening program does not exist. Globally, telemedicine programs have demonstrated accuracy in classification of DR into referable disease, as well as into stages, with accuracies reaching that of human graders, in a cost-effective manner and with sufficient patient satisfaction. In this major review, we have summarized the global experience of telemedicine in DR screening and the way ahead toward planning a national integrated DR screening program based on telemedicine.

Management of age-related macular degeneration.

With the increase in life expectancy across the world, the magnitude of blindness due to age-related macular degeneration (AMD) is expected to rise. Exudative form is the major cause of visual loss from AMD. Several treatment options are available for this form of the disease. However, all treatment strategies aim at preservation of residual vision rather than regaining the lost vision. Two well-proven strategies are laser photocoagulation and photodynamic therapy. Other viable options are submacular surgery, transpupillary thermotherapy and pharmacological modalities like angiostatic-steroids. Oral anti-oxidants and zinc appear to be beneficial in preventing disease progression in early cases. Further research is on to explore more efficient treatments and to prove the safety and efficacy of large number of emerging newer treatment options.

An outbreak of trematode-induced granulomas of the conjunctiva.

PURPOSE: To describe the epidemiologic, clinical, and histopathologic features of trematode granulomas of the conjunctiva, eyelid, and anterior chamber in pediatric patients. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Forty-one children from a southern Indian village with conjunctival granulomas. METHODS: The village of Sellananthal was selected for a field visit after analysis of earlier hospital-based allergic conjunctival granuloma cases. Children with ocular diseases were examined, and histories of exposure to assumed risk factors and clinical findings were evaluated. Selected patients were brought to the base hospital for excisional biopsy. Serial sections obtained from the excised nodules were examined for the presence of a parasite. MAIN OUTCOME MEASURES: Histopathologic examination of excised conjunctival lesions or response of lesions to local medical therapy. RESULTS: In this year-long prospective study, 41 children (16 years or younger; 38 boys and 3 girls) with clinical features of allergic conjunctival granulomas were examined. Thirty-four patients were from a single village located in the southern Indian state of Tamil Nadu; the remaining 7 were from various parts of the same state. All children swam in their village's freshwater pond. Twenty patients with nodules less than 5 mm in diameter received medical treatment; 13 with larger nodules underwent surgical excision of the lesions. Nine of these 13 cases revealed a zonal granulomatous inflammation admixed with eosinophilic leukocytes; 4 of these 9 displayed fragments of the tegument and internal structures of a trematode and Splendore-Hoeppli phenomenon. The remaining 4 of the 13 cases revealed nongranulomatous inflammation made up of lymphocytes, histiocytes, and eosinophils. Eight patients refused surgical treatment. CONCLUSIONS: In southern India, one cause of allergic conjunctival granulomas in children seems to be trematode infection. The clustering of cases in a single village and exposure to a village freshwater pond indicate the need for an epidemiologic investigation and study of the parasite's life cycle. Sporadic cases from other parts of the state with similar histories of exposure to their local pond or river water suggest a widespread distribution of the etiologic agent.

Malignant melanoma of choroid.

Four cases of malignant melanoma of the choroid are reported due to rarity of the condition in India. One of the cases presented with Naevus of Ota. All the cases had typical clinical and investigative features. All cases were enucleated. Histopathologically three of them were of mixed type and one was of the epithelioid type. Two of the cases were seen in patients below 40 years of age.

Immunological status of patients of Eales' disease.

To test the hypothesis that altered immune reactivity to an extraneous agent might lead to primary retinal perivasculitis, a study was undertaken to determine the serum immunoglobulin levels, T lymphocyte subsets, antibody responses to BCG and 'S' antigen, and lymphoproliferative response to mitogens. No difference was observed in these parameters between patients and controls. Both Mantoux positive and negative conditions existed in patients with Eales' disease. Mantoux positive patients showed a higher level of lymphoproliferative response in vitro to PPD than Mantoux positive controls, indicating the presence of two populations among Eales' patients.

Combined photocoagulation and cryotherapy in treatment of Eales' retinopathy. Preliminary report.

This is a preliminary report of Eales' disease study (EDS). Compilation of two years data shows that combined xenon are photocoagulation and peripheral cryotherapy has beneficial effects in treatment of Eales' disease with grade II and grade III retinopathy. In very advanced stage of the disease (grade IV retinopathy) the treatment has no beneficial effects and untreated also it leads to vitreous haemorrhage and traction retinal detachment. The Eales' disease study (EDS) is still an on-going project and recruitment of the patients is continuing. Over another year we hope to have a larger number of patients, accumulate enough data and cover a longer follow-up period to substantiate these preliminary findings.

Wedge scleral buckling in prevention of fish mouth phenomenon in retinal detachment surgery.

Wedge scleral buckling done in 45 eyes of 43 patients with ballooning detachment and large horseshoe tears where fish-mouth phenomenon was anticipated pre-operatively is analysed. In all of the cases, the retinal break settled on the wedge buckle after drainage of sub-retinal fluid and there was no radial retinal folds over the buckle nor was there fish-mouthing of the tears. The final success rate was 89%. There were no significant operative or post-operative complications and in none of the cases was there extrusion of implant or infection.

Photocoagulation of serous detachments of the retinal pigment epithelium in patients with senile macular disease.

Twenty-one eyes of 18 patients aged 58 to 78 years (mean: 66 years) showing serous retinal pigment epithelial detachment associated with senile macular degeneration underwent green argon laser photocoagulation and were observed from 7 to 69 months (mean: 27 months). Treatment collapsed the retinal pigment epithelial detachment in 17 eyes (81.0%). Sustained improvement in visual acuity was obtained in seven eyes (33.3%), and stabilization of visual acuity in one eye. Analysis of available data describing the natural history of this condition indicates that although photocoagulation does not reduce the incidence of choroidal neovascularization, the treatment can be beneficial.

Clinical trail of intravitreal C F in retinal detachment surgery.

A mixture of 40% octafluorocyclobutane (C4F8) and 60% air was used clinically in eight patients with long-standing retinal detachment. In seven cases the retina reattached after intravitreal injection of C4F8 and intrascleral diathermization of the retinal tear. The one failure was due to massive vitreous retraction and preretinal proliferation prior to the surgery. Except for a slight postoperative iritis when 4 cc of gas lasted for 12 to 30 days after intravitreal injection. On the basis of this and our previous studies, we recommend the use of C4F8 in retinal detachment surgery.