Clinical and surgical outcomes of glaucoma drainage device tube in ciliary sulcus versus anterior chamber in North Indian glaucoma patients

Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.

Quality of life in glaucoma patients: Comparison of medical therapy, trabeculectomy, and glaucoma drainage device surgery

Purpose: To compare the quality of life (QoL) in patients with glaucoma on medical therapy and after trabeculectomy and glaucoma drainage device (GDD) using vision, glaucoma, and surgery?specific questionnaires. Methods: This cross?sectional study enrolled 30 patients of moderate to severe glaucoma, each in medical, trabeculectomy, and GDD groups. National Eye Institute Visual Function Questionnaire 25 (NEIVFQ?25), Glaucoma Quality of Life (GQL?15), and Surgery Specific Questionnaire (SSQ) were administered, and cumulative scores were compared. Results: The mean age of the participants was 58.95 ± 13.6 years with a male preponderance (73.3%, n = 66). The mean scores (SD) in the medical, trabeculectomy, and GDD groups using NEIVFQ?25 were 68.97 (6.98), 72.83 (7.81), and 75.20 (8.77), respectively, those using GQL?15 were 20.63 (6.00), 26.23 (9.12), and 28.43 (7.74), respectively, and for the SSQ, they were 74.33 (8.75) and 72.10 (5.92) in trabeculectomy and GDD groups, respectively. NEIVFQ?25 showed a better QoL in the GDD group compared to the medical group, whereas GQL?15 showed a better QoL in the medical group and comparable QoL in trabeculectomy and GDD. Both these QoL scores correlated to the LogMAR visual acuity. SSQ scores did not show a significant difference in the QoL across both surgical groups. Conclusion: NEIVFQ?25 questionnaire scores provided a holistic measure of QoL. GQL?15 assessed the activity limitation and visual disability of the patients but did not take into account the general health and psychological factors influencing the QoL. We did not find a significant difference between trabeculectomy and GDD using the SSQ. For QoL assessment in medically or surgically treated glaucoma, vision?specific and disease?specific questionnaires should always be used in conjunction

Normative database for Spaeth Richman contrast sensitivity test for Indian eyes

Purpose: To ascertain normative database of contrast sensitivity (CS) using Spaeth/Richman CS test (SPARCS) in the Indian population. Methods: This cross?sectional study enrolled 200 healthy individuals, and CS was tested in both eyes of each participant using SPARCS. A detailed ocular examination was done before enrollment to rule out pathologies that may affect CS. A practice test was performed in the right eye (OD), followed by uniocular testing in each eye and a final binocular test. Results: Data of 400 eyes of 200 subjects who fulfilled the inclusion criteria was evaluated. The average age of subjects was 46.57 ± 16.77 years (range 21–79 years), with a slight female preponderance (53%, n = 106). A statistically significant decline in average SPARCS scores was noted with increasing age (P < 0.05), ranging from 86.68 (20–29 years age group) to 67.44 (70–79 years age group). Higher scores were noted in binocular testing than uniocular testing (Interclass correlation coefficient [ICC] = 0.83; P < 0.001). Females achieved statistically significant higher total scores in uniocular SPARCS testing (both OD and OS), but there was no significant difference noted between the two genders in binocular testing. Correlation between practice and main tests was statistically Significant with an interclass correlation coefficient of 0.54 (P < 0.001). Conclusion: Normative database for SPARCS was established for Indian eyes, with a decreasing trend noted in peripheral as well as central CS scores with increasing age.

Twitter sentiment analysis for COVID-19 associated mucormycosis

Purpose: COVID?19?associated mucormycosis (CAM) was a serious public health problem during the second wave of COVID?19 in India. We planned to analyze public perceptions by sentiment analysis of Twitter data regarding CAM. Methods: In this observational study, the application programming interface (API) provided by the Twitter platform was used for extracting real?time conversations by using keywords related to mucormycosis (colloquially known as “black fungus”), from May 3 to August 29, 2021. Lexicon?based sentiment analysis of the tweets was done using the Vader sentiment analysis tool. To identify the overall sentiment of a user on any given topic, an algorithm to label a user “k” based on their sentiments was used. Results: A total of 4,01,037 tweets were collected between May 3 and August 29, 2021, and the peak frequency of 1,60,000 tweets was observed from May 17 to May 23, 2021. Positive sentiment tweets constituted a larger share as compared to negative sentiment tweets, with weekly variations. A temporal analysis of the demand for utilities showed that the demand was high in the initial period but decreased with time, which was associated with the availability of resources. Conclusion: Sentiment analysis using Twitter data revealed that social media platforms are gaining popularity to express one’s emotions during the ongoing COVID?19 pandemic. In our study, time?based assessment of tweets showed a reduction over time in the frequency of negative sentiment tweets. The polarization in the retweet network of users, based on sentiment polarity, showed that the users were well connected, highlighting the fact that such issues bond our society rather than segregating it.

Impact of moderate and severe primary open-angle glaucoma on quality of life due to activity limitation

Purpose: To study the impact of moderate and severe primary open?angle glaucoma (POAG) on the quality of life (QoL) due to activity limitation using glaucoma?specific questionnaires. Methods: This cross?sectional study enrolled 122 participants, 50% (n = 61) being controls and 50% were diagnosed cases of moderate/ severe POAG. Three orally administered glaucoma?specific QoL instruments were used: Glaucoma Activity Limitation (GAL?9), Glaucoma Quality of Life (GQL?15), and Viswanathan questionnaires. The questions related to activity limitation were identified and analyzed for each questionnaire separately. Results: The mean age of the participants was 61.04 ± 9.88 years and a majority were males (64.8%, n = 79). The mean scores in controls, moderate glaucoma, and severe POAG patients for GAL?9 questionnaire were 9.77 ± 1.36 (P = 0.44), 13.75 ± 4.76 (P < 0.001), and 23.45 ± 5.62 (P < 0.001), for GQL?15, these were 16.39 ± 2.18 (P = 0.5), 22.75 ± 7.89 (P < 0.001), and 39.34 ± 9.42 (P < 0.001), respectively, while for the Viswanathan questionnaire, they were 9.49 ± 0.94 (P = 0.38), 7.91 ± 1.59 (P < 0.001), and 4.41 ± 2.20 (P < 0.001), respectively. The GQL?15 and GAL?9 questionnaires concluded that activity limitation pertaining to dark adaptation?related tasks affected the QoL the most in moderate as well as severe POAG (P < 0.001). Using the Viswanathan questionnaire, it was observed that the peripheral vision?related activity limitation was most significant for the decrease in QoL in moderate POAG while near vision?related activity limitation affected the QoL the most in severe POAG (P < 0.001). Conclusion: All three questionnaires concluded that the activity limitation due to moderate and severe glaucoma has a negative impact on the QoL. The limitation of the tasks involving dark adaptation/glare and peripheral vision has the most significant impact on the QoL in moderate glaucoma. As the disease progresses to a severe category, the limitation of activities requiring central and near vision causes the most significant worsening in QoL.

A rare case of Enterococcus faecalis-induced orbital cellulitis and myositis.

Orbital cellulitis is an infection of soft tissue behind the orbital septum. Common pathogens isolated include Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae. It is a straightforward diagnosis and usually responds to empirical treatment without any sequela. We report a case of orbital cellulitis caused by Enterococcus faecalis, which was complicated by myositis of levator palpebrae superioris. To the best of our knowledge, only one case report exists dating way back to 1986.

Profile of angle closure in a tertiary care center in north India.

Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC) were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434) were diagnosed to have various subtypes of angle closure. Mean (±SD) age at presentation was significantly higher for males (57.57 ± 11.62 years) as compared to females (53.64 ± 10.67 years) (P < 0001). Primary angle closure glaucoma (PACG) was most frequently diagnosed subtype (49.38%) followed by Primary angle closure (PAC) (39.68%) and Primary angle closure suspect (PACS) (10.93%) respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction). Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical) done.

Acute orbital abscess complicating deep posterior subtenon triamcinolone injection.

A 54-year-old diabetic female presented with orbital abscess and corneal infiltrate 3 days after deep posterior subtenon triamcinolone acetonide injection in her right eye. This was administered immediately after focal laser photocoagulation for diabetic macular edema. The orbital abscess and corneal infiltrate responded to systemic and topical antibiotics.