Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India

Purpose: To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome. Methods: A prospective interview-based analytical cohort study was conducted on 156 children aged 0� years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome. Results: The mean age of presentation was 7.78 � 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1�months, 11 (7%) had delay of 6� months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes. Conclusion: Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.

Audit of 1000 consecutive cases of sutureless cataract surgery in children above two years of age

Purpose: To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods: It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results: Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion: Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.

Novel technique for traumatic cyclodialysis repair with phacoemulsification and Cionni's ring implantation

A 17-years-old boy presented with cataract, 360° choroidal effusion and disc oedema secondary to chronic hypotony. Gonioscopy and AS-OCT revealed 2 clock hours of cyclodialysis in the superonasal quadrant. The case was successively managed with phacoemulsification with foldable IOL in the bag and Cionni's ring sutured in the superonasal quadrant. Post surgery, the BCVA improved from counting finger 1 meter to 20/40. IOP returned to normal and there was resolution of choroidal effusion and fundus signs. The case highlights the use of Cionni's ring in management of small cyclodialysis cleft by providing internal compression.

Pattern of steroid misuse in vernal keratoconjunctivitis resulting in steroid induced glaucoma and visual disability in Indian rural population: An important public health problem in pediatric age group

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA <3/60). Post treatment marginal improvement in CDVA was found (P = 0.46). However, statistically significantly improvement was noticed in IOP (P < 0.00001). Conclusion: Injudicious use of steroids leads to vision threatening complications like ocular hypertension and glaucoma in children of VKC. Weak steroids like loteprednol or fluorometholone should be used instead of higher potency drugs. Vision and IOP should be monitored fortnightly in children using topical steroids to detect steroid responders at the earliest.

A cluster of central retinal artery occlusions following cataract surgery

Purpose: To report a series of central retinal artery occlusions (CRAO) following cataract surgery complicated by posterior capsular rupture (PCR). Methods: Data from 14 patients with acute CRAO following cataract surgery was collected for this study including subject demographics, initial and final best-corrected visual acuity, systemic investigations, optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) findings. Results: Mean subject age was 59.9 ± 12.1 years. Male: Female ratio was 1:1. All patients were operated between October and November 2015 and presented with acute vision loss 1 to 4 days after surgery. All the patients underwent cataract surgery under peribulbar anesthesia and had PCR for which anterior vitrectomy (AV) was done. In all the cases Ethylene oxide (ETO) sterilized vitrectomy probe was used for AV. Clinical picture of CRAO was noted in all the cases during the immediate postoperative period. OCT showed inner retinal layer hyperreflectivity while FFA was normal in all the cases. The final visual acuity was poor in all the eyes. This paper discusses the possible mechanisms of CRAO in these cases. Conclusion: CRAO is a potential complication of peribulbar anesthesia for intraocular surgery in patients with vascular risk factors and hence any substance that can aggravate the vasospasm in such patients should be used cautiously. Vasospasm could be caused by ETO as residual ETO could be present in the vitrectomy machine tubing causing toxicity. It is recommended to be cautious while using ETO sterilized instruments for cataract surgery.

A case of retinal cavernous hemangioma analyzed with optical coherence tomography angiography

Retinal cavernous hemangiomas is a rare vascular tumor, isolated and non-progressive. This tumor is incidentally diagnosed on fundus examination and visual impairment can be rare presentation from vitreous hemorrhage, pre-retinal traction, hyphema, or macular scarring. The tumor has typical appearance of grape-like clusters of dilated vascular sacs with variable surface gliosis. Characteristic imaging findings aids in diagnosis. Newly emerged imaging tool is optical coherence tomography angiography (OCT A) which obtains high-resolution visualization of retinal vasculature in non-invasive fashion. In the present case report, we analyzed various diagnostic tool available for retinal cavernous hemangiomas; illustrating on the OCT A features.

Simultaneous Estimation Of Mometasone Furoate And Formoterol Fumarate By Hplc Method In Rotacaps

Objective: To develop and validate a simple and sensitive RP-HPLC method for the simultaneous determination of mometasone furoate (MOM) and formoterol fumarate (FOR) in pharmaceutical dosage forms. Methods: In RP-HPLC method, chromatographic separation was achieved using a mixture of a solvent system consisting of methanol–water (pH 3.5) in the ratio of 85:15 % v/v at a flow rate of 1 ml/min and detection was carried out at 225 nm. Results: The run time for the simultaneous estimation of drugs for the proposed method was 10 min as drugs eluted at 5.217 min (MOM) and 8.650 min (FOR). The linearity was found in the range of 33.33-299.97 μg/ml and 1-9 μg/ml for MOM and FOR, respectively. The values of limit of detection and limit of quantification were 3.634, 0.266 µg/ml and 11.014, 0.807 µg/ml, which indicates the sensitivity of the method for the estimation of MOM and FOR, respectively. The results of recovery studies for both the drugs were within the range i.e. 98.87-101.48 % which indicates the accuracy of the method. Relative standard deviation obtained from repeatability and reproducibility studies were less than 2% indicates the precision of the method. The proposed method was validated according to ICH guidelines. Conclusion: The proposed RP-HPLC method was found to be sensitive and precise because of the low LOD, LOQ and % RSD values (<2). The proposed work does not require acetonitrile and ion pairing reagent as compared to the reported methods. Therefore, method can be used preferably for routine analysis due to its simplicity and economic advantages.

Study on morphological variations of cadaveric vermiform appendix and caecum in Narayan Medical College and Hospital

Vermiform appendix is one of the most variable organs inside the abdomen. Unusual positions pose diagnostic and surgical challenges. The present study was conducted on 38 cadavers in Narayan Medical College and Hospital to find the morphological variations of vermiform appendix and caecum. It was seen that the most common position of appendix was retrocaecal (61%) while second most common position was pelvic (21%). Mean length of appendix was found to be 5.98 ± 1.67 cm. Mean outer girth was 2.87 ± 0.36 cm. Mean distance of Vermiform Appendix from ileocaecal junction was found to be 2.58 ± 0.46 cm. Adult type is the most common shape (71%) followed by exaggerated one (18%). Mean length of caecum was 7.61 ± 0.80 cm. and mean width being 8.49 ± 0.88 cm. Knowledge about morphological pattern of appendix and caecum is helpful in proper clinical management.

Some ecological aspects and potential threats to an intertidal gastropod, Umbonium vestiarium.

Kalbadevi Bay in Ratgnairi has been identified as potential site for placer mining along the west coast of India. Since, U. vestiarium is a keystone species of the region; study on some ecological aspect was carried. The paper also discusses the possible impact of beach sand mining and other threats to this ecologically important gastropod. Seasonal sampling was carried in 2004-2005 at 13 transects by quadrate method. U. vestiarium was restricted to mid and low tide zone of Station 1-3 and 8-10 located at the north and south ends of the beach. Abundance was highest at Station 10 MT (16 to 12488 ind m-2). Based on the size-frequency, it may be considered that U. vestiarium like other tropical fauna recruit during monsoon. Eleven different colour patterns of U. vestiarium were observed. However, average individual size was larger in the samples collected from the north (stn. 1-3) end of the beach. The fastidious nature and sporadic distribution of U. vestiarium make them vulnerable to natural and anthropogenic disturbance.

Physical work capacity of young underprivileged school girls: Impact of daily vs intermittent iron-folic acid supplementation – A randomized controlled trial.

Objectives: To assess impact of daily and intermittent iron-folate (IFA) supplementation on physical work capacity of underprivileged schoolgirls in Vadodara. Design: Randomized controlled trial. Setting: Municipal Primary schools. Participants: Schoolgirls (n=163) in the age group of 9-13 years. Intervention: Three randomly selected schools were given IFA tablets (100 mg elemental iron + 0.5 mg folic acid) either once weekly or twice weekly or daily for one year. The fourth was the control school. Outcome Measures: Hemoglobin, modified Harvard's Step test for physical work capacity. Results: All three IFA supplemented groups showed significant improvement in number of steps climbed and recovery time compared to controls; with impact being relatively better in girls with higher Hb gain (>1 g/dL) vs. lower Hb gain. Similarly, higher the frequency of dosing better was the impact- it being the best in daily IFA group. Twice weekly IFA was as good as daily IFA under conditions of good compliance. Conclusion: Twice weekly IFA supplementation is comparable to daily IFA in terms of beneficial effects on physical work capacity in young girls.

Comparative analysis of codon usage patterns and identification of predicted highly expressed genes in five Salmonella genomes.

PURPOSE: To analyse codon usage patterns of five complete genomes of Salmonella , predict highly expressed genes, examine horizontally transferred pathogenicity-related genes to detect their presence in the strains, and scrutinize the nature of highly expressed genes to infer upon their lifestyle. METHODS: Protein coding genes, ribosomal protein genes, and pathogenicity-related genes were analysed with Codon W and CAI (codon adaptation index) Calculator. RESULTS: Translational efficiency plays a role in codon usage variation in Salmonella genes. Low bias was noticed in most of the genes. GC3 (guanine cytosine at third position) composition does not influence codon usage variation in the genes of these Salmonella strains. Among the cluster of orthologous groups (COGs), translation, ribosomal structure biogenesis [J], and energy production and conversion [C] contained the highest number of potentially highly expressed (PHX) genes. Correspondence analysis reveals the conserved nature of the genes. Highly expressed genes were detected. CONCLUSIONS: Selection for translational efficiency is the major source of variation of codon usage in the genes of Salmonella . Evolution of pathogenicity-related genes as a unit suggests their ability to infect and exist as a pathogen. Presence of a lot of PHX genes in the information and storage-processing category of COGs indicated their lifestyle and revealed that they were not subjected to genome reduction.

Electroantennogram responses of the potato tuber moth, Phthorimaea operculella (Lepidoptera; Gelichiidae)to plant volatiles.

Electroantennograms (EAGs)were recorded from males and females of the potato tuber moth,Phthorimaea operculella in response to a broad range of plant volatile compounds belonging to diverse chemical classes.The responses to 27 compounds were evaluated,which indicated significant differences in EAGs between chemicals as well as between sexes.The fatty acid derivatives comprising essentially green leaf volatile components elicited significantly greater responses in females.The response profile of males was,in general,lower than that of females.EAG responses to the oxygenated and hydrocarbon monoterpenes were lower in both males and females.Dose -response studies indicate differences in response between the sexes and concentrations,suggesting the existence of sexual dimorphism. Compounds belonging to the fatty acid derivatives class appear to be important for an oligophagous pest such as the potato tuber moth and the findings are discussed in relation to host plant selection in this species.

Deleterious functional impact of anemia on young adolescent school girls.

Iron deficiency anemia during adolescence may reduce physical work capacity and cognitive function. OBJECTIVES: To assess the physical work capacity and cognition of underprivileged anemic schoolgirls in Vadodara in early adolescence as compared to their non-anemic counterparts. DESIGN: Prior to initiating anemia control interventions, schoolgirls in early adolescence were studied with regard to their hemoglobin status, physical work capacity and cognitive functions. SETTING: Schoolgirls from four municipal primary schools in the age of 9 - 14 years were studied. METHODS: In four Primary Municipal schools, hemoglobin of subjects was assessed using standard methods; physical work capacity using Modified Harvards Step test and cognitive functions using selected tests from the modified Wechsler Intelligence Scale for Children (WISC), suitably adapted for this group (n = 230). RESULTS: The mean hemoglobin was 11.32 g/dL, and anemia prevalence: 67%. A higher number of steps were climbed and a shorter time was taken to revert to the basal pulse rate (recovery time) by non-anemic girls compared to anemic girls (P < 0.001). Significantly lower scores in digit span and visual memory test were seen in anemic compared to non-anemic girls. The adverse impact of anemia remained after controlling for undernutrition (BMI). CONCLUSION: Anemia is likely to adversely affect physical work capacity and cognition in young adolescent girls undergoing pubertal development. Further research should be conducted in both school and community based settings to cover non-school going children.