Maxillofacial trauma and ocular injuries: reports from a prospective study from Pondicherry, India.

PURPOSE: To report the spectrum and the factors affecting the visual outcome of ocular injuries associated with maxillofacial trauma. METHODOLOGY: A prospective observational study was carried out from January 2019 to June  2020 on patients of maxillofacial trauma at a rural tertiary care centre, in Pondicherry, India. Detailed history was obtained. Investigations including imaging was done as indicated. Predictors of eye injuries and prognostic factors for vision were assessed. RESULTS: A total of 135 eyes of 126 patients were evaluated. Males constituted 92.06%. Road traffic accident (RTA), domestic injuries, assault, and work-place-related injuries accounted for 86.5%, 4.7%, 2.3%, and 2.3%. Alcohol consumption (42.06%) and lack of eye protective device (94.4%) and injury to posterior segment were the major risk factors. On presentation 80.6% had visual acuity ≥ 6/12. Orbital and maxillofacial fractures were noted in 70.6% of cases. Closed-globe injury was seen in 83 (61.4%) and open-globe injury in 2 (1.4%). Majority (86.7%) suffered soft tissue injuries. Common sight-threatening injuries were traumatic optic neuropathy (4.4%), vitreous haemorrhage (0.7%), retrobulbar haemorrhage (0.7%), and commotio retinae (0.7%). CONCLUSION: Most of the injuries in this population occurred from RTA, with associated fractures, adnexal and globe injuries. Alcohol consumption and lack of eye protective device were the major risk factors. Patients with open-globe injuries and injuries with posterior segment involvement had poor visual outcome.

Serum magnesium in diabetic retinopathy: the association needs investigation.

BACKGROUND: Magnesium has an essential role in glucose metabolism, and hypomagnesaemia is common in diabetes mellitus. However, the relationship between serum magnesium and diabetic retinopathy is poorly understood. AIM: To determine the association between serum magnesium levels and retinopathy in type 2 diabetic patients with normal renal function and to correlate it with severity of retinopathy. METHODS: This cross-sectional observational study was conducted in a semi-urban tertiary-care teaching hospital. Clinicodemographic profile and serum magnesium levels were determined in patients with type 2 diabetes mellitus (DM) with (group 1) and without (group 2) retinopathy. Serum magnesium levels were correlated with the presence and severity of retinopathy. RESULTS: Of 104 type 2 DM patients, 50 had retinopathy. Younger age, longer duration of disease and poorer glycaemic control (p < 0.05) were found to be associated with retinopathy. The mean serum magnesium levels in patients with retinopathy and those without retinopathy were 1.63 ± 0.30 mg/dL and 1.76 ± 0.22 mg/dL, respectively (p = 0.029). Reduced serum magnesium was associated with elevated fasting sugars (p = 0.019) and female gender (p = 0.037). On comparative analysis of patients with sight-threatening diabetic retinopathy (STDR), non-STDR and no retinopathy by ANOVA test, patients with STDR had significantly lower serum magnesium (1.55 ± 0.33 mg/dL) (p = 0.031). CONCLUSION: Serum magnesium levels were lower in patients with diabetic retinopathy. Patients with STDR had lower serum magnesium compared with those without STDR. SUMMARY: Serum magnesium, studied extensively for its role in glucose metabolism, was found to be lower in patients with diabetic retinopathy compared with those without retinopathy. Sight-threatening diabetic retinopathy had significantly lower levels of serum magnesium.

Comparison of Central Corneal Thickness using Anterior Segment Optical Coherence Tomography Versus Ultrasound Pachymetry.

INTRODUCTION: Corneal thickness is an important and sensitive indicator of corneal health. It is useful in monitoring corneal diseases such as corneal oedema and keratoconus, and selecting patients for refractive surgery. Central Corneal Thickness (CCT) is a risk factor for Primary Open-Angle Glaucoma (POAG). AIM: To compare CCT using ultrasound pachymetry and Anterior Segment Optical Coherence Tomography (AS-OCT), and also to find out the reproducibility of AS-OCT readings for both central and pericentral corneal areas. MATERIALS AND METHODS: This prospective cross-sectional study was conducted on 120 patients above 40 years of age, and with clinically normal corneas, who underwent CCT measurements by both ultrasound and AS-OCT. Both the eyes were analysed. Two measurements by AS-OCT and 25 measurements by ultrasound pachymetry were taken. The readings were averaged and compared by paired t-test. Repeatability of the OCT pachymetry map sector averages, was assessed by pooled standard deviation, obtained from the two measurements taken from each eye. RESULTS: The CCT in right eye by OCT and ultrasound was 516.28±29.76 µm and 532.42±29.71 µm, respectively. The CCT in left eye by OCT and ultrasound was 515.82±29.88 µm and 532.36±29.83 µm, respectively. The difference in CCT measurement by AS-OCT and ultrasound was statistically significant (p<0.001); mean ultrasound CCT being 16.14 µm and 16.54 µm greater than the mean AS-OCT, CCT in right eye and left eye respectively. For AS-OCT, intra-session repeatability was measured. Repeatability of the OCT mapping was 0.01 µm to 1.6 µm and 0.01 µm to 1.9 µm in the right eye and left eye respectively. CONCLUSION: The CCT measurement by ultrasound pachymetry gives higher values compared to AS-OCT measurement. Hence, they cannot be interchangeably used in clinical practice. The AS-OCT provides highly repeatable pachymetry map measurements both centrally and pericentrally.

Multimodal Hallucinations in a Visually Impaired Elderly Female: Is it a Variant of Charles Bonnet Syndrome?

Charles Bonnet Syndrome (CBS) is a common cause of visual hallucinations seen in elderly people with visual impairment. Well-formed visual hallucinations in clear consciousness with preserved insight are commonly reported in literature. We report a case of CBS having multisensory hallucinations. An elderly patient with visual impairment fulfilling the criteria of CBS presents with various modalities of hallucinations viz. visual, auditory and tactile hallucinations improved completely with low dose of antipsychotics. Atypical features are common in CBS and thus often make it difficult to diagnose this condition.

Indian Soldiers Need Eye Protection.

Combat-related eye injuries entail enormous financial, social and psychological cost. Military Combat Eye Protection (MCEP) decreases both the incidence and severity of eye injuries. Experts have recognised the need for MCEP for Indian soldiers. We aim to review the combat-related eye injuries and combat eye protection among the Indian soldiers. Global practices of MCEP are also reviewed. We also aim to offer our recommendations for Indian soldiers. We carried out Medline search for combat-related eye injuries and MCEP and separately searched for eye injuries among Indian soldiers during war and other operations. We present the findings as results. Recommendations are based on the opinions of the experts. Combat-related eye injuries increased from 3% of injured in the 1965 Indo-Pakistan War to 4.8% in 1971 war. During peace-keeping operations in Sri Lanka (1987-89) eye injuries increased to 10.5% of the injured. Statistics on eye injuries during counterinsurgency operations are not available. MCEP have shown reduction in eye injuries, and thus MCEP forms a part of personal equipment of the soldiers in developed countries. Indian soldiers do not have provision of MCEP. Combat-related eye injuries among Indian Army soldiers have been increasing. Data on eye injuries during counterinsurgency operations are not available. Indian soldiers do not have provision of MCEP. Provision of MCEP is therefore desirable. Awareness program among the commanders and the soldiers shall result in attitudinal changes and increased compliance.

Role of Optical Coherence Tomography in Assessing Anterior Chamber Angles.

INTRODUCTION: Gonioscopy is the gold standard in assessing anterior chamber angles. However, interobserver variations are common and there is a need for reliable objective method of assessment. AIM: To compare the anterior chamber angle by gonioscopy and Spectral Domain Optical Coherence Tomography (SD-OCT) in individuals with shallow anterior chamber. MATERIALS AND METHODS: This comparative observational study was conducted in a rural tertiary multi-speciality teaching hospital. A total of 101 eyes of 54 patients with shallow anterior chamber on slit lamp evaluation were included. Anterior chamber angle was graded by gonioscopy using the shaffer grading system. Angles were also assessed by SD-OCT with Trabecular Iris Angle (TIA) and Angle Opening Distance (AOD). Chi-square test, sensitivity, specificity, positive and negative predictive value to find correlation between OCT parameters and gonioscopy grading. RESULTS: Females represented 72.7%. The mean age was 53.93 ±8.24 years and mean anterior chamber depth was 2.47 ± 0.152 mm. Shaffer grade ≤ 2 were identified in 95(94%) superior, 42(41.5%) inferior, 65(64.3%) nasal and 57(56.4%) temporal quadrants. Cut-off values of TIA ≤ 22° and AOD ≤ 290 µm were taken as narrow angles on SD-OCT. TIA of ≤ 22° were found in 88(92.6%) nasal and 87(87%) temporal angles. AOD of ≤ 290 µm was found in 73(76.8%) nasal and 83(83%) temporal quadrants. Sensitivity in detecting narrow angles was 90.7% and 82.2% for TIA and AOD, while specificity was 11.7% and 23.4%, respectively. CONCLUSION: Individuals were found to have narrow angles more with SD-OCT. Sensitivity was high and specificity was low in detecting narrow angles compared to gonioscopy, making it an unreliable tool for screening.

Ophthalmology Teaching-Learning in Undergraduate Classes: Roadblocks and The Remedies.

The curriculum needs to run apace with the changing morbidity pattern and social needs. Teaching methodology requires constant evolution. With a static curriculum and teaching methods undergraduate ophthalmology proves difficult for many students. This article briefly analyses the ophthalmology curriculum, highlights the problems of teaching and offers some solutions.

How to Write Articles that Get Published.

Publications are essential for sharing knowledge, and career advancement. Writing a research paper is a challenge. Most graduate programmes in medicine do not offer hands-on training in writing and publishing in scientific journals. Beginners find the art and science of scientific writing a daunting task. 'How to write a scientific paper?, Is there a sure way to successful publication ?' are the frequently asked questions. This paper aims to answer these questions and guide a beginner through the process of planning, writing, and correction of manuscripts that attract the readers and satisfies the peer reviewers. A well-structured paper in lucid and correct language that is easy to read and edit, and strictly follows the instruction to the authors from the editors finds favour from the readers and avoids outright rejection. Making right choice of journal is a decision critical to acceptance. Perseverance through the peer review process is the road to successful publication.

High Altitude and the Eye.

The purpose of this study was to review the available data on the effect of high altitude on the eyes. We carried out electronic literature search on www.pubmed.com for articles published through year 2011. The search terms included high altitude and the eye, high-altitude retinopathy, eye problems in the Himalayas, and eye diseases in Tibet. Other terms like visual functions, intraocular pressure, corneal thickness, tear function, and ocular motility, at high altitude, were searched separately and in combination. Data were retrieved from both prospective and retrospective studies published in the English language.High altitude has both short-term and long-term effects on the eyes. The short-term effects include high-altitude retinopathy, change in corneal thickness, and photokeratitis. Long-term effects include pterygium, cataract, and dry eye syndrome. High-altitude retinopathy of mild degree does not affect vision but has a predictive value for the development of high-altitude cerebral edema. Change in corneal thickness at altitude induces refractive changes in eyes with radial keratotomy and in eyes with LASIK. High altitude does not adversely affect visual acuity and contrast sensitivity; scotopic vision may be affected if supplemental oxygen is not used.