Evaluation of scleral incisions and their effects on corneal curvature in manual small-incision cataract surgery.

Purpose: Incisions in cataract surgery can be modified in various ways in terms of size, shape, and axis to reduce or tailor astigmatism. This study was conducted to examine the effect of site (superior vs, temporal) and shape (frown vs. V-shaped, chevron) of scleral incisions for cataract surgery on corneal curvature. Methods: The prospective study was carried out on 200 consecutive patients with senile cataract and who were planned for surgery at a tertiary eye hospital in north India. The placement of the incision was decided by the steeper corneal meridian-whether superior or temporal-and then patients of these two groups were randomized for frown and V-shaped incision; in this way, four groups of 50 patients each were formed. Follow-up was done on day 1, at 2 weeks, 4 weeks, 8 weeks, and 12 weeks. At each follow-up, post-operative keratometry with routine postoperative examination was done. The results were statistically analyzed by using student's t-test, Chi-squared test, and the Pearson correlation coefficient. Results: In all the four groups, the difference of preoperative astigmatism and surgically-induced astigmatism was statistically highly significant. The analysis of uncorrected visual acuity (UCVA) was statistically significant (P < 0.05) on postoperative day 1 and at 2, 4, and 12 postoperative weeks; it was statistically insignificant (P > 0.05) at postoperative week 8. Conclusion: Temporal incisions result in lesser postoperative surgically induced astigmatism (SIA) than superior incisions. Chevron incisions result in minimal change in corneal curvature. This effect can be utilized to tailor the postoperative astigmatism.

A rare presentation of exudative macroaneurysms in unilateral Eales' disease.

BACKGROUND: A case of exudative macroaneurysms in unilateral Eales' disease is reported. 'Eales disease' is an idiopathic bilateral occlusive periphlebitis with neovascularisation and mostly presents with vitreous hemorrhage. CASE: A 30 year old male presented with diminution of vision in left eye (6/36) for 1 month. Slit Lamp examination of both eyes revealed normal anterior segment. Fundus examination of left eye with + 90 D lens revealed reddish lesions at the macula with surrounding circinate exudation. On peripheral examination hemorrhages were seen along with vasculitis in the superotemporal quadrant.The right eye fundus was normal.All laboratory investigations were found within normal limits. CONCLUSION: Eales' disease is mostly a bilateral condition but this case is rare as there is uniocular involvement with exudative macroaneurysms.Laser therapy was instituted which was effective in management of this condition with restoration of normal visual acuity.There was no relapse on follow up for 2 years.

Assessment of insulin like growth factor-1 and IGF binding protein-3 in healthy Indian girls from Delhi and their correlation with age, pubertal status, obesity and thyroid hormonal status.

BACKGROUND: Population specific data and influence of sub-clinical hypothyroidism on insulin like growth factor-1 (IGF-1) and its binding protein-3 (IGFBP-3) in Indian children is lacking. This study was undertaken to evaluate serum IGF-1 and IGFBP-3 and their correlation with age, gender, pubertal status and thyroid functions. METHODS: A total of 840 apparently healthy school girls aged 6-18 years, were recruited for the study and underwent assessment of height, weight, body mass index, pubertal status and serum T3, T4, TSH, IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio. RESULTS: The mean serum levels of IGF-1, IGFBP-3 levels and IGF-1/IGFBP-3 molar ratio were 381.8±240.5 ng/mL, 4.19±2.08 µg/mL and 40.5±37.2%, respectively. The serum IGF-1 and IGF-1/IGFBP-3 molar ratio increased significantly (p<0.0001) at 11 years followed by a steady yet non-significant rise till 16 years of age. A similar pattern was observed for IGFBP-3 showing a steep rise at 12 years and peaking at 16 years. Likewise, serum levels of IGF-1 and molar ratio of IGF-1/IGFBP-3 increased significantly with pubertal maturation from stage 1 to 3 and were higher in overweight girls compared to normal weight and obese girls. The growth factors were no different in girls with or without subclinical hypothyroidism. CONCLUSIONS: There was no significant impact of age on IGF-1 and IGFBP-3 in pre-pubertal girls. A sudden marked increase at 11 years followed by a gradual rise in growth factors till 16 years is indicative of pubertal initiation and maturation. Subclinical hypothyroidism did not influence growth factors in girls.

Potency dependent activity of homeopathic nanomedicine- classical and quantum electrodynamical approach

The effect of homeopathic medicine on biological and physical system is directly related to its potency [1]. However, from physico-chemical point of view it is difficult to explain this effect at such high dilution, as then the existence of even trace amount of particle is questionable. It has been reported that during the process of potentization, a large amount of mechanical energy gets transferred to the medium due to succussion [2]. This energy in all probability reduces the size of the drug aggregates. The drug then penetrates easily through the membrane barrier, and thereby gives rise to enhanced activity of the medicine. It has been experimentally proved by us and supported by others that indeed a reduction of size of the aggregates takes place with increase in potency [3]. Using five different homeopathic medicines, their sizes at three different potencies have been estimated and a general mathematical expression relating the size of the particle (Y) and the corresponding potency (X) has been derived as follows Y = a X -n. (AU)

A rare case of a solitary intraocular neurofibroma.

BACKGROUND: Solitary neurofibroma in the absence of neurofibromatosis is of rare occurrence and very few cases have been reported till date. OBJECTIVE: To report a case of a solitary intra-ocular neurofibroma. CASE: A 65-year-old man presented to us with a large swelling appearing to arise from right pthisical eye for the past one and a half years. After knowing the extent and origin of mass lesion, right eyeball was enucleated and subjected to histopathological examination which revealed intraocular neurofibroma in the absence of neurofibromatosis which is of very rare occurrence. CONCLUSION: The isolated neurofibroma of intraocular origin can present as an isolated orbital mass without systemic features.

Tractor nail as impacted foreign body: rare case scenario.

A patient presented with a metallic nail impacted in the right orbital floor after being hit by a projectile. The nail was disimpacted and removed as guided by the radiograph image. Radiography proved helpful in forming a coherent scheme for case management.

A comparative study of combined small-incision cataract surgery with sutureless trabeculectomy versus trabeculectomy using W-shaped incision.

INTRODUCTION: Manual small-incision cataract surgery with trabeculectomy is now an acceptable option in the surgical management of combined cataract and glaucoma uncontrolled with maximum tolerated medical therapy. OBJECTIVE: To compare the results and complications of combined manual small-incision cataract surgery (SICS) and posterior chamber intraocular lens (PCIOL) implantation with trabeculectomy by sutureless versus W-shaped incision technique. MATERIALS AND METHODS: The study included 30 eyes of 28 patients with senile cataract and primary open-angle glaucoma (POAG) who were randomly divided into two groups. The patients in Group A (n = 15) underwent SICS with sutureless trabeculectomy and those in Group B (n =15) underwent SICS with trabeculectomy using W-shaped incision with one suture. Post-operative evaluation was done at the first post-operative day and thereafter on follow-ups at 1 week, 2 weeks, 4 weeks and 8 weeks. RESULTS: The mean preoperative and postoperative intraocular pressure (IOP) in Group A was 27.33 ± 3.35 mmHg and 16.13 ± 4.30 mmHg respectively and in Group B it was 29.46 ± 6.06 mmHg and 14.66 ± 2.69 mmHg respectively. The mean reduction in IOP after 8 weeks of follow-up in Group A was 12.52 ± 3.59 mmHg and that in Group B was 16.47 ± 3.79 mmHg (p less than 0.001). Besides this, the uncorrected visual acuity (UCVA) was better in Group B postoperatively with less surgically-induced against-the-rule (ATR) astigmatism. CONCLUSION: Combined SICS with trabeculectomy using W-shaped incision offers better prospective in terms of glaucoma control and visual performance than sutureless combined surgery.

Pilomatrixoma of eyelid in a middle aged.

BACKGROUND: Pilomatrixoma , also known as Malherbes's calcifying epithelioma, known to occur in children, is not common especially in middle aged and those below 10 years of age . Pilomatrixoma presents as a firm skin nodule on eye lid or eye brow, so should be considered in the differential diagnosis of such lesions involving eyelids. CASE: A 45-year-old male presented with a swelling in the left upper lid for the last 4 months. There was firm to hard non tender nodule measuring 1.5 cm. x 1.5cm in size on the lateral aspect of the left upper eye lid , involving the lid margin with variegated appearance of overlying skin with a few ulcerated areas on the surface. A presumptive diagnosis of meibomian gland carcinoma was made and an excision biopsy with primary lid repair was carried out. Histopathological examination confirmed the diagnosis of pilomatrixoma. CONCLUSION: The present case is reported to sensitize the ophthalmologists to think beyond chalazion and meibomian gland carcinoma for a firm, nodular, non ulcerated, painless lid swelling.

A comparative study of sclero-corneal and clear corneal tunnel incision in manual small-incision cataract surgery.

BACKGROUND: Cataract surgery techniques have improved a lot over the years from couching to the latest micro-incision cataract surgery. OBJECTIVES: To compare the temporal sclero-corneal and clear corneal tunnel incisions in patients undergoing manual small-incision cataract surgery (SICS) with respect to the surgically-induced astigmatism. MATERIALS AND METHODS: The present study included 60 patients who underwent manual SICS with posterior chamber intraocular lens implantation. Group A comprised of 30 patients, selected randomly, who underwent sutureless manual SICS through 6 mm curvilinear clear corneal tunnel incision made temporally and Group B comprised of 30 patients, selected randomly, who underwent sutureless manual SICS through 6 mm straight sclero-corneal tunnel made temporally. The patients were assessed at 1 week, 2 weeks, 1 month and 2 months post-operatively and visual acuity and keratometry findings were recorded. The amount of surgically induced astigmatism was calculated using Holladay's formula. STATISTICS: Numerical data were compared between the two groups using unpaired Student's t-test. The p value of less than 0.50 was considered significant. RESULTS: The mean induced astigmatism in Group A was 2.69 ± 0.84 D at 1 week, 2.31 ± 0.77 D at 2 weeks; 2.03 ± 0.82 D at 4 weeks and 1.98 ± 0.54 D at 8 weeks post-operatively. In group B, it was 1.85 ± 0.62 D, 1.56 ± 0.54 D, 1.35 ± 0.49 D and 1.34 ±0.45 D at 1 week, 2 weeks, 4 weeks and 8 weeks postoperatively. Uncorrected visual acuity (UCVA) of 20/ 20 was seen in 20 % of patients in group A and in 40 % in group B at 8 weeks postoperatively. CONCLUSION: Surgically-induced astigmatism is significantly higher in clear corneal manual SICS than in sclero-corneal. Our study confirmed the safety and improvement in visual acuity after small-incision cataract surgery using sclero-corneal tunnel incision.

Experimental study of oculocardiac reflex (OCR) with graded stimuli.

The present study was conducted to observe the effect of graded mechanical stimuli on occurrence of oculocardiac reflex (OCR). The experiments were carried out in twenty albino rabbits of either sex weighing between 1-2 kg. Changes in heart rate and/or cardiac rhythm (oculocardiac reflex) were studied by applying traction with progressively increasing weights to medial rectus muscle. Mean threshold value of square wave mechanical stimulus just sufficient to produce oculocardiac reflex was found to be 19 +/- 8.52 g. As the traction weights were progressively increased, more and more decrease in heart rate was observed. It was concluded that once the threshold value of stimulus was reached, the oculocardiac reflex showed a graded response with progressively increasing traction weights.

Contrast sensitivity function in pseudophakics and aphakics.

PURPOSE: To study the effect of posterior chamber intraocular lenses and aphakic spectacles on contrast sensitivity. METHODS: Contrast sensitivity was evaluated in 20 patients in each group of pseudophakics with post chamber IOL (group I), aphakics with spectacle correction (group II), and age and sex-matched normal subjects (group III) using the Pelli-Robson chart. RESULTS: The mean values of log contrast sensitivity in pseudophakics (1.665+/-0.105) and aphakes with spectacle correction (1.5075+/-0.1) were found to be statistically significantly low (t: 5.186, p < 0.001; t: 11.302, p < 0.001, respectively) as compared to the mean value of normal phakic subjects (1.8075+/-0.0576). Further, mean values of log contrast sensitivity in aphakes with spectacles correction were also found to be statistically significantly low (t: 4.727, p < 0.001) when compared to that in pseudophakes. CONCLUSION: From observations of the present study, it can be concluded that posterior chamber IOL implantation offers an added advantage of higher contrast sensitivity, over and above the well documented advantages of increased field of vision, negligible effect on image size and elimination of prismatic effect and spherical aberration of thick glasses.

Profile of lower gastrointestinal bleeding in children from a tropical country.

Eighty five children were evaluated endoscopically for recurrent lower gastrointestinal (GI) bleeding. The male: female ratio was 2.4:1 with a mean age of 6 years (range 8 months to 2 years). After adequate bowel preparation endoscopic evaluation was done using olympus CF 101 colonoscope. Sedation was given only in two patients. Full length colonoscopy had been done in 16 cases only, to look for extent of disease in 8 cases and to ascertain site of bleeding when no lesion could be seen on sigmoidoscopy. Juvenile polyps were seen in 40 cases, amoebic ulcer in 20, solitary rectal ulcer in 4 and polyposis syndrome in 5 cases. Sigmoidoscopy alone could establish the diagnose in 76 cases. We conclude that flexible sigmoidoscopy alone is safe and adequate in ascertaining the cause of prolonged recurrent lower GI bleeding.

Management of foreign bodies of the upper gastrointestinal tract.

The use of flexible endoscopes had made removal of foreign bodies in the upper gastrointestinal tract easier and safer. We describe our experience of 49 cases of foreign bodies of the upper gastrointestinal tract. Majority (67%) of the patients were children and only 4 patients (8%) were above 45 years of age. The most common foreign bodies encountered were coins (25), fruit stones (4) and dentures (3). In 29 patients foreign bodies were lodged in the oesophagus and in 15 cases in the stomach. Forty one patients were considered for endoscopic removal of the foreign bodies and 40 could be managed successfully. There were no procedure related complications. We conclude that endoscopic removal of the foreign bodies of the upper gastrointestinal tract is a safe and effective technique.

Evaluation of subconjunctival anaesthesia vs peribulbar anaesthesia in cataract surgery.

A comparative study was carried out to evaluate peribulbar anaesthesia (group A) vs subconjunctival anaesthesia (group B). The results proved peribulbar anaesthesia to be more effective than subconjunctival anaesthesia as regards orbicularis akinesia (p < 0.05) and ocular akinesia (p < 0.05). There was no significant difference in the sensory anaesthesia, analgesia and intraocular pressure changes in the two groups (p > 0.05). Block assessment was ideal in 80% of patients in group A in comparison to 51% in group B (p < 0.05), and unsatisfactory in 14% in group A and 30% in group B (p < 0.05). Further, no significant complications were observed with peribulbar anaesthesia. Therefore, we conclude that peribulbar anaesthesia should be preferred over subconjunctival anaesthesia for conventional extracapsular cataract extraction with or without intraocular lens implantation.

Changes in arterial blood pressure during traction of extra-ocular muscles. A study in rabbits.

A significant reflex fall in mean arterial blood pressure from baseline values was observed during extra-ocular muscle traction in rabbits. This effect could be abolished only by retrobulbar block (afferent pathway block) and not by vagotomy, intravenous atropine or glycopyrronium, suggesting that it is distinct from, and independent of, the oculocardiac reflex. We suggest that these reflex changes in blood pressure be known as the 'oculodepressor reflex'.

Tear film profile in Graves' ophthalmopathy.

Tear film profile was studied in 30 patients with Graves' ophthalmopathy. Tear film pH, fluorescein staining, marginal tear strip and Schimer test values in patients with Graves' ophthalmopathy were comparable with controls, indicating normal tear secretion. Tear film break-up-time (BUT) in late Graves' ophthalmopathy was significantly low suggesting unstable tear film. Rose bengal as well as lissamine green staining intensity scores were significantly high, indicating presence of drying epithelial cells in early as well as late Graves' ophthalmopathy patients.

A clinico-investigative profile in Graves' ophthalmopathy.

A clinico-investigative profile was studied in 30 patients with Graves' Ophthalmopathy (GO) (15 each with early and late). In accordance to the thyroid status 63.3% of patients were hyperthyroid and 36.7% euthyroid. There was slight female preponderence, with ratio being 1.5:1. Exophthalmometric readings were significantly high in GO patients as compared to controls. However, no significant diagnostic role of postural exophthalmometry was seen. Positional tonometery may have respectable place among the tests for early diagnosis of GO; however, it could not differentiate between hyperthyroid and euthyroid cases. Further the role of ultrasonography, if available could not be overemphasized.