A quantitative evaluation of the effect of meals on macular thickness in diabetic patients with diabetic macular edema.

PURPOSE: Central subfoveal thickness measurement is used in a large number of clinical trials to monitor the progression and treatment response of diabetic macular edema (DME) in patients of diabetic retinopathy (DR). Several studies have been carried out to investigate various factors affecting the central subfoveal thickness in order to minimize errors in the testing. We planned a study to investigate the effect of meals on central macular thickness (CMT) in patients with DME and compare that with nondiabetic patients. METHODS: In this observational study, 50 patients of diabetes with DME and 50 normal controls were included. Macular thickness was measured after overnight fasting and 2 h postprandial for both the groups. Any changes in morphology and CMT were evaluated. RESULTS: Each group had 22 females and 28 males with a mean age of 60.6 ± 6.6 in the diabetic group and of 49.66 ± 11.13 in the control group. Reduction in the CMT was noticed after the meals (mean: -9.78 ± 12.77 µm; P < 0.001) in those with DME as compared to the control group. This was more prominent in those who had intraretinal cystic spaces (17.14 ± 10.33 µm) and neurosensory detachment (66 µ). Patients with high blood sugar levels had higher CMT and a greater reduction in thickness was noticed in them postprandially (r = 0.414; P = 0.0028). CONCLUSION: The CMT values in patients with DME are significantly affected by meals. Hence, an attempt should be made to measure CMT during the fasting state for more accurate results.

Triplet of doubles: Double anterior chamber, double descemet membranes, and double rhexis.

A 52-year-old women underwent penetrating keratoplasty for total corneal opacity after healed microbial keratitis with an uneventful postoperative period until six months when she developed gross diminution of vision. During examination, she was detected to have a membrane in the anterior chamber, creating a double anterior chamber with a total cataract. The graft was clear, and sutures were intact. Anterior segment optical coherence tomography (OCT) showed the membrane in the anterior chamber crossing the graft host junction, suggesting this membrane to be retained host descemet membrane. This was confirmed on histopathological examination. Double rhexis (descemetorhexis and capsulorhexis) was performed with cataract removal and intraocular lens (IOL) implantation, and patient had good visual recovery postoperatively.

To Study the Role of Serum Homocysteine Levels and Ocular Involvement in Retinal Vasculitis.

Idiopathic retinal vasculitis is a chronic disease of unknown aetiology which results in ocular morbidity in patients of productive age group. Homocysteine has been implicated in various ocular conditions like age-related macular degeneration, retinal vein occlusions, diabetic retinopathy, and optic nerve diseases. We conducted a study to investigate the relation between serum homocysteine levels and retinal vasculitis at a tertiary care centre in North India. In this case-control study, 32 cases and 64 controls were included and the duration was from June 2017 to March 2019. Serum homocysteine of cases and controls was detected by reflectance photometry using VITROS Chemistry Products HCY 2 (Homocysteine) and the normal range of serum homocysteine as per this method was 6.60 to 14.80 micro mol per litre. Our study found that of the total 32 retinal vasculitis patients, serum homocysteine was raised in 65.62% (21 cases out of 32) and in 70.31% of control group (45 out of 64). Chi square test results showed that there was no significant association found between S. homocysteine levels and Reticular vasculitis (P: 0.64). The two groups were comparable in terms of the age with mean ± SD in cases being 33.47 ± 8.336 years and controls being 35.16 ± 8.568 years with a P value of 0.37 being statistically insignificant. The data collected was analysed using SSPS-16 (Statistical Package for Social Sciences Version 16) software and test of association was Odd's ratio. Power of study was 80% and P < 0.05 is considered statistically significant. We found that there is no significant association between raised serum homocysteine and retinal vasculitis (with P < 0.64). Odds ratio was 0.80(0.33-1.99) implying that the cases and controls were statistically significantly different with respect to homocysteine levels.

Study of correlation between stereopsis and retinal nerve fiber layer thickness in cases of glaucoma.

BACKGROUND: Glaucoma is an important and common optic neuropathy characterized by progressive loss of retinal ganglion cells and associated morphological changes to the optic nerve and retinal nerve fiber layer (RNFL). The most common assessment of visual function in glaucoma uses perimetric measurements of visual sensitivity. Only few studies have evaluated the binocular function in patients with glaucoma. This study was taken up to establish the correlation of RNFL thickness, in glaucoma, with near and distance stereopsis. METHODS: This pilot, cross-sectional observational study included 100 diagnosed cases of glaucoma and 100 normal participants as controls, studied over a period of one year. The records of all the participants were checked, and only established cases of glaucoma after fulfilling the inclusion and exclusion criteria were included. Analysis of the RNFL using spectral-domain optical coherence tomography was carried out. All the participants were thereafter evaluated for stereoacuity by near (at 40 inches) and distance (at 3 meter) Randot stereoacuity charts. RESULTS: There was a negative correlation between the RNFL thickness and the absolute value of streoacuity (-0.303 for distance versus -0.101 for near in cases and -0.308 for distance and -0.416 for near in control group), decreasing the actual functional stereoacuity, therefore the cases with lower RNFL thickness had lower stereoacuity both for distance and near, however it was statistically significant only for distance (p=0.002). CONCLUSION: Functional aspects, such as stereoacuity, may also be affected in the glaucoma because of decrease in RNFL thickness. Therefore, binocular status should also be evaluated in cases of glaucoma.

New use of a pupillary expansion ring to avoid intraoperative positive vitreous pressure during triple procedures.

Positive vitreous pressure can complicate cataract surgery during a triple procedure by inadvertently extending the capsulorhexis. This occurs because the procedure is open sky and positive vitreous pressure cannot be countered by injecting ophthalmic viscosurgical devices. We describe a new use of a pupillary expansion ring (Malyugin) to achieve a stable open anterior chamber under open sky during triple procedures. The scrolls are tucked under cut margins of the host cornea to create the capsulorhexis, the cataractous nucleus is removed, and an intraocular lens (IOL) is implanted in the bag. This technique is especially useful in cases of hypermature cataract and nondilating pupils with positive vitreous pressure in patients having triple procedures. The technique provides a stable open anterior chamber, increasing to the safety of the procedure and the chance of achieving a continuous curvilinear capsulorhexis and IOL implantation in the capsular bag.

Symptomatic hypertrophic obstructive cardiomyopathy: semi-supine bicycle ergometry as a useful provocative manoeuvre to elicit latent gradient.

We report the case of a 58-year-old Caucasian woman with severe symptoms attributable to hypertrophic obstructive cardiomyopathy (HOCM). When supine there was no significant left ventricular outflow tract (LVOT) gradient on echocardiography or cardiac catheter measurements-despite provocation with supine leg exercise and right ventricular pacing. However, semi-supine bicycle exercise induced a marked increase in the LVOT gradient, which helped guide successful percutaneous alcohol septal ablation. This case report demonstrates the usefulness of bicycle exercise echocardiography in diagnosing HOCM with latent LVOT obstruction.