Pregnancy-induced keractesia - A case series with a review of the literature.

We report a case series of patients who developed post-laser-assisted in situ keratomileusis (LASIK) ectasia or had a progression of keractesia during pregnancy. We reviewed the medical records of 12 patients (20 eyes) who had reported deterioration of vision during their pregnancy and were diagnosed with keractesia. All 12 patients had experienced symptoms of deterioration of vision between 2 months to 1 year of onset of their pregnancies. A total of 17 eyes of 10 patients had developed post-refractive surgery keractesia. Sixteen of these had undergone LASIK and one had undergone femtosecond lenticule extraction (FLEX). Three eyes of two patients had an exacerbation of keratoconus during pregnancy while one patient had associated hypothyroidism. The results indicate that the hormonal changes that take place in pregnant women can affect the biomechanical stability of the cornea and may trigger the onset of keractesia.

Pigment dispersion syndrome associated with spontaneous subluxation of crystalline lens.

Pigment dispersion syndrome (PDS) is an ocular condition characterized by a dispersion of iris pigment throughout the eye. This pigment is deposited in a characteristic manner on the corneal endothelium as Krukenberg's spindle, anterior surface of the iris, in the trabecular meshwork, on the lens and zonule and occasionally on the anterior hyaloid face. Even with deposition of pigment on zonular fibers, no zonular weakness, or zonular dehiscence has been reported in these cases. We report a unique case of PDS with bilateral spontaneous subluxation of crystalline lens. With characteristic findings of pigment distribution in both his eyes, the patient had concave iris configuration with heavily pigmented trabecular meshwork confirming the diagnosis of PDS. The patient had bilateral 180° temporal subluxation of crystalline lens in both his eyes. The usual cause of lens subluxation such as Marfan's Syndrome and Ehler's Danlos Syndrome was ruled out. The patient underwent right eye followed by left eye intracapsular cataract extraction with ab-interno technique with postoperative best-corrected visual acuity (BCVA) of 6/9 in both eyes. Spontaneous subluxation of crystalline lens in isolated PDS is not known to occur and has been reported by means of this case. We recommend a thorough assessment of zonular status in all cases of PDS.

Diode laser cyclophotocoagulation in Indian eyes: efficacy and safety.

Diode laser cyclophotocoagulation (DLCP) has emerged as a time-tested procedure for end-stage glaucoma with fewer complications. By means of this study, we have evaluated its wide indications, its efficacy, and safety in darkly pigmented Asian Indian eyes. Ninety-one eyes with uncontrolled glaucoma presenting to glaucoma clinic of a tertiary care center over a period of 6 years were scheduled for DLCP. The semiconductor diode laser with a G probe was used with laser energy delivered about 1.5 mm behind the surgical limbus. The extent of clock hours of laser application was determined by pretreatment intraocular pressure (IOP) and superior area was spared in cases where future filtration surgery was contemplated. The DLCP was repeated earliest at 1 month in case of non-response and a maximum of three laser procedures were performed for any patient. Ninety-one eyes of 89 patients (40 males, 49 females) were included. Common indications included secondary glaucoma (37.3 %), failed trabeculectomies (27.4 %), angle closure glaucoma (17.5 %), etc. Laser power delivered ranged from 990 to 1800 mW, (mean 1396 + 182.14 mW) with an average of 17 spots. Patients improved from pretreatment IOP of 38.18 + 8.96 mmHg (range 20.6-64) to post treatment IOP of 17.86 + 7.75 mmHg (range 10-42). Qualified success was defined as final IOP of 20 mm Hg or less on topical medications that could be achieved in 70 % eyes with one or repeat treatment. Pre op visual acuity ranged from PL+ to 6/18 showing a slight improvement to PL+ to 6/12 post op. A 58.5 % reduction of IOP was noted. No incidence of serious complications was noted during follow-up ranging from 9 months to 3 years. DLCP is an effective and safe tool to be used in Indian population for control of IOP. It can be safely used as a primary modality to bring IOP to permissible levels before trabeculectomy.

Using Role-plays as an Empathy Education Tool for Ophthalmology Postgraduate.

PURPOSE: To assess the role of an "empathy sensitizing module" (ESM) in ophthalmology postgraduates in promoting effective empathetic communication. METHODOLOGY: Thirty-nine ophthalmology postgraduates were taught effective empathetic communication using specially designed module, comprising of five illustrative role-plays. We evaluated the impact of the training by (a) self-assessment of empathy quotient by residents using Jefferson Scale of Empathy (JSE scale) before and 6 weeks after ESM training and (b) nonparticipant observation (NPO) by trained faculty in real-life settings over the next 4 months. A peer-validated, self-designed checklist was used for NPO. The change in score was analyzed using Student's paired t-test. The faculty observed the use of empathy in real-life patient encounters of the trainees over the next 6 months. In addition, secondary qualitative data were collected and analyzed to assess the impact of the module on other stakeholders such as the role-playing undergraduate students and core faculty. RESULTS: Pretraining assessment revealed that concept of empathy during patient communication was understood by only 10% students. PostESM training, the self-rated mean empathy score, on JSE, significantly increased from 95.9 to 106.7 (of a maximum of 140). This was also confirmed by a significant improvement in externally rated empathy and soft skills scores (from 29.3 to 39.1; of a maximum of 55) using the NPO tool. Focus group discussion was done on the continued display of empathy by the trainees in real-life situation over 6 months of observation by the faculty. The group agreed that there was a gradual attrition of initial gain in empathy behavior over the observation period of 6 months. The spillover benefits of the training process were observed among the role-playing undergraduates as well. A thematic analysis of their reflections on the process revealed a substantial change with an improved understanding of effective communication. CONCLUSIONS: There is a definite scope for introducing empathetic communication in medical training. Empathetic communication can be improved by effective training in a contextual manner with a need for regular reinforcement. Sensitization at all levels including the faculty is required to implement effective communication skills in medical profession.

Pattern ERG in central serous retinopathy.

BACKGROUND: To evaluate the pattern electroretinogram (PERG) in central serous retinopathy. METHODS: In this prospective study, 20 patients with recent onset (<6 weeks) unilateral CSR were studied with the fellow eye acting as control. BCVA, psychophysical parameters, FFA, OCT, flash and pattern ERG were evaluated. RESULTS: The mean P50 amplitude in the affected eye at presentation was 2.36 ± 0.8 µv compared to 3.24 ± 0.85 µv in the normal eye. At 12 weeks, the mean P50 amplitude in the affected eye was 3.16 ± 0.88 µv compared to 3.63 ± 0.82 µv in the normal eye. The reduction of 27 % in P50 amplitude even after recovery was statistically significant (P < 0.001). A reduction of 19.77 % in the amplitude of N95 wave in the affected eye compared to the normal eye was seen, which was statistically significant (P < 0.001). In the affected eye, there was statistically significant improvement in the psychophysical tests at 12 weeks. CONCLUSIONS: This study reveals that P50 component of the PERG is reduced in cases of CSR, indicating functional disturbance of the macular photoreceptors. A normal flash ERG indicates that pathology is electrophysiologically localised to macula without affecting general retina. Residual deficit in the PERG explains poor quality of vision in spite of normal anatomical apposition and quantitative 6/6 visual acuity.