The Psychological Impact of Rhino-Orbital Mucormycosis During the Second Wave of COVID-19 Pandemic From South East Asian Country.

AIM: The present study addressed overcoming the lacunae in the literature of psychiatric manifestations associated with rhino-orbital mucormycosis. The current study aimed to assess the symptoms of depression, anxiety, stress, coping measures, suicidal intent, and visual disability in patients of rhino-orbital mucormycosis (ROM) during the epidemic of the disease at the nodal tertiary care center in North India. METHODS: Fifty-four inpatients of laboratory-proven rhino-orbital mucor-mycosis (ROM) were included for an observational, cross-sectional study at nodal, designated COVID-19, and mucormycosis treating tertiary care hospital. Patients with Hindi Mini-Mental State Examination score <24, prior psychiatric illness, and severely ill requiring ventilator support were excluded. The psychological variables were assessed using Depression, Anxiety, and Stress Scale 21 (DASS 21), Beck's Suicide intent Scale, Coping Scale Questionnaire, and Visual disability scale (IND-VFQ33). Their socioeconomic status was assessed using the Modified Kuppuswamy Scale. RESULTS: Ninety percent of patients with ROM had diabetes mellitus. The majority (44%) of patients belonged to lower socioeconomic strata. Higher frequencies of severe depression (28%), extremely severe anxiety (26%), and mild stress (17%) were noted in the study participants. On the Tukey test, depression score was higher in patients of ROM compared to COVID (with ROM) (p-value= 0.016). On Tukey analysis, anxiety score was significantly higher in ROM patients compared to COVID (with ROM) patients (p-value = 0.018). Coping scores were significantly higher in COVID (with ROM) patients compared to ROM patients (p value = 0.035). Mild to moderate visual disability was noted in the study participants.  Conclusion: The current study reflects the association of higher depression and anxiety scores in cases with ROM that indicated higher mental health needs. Early assessment, early detection, and early intervention for psychological help, along with the multidisciplinary team, helped to improve the overall psychological outcome of the affected patients.

Low Dose Atropine in Preventing the Progression of Childhood Myopia: A Randomised Controlled Trial.

PURPOSE: To study the efficacy of low dose atropine (0.01%) eye drops in preventing myopia progression in children by comparing the mean change in spherical equivalent (diopter) and axial length (mm) over a period of one year to a control group and study its effect on near vision, pupil size, keratometry and pachymetry. METHODS: 200 eyes of 100 myopic children were randomized into two groups based on a computer-generated random number table. The treatment group was administered 0.01% atropine eye drop once at bedtime and control group was administered a placebo. The follow up was done 3-monthly for 12 months by assessing the mean change in spherical equivalent and mean change in axial length. Other parameters like near vision, pupil size, keratometry and pachymetry were assessed at each follow up. RESULT: The study was age and sex matched. The mean change in spherical equivalent refraction and axial length was significantly lower in the treatment group (0.31 ± 0.55 D; 0.11 ± 0.22 mm) than the placebo group (0.80 ± 1.65 D; 0.23 ± 0.44 D) (p-value: 0.003). Less steepening of the corneal curvature was observed in the treatment group (0.16 ± 0.28 D vs 0.29 ± 0.3 D; p < 0.001) and the mean change in pachymetry was comparable between the groups (0.00 ± 0.01) (p-value 0.489). No significant change was seen in near vision (96% of the eyes with atropine had no change in near vision; 2% of the eyes had a change of near vision by one line (p-value 0.500); 2% had a change by 3 lines (p-value: 0.07) or pupil size following treatment. CONCLUSION: The use of 0.01% atropine eye drop reduced the progression of myopia over the study period of one year with no significant changes in near vision, pupil size. No patient reported any systemic and local side effects with administration of 0.01% atropine eye drop.

Presenile cataract and its risk factors: A case control study.

PURPOSE: Early onset opacification of the lens (cataract) has been observed to be on the rise globally. This study was conducted to determine the various types of presenile cataract and to determine the probable risk factors associated with the occurrence of presenile cataract. MATERIALS AND METHODS: Patients in the age group of 18-40 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were recruited as cases. An equal number of consecutive patients of the same age group were included in the control group. Those who gave consent to participate in the study were interviewed through a preformed questionnaire and underwent a complete ocular examination and set of blood investigations. The type of cataract was noted, data obtained were compiled, and examination and investigations done were documented and analyzed using frequency distribution and Chi-squared test. RESULTS: In total, 90 cases and 90 controls that fulfilled the inclusion criteria were recruited. Most common type of cataract was found to be posterior subcapsular cataract. Presenile cataract was observed to be significantly associated with tobacco intake (P = 0.035), hypercholesterolemia (P = 0.002), fuel exposure (P = 0.004), and lower socioeconomic status (P = <0.001). CONCLUSIONS: Tobacco chewing, hypercholesterolemia, and excessive fuel exposure are risk factors for early development of cataract.

Evaluation of intravitreal bevacizumab as monotherapy and in combination with macular grid laser photocoagulation in diffuse diabetic macular edema.

BACKGROUND AND OBJECTIVE: The objective of the study was to compare the efficacy of intravitreal bevacizumab (IVB) as monotherapy versus combination with modified macular grid (MMG) laser photocoagulation in the primary treatment of diffuse diabetic macular edema (DDME). MATERIALS AND METHODS: A prospective randomized trial was carried out in sixty eyes with DDME after Institutional Ethical clearance. Group A received three doses of IVB at a 1-month interval. Group B received MMG in addition to IVB. Complete examination including best-corrected visual acuity (BCVA) (Snellen's), central macular thickness (CMT) using spectral domain-optical coherence tomography was carried out at 0, 1, 4, 8, 12, and 24 weeks. RESULTS: mean CMT at baseline, 12 and 24 weeks in Group A was 401 (±76), 280 (±49), and 307 (±46) and in Group B, 405 (±73), 237 (±33), and 242 (±45), respectively. Group B had significantly greater reductions (P < 0.001) from 12 weeks onward. BCVA and contrast sensitivity showed improvements with no significant difference. CONCLUSION: Combined therapy has more advantage in primary DDME by reducing CMT on longer follow-up.

Efficacy of Phacotrabeculectomy Alone versus Phacotrabeculectomy Augmented with Autologous Anterior Capsule Implantation Beneath the Sclera Flap.

PURPOSE: To evaluate the efficacy of autologous anterior lens capsule (ALC) in phacotrabeculectomy. MATERIAL AND METHODS: In this prospective, randomized case control study, after obtaining institutional ethical clearance and informed consent, 88 eyes posted for phacotrabeculectomy were divided into ALC and non-ALC groups. Combined phacoemulsification, with posterior chamber intraocular lens implantation and trabeculectomy, was performed in both groups. Anterior lens capsule transplantation was done in the first group beneath the sclera flap. Follow-up of three months was carried out and the morphology of bleb, intraocular pressure (IOP), requirement for additional medications, and complications were compared between the two groups. RESULT: Statistical difference favoring the ALC group was seen in IOP reduction (p < 0.05) at each follow-up, qualified success rate and failure rate at the three-month follow-up (p = 0.006), but no difference in bleb morphology was seen. CONCLUSION: ALC implantation is beneficial in maintaining filtration in a combined surgery with minimal complications.

Comparative Evaluation of Corneal Endothelium in Patients with Diabetes Undergoing Phacoemulsification.

PURPOSE: The purpose of this study is to determine if phacoemulsification with posterior chamber foldable intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetic controls. MATERIALS AND METHODS: This study compared the corneal endothelial status in sixty patients with diabetes with good glycemic control and sixty nondiabetic controls before and after (1 week, 1 month, 2 month, and 3 month) uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality, and coefficient of variation were measured using a noncontact specular microscope. Central corneal thickness was taken as a surrogate marker for endothelium functional status. RESULTS: Data were age and sex matched. Patients with diabetes showed significantly higher loss in endothelial cell count as compared to nondiabetic controls. Furthermore, the patients with diabetes showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the coefficient of variation. Significant correlation was found between energy used and change in endothelial count as well as coefficient of variation in nondiabetics only. CONCLUSION: In spite of good glycemic control, patients with diabetes have significantly more endothelial damage in comparison to nondiabetic controls with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in patient with diabetes.

A prospective randomized double masked controlled clinical trial to determine the efficacy of multiple drop centbucridine as an ocular surface anaesthetic.

In this study, the ocular surface anaesthetic and analgesic efficacies of 0.5% and 1% centbucridine both in saline were compared with 4% lignocaine drops in distilled water in normal healthy volunteers divided into three equal groups. In 99 healthy eyes, keeping one eye as an unanaesthetized control, one drop of any of the above three coded drugs was instilled in the contralateral eye, followed by one more drop of the same drug in the same eye after 3 minutes. The oneset of anaesthesia, achievement and duration of peak activity, total duration of action, the depth of analgesia, and period of burning sensation were all noted in this double-masked randomized controlled trial with the various drug solutions. Total peak duration of anaesthetic as well as analgesic effects in the 99 healthy normal eyes were found to be the highest with centbucridine 1%, followed by 4% lignocaine and 0.5% centbucridine respectively.