Ten-core versus 16-core transrectal ultrasonography guided prostate biopsy for detection of prostatic carcinoma: a prospective comparative study in Indian population.

PURPOSE: To compare the cancer detection rate in patients with raised serum prostate-specific antigen (PSA) or abnormal digital rectal examination (DRE) results between the 10-core and the 16-core biopsy techniques in an Indian population. METHODS: Between November 2010 and November 2012, 95 men aged >50 years who presented to the Urology Department with lower urinary tract symptoms, elevated serum PSA, and/or abnormal DRE findings underwent transrectal ultrasonography (TRUS)-guided prostate biopsy. A total of 53 patients underwent 10-core biopsy and 42 patients underwent 16-core biopsy. RESULTS: Of the 53 men in the 10-core group, 8 had cancer, whereas in the 16-core biopsy group, 23 of 42 men had cancer. Detection of prostate cancer was significantly higher in patients who underwent 16-core biopsy than in those who underwent 10-core biopsy (P<0.001). Among the 95 men, 44 men had abnormal DRE findings (46.3%), of whom 23 showed cancer (52.27%). Of 51 men with normal DRE findings and elevated PSA, 8 men had malignancy with a cancer detection rate of 15.68%. Among 20 men with PSA between 4.1 and 10 ng/mL, 2 (10%) had cancer. In 31 men with PSA between 10.1 and 20 ng/mL, 3 cancers (9.67%) were detected, and in 44 men with PSA >20 ng/mL, 26 cancers were detected (59.09%). CONCLUSIONS: The cancer detection rate with 16-core TRUS-guided biopsy is significantly higher than that with 10-core biopsy (54.76% vs. 15.09%, P<0.001). In patients with both normal and abnormal DRE findings, 16-core biopsy has a better detection rate than the 10-core biopsy protocol. With increasing PSA, there is a high rate of detection of prostate cancer in both 10-core and 16-core biopsy patients.

A survey of severe visual impairment in children attending schools for the blind in a coastal district of Andhra Pradesh in South India.

PURPOSE: To identify the major causes of severe childhood visual impairment and blindness among students attending schools for the blind in a coastal district of Andhra Pradesh (AP) in South India. METHODS: Children ≤ 16 years of age attending six schools for the blind in the study area were interviewed and examined in the year 2009, and causes were classified according to the World Health Organization Program for Prevention of Blindness (WHO/PBL) childhood blindness proforma. A total of 113 children underwent a detailed eye examination by an experienced ophthalmologist. RESULTS: The major causes of blindness were congenital eye anomalies in 46 children (41.4; 95% confidence interval (CI): 32.3-50.6), followed by retinal disorders in 21 children (18.9%; 95% CI: 11.6-26.2), cataract in 9 children (9.7%; 95% CI: 2.9-12.9), and corneal conditions (scar and Staphyloma) in 8 children (7.1%; 95% CI: 2.4-11.8). More than half the children (56.6%) were blind due to conditions that could have been treated or prevented. DISCUSSION: Congenital anomalies were found to be the most common cause of blindness. The majority of the cases were due to avoidable causes of blindness. Therefore, robust screening measures may help reduce the burden of visual impairment in children.

Is microsporidial keratitis a seasonal infection in India?

Microsporidia are emerging ocular pathogens. In this study, we describe the seasonal trends of microsporidial keratitis. The incidence of microsporidial keratitis is increasing in India, with a seasonal trend towards disease onset during the monsoon.

Geo - hydrological investigations and impact of water harvesting structures on groundwater potential in Anantapur District, Andhra Pradesh, India.

In this paper, the data pertaining to the rainfall, its departure from normal, moving mean rainfall, depth of water levels in pre-monsoon and post-monsoon seasons, groundwater availability, groundwater utilization and impact of storage of water in large water bodies are analyzed graphically. The results indicate that the groundwater is over exploited in many places in Anantapur District (India). The groundwater levels found fluctuating, when compared the observations in pre-monsoon and post-monsoon seasons. Hence, it is concluded that the construction of water harvesting structures at suitable locations will have a definite impact on the groundwater potential in Anantapur District.

Comparison of in vitro susceptibilities of Gram-positive cocci isolated from ocular infections against the second and fourth generation quinolones at a tertiary eye care centre in South India.

PURPOSE: To compare the in vitro antimicrobial susceptibilities of Gram-positive cocci isolated from the ocular infections to the second and fourth generation fluoroquinolones at a tertiary eye care centre in south India. METHODS: A retrospective review of microbiology records at LV Prasad eye institute, Hyderabad, India, identified 787 Gram-positive cocci isolated from different ocular infections between January 2005 to May 2008.The isolates were identified using culture characteristics and biochemical tests. In vitro antibiotic susceptibility of the isolates was determined by using Kirby-Bauer disc diffusion method. We analysed the susceptibility data of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin. RESULTS: Out of 787 isolates, 147 (18.7%) were Staphylococcus aureus, 279 (35.2%) were coagulase-negative Staphylococci, 357 (45.4%) were Streptococcus pneumoniae,and 4 (0.4%) were other Streptococcus species. Of the four quinolones, susceptibility to gatifloxacin was highest (85.6%) followed by ofloxacin (65.6%), moxifloxacin (63.9%), and ciprofloxacin (60.5%). In all, 33 (4.2%) of 787 isolates were resistant to all the four fluoroquinoles. S. aureus and coagulase-negative Staphylococcus isolates that were resistant to ciprofloxacin and ofloxacin were most susceptible to gatifloxacin. S. pneumoniae were more susceptible to gatifloxacin, ofloxacin, and ciprofloxacin than moxifloxacin. CONCLUSIONS: In our institute, we observed that gatifloxacin is more potent than moxifloxacin against Gram-positive cocci isolated from ocular infections.

Associated factors for age-related maculopathy in the adult population in southern India: the Andhra Pradesh Eye Disease Study.

BACKGROUND: To assess prevalence, potential risk factors and population attributable risk percentage (PAR) for age-related maculopathy (ARM) in the Indian state of Andhra Pradesh. METHODS: A population-based study, cross-sectional epidemiological study was conducted in the state of Andhra Pradesh in India during 1996 and 2000. Participants from 94 clusters in one urban and three rural areas representative of the population of Andhra Pradesh underwent a detailed interview and a detailed dilated ocular evaluation by trained professionals. This report presents the prevalence estimates of ARM and examines the association of ARM with potential risk factors in persons aged 40-102 years (n = 3723). ARM was defined as per the international classification and grading system. RESULTS: ARM was present in 327 subjects, an age-gender-area-adjusted prevalence of 8.9% (95% confidence interval (CI), 8.1% to 9.9%). Multivariate analysis showed that, the adjusted prevalence of ARM was significantly higher in those 70 years of age or older (adjusted odds ratio (OR), 3.65; 95% CI 2.24 to 5.94) and in subjects with hypertension OR 1.30 (95% CI 1.02 to 1.65). The presence of any cataract and urban residence were significantly associated with increased prevalence of ARM (OR 1.67; 95% CI 1.27 to 2.21 and 2.30; 95% CI 1.79 to 2.96) respectively. Increased intraocular pressure (IOP) and increased cup-to-disc ratio (CDR) were also significantly associated with increased prevalence of ARM (OR 1.03; 95% CI 1.002 to 1.06 and 2.25; 95% CI 1.10 to 4.67) respectively. The PAR for hypertension and any cataract was 12% and 18% respectively in this population. CONCLUSION: The prevalence of ARM in this south Indian population is similar to those reported from other developed countries. Increased age, increased IOP and increased CDR were significantly associated with the increased risk of ARM.

Combined trabeculotomy and trabeculectomy in advanced primary developmental glaucoma with corneal diameter of 14 mm or more.

PURPOSE: To report the safety and efficacy of combined trabeculotomy and trabeculectomy (CTT) in advanced primary developmental glaucoma with corneal diameter 14 mm or more. PATIENTS AND METHODS: A total of 74 (121 eyes) consecutive patients aged 3 days-100 months (median, 10 months) with advanced developmental glaucoma were included. Primary CTT was performed by a single surgeon at a tertiary eye care centre in India over a 13-year period. The main outcome measures were changes in and final levels of intraocular pressure (IOP), corneal clarity, visual acuity, and refractive status. RESULTS: Mean preoperative IOP was 29.4+/-7.6 mmHg (range, 10-56 mmHg) and mean postoperative IOP was 15.5+/-6.6 mmHg (range, 6-38 mmHg) (P<0.0001) with percentage reduction of 44.5+/-27.1. Kaplan-Meier survival analysis revealed 3-, 6-, 9-, 12-, 24-, 48-, and 72-month success rates of 86.5, 80.5, 78.1, 75.5, 71.1, and 60.5%, respectively. Majority (80.5%) of the patients were myopes with mean spherical equivalent of 5.8+/-4.5D (range, 0.75-22.0D). Using various age-appropriate testing procedures, at the final follow-up visit, 14 patients (41.2%) had age-appropriate normal visual acuity and 20 patients (58.8%) had subnormal visual acuity. Best-spectacle-corrected visual acuity of > or =20/60 was achieved in seven patients (26.9%). There were no sight-threatening intraoperative and postoperative complications. CONCLUSION: CTT is safe and effective in patients with advanced primary developmental glaucoma. It offers good IOP control with a low complication rate, with about one-third of patients achieving a visual acuity of 20/60 or better.

Safety and efficacy of phacoemulsification compared with manual small-incision cataract surgery by a randomized controlled clinical trial: six-week results.

OBJECTIVE: To compare the efficacy, safety, and refractive errors of astigmatism after cataract surgery by phacoemulsification and manual small-incision cataract surgery techniques. DESIGN: Masked randomized control clinical trial. PARTICIPANTS: Four hundred eyes of 400 patients, 1:1 randomization with half in each arm of the trial. METHODS: A total of 400 eyes was assigned randomly to either phacoemulsification or small-incision groups after informed consent and were operated on by 4 surgeons. They were masked to the technique of surgery before, during, and after cataract surgery and followed up to 1 year after surgery. The intraoperative and postoperative complications, uncorrected and best-corrected visual acuity, and astigmatism were recorded at 1 and 6 weeks postoperatively. MAIN OUTCOME MEASURES: The proportion of patients achieving visual acuity better than or equal to 6/18 with and without spectacles after cataract surgery in the operated eye up to 6 weeks, postoperative astigmatism, and complications during and after surgery. RESULTS: This article reports clinical outcomes up to 6 weeks. Three hundred eighty-three of 400 (95.75%) patients completed the 1-week follow-up, and 372 of 400 (93%) patients completed the 6-week follow-up. One hundred thirty-one of 192 (68.2%) patients in the phacoemulsification group and 117 of 191 (61.25%) patients in the small-incision group had uncorrected visual acuity better than or equal to 6/18 at 1 week (P = 0.153). One hundred fifty of 185 (81.08%) patients of the phacoemulsification group and 133 of 187 (71.1%) patients of the small-incision group (P = 0.038) were better than or equal to 6/18 at the 6-week follow-up for presenting visual activity. Visual acuity improved to > or = 6/18 with best correction in 182 of 185 patients (98.4%) and 184 of 187 (98.4%) patients (P = 0.549), respectively. Poor outcome (postoperative visual acuity < 6/60) was noted in 1 of 185 (0.5%) in the phacoemulsification group and none in the small-incision group. The mode of astigmatism was 0.5 diopters (D) for the phacoemulsification group and 1.5 D for the small-incision group, and the average astigmatism was 1.1 D and 1.2 D, respectively. There was an intra-surgeon variation in astigmatism. The phacoemulsification group had 7 posterior capsular rents compared with 12 in the small-incision group, but the phacoemulsification group had more corneal edema on the first postoperative day. CONCLUSIONS: Both the phacoemulsification and the small-incision techniques are safe and effective for visual rehabilitation of cataract patients, although phacoemulsification gives better uncorrected visual acuity in a larger proportion of patients at 6 weeks.