Reactive Hypoglycemia in Patients Prior to Cataract Surgery: A Case Series.

Cataract surgery is one of the most frequently performed surgical procedures and is often performed under topical anesthesia in conscious patients. Sweating, palpitations, and anxiety may be seen in patients about to undergo surgery. However, these are typical adrenergic symptoms of hypoglycemia and should be further investigated if occurring before surgery. Here, we report five cases of postprandial or reactive hypoglycemia observed in hospital settings just before conducting cataract surgeries in non-diabetic 52-78-year-old patients from 2019 to 2023.

A study of retinal changes in women with polycystic ovarian syndrome.

Purpose: To compare the optical coherence tomography (OCT)-based retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness at the posterior pole, and total macular thickness of women with the polycystic ovarian syndrome (PCOS) versus healthy reproductive age group females. Methods: The study included 110 eyes of 55 diagnosed cases of PCOS (study group) and 110 eyes of 55 healthy reproductive age group (15-49 years) females (control group). All patients underwent a detailed ophthalmological evaluation followed by an OCT to measure their retinal thicknesses. The body mass index (BMI) of patients was noted and compared with the retinal thickness. Also, the lipid profile and serum testosterone levels of PCOS patients were recorded. Results: The retinal thicknesses in the two study were similar and there was no statistically significant difference. However, on stratification with BMI, it was seen that in patients with BMI>30 kg/m2, the superior Retinal Nerve Fibre Layer (RNFL) was significantly thicker in the PCOS group as compared with the control group (P = 0.0006). The mean serum testosterone level in patients with PCOS was 141.3 ± 23.2. Also, 65.45% of patients had a serum testosterone level of more than 70 ng/dL. The mean HDL cholesterol in patients with PCOS was 38.1 ± 15.6. The mean LDL cholesterol in PCOS patients was 98.4 ± 21.7, and the mean total cholesterol in PCOS patients was 153.6 ± 27.3. Conclusion: Androgens have a trophic action on nerves, which could explain the increased RNFL thickness in these patients.

Lobular capillary hemangioma of the conjunctiva.

We report a case of lobular capillary hemangioma of the conjunctiva in a 32-year-old man, who had no history of eye surgery or trauma, and did not respond to topical corticosteroid therapy. He was treated successfully by surgical excision. Excisional biopsy confirms the diagnosis and rules out any malignant lesion in medically uncontrolled cases.

Subconjunctival foreign body with suspected scleral penetration.

Ocular foreign bodies may be threat to vision loss. Superficial foreign body present on the conjunctiva or cornea can be easily detected and removed, and may not cause much harm if treated appropriately without delay. Subconjunctival foreign bodies are relatively rare, commonly missed and present as foreign body granuloma, even if they are visible their extent in deeper tissue is difficult to assess. Foreign bodies penetrating the ocular coat can result in partial or full thickness penetration of cornea and sclera with or without involvement of posterior segment. Here we present a case of subconjunctival metallic foreign body embedded in deeper sclera in a 22-year male working in factory. Foreign body was removed carefully under local anaesthesia avoiding further damage to the eye.

Ganglion cell complex and retinal nerve fiber layer thickness in gestational diabetes mellitus.

PURPOSE: The purpose of this study was to compare ganglion cell complex and peripapillary retinal nerve fiber layer (RNFL) thickness between pregnant females with gestational diabetes mellitus (GDM) and healthy pregnant females. MATERIALS AND METHODS: This was a single-center, prospective, analytical cross-sectional study including pregnant females with a gestational age of 24 weeks or more in the GDM and control groups. The GDM group included 162 pregnant females with GDM, and the control group included 162 healthy pregnant females. Peripapillary RNFL (pRNFL), macular RNFL (mRNFL), GCL+ (ganglion cell layer [GCL] + inner plexiform layer [IPL]), and GCL++ (mRNFL + GCL + IPL) thickness were analyzed using spectral-domain optical coherence tomography (OCT), and comparisons were made between the groups. RESULTS: Both the groups had similar mean age (P = 0.219), intraocular pressure (P = 0.186), central corneal thickness (P = 0.689), Schirmer test value (P = 0.931), and tear breakup time (P = 0.651). The mean pRNFL thickness of the GDM and control groups was 100.75 ± 8.36 µm and 106.77 ± 8.44 µm (P < 0.0001). pRNFL was significantly thinner in all four quadrants (P < 0.05) in the GDM compared to the control group. We observed that the mean mRNFL, GCL+, and GCL++ thickness were significantly reduced in GDM in comparison to the control group (P < 0.05). CONCLUSION: Our study showed that OCT plays an indispensable role in determining initial retinal changes caused by GDM before the development of diabetic retinopathy.

Bilateral severe microphthalmos with bilateral colobomatus orbitopalpebral cyst: accessibility of speciality eye-care and rehabilitation services in low and middle-income countries.

A 12-year-old girl presented with an unusually large mass under the right lower eyelid and a smaller mass under the left lower lid since the last 6 months. The parents had noticed the absence of the right eyeball and a very small left eyeball and no vision in both eyes since birth but did not approach the healthcare system. The patient was diagnosed as a case of bilateral severe microphthalmos with colobomatous cyst with late presentation and was treated surgically. The parents were counselled for education and training of the child in schools for visually impaired. Early treatment and rehabilitation help patients lead a normal life in these cases. In rural areas, patients face challenges in getting access to the specialty eye-care services due to several barriers, including lack of availability and affordability. This case highlights the disparities in essential health services in low and middle-income countries.

Intraoperative mitomycin C and cryotherapy as adjunct therapy for recurrent lobular capillary haemangioma of conjunctiva.

Recurrence of lobular capillary haemangioma of conjunctiva after surgical excision is rare but sometimes it may be difficult to manage multiple recurrences. A 31-year-old female patient presented with recurrent polypoid conjunctival lobular capillary haemangioma. Excisional biopsy was performed, followed by eye drop mitomycin C 0.04% four times a day for 1 week postoperatively. She reported again after 3 months with recurrence of vascular elongated nodular lesion. Excision of the mass with application of mitomycin C 0.02% intraoperatively for 1 min and cryotherapy using double thaw technique of the peripheral conjunctival margin was done. The histopathological examination confirmed the recurrence of lobular capillary haemangioma. On review, 1 year after treatment there was no evidence of recurrence. A combined use of cryotherapy and intraoperative mitomycin C as adjunctive therapy after surgical excision can successfully prevent further recurrence without any adverse effect.

Rebound tonometer: ideal tonometer for measurement of accurate intraocular pressure.

AIM: To assess the accuracy of a rebound tonometer (RT) in patients with glaucoma, comparing the measurements with those obtained by a noncontact tonometer (NCT) and a Goldmann applanation tonometer (GAT). MATERIALS AND METHODS: A total of 71 patients (142 eyes) with glaucoma from our hospital-based glaucoma clinic were included in the study. Intraocular pressure (IOP) was measured with RT, NCT, and GAT with an interval of 10 minutes, in between the readings obtained by the different tonometers. RESULTS: In eyes with normal IOP, the IOP measured by RT is 1 to 3 mm Hg higher than that by NCT and 2 to 3 mm Hg higher than that by GAT. There was a trend toward greater difference when the IOP values were higher (>21 mm Hg). Mean IOP readings recorded by RT were higher than IOP recorded by NCT and GAT. A statistically significant tendency to an overestimation of IOP with RT as compared with GAT was found. CONCLUSIONS: IOP readings obtained by an I-care tonometer in our study have shown reasonable concordance with GAT. Overestimation of IOP measured by RT as compared with GAT is directly proportional to the IOP. As the I-care tonometer measured IOP with good accuracy, it may be considered as an appropriate method for clinical use in normal subjects and glaucoma patients.

Long-term change in intraocular pressure after extracapsular cataract extraction with posterior chamber intraocular lens implantation versus phacoemulsification with posterior chamber intraocular lens implantation in Indians.

PURPOSE: The purpose of the study is to evaluate the long-term changes in intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation versus phacoemulsification with PCIOL implantation in otherwise normal cataract patients in India. MATERIALS AND METHODS: The study was conducted in the Department of Ophthalmology, King George's Medical College, Lucknow between August 2000 and August 2001. One hundred and seventeen eyes of 115 patients were included in the study. 84 patients were randomly selected for ECCE with PCIOL implantation (ECCE group) and 31 patients were selected for phacoemulsification with PCIOL implantation (Phaco group). IOP was measured pre-operatively and post-operatively, from the 1(st) month to the 12(th) month. Statistical significance was indicated by P > 0.05. RESULTS: There was a mean fall in IOP of 2.70 mm Hg (19.74%) in the ECCE group and 2.74 mm Hg (20.57%) in the phaco group. The decrease in the mean post-operative IOP from baseline was statistically significant (P > 0.01) at the end of 2 months in both groups. There was no statistically significant difference in post-operative IOP at any visit between groups (P < 0.05, all post-operative visits). After 4(th) monthpost-operatively, the IOP was mostly stable, but it was significantly lower than the pre-operative IOP. CONCLUSION: Significant IOP reduction may be expected after cataract surgery with either ECCE or phacoemulsification with IOL implantation. The lowering of IOP became statistically significant at about 2 months post-operatively, but became almost stable after the 4(th) month.

Transcanalicular endoscope combined laser-assisted dacryocystorhinostomy.

AIMS: In this study, we have tried to assess the success rate and difficulties that we came across while performing the transcanalicular endoscope combined laser-assisted dacryocystorhinostomy (T-ECLAD). MATERIALS AND METHODS: A prospective study of 60 patients suffering from nasolacrimal duct obstruction confirmed by preoperative syringing was carried out at the Regional Institute of Ophthalmology. T-ECLAD is a new minimally invasive dacryocystorhinostomy procedure, which is performed by diode laser (980 nm diode laser with power of 10 watts) through lacrimal canaliculi with the help of a cannula and fiber optic cable. The interior of the nasal cavity was visualized with the help of the nasal endoscope on a monitor. Success of procedure was assessed by patency of the lacrimal drainage system on irrigation. RESULTS: We performed 56 successive T-ECLAD. The average procedure time was 10 min, and on an average 235 Joules of laser energy was needed. We observed a patent nasolacrimal duct on irrigation in 39 out of 56 treated eyes. 1 patient had partial, 5 patients had blocked irrigation, and 10 patients did not return for follow up. This yields a success rate of 69.6% (if we exclude patients who did not return for follow up) with an average follow-up period of 6 months. CONCLUSIONS: The 980-nm T-ECLAD is a new contribution to the field of lacrimal surgery. It is a minimally invasive and quick procedure.