Biometric evaluation of myopic eyes without posterior staphyloma: disproportionate ocular growth.

PURPOSE: To evaluate changes in the anterior segment of myopic eyes and assess anterior biometry as a function of axial length (AL). DESIGN: Retrospective investigational study. PARTICIPANTS: Patients evaluated for phakic intraocular lens surgery at a tertiary eye care centre. METHODS: Patients with corrected visual acuity > 20/40 and AL > 24.5 mm were included in the study. Posterior staphyloma and maculopathy were ruled out in all the patients, and 176 eyes were included for analysis. AL was measured with partial coherence interferometry, while keratometry, central corneal thickness (CCT), anterior chamber depth (ACD), and horizontal white to white (WTW) were measured with slit-scanning topography. Group 1 included 55 eyes with AL < 26.5 mm, group 2 had 57 eyes with AL between 26.5 and 28.5 mm while group 3 had 64 eyes with AL > 28.5 mm. MAIN OUTCOME MEASURE: Correlation of AL with anterior biometry. RESULTS: The mean AL of the study eyes was 27.88 + 2.14 mm. The mean values of ACD (2.99 mm), CCT (0.52 mm), WTW (11.68 mm), and keratometry (43.62 D) were within the normal range. Overall, very weak correlations could be established between AL and CCT (R = 0.17, p = 0.02), AL and keratometry (R = - 0.28, p < 0.001), and AL and WTW (R = 0.22, p = 0.002), while ACD did not relate to AL significantly. The ACD and CCT did not relate significantly to AL in any of the three groups. Keratometry had a weak negative relation with AL in groups 1 and 2, while WTW had a weakly positive relation with AL in group 2 only. No variable had any significant relation with AL in group 3. CONCLUSION: There is disproportionate elongation of the eyeball in myopic patients with very weak or no correlation between anterior biometry and AL. This discord is more in longer eyes. Such a scenario can be challenging to a refractive surgeon treating highly myopic eyes and needs further evaluation.

Comparative evaluation of outcomes of phacoemulsification in vitrectomized eyes: silicone oil versus air/gas group.

The purpose of this study is to comparatively evaluate the morphology of cataract, intraoperative and postoperative complications (IPC), and surgical outcomes of phacoemulsification in post 23G vitrectomized eyes in silicone oil versus air/gas group. This prospective interventional clinical study took place in the Dr. RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. Eighty-nine eyes of 89 consecutive vitrectomized patients with cataract were included. All underwent phacoemulsification and evaluated for cataract morphology, surgical difficulties, IPC, visual acuity, and specular count. Mean age of patients was 50.24 ± 15.19 years. There were 65 males and 24 females and 48 eyes in silicone oil group and 41 in air/gas group. Combination type was the commonest morphology seen in both silicone oil (52.08 %) and air/gas group (70.33 %) followed by posterior subcapsular cataract (PSC) in 31.25 % silicone group and 12.2 % air/gas group. Posterior capsular plaque (PCP) was seen in 41.67 % of silicone oil versus 7.32 % air/gas group; p < 0.005. Pupillary abnormalities were significantly more in oil (31.25 %) than in air/gas group (9.76 %); p = 0.014. Mean duration between vitrectomy and phacoemulsification in oil group versus air/gas group was 8.39 ± 4.7 months and 10.9 ± 5.22 months, respectively; p < 0.005. Mean postoperative logMAR visual acuity was better in air/gas (0.43 ± 0.25) than in oil (0.66 ± 0.29) group, p < 0.005. There was no significant difference in mean endothelial cell loss postoperatively in either groups (p = 0.25). Morphology of cataract differs in the two groups with PSC being more common in oil group. The mean time of cataract onset was significantly less in patients with oil group, and poor visual outcome in oil group may be attributable to the increased PCP noted.

Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of mandibular degree II furcation defects: a randomized controlled clinical trial.

BACKGROUND: The treatment of molar furcation defects remains a considerable challenge in clinical practice. The identification of clinical measurements influential to treatment outcomes is critical to optimize the results of surgical periodontal therapy. The present study aimed to explore the clinical and radiographical effectiveness of autologous platelet-rich fibrin (PRF) and autologous platelet-rich plasma (PRP) in the treatment of mandibular degree II furcation defects in subjects with chronic periodontitis. MATERIAL AND METHODS: Seventy-two mandibular degree II furcation defects were treated with either autologous PRF with open flap debridement (OFD; 24 defects) or autologous PRP with OFD (25), or OFD alone (23). Clinical and radiological parameters such as probing depth, relative vertical clinical attachment level and horizontal clinical attachment level along with gingival marginal level were recorded at baseline and 9 mo postoperatively. RESULTS: All clinical and radiographic parameters showed statistically significant improvement at both the test sites (PRF with OFD and PRP with OFD) compared to those with OFD alone. Relative vertical clinical attachment level gain was also greater in PRF (2.87 ± 0.85 mm) and PRP (2.71 ± 1.04 mm) sites as compared to control site (1.37 ± 0.58 mm), and relative horizontal clinical attachment level gain was statistically significantly greater in both PRF and PRP than in the control group. CONCLUSIONS: The use of autologous PRF or PRP were both effective in the treatment of furcation defects with uneventful healing of sites.

"Pneumomediastinum: A marker of severity in Covid-19 disease".

Objective: The goal of this study was to look at the incidence, risk factors, clinical characteristics, and radiological aspects of COVID-19 patients who developed pneumomediastinum and compare these features between those who died and those who survived. Materials and methods: This retrospective observational study included COVID-19 patients having pneumomediastinum on CT from May 2020 to May 2021 in a COVID-19 care hospital. 1st wave patients were considered between the period of May 2020 to January 2021 and those in the second wave between February 2021 to May 2021. The clinical details were analyzed by a consultant intensivist and CT scans were read by a team of 6 resident radiologists and 5 experienced radiologists. Demographic data, co-morbidities, clinical parameters, hemodynamic markers, radiological involvement and associated complications were analyzed. Results: During the study period, 10,605 COVID-19 patients were admitted to our hospital of which 5689 underwent CT scan. 66 patients were detected to have pneumomediastinum on CT; 26 of them in the first wave and 40 in the second wave. Out of 66, 28 patients were admitted to ICU, 9 during the first wave and 18 during the second wave. The overall incidence of developing pneumomediastinum was 1.16%. Incidence in the 1st wave was 1.0% and in the 2nd wave was 1.29%. The overall mortality rate in admitted COVID-19 patients was 12.83% while it was 43.9% in COVID-19 patients who developed pneumomediastinum. Incidence of pneumomediastinum and pneumothorax was high in patients with extensive parenchymal involvement. 59/66 (89%) cases of pneumomediastinum had severe CT score on imaging. Conclusion: We conclude that pneumomediastinum is a marker of poor prognosis. Timely diagnosis of interstitial emphysema or pneumomediastinum will aid in planning early protective ventilation strategies and timely intervention of complications.

Peripheral ossifying fibroma: case report.

We present a case of peripheral ossifying fibroma (POF) in a 17-year-old boy. Clinical, radiographic and histologic characteristics are discussed and recommendations regarding differential diagnosis, treatment and follow-up are provided. Lesions histologically similar to POF have been given various names in the existing literature; therefore, the controversial varied nomenclature and possible etiopathogenesis of POF are discussed. A slowly growing soft tissue mass with speckled calcifications in the anterior oral cavity of children or young adults should raise the suspicion of a reactive gingival lesion such as POF.

Tribology of the sock-skin Interface - the influence of different fabric parameters on sock friction.

BACKGROUND: The purpose of this parametric design of experiments was to identify and summarize how the influence of knit structure (single jersey vs. terry), fiber composition (polyester vs. cotton), fiber linear density (30/1 Ne vs. 18/1 Ne & 1/150/34 vs. 2/150/34), and yarn type (filament vs. spun) affected the frictional profile across the sock-skin interface. METHODS: Friction testing trials were completed against both a polypropylene probe and a synthetic skin material (Lorica soft®) to determine if there was a difference in friction based on interface interaction. Friction testing was completed by sliding a probe across the inside bottom surface of the sock (the part that is usually in-contact with the bottom of the foot) while instantaneously measuring the frictional force every tenth of a second. RESULTS: For both trials (plastic probe and synthetic skin), in the dry condition, knit structure was found to be the most prominent fabric parameter affecting the frictional force experienced at the sock-skin interface. It was also determined that fiber linear density, and yarn type are tertiary factors affecting the frictional force measured at the sock-skin interface. Finally, in the dry state, it was determined that fiber composition had seemingly no effect on the frictional force experienced at the sock-skin interface. CONCLUSION: This parametric design of experiments has further enhanced the understanding of the tribology at the sock-skin interface. Through strategic design, four different textile parameters have been investigated, measured, and justified as to how each influence the friction measured between the two interfaces. This knowledge can be used to develop socks that mitigate the risk of friction blisters formation.

Biometric changes in Indian pediatric cataract and postoperative refractive status.

Purpose: To prospectively evaluate the biometric changes in Indian pediatric cataract and postoperative refractive status. Methods: A total of 147 patients were recruited into three groups: age <6 months, age between 7 months and 18 months, and age between 19 and 60 months and prospectively observed for 6 months. Exclusion criteria were preterm birth, microphthalmia, microcornea, megalocornea, uveitis, glaucoma, and traumatic or complicated cataract. Axial length and keratometry, the primary outcome measures, were taken preoperatively under general anesthesia before surgery. These children were followed up for 6 months to look for refractive and biometric changes. T-test and linear regression with the logarithm of independent variables were done. Results: All unilateral cataractous eyes (n = 25) and randomly selected bilateral cases (n = 122) were included in the analysis, for a total of 147 eyes. Mean age was 17.163 ± 13.024 months; axial length growth was 0.21, 0.18, 0.06 mm/month, and keratometry decline was 0.083, 0.035, 0.001 D/month in age groups 0-6, 7-18, and 19-60 months, respectively. The visual acuity improved in log MAR from 1.020 to 0.745 at 6 months postoperatively. There was statistically significant (Spearman's correlation coefficient = -0.575, P < 0.001) between age and postoperative refraction. There were no intraocular lens (IOL)-related complications seen in the immediate postoperative period. Peripheral opacification was seen in 102 eyes and central opacification in 1 eye at a 6-month follow-up. Conclusion: Indian eyes have a lower rate of axial length growth and keratometry change in comparison with western eyes implying smaller undercorrection in emmetropic IOL power for Indian pediatric eyes to achieve a moderate amount of hyperopia.

Pediatric Cataract - Importance of Early Detection and Management.

Pediatric cataract is often diagnosed and managed late. This delay may be due to the ignorance on the part of the community, financial constraints, delay in the diagnosis and lack of tertiary care facilities. There is an urgent need to include rubella vaccination in the universal immunization program. A Simple Red Reflex test to detect a cataract and guiding the parent for early intervention will go a long way in achieving the target of eliminating cataract as a cause of childhood blindness. The importance of early detection and quick referral to a multispecialty center can save the child of lot many blind-years. These children have the potential to achieve the best possible visual acuity if managed early.

Innovations in pediatric cataract surgery.

Advances in technology have made surgery in children safer and faster. The management of pediatric cataract has made rapid progress in the past decade with the availability of safer anesthesia, newer technique's, more predictable intraocular lens (IOL) power calculation, a better understanding of neurobiology, genetics, amblyopia management, improved IOL designs for preventing visual axis opacification, and adjuvant postoperative care. Modern vitrectomy machines with minimally invasive instruments, radiofrequency, diathermy, and plasma blades help immensely in complicated cases. Preoperative evaluation with ultrasound biomicroscopy and optical coherence tomography (OCT) allows better planning of surgical procedure. The future holds good for stem cell research, customized OCT, and Zepto (precision pulse capsulotomy).

Locally Delivered 0.5% Azithromycin as an Adjunct to Non-Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial.

BACKGROUND: Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes. METHODS: A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL). RESULTS: Both therapies resulted in significant improvements. Using a patient-based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1. CONCLUSION: Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome.

Effect of balanced phacoemulsification tip on the outcomes of torsional phacoemulsification using an active-fluidics system.

PURPOSE: To compare the outcomes of torsional phacoemulsification with a new balanced tip (Intrepid) and a conventional tip (Kelman) using a single active-fluidics torsional phacoemulsification machine (Centurion). SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. DESIGN: Prospective comparative case-control study. METHODS: Patients with senile cataract had torsional phacoemulsification with the Kelman conventional tip or the new Intrepid balanced tip using the active-fluidics torsional machine. Intraoperative parameters, such as cumulative dissipated energy (CDE), total ultrasound (US) time, torsion use time, torsion amplitude, aspiration time, and fluid use, were noted and compared. Endothelial cell loss and central corneal thickness (CCT) changes were evaluated at 1 month. RESULTS: The new tip showed significantly less CDE, total US time, torsion amplitude, aspiration time, and fluid use (8.55 ± 6.9 [SD], 33.59 ± 28.12 seconds, 37.8 ± 13.42, 173.19 ± 47.26 seconds, and 66.59 ± 20.44 mL, respectively) than the conventional tip (13.47 ± 10.65, 42.8 ± 33.46 seconds, 42.58 ± 16.38, 202.25 ± 71.28 seconds, and 97.14 ± 36.86 mL, respectively) (P < .01), especially in higher grades of cataract. Anterior capsulorhexis margin tear occurred in 2 patients with the new tip. There were no corneal burns in either group. The mean endothelial cell loss and the percentage change in CCT were not significantly different at 1 month. CONCLUSIONS: The new balanced tip performed phacoemulsification more efficiently, especially in hard cataracts requiring higher energy and prolonged phacoemulsification time.

Long-Term Evaluation of Specular Microscopic Changes Following Nd: YAG Iridotomy in Chronic Primary Angle-Closure Glaucoma Eyes.

AIM: The aim of this study was to evaluate specular microscopy of chronic primary angle-closure glaucoma (CPACG) eyes at least 1 year after Nd:YAG iridotomy, and compare them with CPACG eyes without an iridotomy and age-matched, normal eyes. PATIENTS AND METHOD: Consecutive patients of CPACG at the Glaucoma service were screened. All patients underwent slit-lamp biomicroscopy, +90 D examination, and applanation tonometry. A total of 100 eyes of 100 consecutive patients of CPACG with an Nd:YAG iridotomy performed ≥1 year before, who met all inclusion/exclusion criteria, 60 consecutive CPACG eyes without an iridotomy, and 60 age and refraction-matched control eyes were enrolled. A specular microscopy was performed in one eye of each patient by an observer masked to diagnosis. RESULTS: CPACG patients had a mean age of 62±8 years, a mean intraocular pressure of 18±5.3 mm Hg, a mean specular count of 2536±224 cells/mm, and mean duration after iridotomy of 3.2±2 years. There was a significant correlation of specular endothelial counts with age (r=-0.39; P<0.001) and interval after iridotomy (r=-0.25; P=0.01). CPACG eyes without an iridotomy had a mean age of 62±5 years and a mean specular count of 2469±199 cells/mm. Normal control eyes with a mean age of 61±6 years had a mean specular count of 2729±299 cells/mm. There was no significant difference in specular count between CPACG eyes with or without an iridotomy (P=0.19); however, both CPACG groups had a specular count significantly lower than controls (P=0.01 and 0.02, respectively). There was no statistically significant difference seen in polymegathism (coefficient of variation) and pleomorphism (% of hexagonal cells) in endothelial cells among the 3 groups. CONCLUSIONS: An Nd:YAG iridotomy in CPACG eyes did not lead to any significant changes in central corneal specular microscopy in the long term as compared with patients who did not undergo iridotomy. Eyes with CPACG, without and after an iridotomy, had a lower specular count compared with age-matched controls.

Platelet-Rich Fibrin Combined With a Porous Hydroxyapatite Graft for the Treatment of 3-Wall Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: Porous hydroxyapatite (HA) bone grafting material has been used to fill periodontal intrabony defects (IBDs), resulting in clinically acceptable responses. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and, therefore, has the potential for use as regenerative treatment for periodontal defects. The present study aims to explore the clinical and radiographic effectiveness of autologous PRF versus PRF + HA in treatment of IBDs in patients with chronic periodontitis. METHODS: Ninety IBDs were treated with autologous PRF with open-flap debridement (OFD), PRF + HA with OFD, or OFD (controls) alone. Clinical and radiologic parameters, including probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect fill were recorded at baseline and 9 months postoperatively. RESULTS: Mean PD reduction was greater in PRF (3.90 ± 1.09 mm) and PRF + HA (4.27 ± 0.98 mm) groups than the control group (2.97 ± 0.93 mm), and mean CAL gain was greater in PRF (3.03 ± 1.16 mm) and PRF + HA (3.67 ± 1.03 mm) compared to controls (2.67 ± 1.09 mm). Furthermore, significantly greater percentage of mean bone fill was found in the PRF (56.46% ± 9.26%) and PRF + HA (63.39% ± 16.52%) groups compared to controls (15.96% ± 13.91%). CONCLUSIONS: Treatment of IBD with PRF results in significant improvements of clinical parameters compared to baseline. When added to PRF, HA increases the regenerative effects observed with PRF in the treatment of 3-wall IBDs.

Assessment of Retinal Nerve Fiber Layer Changes by Cirrus High-definition Optical Coherence Tomography in Myopia.

INTRODUCTION: To evaluate the relationship between retinal nerve fiber layer (RNFL) thickness measured by Cirrus high-definition (HD) optical coherence tomography (OCT) and the axial length and refractive error of the eye. MATERIALS AND METHODS: A total of 100 eyes of 100 healthy subjects (age 20-34 years with M/F ratio of 57/43), comprising 50 eyes with emmetropia [spherical equivalent (SE) 0 D], 25 eyes with moderate myopia (SE between -4 D and -8 D), and 25 eyes with high myopia (SE between -8 D and -12 D) were analyzed in this cross-sectional study. Average and mean clock hour RNFL thicknesses were measured by cirrus HD-OCT and compared between the three groups. Associations between RNFL measurements and axial length and SE were evaluated by linear regression analysis. RESULTS: The average RNFL measurements were significantly lower in high myopia (78.68 +/- 5.67) and moderate myopia (83.76 +/- 3.44) group compared with emmetropia group (91.26 +/- 2.99), also in the superior and inferior mean clock hours. Significant correlations were evident between RNFL measurements and the SE and axial length. The average RNFL thickness decreased with increasing axial length (r = -0.8115) and negative refractive power (r = 0.8397). Myopia also affected the RNFL thickness distribution. As the axial length increased and the SE decreased, the thickness of the superior, inferior, and nasal peripapillary RNFL decreased. CONCLUSION: The axial length/refractive error of the eye affected the average RNFL thickness and the RNFL thickness distribution. Analysis of RNFL thickness in the evaluation of glaucoma should always be interpreted with reference to the refractive status. When interpreting the RNFL thickness of highly myopic patients by OCT, careful attention must be given to the inherently thinner RNFL to avoid a false diagnosis of glaucoma. HOW TO CITE THIS ARTICLE: Singh D, Mishra SK, Agarwal E, Sharma R, Bhartiya S, Dada T. Assessment of Retinal Nerve Fiber Layer Changes by Cirrus High-definition Optical Coherence Tomography in Myopia. J Curr Glaucoma Pract 2017;11(2):52-57.

Pediatric cataract.

Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.

Autologous Platelet-Rich Fibrin in the Treatment of 3-Wall Intrabony Defects in Aggressive Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: Platelet-rich fibrin (PRF) has recently been applied in osseous regeneration. The aim of the present study is to explore the efficacy of PRF in treatment of intrabony defects (IBDs) in aggressive periodontitis. METHODS: Fifty-four IBDs in 17 patients were treated either with autologous PRF with open flap debridement (OFD) or OFD alone. Clinical and radiologic parameters such as probing depth (PD), clinical attachment level (CAL), IBD depth, and percentage defect change were recorded at baseline and 9 months postoperatively. RESULTS: Mean PD reduction and mean CAL gain were significantly greater in PRF compared with the control group. Furthermore, a significantly greater percentage of mean bone defect change was found in the PRF group. CONCLUSION: Within the limits of the present study, there is greater bone fill at sites treated with PRF with conventional OFD than conventional OFD alone.

Comparison of Eye Drop Instillation Before and After Use of Drop Application Strips in Glaucoma Patients on Chronic Topical Therapy.

PURPOSE: To evaluate the impact of using drop application strips on eye drop instillation in glaucoma patients on chronic topical ocular hypotensive therapy. METHODS: A total of 72 patients with primary open-angle glaucoma with an uncorrected visual acuity of 3/60 or more, self-administering topical antiglaucoma medication for >1 year were evaluated. One eye of each patient was included in the study. Patients were instructed to instill 0.5% carboxymethyl cellulose drop in 1 eye. They were then instructed to instill the same drop using the drop application strips. RESULTS: Mean age of the patients included in the study was 50.39 ± 12.04 years. Before assistance of drop application strips, 35 (48.61%) patients placed the drop into the eye without any contact of the dropper nozzle, and, after application of the drop application strips, 66 (91.67%) patients placed the drop in the eye without any contact (P=0.025). The number of patients putting the first drop of drug into the eye without spilling over the adenexae increased from 30 (41.67%) to 45 (62.5%) after application of the strip (P<0.001). The mean number of drops instilled to get 1 drop into the eye decreased from 2 ± 0.95 to 1.56 ± 0.78 when the drop application strip was used (P<0.001). CONCLUSIONS: Use of a drop application strip causes a significant decrease in contact of the eye drop bottle nozzle with the eyeball and eyelid, decreases the number of drops instilled to get 1 drop into the eye, and is associated with an overall improvement in eye drop instillation.