PURPOSE:The purpose of this study was to compare ganglion cell complex and peripapillary retinal ... more 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.
Spectacle-related glass foreign body eye injury is commonly associated with sports activities and... more Spectacle-related glass foreign body eye injury is commonly associated with sports activities and a significant contributor to penetrating eye injury. Optically clear glass particles may easily be missed during the examination. We present a case of intrastromal glass foreign body embedded in superficial layers of corneal stroma associated with sports-related spectacle injury in a 21-year male. There were multiple superficial lacerations and multiple small glass fragments on the surface of the cornea. After the removal of glass fragments under a slit lamp, the eye was washed thoroughly and patched with antibiotic and cycloplegic eye drops for twenty-four hours. However, the next day we could detect a small intrastromal glass fragment in the superficial layers of the corneal stroma under slit-lamp examination with high magnification. A small piece of glass (1mm in length) was removed under topical anaesthesia.
Trauma involving the eye, orbital and periorbital regions are commonly seen in cases of road traf... more Trauma involving the eye, orbital and periorbital regions are commonly seen in cases of road traffic accidents, sports injuries and physical assaults, but cases of intraorbital / periorbital foreign bodies are rare. Early presentation, history of trauma, and imaging help in diagnosis. However, sometimes the diagnosis is missed, particularly in cases with late presentation and a vague history of minor trauma and trauma with a non-metallic foreign body. A missed foreign body may present later with infection, repeated inflammation, ptosis, and proptosis and motility defect, further complicating the management. Here, we present a case of missed foreign body during the primary repair of facial injury in a 32-year male with polytrauma sustained in a road traffic accident. Evidence of foreign body was reported in a CT scan head advised for head injury. Re-exploration of wound and removal of foreign body is performed under local anaesthesia.
Ocular foreign bodies may be threat to vision loss. Superficial foreign body present on the conju... more 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.
Ophthalmology Research: An International Journal, 2021
Angular dermoid cysts are common periorbital tumours in children. They are tumours of embryonic o... more Angular dermoid cysts are common periorbital tumours in children. They are tumours of embryonic origin that arise along bony sutures as a result of abnormal ectodermal sequestration during development. Angular dermoid cysts usually present in early childhood, are characteristically small benign and slow growing lesion. External angular dermoid present in the superotemporal quadrant is more common compared to internal angular dermoid in the superonasal quadrant. Early surgical excision is recommended and performed in the majority of cases, particularly to restore facial cosmesis. Here we report an unusual case of a large internal angular dermoid cyst indenting the globe in a 3-year-old girl presented with left upper eyelid mass at medial angle since one year of age. The cyst was excised completely by anterior orbitotomy through a small superior lid crease incision.
Obesity is known to cause physical and metabolic diseases. It is often assumed by people (includi... more Obesity is known to cause physical and metabolic diseases. It is often assumed by people (including the healthcare workers) that the person with obesity lacks self-control in matters of diet and physical exercise, and is therefore responsible for his or her weight. Persons with obesity have to face sarcasm, barbs, and discrimination due to their condition. They often have difficulty in getting jobs or have to accept lower than standard pay for their work. Although weight gain requires calorie intake in excess of calorie expenditure, it is sometimes not easy for the person to restrict calories due to the underlying causes of obesity. The body resists losing weight, and attempts to hoard calories by reducing the metabolic rate. In this chapter we have explained and classified the causes of obesity into endogenous and exogenous. The endogenous causes include genetic and epigenetic causes, maternal factors, and hormonal causes, while exogenous causes include obesogenic environment, life...
Recurrence of lobular capillary haemangioma of conjunctiva after surgical excision is rare but so... more 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.
Infectious Eye Diseases - Recent Advances in Diagnosis and Treatment
Fungal keratitis or fungal corneal ulcer is potentially blinding infection of cornea, is consider... more Fungal keratitis or fungal corneal ulcer is potentially blinding infection of cornea, is considered one of the major cause of ocular morbidity, particularly in developing countries. It is a common cause of infectious keratitis, especially in tropical and subtropical countries. Fungal keratitis is notoriously challenging to diagnosis and difficult to treat. Delay in diagnosis may result in irreversible sequelae of corneal fungal infections, which can be preventable. Fungal keratitis often have worse treatment outcomes than bacterial keratitis, Delayed diagnosis and scarcity of effective antifungal agents are the major factors for poor outcome. In the recent years considerable advancement in the diagnosis and treatment has been occurred. In this chapter, we will discuss the recent advances in diagnosis and management of fungal keratitis with a brief discussion on pathogenesis and future therapeutic models.
A 12-year-old girl presented with an unusually large mass under the right lower eyelid and a smal... more 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.
Aims: To evaluate and compare the diagnostic values and clinical utility of the Ocular Surface D... more Aims: To evaluate and compare the diagnostic values and clinical utility of the Ocular Surface Disease Index (OSDI) questionnaire, the tear film break-up time test (TBUT), and the Schirmer’s test in diagnosing dry eye disease in patients presenting with dry eye symptoms. Study Design: A prospective observational study. Place and Duration of Study: Department of Ophthalmology, AIIMS Jodhpur, Rajasthan, India. Two-month period between July 2016 and September 2016. Methodology: We have included 100 patients aged >20 years having foreign body sensations, burning sensations, pain, dryness, blurred vision, photophobia, redness in the study. Routine ophthalmological examination was performed after OSDI questionnaire, followed by TBUT and Schirmer’s test and outcomes were evaluated. Results: The mean age of 100 participants was 43 ± 15.97years (range 20–78 years). The mean OSDI, TBUT, and Schirmer’s test scores were 58.67± 12.12 (range 30.0–88.9), 5.77 ± 3.49 seconds (range 0–17 seconds...
Background: Corneal stromal pseudohypopyon is a rare entity. Case: A 65-year-old female developed... more Background: Corneal stromal pseudohypopyon is a rare entity. Case: A 65-year-old female developed a suture abscess in her pseudophakic right eye, three years after conventional extra-capsular cataract extraction with posterior chamber intraocular lens implantation. Pus from the suture abscess tracked down the corneal stromal layers and formed a pus level leading to the appearance of a corneal intra-stromal pseudo-hypopyon. Conclusion:This case is unique due to its unusual clinical presentation and highlights the fact that corneal pseudohypopyon may occur without any associated anterior chamber hypopyon or Descemet’s detachment. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5871 NEPJOPH 2012; 4(1): 174-175
PURPOSE:The purpose of this study was to compare ganglion cell complex and peripapillary retinal ... more 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.
Spectacle-related glass foreign body eye injury is commonly associated with sports activities and... more Spectacle-related glass foreign body eye injury is commonly associated with sports activities and a significant contributor to penetrating eye injury. Optically clear glass particles may easily be missed during the examination. We present a case of intrastromal glass foreign body embedded in superficial layers of corneal stroma associated with sports-related spectacle injury in a 21-year male. There were multiple superficial lacerations and multiple small glass fragments on the surface of the cornea. After the removal of glass fragments under a slit lamp, the eye was washed thoroughly and patched with antibiotic and cycloplegic eye drops for twenty-four hours. However, the next day we could detect a small intrastromal glass fragment in the superficial layers of the corneal stroma under slit-lamp examination with high magnification. A small piece of glass (1mm in length) was removed under topical anaesthesia.
Trauma involving the eye, orbital and periorbital regions are commonly seen in cases of road traf... more Trauma involving the eye, orbital and periorbital regions are commonly seen in cases of road traffic accidents, sports injuries and physical assaults, but cases of intraorbital / periorbital foreign bodies are rare. Early presentation, history of trauma, and imaging help in diagnosis. However, sometimes the diagnosis is missed, particularly in cases with late presentation and a vague history of minor trauma and trauma with a non-metallic foreign body. A missed foreign body may present later with infection, repeated inflammation, ptosis, and proptosis and motility defect, further complicating the management. Here, we present a case of missed foreign body during the primary repair of facial injury in a 32-year male with polytrauma sustained in a road traffic accident. Evidence of foreign body was reported in a CT scan head advised for head injury. Re-exploration of wound and removal of foreign body is performed under local anaesthesia.
Ocular foreign bodies may be threat to vision loss. Superficial foreign body present on the conju... more 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.
Ophthalmology Research: An International Journal, 2021
Angular dermoid cysts are common periorbital tumours in children. They are tumours of embryonic o... more Angular dermoid cysts are common periorbital tumours in children. They are tumours of embryonic origin that arise along bony sutures as a result of abnormal ectodermal sequestration during development. Angular dermoid cysts usually present in early childhood, are characteristically small benign and slow growing lesion. External angular dermoid present in the superotemporal quadrant is more common compared to internal angular dermoid in the superonasal quadrant. Early surgical excision is recommended and performed in the majority of cases, particularly to restore facial cosmesis. Here we report an unusual case of a large internal angular dermoid cyst indenting the globe in a 3-year-old girl presented with left upper eyelid mass at medial angle since one year of age. The cyst was excised completely by anterior orbitotomy through a small superior lid crease incision.
Obesity is known to cause physical and metabolic diseases. It is often assumed by people (includi... more Obesity is known to cause physical and metabolic diseases. It is often assumed by people (including the healthcare workers) that the person with obesity lacks self-control in matters of diet and physical exercise, and is therefore responsible for his or her weight. Persons with obesity have to face sarcasm, barbs, and discrimination due to their condition. They often have difficulty in getting jobs or have to accept lower than standard pay for their work. Although weight gain requires calorie intake in excess of calorie expenditure, it is sometimes not easy for the person to restrict calories due to the underlying causes of obesity. The body resists losing weight, and attempts to hoard calories by reducing the metabolic rate. In this chapter we have explained and classified the causes of obesity into endogenous and exogenous. The endogenous causes include genetic and epigenetic causes, maternal factors, and hormonal causes, while exogenous causes include obesogenic environment, life...
Recurrence of lobular capillary haemangioma of conjunctiva after surgical excision is rare but so... more 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.
Infectious Eye Diseases - Recent Advances in Diagnosis and Treatment
Fungal keratitis or fungal corneal ulcer is potentially blinding infection of cornea, is consider... more Fungal keratitis or fungal corneal ulcer is potentially blinding infection of cornea, is considered one of the major cause of ocular morbidity, particularly in developing countries. It is a common cause of infectious keratitis, especially in tropical and subtropical countries. Fungal keratitis is notoriously challenging to diagnosis and difficult to treat. Delay in diagnosis may result in irreversible sequelae of corneal fungal infections, which can be preventable. Fungal keratitis often have worse treatment outcomes than bacterial keratitis, Delayed diagnosis and scarcity of effective antifungal agents are the major factors for poor outcome. In the recent years considerable advancement in the diagnosis and treatment has been occurred. In this chapter, we will discuss the recent advances in diagnosis and management of fungal keratitis with a brief discussion on pathogenesis and future therapeutic models.
A 12-year-old girl presented with an unusually large mass under the right lower eyelid and a smal... more 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.
Aims: To evaluate and compare the diagnostic values and clinical utility of the Ocular Surface D... more Aims: To evaluate and compare the diagnostic values and clinical utility of the Ocular Surface Disease Index (OSDI) questionnaire, the tear film break-up time test (TBUT), and the Schirmer’s test in diagnosing dry eye disease in patients presenting with dry eye symptoms. Study Design: A prospective observational study. Place and Duration of Study: Department of Ophthalmology, AIIMS Jodhpur, Rajasthan, India. Two-month period between July 2016 and September 2016. Methodology: We have included 100 patients aged >20 years having foreign body sensations, burning sensations, pain, dryness, blurred vision, photophobia, redness in the study. Routine ophthalmological examination was performed after OSDI questionnaire, followed by TBUT and Schirmer’s test and outcomes were evaluated. Results: The mean age of 100 participants was 43 ± 15.97years (range 20–78 years). The mean OSDI, TBUT, and Schirmer’s test scores were 58.67± 12.12 (range 30.0–88.9), 5.77 ± 3.49 seconds (range 0–17 seconds...
Background: Corneal stromal pseudohypopyon is a rare entity. Case: A 65-year-old female developed... more Background: Corneal stromal pseudohypopyon is a rare entity. Case: A 65-year-old female developed a suture abscess in her pseudophakic right eye, three years after conventional extra-capsular cataract extraction with posterior chamber intraocular lens implantation. Pus from the suture abscess tracked down the corneal stromal layers and formed a pus level leading to the appearance of a corneal intra-stromal pseudo-hypopyon. Conclusion:This case is unique due to its unusual clinical presentation and highlights the fact that corneal pseudohypopyon may occur without any associated anterior chamber hypopyon or Descemet’s detachment. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5871 NEPJOPH 2012; 4(1): 174-175
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