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Purpose:In this study, we intend to analyze ropivacaine and bupivacaine in various parameters during phacoemulsification under deep topical fornix nerve block (DTFNB), a known form of nerve block for phacoemulsification.Methods:This prospective randomized study was conducted on 100 patients undergoing elective cataract surgery by phacoemulsification under DTFNB. Patients were divided into two equal groups of fifty patients each, Groups B (bupivacaine) and Group R (ropivacaine). Two sponges, approximately 2 mm × 3 mm dimensions, saturated with either 0.5% bupivacaine or 0.75% ropivacaine were placed deep in the conjunctival fornices to perform the deep topical block. Both groups were evaluated for magnitude of pain and discomfort at various stages of phacoemulsification using a simple pain scoring system. The level of surgeon satisfaction, requirement for supplementary anesthesia, and surgical complications were also evaluated. Quantitative variables between the two groups were compared using unpaired t-test. Qualitative variables were correlated using Chi-square test.Results:Overall demographic parameters of patients were similar in both groups. Similar mean pain scores were found in the ropivacaine and bupivacaine groups, with no statistical significance. Surgical satisfaction and the need for supplemental anesthesia were also statistically insignificant.Conclusion:Ropivacaine is a good alternative for deep topical anesthesia as it has a better safety margin and lesser toxic effect than other comparable local anesthetic agents.

Introduction: Retinopathy is one of major micro vascular complication in long standing diabetes, but diabetic keratopathy has potential to decompensate following stress. The central corneal thickness is a sensitive indicator of health of cornea and may influence outcome in cataract, refractory surgeries and may lead to fallacy in Intraocular pressure measurement. Present study was cross sectional observational study, undertaken to determine the correlation between central corneal thickness (CCT), and diabetes control and duration in hilly north Indian patient.Material and Methods: This is a cross-sectional study conducted in the department of ophthalmology of a tertiary care centre in Kumaon region. 400 subjects from age group 40 to 80 years were studied. An ultrasound pachymeter was used to measure CCT. The subjects were divided into two groups, 200 of them were non-diabetic subjects, and 200 were diabetic patients. The collected data was transformed into variables, coded and entered in Microsoft Excel. Data was analysed and statistically evaluated using SPSS-PC-17 version. Results:The average central corneal thickness in diabetic patients was 527.01± 25.57 microns. The average central corneal thickness found in non-diabetic patients was 513.38 ± 27.01 microns. The statistically significant (p<0.001) increase in central corneal thickness found in diabetic patients compared to non-diabetic patients.CCT tends to increase significantly (p value<0.05) in uncontrolled diabetes (HbA1C level > 7%) and longer duration of diabetes.Conclusion: Diabetic patients had an increased central corneal thickness when compared with non-diabetic patients. And this is more in patient with longer duration of uncontrolled diabetes.Key Messages: Diabetic patients exhibit a greater statistically significant average CCT than non diabetic patients. There was also a positive correlation of thicker cornea with longer duration of diabetes and poorly controlled diabetes signifying that thicker cornea are more likely to be found in advanced stage. Diabetic keratopathy may lead to fallacy in IOP measurement and may decompensate following stress in refractory surgery.

BACKGROUND India has the largest blind population, more than any other country in the world. Among the total disability population of India, disability in seeing accounts for 18.8%. A total population of 5 million people have disability in seeing, of which 1.1 million are between the age group 5-19 years. Eye diseases in this group of population are important cause of medical consultation and require prompt attention because of their impact on education, future work and quality of life. In the state of Uttarakhand, blindness has been reported in 29,107 cases, of which 5,371 cases are from age group 5-19 years. [1] MATERIALS AND METHODS The present study was done to determine the pattern of eye diseases and the socio-demographic factors responsible for the ocular morbidity among the patients aged 5 to 16 years from Kumaon region, who presented to the Department of Ophthalmology, Government Medical College, Haldwani, Uttarakhand, between October 2014 and October 2016. A sample size of 400 was taken and a complete enumeration method was applied. A pre-designed proforma was used to document the patient particulars, history, examination and the diagnosis. Multiple ocular diseases were diagnosed by using different diagnostic test and criteria for individual diseases. Once the diagnosis was made by the attending ophthalmologist, the patient data and frequency of different ocular morbidities were documented. Socio-demographic factors responsible for ocular morbidity were studied by determining frequency of each morbidity in different age groups, gender and socioeconomic class. RESULTS In the present study, overall the disorders of ocular muscles, binocular movement, accommodation and refraction was the most common (37.25%) cause of ocular morbidity followed by Disorders of conjunctiva (25.75%), Congenital malformations of eye (7%), Disorders of eyelid, Lacrimal system and orbit (6.50%), Injury of eye and orbit (3%), Superficial injury of eye (1.50%), Disorders of sclera, cornea, iris and ciliary body (1%), Disorders of choroid and retina (0.75%) and Presence of functional implant (IOL) (0.5%). CONCLUSION Most causes of ocular morbidity among the study group in this survey were avoidable, refractive error being the leading cause. Stable intervention programs targeting refractive errors, allergic conjunctivitis, infections of lid and adnexa and trauma may significantly decrease the burden of ocular morbidity in this region.

Diabetes is one of the important public health problem. There are currently 415 million people affected worldwide and number is increasing day by day to an epidemic proportion. Diabetes is a lifestyle related metabolic disorder; besides genetic factor other risk factors are also involved in causation. Gravity of situation is compounded by the fact that fifty percent cases of diabetes remain undiagnosed until complication appear. A change in lifestyle, weight reduction, activity and improved awareness about diabetes can delay diabetic related complication. METHODSA cross-sectional questionnaire based interview of 450 patients was carried out in diabetic OPD of Dr. Susheela Tiwari Memorial Hospital associated with Government Medical College, Haldwani, Nainital, Uttarakhand. The question regarding patient's demographic characteristic and awareness of various aspect of diabetes including general knowledge, cause, complication and prevention were asked. RESULTIn present study, 302 (67.1%) knew what diabetes is. Most of the patients, i.e. 383 (85.1%) patients in present study were not aware about symptoms of diabetes. Among studied patients, 249 (55.3%) did not know that diabetes can cause ocular complication. Nearly half (48.8%) patients were not aware about the cause of diabetes; 168 (37.3%) patients were not aware about specific organ involvement in diabetes. The main source of awareness about diabetes was family members and friends, i.e. 201 (44.7%). A large number of patients (n=215, 47.7%) were not aware about preventive measure of diabetes. CONCLUSIONThis study clearly indicates that despite a good literacy rate, patient's knowledge about preventive measures is still low. There is a need to improve awareness regarding diabetes and its different aspect in the community. KEYWORDSAwareness, Diabetes Mellitus, Systemic and Ocular Complication, Questionnaire-Based Survey, Kumaon.HOW TO CITE THIS ARTICLE: Satyawali V, Pandey S, Sharma V, et al. Assessment of level of awareness for diabetes mellitus, its systemic and ocular complications: a questionnaire-based survey at tertiary care centre of Kumaon region.

Purpose: To compare applanation biometry (A-Scan) and optical coherence biometry (AL-Scan) methods for IOL power calculation based on Axial Length and post operative refractive outcome. Methodology: Prospective and Interventional Randomized Comparative Study, Sample size of 400, studied under two sub groups, for Axial Length readings and IOL power calculation by A-Scan (Biomedix) and AL-Scan (Nidek). Keratometry readings are taken only by AL-Scan.Results: Mean ± St. dev. of A.L. measured by App. Biometry was low (22.79 ± 0.9 mm) than Opt. Coh. Biometry (23.16 ± 0.78 mm) to be significant (P= .0001). Mean ± St. dev. IOL power was higher (21.75 ± 2.1D) than App. Biometry (20.88 ± 1.59 D) to be significant (P= 0.0001). Mean ± St. dev. of refractive status for Myopia is higher -0.97 ± 0.53 by App. Biometry than Opt. Coh. Biometry -0.5 ± 0.19, to be significant (P= 0.0001) and Mean ± St.dev. for Hyperopia is higher 0.98 ± 0.59 by App. Biometry than Opt. Coh. Biometry 0.46 ± 0.18, to be significant (P= 0.0001). Bland–Altman plots showed perfect agreement between both methods regarding A.L. and calculated IOL power. Further subgroup analysis revealed a statistically significant difference in different age groups and types of cataract for Posterior Sub capsular cataract alone and Nuclear Sclerosis with Posterior Sub capsular cataract (P= 0.001). Conclusion: There is significant difference between App. and Opt. Coh. Biometry; however, certain situations of Cataract is demanding mandatory role of App. Biometry.

Ocular trauma is an important public health hazard. A study done at a teaching referral hospital in Haldwani revealed 14.54% of blindness to be attributed to trauma alone. The objective of the study was to determine the pattern of ocular trauma among patients presenting in Dr. Sushila Tiwari Government Hospital, Haldwani. A 1 year retrospective review of records of 165 patients with ocular trauma seen from 1 st Feb 2011 to 31 st Jan 2012 was done using a structured format. Association between variables were checked by Chi square test and significance was considered when p<0.05. Ocular trauma accounted for s165 (1.03%) of the 15, 970 ocular patients seen at OPD and Emergency in the aforementioned 1 year period. Of the studied 165 cases, 93 patients were below 30 years of age. M: F ratio was 10:1.21(12.7%) patients presented to hospital within 2-7 days of injury. Duration of presentation has significant association with the presence of infection & other complication (p<0.05). The cause of injury were road traffic accidents, sports playing & recreational activities and occupational in 54(32.7%), 42(25.5%) and 33(20%) respectively. Closed globe injuries accounted for 54(32.7%) and open globe for 75(45.4%) and adnexal injuries constituted 36(21.8%). Delay in presentation was associated with complications.

ABSTRACT:The objective of present study was to compare the results of endonasal endoscopic dacryocystorhinostomy and external dacryocystorhinostomy. It was a prospective study. Forty two consecutive patients having complaints of epiphora, swelling near medial canthus, angular conjunctival congestion, with naso lacrimal duct obstruction were selected for the study. Selection of type of operation was left to the patient's choice. All patients had preoperative counseling and both the procedures were explained in detail with their advantages and disadvantages. Twenty two patients underwent endonasal dacryocystorhinostomy and twenty had external dacryocystorhinostomy. The follow-up was done at 7 th , 21 st , & 3 months after surgery. The patency of lacrimal passage was confirmed by syringing and patients were questioned about their symptoms. There was no significant difference in the results of both surgeries. The complication rate in both groups was almost equal. Thus we came to the conclusion that these two different dacryocystorhinostomy techniques are acceptable alternative. Success of external DCR & endonasal DCR based on patency of passage on 3 rd month was 85% & 81.8% respectively.