Purpose: To determine the etiological spectrum of irreversible blindness in Kashmir Valley in India. Methods: Patients presenting to a tertiary care hospital in Kashmir, India, with unilateral or bilateral blindness from April 2019 to March 2020 were included in this cross-sectional study. Blindness was defined using the World Health Organization (WHO) criteria. All subjects had a complete ophthalmologic examination and information was gathered regarding their demographic profile, nature of ocular disorder whether primary or secondary and laterality, if the ocular involvement was unilateral. Results: 248 patients were enrolled in the study. The mean age of the patients was 57.17 years. The male: female ratio was 2.17:1. The commonest cause of unilateral or bilateral blindness was glaucoma (22.58%) followed by diabetic retinopathy (DR) (17.74%). Unilateral blindness was seen in 78.62% of the patients. Unilateral blindness occurred mainly due to glaucoma (16.41%), DR (14.87%), age-related macular degeneration (13.33%), and trauma (pellet injury: 10.76%, non-pellet injury: 10.25%). The major causes of bilateral blindness were glaucoma (45.28%), DR (28.30%), and hereditary/congenital retinal diseases (16.98%). Socioeconomic status and educational status were significantly associated ( P < 0.05 each) while age, gender, place of residence, and occupation were not significantly associated ( P > 0.05 each) with the number of eyes affected by blindness. Conclusion: Glaucoma and DR are the foremost causes of irreversible blindness in Kashmir. Public health plans aimed at encouraging good health education of patients should be developed in this region. Moreover, patients should be screened effectively for glaucoma and diabetes at the level of primary health care facilities.
Aim: To study clinical features and surgical outcomes of limbal dermoid excision in Kashmiri patients. Study Design :Interventional, Prospective Material and Methods: 20 patients with epibulbar limbal dermoid who attended the Out Patient department of Government Medical College ,Srinagar, from August 2019 to September 2020, across all age groups were included in the study. All the patients were examined for site, colour, presence of pigmentation and presence of ocular and systemic associations of the lesions and then surgically managed. Simple Excision was done with blade and scissors. Postoperative follow up was done upto 3 months Results: The age group included was 4 to 60 years with male to female ratio 3:2. All the patients had unilateral epibulbar dermoids located at infero-temporal quadrant of the limbus. Most lesions (13 cases - 65%) extended equally to cornea and sclera while a few extended more on the sclera (3 cases - 15%) or cornea (3 cases - 15%). Most (15 cases - 75%) were round. Two (10%) had Goldenhar Syndrome and both had preauricular tags and maxillary hypoplasia. Postoperatively one patient (5%) had corneal thinning and two(10%) patients had granulation tissue formation.Pigmentation of the lesion was seen in 18 cases (80%). Conclusion:Limbal dermoids in Kashmiri patients have clinical characteristics resembling those described in other parts of the world. Treatment with simple excision and supercial sclerokeratectomy gives satisfactory results.
Purpose: To evaluate the changes in retinal nerve ber layer (RNFL) thickness following mechanical microkeratome assisted laser assisted in situ keratomileusis (LASIK) Material and Methods: This hospital based prospective study was carried out on 56 patients with myopia between -1 and -8.5D and myopic astigmatism of upto -2.5D, who underwent LASIK at the LASIK Centre in the Postgraduate Department of Ophthalmology, Government Medical College, Srinagar for a period of one and a half year (from April 2018 to October 2019). Intraocular pressure (IOP) was noted at all pre and postoperative examinations. RNFL thickness was measured using optical coherence tomography(OCT) prior to the surgery and at 1 month and 3 months postoperatively. Results: The mean age of the patients was 26.9± 4.71 years …. The study included 30(53.5%) males and 26(46.4%) females. At the end of 3 months, the mean spherical equivalent of refraction was -0.25 ± 0.469 compared to a preoperative mean of -4.71 ± 2.043. The mean pre-LASIK RNFL thickness was 105.24±5.43μm and the mean RNFL thickness post-LASIK was 103.96±6.25 μm, and 104.76±5.27μm at 1 month and 3 months respectively. The difference in the RNFL thickness before and after LASIK was not statiscally signicant (p value>0.05).The IOP was within the normal range both pre and postoperatively. Conclusion: LASIK performed in young myopic subjects does not signicantly affect the retinal nerve ber layer thickness as determined by optical coherence study.However the long term effects of the procedure on the optic nerve and RNFL are not clear and require further evaluation.
Purpose: To compare the visual outcome in patients of nucleus drop undergoing same day pars plana vitrectomy (PPV) versus delayed PPV. Methods: A prospective observational study was conducted on 50 eyes with posteriorly dislocated nucleus after cataract surgery who underwent PPV. Study variables included the time duration between nucleus drop and PPV, nal best-corrected visual acuity(BCVA), and complications after PPV. In 7(14%) eyes, PPV was performed on the same day of cataract surgery and in 43(86%) eyes, an elective PPV was performed after 1 week of cataract surgery. All our cases had intraocular lens(IOL) implanted at the end of PPV. Patients were followed up for 6 months with BCVA, intraocular pressure (IOP) measurement, indirect ophthalmoscopy and ocular coherence tomography(OCT).Results: Comparison was made between VA in patients who underwent PPV on same day (n=7) and those who underwent delayed PPV (n=43). In the same day group, 85.71% patients had BCVA ranged between 6/6 to 6/18, while only 14.29% had BCVA between 6/18 to 6/60 at the nal follow up. In the delayed PPV group , 60.47% had BCVA range between 6/6 to 6/18, 27.90% had BCVA ranged between 6/18 to 6/60 and only 11.63% patients had BCVA of <6/60- hand movements (HM) . Pvalue was 0.398 which was not statistically signicant.Conclusion: Majority of the patients obtain good VAafter PPVfor nucleus drop irrespective of the time. The visual outcome in both the groups was comparable, but slightly better results were obtained in the same day PPVgroup.
Purpose: To study the effects of combined intravitreal injections of bevacizumab (IVB) and triamcinolone acetonide (IVTA) in patients with non-resolving macular edema (ME) secondary to Branch Retinal Vein Occlusion (BRVO). Methods: In a prospective observational study, 50 pseudophakic eyes of BRVO patients with non-resolving central macular edema who had received more than 3 doses of IVB previously were injected with combination therapy of 1.25 mg/0.05 ml IVB and 4 mg of IVTA and followed up for 6 months with best corrected visual acuity(BCVA), intraocular pressure(IOP) and central macular thickness(CMT) Results: The mean BCVA was logMAR 0.75±0.25 at baseline and 0.65±0.15, 0.48±0.20, and 0.22±0.25 at 6weeks, 3 months and 6 months respectively. Mean CMT at baseline was 668.32±254.66 and 434.43±99.55, 243.22±58.92, and 220.83±42.60 at 6 weeks, 3 months and 6 months respectively. Baseline IOP measured was 16.5±3.1 mmHg which progressed to 19.6±3.4mmHg and 21.4±2.8mmHg at 6 weeks and 3 months respectively and decreased to 17.3±2.2 at 6 months. The most common adverse effect seen was increase in IOP in 24(48%)patients, out of which 3(6%) patients needed to start anti-glaucoma medication (AGM). 3(6%) patients had sub-conjunctival hemorrhage(SCH). Conclusion: The prolonged therapeutic effects of combination therapy leads to outstanding anatomical and visual outcome in non resolving ME due to BRVO, with fewer doses and thus fewer adverse effects.
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