Purpose:Strabismus and anisometropia are the most common causes of amblyopia. It can be easily prevented or treated if detected early. With the changing socio-cultural-economic milieu of the society, the perspectives of strabismus in society are gradually changing but still adequate knowledge, awareness, and attitude of parents toward strabismus will help in preventing amblyopia and aid in the proper psychosocial adaptation of such children. This study aimed to assess knowledge and attitude of parents toward children suffering from strabismus.Methods:A prospective study was carried out from January 1 to February 29, 2016, through a structured questionnaire to assess the level of knowledge and attitude of parents of children suffering from strabismus.Results:One hundred and twenty parents of children with strabismus were interviewed through a questionnaire. Education level of 78 parents was less than graduation (60%) and of 42 parents (40%) was graduation or higher. The majority of the parents, i.e., 116 (96.67%) were bothered due to strabismus. One hundred and one (84.17%) parents felt that their child's strabismus was noticed by others during interaction. Seventy-four (61.67%) parents felt that their children will have difficulty in making friends. Ninety (75%) parents felt uncomfortable if someone asked something about their child's strabismus. One hundred and ten (91.67%) parents considered strabismus as cosmetic stigma.Conclusion:Some parents, especially from the lower educated segment, had poor understanding of strabismus, thus resulting in late presentation and ineffective countermeasures. The key to prevent strabismic amblyopia and its psychosocial impacts is to provide health education regarding strabismus.

Yanamandra, Uday, Velu Nair, Surinderpal Singh, Amul Gupta, Deepak Mulajkar, Sushma Yanamandra, Konchok Norgais, Ruchira Mukherjee, Vikrant Singh, Srinivasa A. Bhattachar, Sagarika Patyal, and Rajan Grewal. High-altitude pulmonary edema management: Is anything other than oxygen required? Results of a randomized controlled trial. High Alt Med Biol. 17:294-299, 2016.-Treatment strategies for management of high-altitude pulmonary edema (HAPE) are mainly based on the observational studies with only two randomized controlled trials, thus the practice is very heterogeneous and individualized as per the choice of treating physician. To compare the response to different modalities of therapy in patients with HAPE in a randomized controlled manner. We conducted an open-label, randomized noninferiority trial to compare three modalities of therapy (Therapy 1: supplemental O with oral dexamethasone 8 mg q8 hours [n = 42], Therapy 2: supplemental O with sustained release oral nifedipine 20 mg q8 hours [n = 41], and Therapy 3: only supplemental O [n = 50]). Bed rest was mandated in all patients. The study was conducted in a cohort of previously healthy young lowlander males at an altitude of 3500 m. Baseline characteristics of the patients were comparable in the study arms. Complete response was defined as clinical and radiological resolution of features of HAPE, no oxygen dependency, a normal 6-minute walk test (6MWT) on 2 consecutive days, and normal two-dimensional echocardiography. Results were compared by analysis of variance using SPSS version 16.0. There was no statistical difference in duration of therapy to complete response between the three groups (Therapy 1: 8.1 ± 4.0 days, Therapy 2: 6.7 ± 3.9 days, Therapy 3: 6.8 ± 3.2 days; p = 0.15). There were no deaths in any of the groups. We conclude that oxygen and bed rest alone are adequate therapy for HAPE and that adjuvant pharmacotherapy with either dexamethasone or nifedipine does not hasten recovery.

Purpose Among the retinal vascular diseases, burden of retinal vein occlusion is most common immediately after diabetic retinopathy. Intravitreal corticosteroids are gaining popularity in managing macular edema (ME) of RVO. Our study compares efficacy and safety of intravitreal triamcinolone (IVTA) and dexamethasone implant (IVD) over 6 months.MethodsThis comparative, prospective, randomized study on 40 patients of non-ischemic central RVO with significant ME (> 330 μm) of < 3 months duration. Study was done at Army Research Hospital between Sep-2012 and May-2014 in accordance to Helsinki Declaration. IVD group (n = 20) received Ozurdex® while IVTA group (n = 20) received triamcinolone-acetonide (4 mg/0.1 ml), followed up at day-1 and weeks 4, 8, 12, 24.ResultsAt 6 months, mean improvement in best corrected visual acuity and retinal thickness (CMT) in the IVD group was 0.43 logmar and 323 μm and in IVTA group was 0.49 logmar and 322 μm respectively. Proportion of patients achieving ≥ 15 letters was about 40% in both groups. IOP rise was significantly higher in IVTA group at 12 and 24 weeks. In IVTA group ≥ 10 mmHg IOP rise was seen in 60% of patients, 41.6% among them had > 35 mmHg and 66% needed combination treatment and failed to reach baseline line IOP at 6 months. In IVD group, 5 pts had IOP rise with all being < 26 mmHg and were easily managed with single agent with IOP reaching baseline by 6th month in all pts. Relative risk of IOP rise with IVTA is 2.4 times higher compared to IVD. Cataract progression and cataract surgeries were required at significantly higher rates in IVTA group. In IVTA group, cataract progression was seen in 35% patients, with 71.5% requiring cataract surgery at 6 months. IVD group, 10% patients had cataract progression while none required surgery at 6 months. Relative risk of cataract progression with IVTA is 3.5 times higher compared to IVD.ConclusionIntravitreal steroids are effective in managing macular edema of retinal vein occlusion, while newer formulation of sustained release dexamethasone implant is significantly safer than IVTA.

This report describes a case of pleomorphic adenoma of an ectopic lacrimal gland arising subconjunctivally in the lateral fornix in a 13-year-old girl. The tumor was removed surgically in toto with the capsule. This is probably the first reported case.

Précis: Swedish Interactive Threshold Algorithm (SITA) Faster (SFR) saves considerable test time but needs further amendments for considering it to be an accurate test that can replace SITA Fast (SF) or SITA Standard (SS). Purpose: To compare visual field results obtained using SFR, SF, and SS programs in patients with manifest and suspect glaucoma. Materials and Methods: In this cross-sectional observational study involving manifest patients with glaucoma and glaucoma suspects, perimetric outcomes of SFR, SF, and SS were compared. Outcomes included test time, mean deviation, pattern standard deviation (PSD), Visual Field Index (VFI), foveal threshold, number of points depressed at P<5%, P<2%, P<1%, and P<0.5% on PSD probability plot, individual threshold test points, glaucoma hemifield test, and grade of field defect. Results: Seventy eyes of 70 patients were included in this study. SFR test times averaged 36.1% shorter than SF and 60.7% shorter than SS (P<0.001). Mean deviation values were lower with SFR compared with both SF and SS (Δ=1.5, P<0.001). Mean PSD and VFI showed no significant differences between the algorithms. The mean foveal threshold was higher for SFR compared with SF (Δ=1.6, P<0.001) and SS (Δ=2.1, P<0.001). The number of points depressed at P<0.5% was lesser in SFR than in both SF and SS (P=0.002). Bland-Altman plots showed that considerable variability existed between the algorithms. Conclusion: SFR provides benefits in test time and shows similar VFI compared with SF and SS. However, the detection of early cases with SFR is questionable and few modifications are needed in the future to improve its accuracy. SF and SS gave almost similar results. The algorithms cannot be used interchangeably for the same patient on different test sessions.

The next care to be taken, in respect of the Senses, is a supplying of their infirmities with instruments, and as it were, the adding of artificial organs to the natural...and as glasses have promoted our seeing, so 'tis not improbable, but that there may be found many mechanical inventions to improve our other senses of hearing, smelling, tasting and touching. " Robert Hooke English natural philosopher (1665) [1] Nothing could demonstrate more than this concept of Hooke with regards to replacement of all the senses by artificial means. Hooke was enthralled by spectacle correction itself and felt that the other senses could also be improved. No doubt the medical world has caught up with hearing aids and cochlear implants but in the real sense the restoration of sight to a blind is still in an experimental stage and the most daunting challenge in ophthalmic research.

High-altitude cerebral oedema (HACO) is the most fatal high-altitude illness seen by rural physicians practising in high-altitude areas. HACO presents clinically with cerebellar ataxia, features of raised intracranial pressure (ICP) and coma. Early identification is important as delay in diagnosis can be fatal. We present two cases of HACO presenting with focal deficits mimicking stroke. The first patient presented with left-sided hemiplegia associated with the rapid deterioration in the sensorium. Neuroimaging revealed features suggestive of vasogenic oedema. The second patient presented with monoplegia of the lower limb. Neuroimaging revealed perfusion deficit in anterior cerebral artery territory. Both patients were managed with dexamethasone and they improved dramatically. Clinical picture and neuroimaging closely resembled acute ischaemic stroke in both cases. Thrombolysis in these patients would have been disastrous. Recent travel to high altitude, young age, absence of atherosclerotic risk factors and features of raised ICP concomitantly directed the diagnosis to HACO.

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