BACKGROUND Pseudoexfoliation syndrome (PXF) is an age-related systemic disease characterized by synthesis and accumulation of abnormal fibrillar material throughout anterior segment of eyes. PXF along with raised IOP and optic nerve head changes leads to pseudoexfoliation glaucoma (PXFG). PXF and PXFG are characterized by thinner corneas with large 24-h IOP fluctuations. We wanted to evaluate if any variation occurs in diurnal central corneal thickness (CCT) and intraocular pressure (IOP) between eyes with pseudoexfoliation syndrome (PXF), pseudoexfoliation glaucoma (PXFG) and in normal subjects. METHODS This is a prospective study conducted among 104 subjects (M=54, F=50). Amongst those, 30 patients had PXF in one eye, 3 patients in both the eyes and 24 patients had PXFG in one eye. Remaining 47 were taken as controls for the study. Testing included CCT and IOP measurement at four different times of the day (8.00 am; 11 am; 2 pm; 5 pm). RESULTS PXFG eyes showed a significantly thinner overall mean CCT (497 µm) followed by PXF eyes (518 µm) as compared to controls with a mean CCT of 527 µm. The mean overall IOP in PXFG (23.6 mmHg) was significantly higher as compared to PXF (14.6 mmHg) and the control group (14.2 mmHg). Furthermore, a significant reduction in CCT and IOP occurred in PXFG group from 8.00 am to 5.00 pm. A significant association between IOP and CCT was found in PXFG eyes. CONCLUSIONS A significantly thinner mean CCT shows the importance of measuring CCT on a regular basis having such clinical setup in order to avoid falsely low IOP measurement in a high-risk glaucoma population. Moreover, a significant correlation between IOP and CCT in PXFG eyes suggests that the decrease in mean CCT that occurred from 8 am to 5 pm may partly be responsible for the similar pattern of decrease in IOP from 8 am to 5 pm with mean CCT and IOP being highest in the morning within three hours of waking up and thereafter decreasing during the day.
BACKGROUND Dry eye disease, though common, is a frequently under-recognized clinical state whose aetiology and management are challenging. Many external and internal factors have been studied, which affects the stability of tear film. This study aims at determining the association between serum 25(OH) Vitamin D and Dry Eye Syndrome (DES) incidence and how treatment with supplementation affects the outcome. METHODS This is a case-control study with 75 DES cases and 75 healthy controls. The main parameter to detect the level of vitamin D was Serum 25(OH)D. The DES parameters included ocular surface disease index (OSDI) scales, tear film breakup time (TBUT), fluorescein staining score (FSS), eyelid margin hyperemia, tear secretion test and Schirmer test. The differences in each parameter between case and control groups were detected and the association of serum 25(OH) D and DES parameter were studied. Deficient patients were given vitamin D-supplementation. The DES parameters were followed up after 8 and 12 weeks. Comparison was done between pre-treatment and post-treatment values. RESULTS 25(OH) D levels were lower in patients with DES than in healthy controls. Vitamin D deficiency was more common in the DES cases. Parameters were measured before treatment and after 8 and 12 weeks of vitamin D supplementation. Mean serum 25(OH)D level was 10.52 ± 4.61 ng/mL. TBUT, and tear secretion test showed an improvement at 8 and 12 weeks after vitamin D supplementation compared to pre-treatment values (p <0.05 for all, paired t-test). Eyelid margin hyperemia and the severity of symptoms showed improvement at 8 and 12 weeks after vitamin D supplementation (p <0.05). CONCLUSIONS A significant association between serum 25(OH)D level and DES incidence was detected in this study. It was found that vitamin D deficiency decreases the TBUT and Schirmer test values. Vitamin D supplementation promoted tear secretion, reduced tear instability, and reduced inflammation at the ocular surface and eyelid margin. Considering the effect of vitamin D on the immune system, it could be assumed that the immuno-regulatory effect of vitamin D might be influencing the development of DES.
Purpose: To study the various ocular findings in patients with closed head injuries, to find any association with the degree of neurological involvement, and to analyze the treatment outcome after the necessary intervention.Setting: Tertiary referral hospital in Eastern India.Design: Prospective observational study.Methods: Patients with closed head injuries attending our Outpatient department as well as referred from the Neurosurgery department for ophthalmic evaluation between October 2017 and September 2019 were recruited for the study. All patients meeting the inclusion criteria were examined by an experienced ophthalmologist. The Glasgow coma scale (GCS) was applied to grade the neurological involvement by the neurosurgery team. Ocular findings were recorded and necessary imaging was requested. Appropriate neurosurgery consultations were done in patients with neurological findings. All ocular injuries were managed as per institutional protocol. Descriptive statistics were used for analysis with p< 0.05 taken as statistically significant.Results: A total of 207 patients (414 eyes) were included in the study. The mean age was 33.82 years, with the prevalence of male patients (82.12%). The most common cause of head injury was RTA (57.01%) followed by assault (11.59%). The majority of patients (53.14%) were classified as having moderate, 46.37% patients with mild, and 0.48% with severe neurological involvement as per GCS scoring. Isolated ocular findings were seen in 70.04% of patients while 29.95% of patients had both neurological and ophthalmic features. Ocular adnexal involvement was observed in 38.6%, anterior segment involvement in 86%, neuro-ophthalmic manifestations in 33.3%, and posterior segment involvement in 38.6% of patients. Ocular signs were resolved over due course of time in 48.8% of patients, completely resolved in 28%, while there was no improvement in 6.28% of patients. The final best-corrected visual acuity of >6/18 was achieved in 51.69% of patients. Statistical significance was observed in the correlation between the GCS scoring and general ocular findings (p= 0.02) as well as a relative afferent pupillary defect (p=0.003). The association between age > 50 years and neuro-ophthalmic features was not found to be statistically significant (p=0.56). Conclusion:Poor visual acuity at presentation, optic canal fractures, the presence of multiple fractures of orbital walls, no improvement in vision within 48 hours of starting intravenous corticosteroids, were indicators of a poor visual prognosis in this study. The GCS, neuro-deficit, and ocular signs contribute significantly to the prediction of outcomes. Prompt treatment and referral can lead to a good resolution of symptoms and signs.
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