BACKGROUND Retinopathy of prematurity (ROP) is one of the leading causes of ocular morbidity and mortality throughout the world. Prematurity, low–birth, and oxygen therapy are considered to be the common risk factors. The maldeveloped retina in those affected are very much prone to develop refractive error, neo-vasculopathy, and neurosensory detachment. The purpose of our study was to find out the incidence and ascertain the risk factors of retinopathy of prematurity among the neonates attending the sick neonatal care unit and OPD of Calcutta National Medical College & Hospital. METHODS This is an institution based cross-sectional observational study conducted in the sick newborn care unit of a tertiary care hospital. Informed consent was obtained from the parents along with proper birth history. Indirect ophthalmoscopy with a + 20 dioptre (+ 20 D) lens with a paediatric scleral depressor was performed in each eye under the guidance of the neonatologist after pupillary dilatation. If either eye was found to have ROP, the baby was considered as an ROP case in the study and each eye was considered as a single case. RESULTS 50.27 % babies (N = 91) were delivered by Lower Uterine Segment Caesarean Section (LSCS) and 55. 24 % babies were < 32 weeks of gestational age whereas 21.45 % (N = 39) babies were having < 1500 gm birth weight. Phototherapy was needed in 50 % of the babies (N = 92) whereas hyperbilirubinemia was present in 59.66 % of total babies. Bradycardia, apnoea, and sepsis were present in 29.83 % (N = 54), 25.41 % (N = 46), 41.98 % (N = 76) of the babies respectively. When compared in the two independent groups (ROP present and absent), low gestational age and low birth weight of the babies were found to be statistically significant (P < 0.05) for the development of ROP. After adjusting with different factors in the regression model we have found that low birth weight and oxygen therapy after birth were statistically significant with the development of ROP (P < 0.05). CONCLUSIONS ROP screening, specifically for those babies with low-birthweight, low gestational age, and those who received oxygen therapy for other systemic reasons, is mandatory to have an early diagnosis and treatment done. KEYWORDS ROP, Low-Birthweight, Gestational Age, Oxygen Therapy
BACKGROUND Intraocular Pressure (IOP) is one of the key physiological factors, which can regulate the ocular health and homeostasis. Accurate measurement of IOP depends on several factors among which instrument factor plays significant role. Considering Goldmann Applanation Tonometer (GAT) as a "GOLD" standard, we have compared Noncontact Tonometers (NCT) with GAT taking Central Corneal Thickness (CCT) into consideration. MATERIALS AND METHODS In this comparative cross-sectional study in a tertiary care hospital, after inclusion and exclusion, patients were thoroughly examined clinically and GAT, NCT and CCT tests are performed using standard technique by single competent ophthalmologist on the same day. Values are tabulated in excel sheet and statistical calculations done using SPSS version 20. RESULTS In the study population, 57.7% were males and 42.3% females (M:F = 187:137). The mean age of the population is 45.16 ± 19.58 years (SD) and mean intraocular pressure of males was found to be 16.63 ± 3.72 (SD) mm of Hg by GAT method and 16.75 ± 3.53 (SD) mm of Hg by NCT, and in females, it was found to be 16.12 ± 3.51 (SD) mm of Hg by GAT method and 16.29 ± 3.28 (SD) mm of Hg by NCT. The difference between methods was statistically significant (P <0.05). Mean central corneal thickness of the study population was found to be 546.10 ± 34.87 (SD) µm, whereas central corneal thickness of males 547.11 ± 33.93 (SD) µm and females were 544.71 ± 36.13 (SD) µm. The difference in IOP measurement between methods was statistically significant (P<0.05) for the entire group and in the subgroup with central corneal thickness more than 575 µm. The reliability indices for the noncontact tonometer considering the Goldmann applanation tonometer as gold standard are highly correlating as coefficient of correlation is near to +1 in all the subgroups in respect to central corneal thickness. CONCLUSION The difference in measurements by noncontact tonometer and the Goldmann applanation method was statistically significant. The measurements by noncontact tonometer were reasonably accurate (coefficient of correlation is near to +1).
BACKGROUND Post-traumatic blindness is one of the leading causes of blindness apart from cataract and glaucoma in India. Ocular injury leading to corneal opacification, resultant astigmatism and post-traumatic complications i.e. uveitis, glaucoma, vitreous haemorrhage, retinal detachment etc., are the major causes of blindness. In tea-garden population, ocular injury in workplace or during daily activities is mainly attributed to geography and poor visibility of walking road in tea gardens. MATERIALS AND METHODS In this study, 35 patients (n=35) from tea gardens with mechanical ocular injury were included in the first 6 months and they are followed up for next 6 months. Their socio-demographic variables, different factors related to injury and outcome were assessed clinically and by appropriate imaging technique. Outcome was tabulated and using SPSS Version 20, statistical calculations were performed.
BACKGROUND Glaucoma is the leading cause of irreversible blindness in India with around 12 million being affected. Primary Open Angle Glaucoma accounts for majority of these patients. With the choice of drugs to reduce intraocular pressure being plenty, confusion persists on which therapy is best for the patients. Our study aims to compare the efficacy of Fixed-Dose Combination of Brimonidine 0.2% and Timolol 0.5% vs. Monotherapy Brimonidine or Timolol with respect to lowering of intraocular pressure and also its effect on vertical cup disc ratio, mean deviation in automated perimetry, retinal nerve fibre layer thickness and their side effect profile. METHODS This is a prospective, parallel group, open label, randomized intervention trial conducted over 16 months among 180 patients with primary open angle glaucoma attending the glaucoma clinic of the Regional Institute of Ophthalmology, Kolkata. The patients were randomized into three groups 1) Brimonidine 0.2% and Timolol 0.5% fixed-dose combination, twice daily 2) Brimonidine monotherapy, thrice daily and 3) Timolol monotherapy, twice daily and followed up at 1, 3 and 6 months. RESULTS The mean reduction in intra ocular pressure was higher in the fixed-dose combination group (mean reduction-9.3 ± 2.9) compared to the other two groups (mean change in Timolol group-5.0 ± 2.0 and mean change in Brimonidine group-4.5 ± 1.8) at 6 months follow up. The mean loss of retinal nerve fibre layer thickness was significant in the timolol group but not in the other two groups at 6 months. The changes in mean deviation from baseline to 6 months in Humphrey field analysis was not statistically significant in any of the groups. There was statistically significant progression of vertical cup disc ratio from baseline to 6 months in the timolol and brimonidine monotherapy groups. CONCLUSIONS Fixed-Dose Combination of Brimonidine and Timolol had superior efficacy in intraocular pressure reduction in patients with primary open angle glaucoma compared to the monotherapy with brimonidine or timolol. Fixed-Dose combination also decreased the progression of glaucoma compared to the other groups
BACKGROUND Variations in the IOP beyond the normal range can lead to different pathologies that are associated with difficulty in vision. Inside the closed space of the globe, cataractous changes along with never ending growth of crystalline lens have been theoretically thought to be associated with a rise in IOP. Distribution of different types of cataracts and the sequential change of IOP in different morphological types of cataract after phacoemulsification with foldable PCIOL implantation in the capsular bag is the sole aim of this study. METHODS This is a prospective observational study. Selected patients with no features of glaucoma, after meeting proper inclusion and exclusion criteria were included in the study. 426 eyes underwent phacoemulsification with PCIOL implantation (by a single competent surgeon using same phacoemulsification machine with similar parameters) were subjected to measurement of IOP by Goldmann Applanation Tonometry 3 days prior to surgery and postoperative day 14 and 28 respectively. Before surgery, dilated pupillary examination was performed to assess the grade of cataract. Data was collected and results analysed thereafter. RESULTS Among 426 eyes evaluated (M:F=1.8:1), with mean age of 54.49 (±6.975) yrs., commonest type of cataract found was Nuclear Sclerosis Grade III (19.9%) followed by Nuclear Sclerosis Grade II (16.4%). Mean preoperative IOP was 16.55 (±1.953) mmHg. Mean postoperative IOP on day 14 and day 28 was 15.11 (±1.755) mmHg and 15.04 (±1.800) mmHg respectively. Nuclear Sclerosis grade V had the least preoperative IOP among all the groups whereas mature cataracts with highest preoperative IOP showed highest fall of IOP after surgery. 8.2% patients who had traumatic cataract which did not show significant postoperative reduction of IOP. CONCLUSIONS Cataract surgery by phacoemulsification and PCIOL implantation reduces IOP in majority of non-glaucomatous patients. Non-diabetic, non-traumatic cataracts and mature cataracts show maximum postoperative reduction of IOP.
BACKGROUND Corneal ulcer is one of the leading causes of ocular morbidity in developing country. Early diagnosis and targeted therapy is indispensable. Sociodemographic variables along with predisposing factors plays a major role in its development and clinicopathological correlation in diagnosis is very much helpful in diagnosis and subsequent management. The aim of the study is to identify the epidemiological factors and causative organism of the suppurative corneal ulcer. MATERIALS AND METHODS In this observational cross-sectional study, after taking proper history, patients with suppurative corneal ulcer are examined for clinical diagnosis. Applying sterile method of swab collection from the ulcer for standard microbiological examination (staining, culture) swabs are taken for predetermined laboratory investigations. Sociodemographic variables (age, gender, occupation) relevant injury history, microbiological data are tabulated for statistical calculations. RESULTS After application of inclusion and exclusion criteria wiling 81 patients, M:F=55:26 were assessed. Major number of patients (n=61, 75.30%) are middle aged between 33-62 years of age. Occupation played a major role as evidenced by 44.44% (n=36) contribution from agricultural workers (tea garden worker, pineapple farmer, other agricultural worker) followed by household worker (n=13, 16.05%). Positive history of prior corneal injury is common in fungal corneal ulcer (n=22, 51.16%) as well as in bacterial (n=8, 66.66%). Among the prior corneal injury associated fungal ulcer vegetative matter injury in 15 patients (32.60%), while in bacterial variety, it is 5 (10.86%) in number. In laboratory investigations, pure fungal growths are found in 37 patients (45.68%), while pure bacterial are 12 in number (14.81%). A good number (n=8, 9.81%) shows mixed infection. Culture negative ulcers are good in number (n=24, 29.63%) among which 6 (7.47%) are microscopically positive. The sensitivity and specificity of clinical diagnosis of fungal corneal ulcer are 84.61% and 72.41% respectively with a high correlation between clinical and microbiological diagnosis of fungal corneal ulcer (either smear positive or culture positive and a quiet high positive predictive value for clinical diagnosis (84.61%). But, in case of bacterial corneal ulcer, the positive predictive value is 41.37%, while negative predictive value is 84.61% in our study. CONCLUSION Middle-aged agricultural workers are more prone to develop corneal ulcer and fungal corneal ulcers are more prevalent in this region of India than bacterial. History of prior corneal injury is a major risk factor. Fungal corneal ulcers have high correlation between clinical and microbiological diagnosis than bacterial.
BACKGROUND Orbital tumour, benign or malignant, comprises of a fair number of patients presenting in hospitals with a mass lesion or proptosis. Its early diagnosis and treatment is necessary especially in malignant cases even it can save patient's life. MATERIALS AND METHODS We have recruited the patients presenting in our oculoplasty OPD in RIO with orbital mass lesion or any patient who has symptoms suggestive of orbital mass lesion after applying inclusion and exclusion criteria. Clinical and radiological diagnosis has been made and diagnostic/therapeutic surgical procedures have been performed in order to reach a histopathological diagnosis. Then, excel data sheet is prepared and statistical analysis done.
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