Purpose Diabetes is a major cause of ocular morbidity as multiple mechanisms play a role in inducing inflammatory changes in the eye. Diabetic retinopathy is the most common complication and is well-documented. However, in the era of modern medicine, attention is also being focused on ocular surface changes in diabetes. Therefore, this study aimed to determine the association between diabetes and ocular surface diseases. Materials and Methods This is a cross-sectional study examining 320 eyes of 160 patients with diabetes who were grouped according to their duration of diabetes. The symptoms were evaluated using the ocular surface disease index (OSDI) questionnaire. Their recent hemoglobin (Hb) A1c value was recorded. Their external or internal hordeolum, blepharitis, meibomian gland dysfunction, and corneal sensitivity were also evaluated. The tear film was examined using tests, such as Schirmer's test, tear film breakup time (TBUT), tear film meniscus height (TFMH), fluorescein stain, and rose bengal stain. The results were correlated with the duration and control of diabetes. Results The mean age of the study population was 56.60 years comprising 56% (n=89) females and 44% (n=71) males. The mean OSDI scores were 7.9 ± 3.55 and 57 ± 19.22 in patients without dry eye and with severe dry eye, respectively. The study observed OSDI scores were consistently high with diabetes severity. About 67% (n=24) of patients with HbA1c of >8% had dry eyes. Dry eye was found in 68% (n=59) of patients with the duration of diabetes being >10 years. About 23.7% (n=38) had blepharitis, whereas only 4% (n=7) had external or internal hordeolum and 44% (n=86) had different grades of meibomian gland dysfunction. Corneal sensitivity was abnormal in only 12% (n=12) of patients. About 55% (n=86) of patients had varying degrees of dry eye. A statistically significant correlation was found between the severity of dry eye and TBUT, TFMH values, and grades of corneal staining (P < 0.0001). Conclusion This study observed that the incidence of dry eyes was found to be higher when patients had uncontrolled diabetes and diabetes for a longer period. The OSDI scoring system is an important diagnostic tool while examining patients with dry eye. In an ophthalmology clinic, patients with diabetes should always be evaluated for any ocular surface changes when being screened for diabetic retinopathy, and proper guidelines should be implemented to detect changes in the ocular surface system as early as possible so that any long-term complications such as infectious or neurotrophic keratitis may be avoided at an early stage.
BackgroundIn India, donor eye collection and promotion of eye banking are insufficient to meet the needs. By adequately evaluating donor corneas, eye banks can maximize the number of viable corneas for transplantation. This study evaluated donor corneal tissue based on age, lens status, and cause of death by their morphology and endothelial cell count via slit lamp and specular microscopy. MethodsWe conducted a prospective observational study of all eye bank donor corneas indicated for eye donation at a tertiary hospital and research center in Western Maharashtra between September 2019 to December 2021. We evaluated the corneoscleral discs by slit-lamp microscopy specular microscopy. We analyzed donor corneas quantitatively and qualitatively and graded them accordingly. We also collected blood samples for serological testing and the donor's behavioral and family medical histories. ResultsWe collected 94 eyes from 47 donors; the mean age of the donor population was 48.2 years, and most donors were aged 41 to 80 years. Thirty-one donors (65.96%) were male, and 16 were female (34.04%. For preservation, we used Cornisol (Aurolab, Madurai, India) in 36 cases (77%) and McCarey-Kaufman medium in 11 cases (23%). We found a mean endothelial cell density (ECD) of 2214.40/mm2, with hexagonality of 53.05%, and a coefficient of variation of 38.01. Further, we observed that ECD and hexagonality of cells in phakic donors were significantly greater than that of pseudophakic (PP) donors. Moreover, ECD and hexagonality significantly decreased in donors with the chronic disease compared to those who had a sudden, unexpected death. ConclusionCorneal grafts from younger donors, phakic donors, and donors who experienced an acute cause of death were qualitatively and quantitatively significantly better than those of older donors, PP donors, and donors who experienced sudden, unexpected death. Therefore, eye bank specular examination can improve tissue utilization and transplantation success. Therefore, we strongly recommend that eye bank personnel evaluate their donor tissue with a specular microscope to enhance the quality of eye care.
A potential complication of cataract surgery is posterior capsular rent, where PCIOL can’t be implanted. Primary Iris claw implantation means that the IC-IOL is implanted in the same setting after cataract removal. While secondary Iris claw lens implant is done in an aphakic eye without capsular support and post cataract surgeries when the eye is left aphakic. To compare the visual outcome in cases of primary and secondary iris claw lens implantation after cataract surgery.This was a hospital-based Prospective Interventional Longitudinal study,conducted on patients in a tertiary care centre, in Western Maharashtra from September 2018 to August 2020. 31 eyes underwent primary iris claw implant and 19 underwent secondary iris claw implant. Highly significant difference in visual acuity preoperatively due aphakia among subjects who underwent secondary iris claw implantation (p=0.000) was seen. Highly significant difference in visual acuity post operatively till 15 days was also seen due to less corneal oedema& inflammation in patients who underwent secondary iris claw implantation. No significant difference in visual acuity was seen on day 40 as lens was put in both the groups and the signs of inflammation had reduced (p=0.759).Overall visual outcome after 40 days is comparable in primary and secondary cases. It is better to do a primary retro fixated iris claw implantation, as in case of a secondary implant the patient will have undue anxiety, to undergo a second surgery along with increased financial burden and patient can develop complications due to aphakia.
To study the association of HbA1C levels with diabetic retinopathy. A total of 330 diagnosed diabetic subjects of all age groups and genders participated in the study. They were grouped according to presence or absence of diabetic retinopathy. All patients HbA1C levels along with fasting blood glucose levels was obtained. Observations were made to find the association between HbA1C levels and diabetic retinopathy. Mean HbA1c level among diabetic retinopathy subjects (9.50) was higher than subjects without retinopathy (8.49). The difference was found to be statistically significant (p < 0.05). With high HbA1c levels high mean fasting blood glucose levels were associated (R value: 0.5856). This is a moderate positive correlation. As glycosylated haemoglobin (HbA1c) levels increases prevalence of diabetic retinopathy also increases and there is a strong relationship between HbA1c levels and diabetic retinopathy.
Background: ROP is a disease of the developing immature blood vessels in the retina of premature new born by toxicity of oxygen. With the recent advances in neonatal care there has been improvement in rates of survival in premature infants. Factors playing a role in ROP are low gestational age, low birth weight and increased oxygen supplementation after birth. Aims: To study the prevalence of retinopathy of prematurity and to determine its risk factors. Materials and Methods: A prospective study was conducted in a tertiary centre from September 2018 to August 2020. 60 babies were screened with birth weight less than 1500 gms and gestational age less than 32 weeks. History was taken from parents and fundus examination was done. The grading of stages and zones was done. Data was entered in Excel and tests of statistical significance were used. Results: The prevalence of ROP was 28%. ROP was seen in zone III in 70% and 47% had stage 2 ROP. Only 7% mothers had completed less than 28 weeks of gestation. The mean birth weight was 1.36 kgs. 71% of the ROP positive babies were delivered by normal vaginal delivery. 100% babies diagnosed with ROP had been subjected to oxygen supplementation. 47% babies developed sepsis whereas 76% babies had history of RDS. Conclusion: ROP is a preventable cause of blindness in childhood. Early screening by an ophthalmologist is important to prevent this. The burden of ROP is bound to rise due to increased advances in the field of neonatology if screening protocols are not implemented stringently.
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