Ophthalmology

Read, learn, and grow VA Bastin Kerala Journal of Ophthalmology 2019 31(1):1-1

Medical education in India - General Profile Alex Joseph Kerala Journal of Ophthalmology 2019 31(1):2-3

Atropine in the treatment of childhood myopia Sanitha Sathyan Kerala Journal of Ophthalmology 2019 31(1):4-10 The practice of using topical atropine to prevent the progression of myopia in children has been going on for decades in some Asian populations. The encouraging results obtained from Atropine for the treatment of childhood myopia (ATOM) studies and animal studies have created much interest among the practitioners regarding the use of atropine in preventing myopic progression. This review aims to summarize the major research works done on the subject and its implications in clinical practice.

Ptosis: Evaluation and management Marian Pauly, R Sruthi Kerala Journal of Ophthalmology 2019 31(1):11-16 Blepharoptosis, or ptosis of the eyelid, refers to drooping of the upper eyelid that usually results from a congenital or acquired abnormality of the muscles that elevate the eyelid. Ptosis may be the presenting sign or symptom of a serious neurologic disease. Regardless of the etiology, when ptosis obstructs vision, it is disabling. The appropriate management requires recognition of the underlying cause. This review article highlights the various aspects of ptosis evaluation and management.

Optical coherence tomography in the evaluation of disc edema Deepa Gaur, H Vijaya Pai Kerala Journal of Ophthalmology 2019 31(1):17-23 Optic disc oedema is a common clinical problem where the ophthalmologist plays an important role in the diagnosis, management. Many optic nerve diseases can cause disc oedema like papilloedema, papillitis, anterior ischaemic optic neuropathy, central retinal vein occlusion, optic nerve head drusen etc. It is important to differentiate pseudoneuritis as in hypermetropia from true disc oedema. The clinical features, fundus examination sometimes may not give the correct diagnosis. Fundus fluorescein angiogram helps to differentiate pseudo from true disc oedema. However it is an invasive procedure. With newer technologies like optical coherence tomography which helps to image the optic disc, it is possible to differentiate pseudo from true disc oedema, also to recognise the aetiology of disc oedema. In this review article we are highlighting the OCT findings in various causes of disc oedema.

The use of atropine in childhood myopia: Experience in Indian eyes Sanitha Sathyan Kerala Journal of Ophthalmology 2019 31(1):24-27 This clinical query section discusses the use of topical atropine in childhood myopia among Indian children. Experts from across the country share their viewpoints, clinical experience, and concerns on the subject.

Correlation between ocular axial length and anterior chamber depth and a differential analysis in same-sized eyes Rakesh Maggon, Sumit Kumar Singh, Maneesh Jha, Avinash Mishra, Sandeep Gupta, Vivek Sharma Kerala Journal of Ophthalmology 2019 31(1):28-32 Purpose: To study correlation between ocular axial length and anterior chamber depth in eyes and to differentially analyse strength of this correlation in eyes with near-equal axial length. Materials and Methods: We conducted an observational study where keratometry and optical biometry records of 872 patients reporting for cataract surgery were taken. A comparative analysis using Optical Biometry (Zeiss IOL master) for pre-operative measurement of Axial length (AL), Anterior chamber depth (ACD) and calculated IOL power was done. Statistical Analysis: Data was analysed to determine overall correlation between two parameters. Patients were then classified into various groups of near-equal AL for a differential comparison within the group. Kendall-Pearson product-moment correlation test was used to assess relationship between AL and ACD, overall and within each subgroup. A P-value < 0.05 was considered as statistically significant. Results: 872 eyes were analysed and it was seen that as the mean AL (23.28mm), increased, mean ACD (2.97mm) also increased in overall analysis. In group analysis correlation between AL and ACD varied widely from 0.86 (AL-17-21 mm) to a negative -0.14 (AL 21-22mm). Conclusions: As mean AL increases ACD also increases. In eyes with near-equal AL there is wide variability in ACD which is either due to variable lens thickness or lens location in different eyes. Since lens thickness variability was obviated by taking age-matched eyes, location of lens is the probable cause. Therefore, Effective Lens Position (ELP) based formulae (Haigis & Holladay II) have an inherent unpredictability and may result in post-operative refractive surprises.

Acute acquired comitant esotropia in children: A benign entity or an ominous sign? R Neena, Anantharaman Giridhar Kerala Journal of Ophthalmology 2019 31(1):33-38 Purpose: The purpose is to study the clinical features of acute acquired comitant esotropia (AACE) in children and analyze the course and outcome. Materials and Methods: A retrospective, clinical study of all patients under the age of 18 years with acute onset, nonaccommodative comitant esotropia in a tertiary eye care center from September 2013 to December 2016. Parameters studied were age, sex, visual acuity, eye involved, age of onset, precipitating event, amount of deviation, presence or absence of amblyopia, cycloplegic refraction, systemic involvement, surgical or nonsurgical intervention, course, and outcome. All patients underwent magnetic resonance imaging of brain and orbits, and systemic evaluation was done in suspicious cases. Minimum follow-up period was 6 months. Results: Out of 12 patients, 8 were male. Average age of the patients was 7.9 years. The mean esodeviation was 33.75 PD, and mean age of onset was 6.14 years (range: 2&#8211;15 years). There was left eye preponderance. Three patients (25&#37;) had a history of a precipitating event. Cycloplegic refraction ranged from &#43;0.50 DS to &#8722;6.75 DS, with majority having <&#43;2.00 DS. Amblyopia was noted in 8 (66.6&#37;) patients. Systemic involvement was seen in three patients in the form of ocular myasthenia, central nervous system glioma, and viral fever, respectively. Esotropia disappeared in one patient with overcorrected, high myopia following atropinization, and change of glass. Eight patients (66.6&#37;) underwent strabismus surgery with good postoperative alignment, and the rest were managed conservatively. Conclusion: AACE is an unusual ocular alignment disorder characterized by a nonaccommodative esodeviation which can occur in older children, adults, and even the elderly. Although most children with this form of esotropia are otherwise healthy, systemic diseases must be considered and ruled out before planning surgery. Prompt amblyopia therapy and timely surgery can result in a satisfactory outcome in those without systemic involvement.

Outcomes of multifocal intraocular lens implantation in pediatric eyes Minnu Parakal, Swapna Nair Kerala Journal of Ophthalmology 2019 31(1):39-44 Objective: To study the pre operative profile and postoperative visual, quality of life outcomes and complications in pediatric eyes with multifocal intraocular lens implants. Methods: All children requiring primary or secondary intraocular lens implantation where the IOL could be placed in the capsular bag were assigned to this prospective study. The cause for cataract, laterality, preoperative and postoperative corrected and uncorrected distance and near visual acuity, slit lamp observations, intraocular pressures, type of surgery, postoperative IOL positioning, intra and post operative complications and quality of life estimates were recorded. SPSS ver21 was used for data analysis and the outcomes were documented. Results: 21 eyes of 14 pediatric patients were included in this study, 7 of them underwent bilateral surgery. The age range was 1 to 14 years. The logmar best corrected visual acuity for distance and near improved in 100&#37; of eyes. The average corrected distant visual acuity was 0.3 (6/12p) and average near vision was 0.38 (N6-N8) without near addition. The average residual spherical power was 0.26DS and astigmatism was -0.22DC. 9 eyes had raised IOP immediate post procedure. The average IOP after 1 month was 13.71 mm of Hg. The quality of life questionnaire indicated satisfactory levels of performance at school and play. Conclusions: Multifocals IOLs are an effective and safe implant to impart instant near vision correction, thereby bypassing the need to wear or be compliant with bifocals, thus aiding in overcoming amblyogenic influences.

Posterior chamber phakic intraocular lenses in refractive surgery: Preoperative profile and postoperative outcomes VL Divya, Swapna Nair Kerala Journal of Ophthalmology 2019 31(1):45-50 Objective: To assess the pre operative visual, refractive and topographic profile and to analyse postoperative vision, contrast and complications of patients undergoing phakic intraocular lens implantation. Methods: This prospective study enrolled patients that underwent phakic intraocular lens implantation after refractive surgery work up. The corrected pre op and uncorrected post op distance visual acuity, pachymetry, keratometry, topography, white to white, anterior chamber depth, and specular microscopy, along with postoperative anterior chamber angles, corneal and lens status and vaulting of the phakic IOL were recorded at 1 month. Results: 59 eyes of 32 patients with myopia, simple and compound myopic astigmatism underwent posterior chamber phakic IOL. The average sphere corrected was -8.4 D and the average cylinder was -1.5 D with 45.8 &#43;/- 2.2 being the average steep k values. The mean central corneal thickness, WTW and ACD in these patients were 511.9 &#43;/-42,11.44 &#43;/- 0.65 mm, 3.24 &#43;/- 0.33 mm respectively. The average post op UCDVA was 0.1 logmar with most eyes gaining more lines than preop CDVA. The average post op phakic IOL vault wrt the natural lens was 455 micron and average IOP 13.74 &#43;/- 2.8 mmHg. Conclusion: Posterior chamber phakic IOLs are a safe and predictable means of providing good vision especially in high myopes with borderline corneae. Accurate preoperative sizing of the lens is key to optimum results.