Category: Nevin Manimala

Indian J Ophthalmol. 2021 Jun;69(6):1563-1568. doi: 10.4103/ijo.IJO_310_21.

ABSTRACT

PURPOSE: Rhino-orbital mucormycosis in times of ongoing COVID-19 pandemic.

AIMS: The aim of the study was to document cases of rhino-orbital mucormycosis seen at our Regional Institute of Ophthalmology during COVID-19 (coronavirus disease 2019) times.

METHODS: The study is a retrospective, institutional cohort, interventional study. It was carried out at our Regional Institute of Ophthalmology from September 2020 to mid-March 2021. All patients of biopsy-proven mucormycosis were enrolled in the study. The patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were treated via a multidisciplinary approach with intravenous liposomal amphotericin B and debridement of local necrotic tissue. Exenteration was done when indicated. A minimum 75-day follow-up period was accorded to all study patients. Statistical analysis was done using Chi-square test. A P value ≤0.05 was taken as significant.

RESULTS: Thirty-one patients were seen, with a mean age of 56.3 years. The major risk factors included uncontrolled diabetes (96.7%) and COVID-19 positivity (61.2%), with concomitant steroid use in 61.2% patients. The most common presentation was diminution of vision (<6/60 in 80.64% patients) and ophthalmoplegia (77.4%). The most common imaging findings were orbital cellulitis (61.29%) and pansinusitis (77.4%). Intravenous liposomal amphotericin B was given to all patients for an average 18.93 days. Exenteration was required in (n = 4) 12.9% of cases. Twenty-eight patients recovered and were alive on follow-up. Mortality was seen in three patients. The presence of cerebral involvement and a HbA1c value of ≥8 were found to be significant in the prediction of survival of patients with mucormycosis.

CONCLUSION: We present the largest institutional cohort of rhino-orbital mucormycosis patients during the ongoing COVID-19 pandemic era from our unique perspective.

PMID:34011742 | DOI:10.4103/ijo.IJO_310_21

J Oral Sci. 2021 May 19. doi: 10.2334/josnusd.21-0019. Online ahead of print.

ABSTRACT

PURPOSE: The present study aimed to analyze in a Spanish population sample the compliance of the anterior maxillary teeth to the dental esthetic proportions described in the literature.

METHODS: Photographs of the smiles of 78 individuals were calibrated and digitally analyzed considering the following proportions: golden proportion (GP), recurring esthetic dental (RED), golden percentage (GPG), Preston’s proportion and Modified golden percentage (MGPG). For statistical analysis, the t-test of an independent sample was applied, and compliance percentages for each standard were recorded.

RESULTS: The existence of RED 70% or 80% has not been registered. The percentages of compliance with GP were within a range between 0% and 16%. The mean tooth width ratios were adjusted to the values described by Preston (P > 0.05), but the compliance percentages were low (3.33-25%). GPG only presented high percentages of compliance in the lateral incisors (53.33-62.5%). MGPG showed the highest percentages of compliance (50-68%).

CONCLUSION: After analyzing a Spanish population sample using smile photographs for the first time, GP, RED, GPG and Preston’s proportion standards are not fulfilled and therefore, not suitable for treatments that seek a smile that reproduces natural principles. However, the values designated by MGPG with a deviation of ±1% are largely applicable for treatments that aim for a natural smile.

PMID:34011828 | DOI:10.2334/josnusd.21-0019

Sci Rep. 2021 May 19;11(1):10566. doi: 10.1038/s41598-021-89453-4.

ABSTRACT

Encoding and recognising complex natural sequences provides a challenge for human vision. We found that observers could recognise a previously presented segment of a video of a hearth fire when embedded in a longer sequence. Recognition performance declined when the test video was spatially inverted, but not when it was hue reversed or temporally reversed. Sampled motion degraded forwards/reversed playback discrimination, indicating observers were sensitive to the asymmetric pattern of motion of flames. For brief targets, performance increased with target length. More generally, performance depended on the relative lengths of the target and embedding sequence. Increased errors with embedded sequence length were driven by positive responses to non-target sequences (false alarms) rather than omissions. Taken together these observations favour interpreting performance in terms of an incremental decision-making model based on a sequential statistical analysis in which evidence accrues for one of two alternatives. We also suggest that prediction could provide a means of providing and evaluating evidence in a sequential analysis model.

PMID:34011973 | DOI:10.1038/s41598-021-89453-4

Indian J Ophthalmol. 2021 Jun;69(6):1537-1543. doi: 10.4103/ijo.IJO_1971_20.

ABSTRACT

PURPOSE: : To characterize the sequelae of microsporidia keratoconjunctivitis (MKC) and outline its management.

METHODS: Retrospective analysis of microbiologically proven MKC returned with persistent disease between January 2015 and December 2019 was done. Demographics, clinical features, management, and outcome were analyzed.

RESULTS: Sixteen patients (21 eyes) of 332 treated for MKC returned with the persisting disease. The mean age of 11 males (68.7%), and 5 females was 35.1 ± 12.2 years. Three-quarter of them did not have a known predisposing risk factor and one-quarter of them were referred for chronic conjunctivitis. Past medications included topical antivirals (n = 8) and topical corticosteroid (n = 6). Three predominant presentations were persistent (>3 weeks) superficial punctate keratitis (SPKs, n = 7), sub-epithelial infiltrates (SEIs, n = 13), and uveitis (n = 2). The lesions recurred in eight eyes (SPK and SEI 4 each) after a disease-free interval of 60.4 ± 40.6 days; there were 13 episodes of recurrence. Topical low potent corticosteroids (loteprednol/fluorometholone), and tacrolimus ointment 0.03% were used in 17 (80.9%) and 8 (38%) eyes, respectively, for a mean duration of 44.8 ± 31.6 and 226.8 ± 180.5 days, respectively. At follow-up, 172.3 ± 183.6 days, visual recovery was statistically significant in persistent eyes (BCVA 0.07 ± 0.07 logMAR; P < 0.00001) but, not in recurrent eyes (BCVA 0.16 ± 0.08 logMAR; P = 0.07). Five of 21 eyes were left with residual significant scar.

CONCLUSION: The sequelae of microsporidial keratoconjunctivitis are not uncommon. Topical 0.03% tacrolimus ointment appeared to be an effective corticosteroid-sparing agent for the treatment of SEIs and prevention of recurrence.

PMID:34011737 | DOI:10.4103/ijo.IJO_1971_20

Indian J Ophthalmol. 2021 Jun;69(6):1553-1558. doi: 10.4103/ijo.IJO_3067_20.

ABSTRACT

PURPOSE: This study aimed to assess the preferred surgical technique and outcome of deep anterior lamellar keratoplasty (DALK) among corneal surgeons in India.

METHODS: An online questionnaire-based cross-sectional survey was conducted among members of the Cornea Society of India (CSI) with experience of performing >10 DALK procedure. The responses pertaining to their surgical experience, preferred technique, complications, and outcome of DALK were collected and analyzed.

RESULTS: A total of 156 responses were received. In total, 35.9% of participants reported annual keratoplasty of >50, and DALK constituted >25% surgeries for 25% of participants. Ectatic corneal disorder was reported as the most common indication for DALK by 71.6% of the respondents. Big-bubble (BB) DALK (W_A-1.82) was the most preferred technique, along with suction trephine (50%) for partial trephination and bottom port cannula (45.5%) for BB formation. On statistical analysis, no difference was observed in the surgeon reported success rate of BB formation with or without anterior lamellar keratectomy (ALK) (χ2 (1,156) = 3.1498, P = 0.08) or paracentesis (χ2 (1,156) = 0.2737, P = 0.60) before stromal air injection, and method of stromal air injection (χ2 (1,156) = 4.7325, P = 0.09). Conversion to penetrating keratoplasty was reported by 16% of participants in >25% cases, while 66.7% reported in <10% cases. Cataract and double anterior chamber were the most common complications. 50% of participants suggested that >20 procedures are required to overcome the learning curve.

CONCLUSION: BB DALK is the most commonly practiced DALK technique, and its success is independent of ALK and paracentesis being performed prior to air injection and method of air injection (cannula/needle).

PMID:34011739 | DOI:10.4103/ijo.IJO_3067_20

Indian J Ophthalmol. 2021 Jun;69(6):1560-1562. doi: 10.4103/ijo.IJO_430_21.

ABSTRACT

PURPOSE: Since the eye is in close proximity to the oro-nasal cavity, transmission of SARS CoV-2 is higher during ophthalmic surgical procedures, it is vital to ensure the safety of the healthcare team by pre-operative Rapid Antigen Test (RAT) and real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) for SARS CoV-2 viral RNA of all patients planned for elective or emergency surgery. Hence, understanding the profile of pre-operative RAT and real-time RT-PCR among patients planned for various ophthalmic procedures, will help us make better decisions for future guidelines, for optimal planning of ophthalmic elective or emergency surgeries, keeping in mind the current scenario.

METHODS: This is a prospective descriptive study conducted on patients planned for elective or emergency ophthalmic surgeries, who had no COVID-19-related symptoms pre-operatively and were subjected to preoperative RAT and real-time RT-PCR of nasopharyngeal and throat swabs for SARS CoV-2 viral RNA. Data was compiled and statistically analysed.

RESULTS: 204 patients underwent pre-operative RAT and RT-PCR testing; of which, 85 were females and 119 were males. Mean age of the study population was 51.44 ± 16.501 years. Among the 204, 2 tested positive for SARS CoV-2 with Rapid Antigen testing as well as RT-PCR and 10 patients tested positive via RT-PCR after a negative RAT result of the same sample.

CONCLUSION: Pre-operative testing for COVID-19 disease is indispensable as there is a high chance of transmission from patient to healthcare workers. RAT has the advantage of quick results and may play a role in case of emergency procedures. However, it is prudent to perform the more sensitive real-time RT-PCR before any elective, non-emergency procedures or surgeries to avoid any undue risk to the healthcare team.

PMID:34011741 | DOI:10.4103/ijo.IJO_430_21

Indian J Ophthalmol. 2021 Jun;69(6):1527-1530. doi: 10.4103/ijo.IJO_2650_20.

ABSTRACT

PURPOSE: The aim of this study was to evaluate the changes in corneal topography, cycloplegic refraction, and best-corrected visual acuity (BCVA) after ptosis correction surgery in patients with congenital ptosis.

METHODS: Our study represents a prospective observational study conducted on 27 eyes of 21 patients with congenital ptosis. All patients underwent complete ophthalmological evaluation, cycloplegic refraction, and baseline Orbscan prior to ptosis surgery. At 6 months postoperative review, the cycloplegic refraction and Orbscan were repeated to evaluate the changes in these parameters. The main outcome measures in our study were Steepest K, Inferior-Superior Asymmetry (I-S Asymmetry), cycloplegic refraction and BCVA.

RESULTS: A significant decrease in Steepest K postoperatively (P < 0.001) was noted. Superior K and Inferior K also decreased, but the decrease in Inferior K was statistically significant (P = 0.044). However, change in I-S Asymmetry was not significant. Variation in BCVA, and cycloplegic sphere and cylinder was minimal. Sim K astigmatism, Surface Regularity Index, I-S Asymmetry and Central Corneal Thickness did not show significant variation.

CONCLUSION: Ptotic eyelid constantly presses on the cornea causing significant changes in corneal contour and surface remodeling. This pressure when relieved, results in significant flattening and regression of anterior corneal surface to its near normal anatomy. This further resulted in improvement of corneal surface irregularity and symmetry.

PMID:34011735 | DOI:10.4103/ijo.IJO_2650_20

Indian J Ophthalmol. 2021 Jun;69(6):1531-1536. doi: 10.4103/ijo.IJO_1820_20.

ABSTRACT

PURPOSE: The aim of this study was to test a method for estimating corneal rigidity before and after cross-linking (CXL) using a Schiøtz tonometer.

METHODS: The study was performed in the Kyiv City Clinical Ophthalmological Hospital “Eye Microsurgical Center”, Ukraine. This was a prospective, consecutive, randomized, masked, case-by-case, clinical study. Corneal rigidity, indicated by the gradient (G) between lg applied weight and corresponding lg scale reading during Schiøtz tonometry, were obtained by increasing (A-mode) then reducing (D-mode) weights by two operators [A] in keratoconus, post-CXL and control subjects for estimation of (i) interoperator and (ii) intersessional errors, (iii) intergroup differences; [B] before and after CXL. Central corneal thickness CCT was measured by scanning slit pachymetry. ANOVA, t tests, linear regression were the statistical tools used.

RESULTS: Average interoperator difference (ΔG) was -0.120 (SD = ±0.294, 95%CI = -0.175 to -0.066). A significant correlation between ΔG and the mean of each pair of G values was found (r = -0.196, n = 112, P = 0.038). Intersessional differences in mean G values were insignificant (P > 0.05). There was a significant correlation between G at first session (X₁) and difference between sessions (ΔG) [Operator 1, ΔG = 0.598x₁-0.461, r = 0.601, n = 27, P = 0.009]. Significant intergroup differences in G were found (Operator 1, one-way ANOVA, F = 4.489, P = 0.014). The difference (Δ) between the pre-(X₂) and post-CXL treatment G values was significantly associated with the pre-CXL treatment value (Operator 1, Δ = 1.970x₂-1.622, r = 0.642, n = 18, P = <.001). G values were correlated with CCT in keratoconus and post-CXL.

CONCLUSION: Corneal rigidity (G) estimated using the Schiøtz tonometer can be useful for detecting changes after CXL. However, G values are linked to CCT, can vary from time-to-time and the procedure is operator dependent.

PMID:34011736 | DOI:10.4103/ijo.IJO_1820_20

Indian J Ophthalmol. 2021 Jun;69(6):1457-1463. doi: 10.4103/ijo.IJO_2964_20.

ABSTRACT

PURPOSE: To evaluate optical coherence tomography angiography findings in patients with multiple sclerosis (MS).

METHODS: This prospective noninterventional study was conducted on 30 eyes of relapsing-remitting MS patients. Group (1) included 10 eyes with a history of optic neuritis (ON), group (2) included 10 eyes without any history of optic neuritis (MS-ON), and group (3) included 10 eyes of normal age/sex/refraction matched participants. Optical coherence tomography (OCT) and OCT-A (ZEISS Cirrus™ HD-OCT Model 4000 (Carl Zeiss-Meditec, Dublin, CA) of the optic disc were done for all patients.

RESULTS: The best-corrected visual acuity was diminished in MS cases, especially in patients with ON with P value <0.001. The retinal nerve fiber layer (RNFL) thickness showed a significant decrease in the average thickness and in all quadrants, notably the temporal quadrant in group 1 (P < 0.001). Ganglion cell layer thickness was diminished in average thickness and in all quadrants in both groups of MS, but only the first group showed statistical significance with P value <0.001). In respect to optic disc perfusion, Average, superficial, and deep vascular density index (AVDI, VDI 1, VDI 2) were statistically significantly lower in groups 1, 2 with (P-value < 0.001).

CONCLUSION: Decreased vascular perfusion of the optic nerve in MS patients, especially in those with ON is strongly correlated with the damage of RNFL and ganglion cell layer detected by OCT.

PMID:34011720 | DOI:10.4103/ijo.IJO_2964_20

Indian J Ophthalmol. 2021 Jun;69(6):1487-1490. doi: 10.4103/ijo.IJO_2956_20.

ABSTRACT

PURPOSE: To assess pre and post vergence and accommodation parameters after monitored reading on a smartphone device.

METHODS: This prospective comparative study was performed in a tertiary eye care center for a duration of 6 months (December 2017 – May 2018). A total of 47 healthy emmetropic subjects of age group ranging from 18-30 years were recruited for the study. Participants underwent an initial visual screening protocol, followed by accommodation and vergence parameters assessment. The subjects were given reading text of optotype N6 at 40cm working distance for 30 minutes in a smart phone device. Pre and post measurements were documented.

RESULTS: Among 47 subjects there were 17 male and 30 females with mean age group of 21.2+2.06 years. There was a statistically significant worsening of accommodative components (negative & positive relative accommodation, lag of accommodation). In vergence parameters, a statistically significant deterioration of negative (12.8 + 1.65 to 12.38 + 1.93 PD) and positive fusional vergence (15.48 + 1.53 to 16.08 +1.61 PD) was observed. The mean vergence facility also showed a statistically significant change in pre and post task measurements (13.51 + 1.64 to 10.71 + 1.91 cpm (cycles per minute)).

CONCLUSION: The current study investigated that perusing text with a smart phone for 30 minutes shows significant effect on accommodative and vergence components for near task, with greater impact on vergence parameters. Drawn out exposure to digital screens at near, may bring about visual quality dysfunction.

PMID:34011725 | DOI:10.4103/ijo.IJO_2956_20