"It is interesting that while in Hindu medicine, cataract was defined by Susruta as opacity due to derangement of the intraocular fluid, subsequent history is full of fantasies and prejudices concerning its nature." Duke Elder[1] "All in all Susruta must be considered the greatest surgeon of the pre medieval period." A.O. Whipple[2]

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Vitreous hemorrhage is one of the most common differential diagnoses for sudden painless decrease in vision. Often, it is caused by retinal vascular disorders secondary to common systemic ailments such as diabetes mellitus, systemic hypertension and haematological abnormalities. Sometimes it may be the beginning of a retinal tear and consequent retinal detachment that can be vision threatening if not operated early. This paper lays out practical guidelines for a tailored approach needed to arrive at the aetiology of vitreous haemorrhage so that appropriate, timely treatment can be planned.

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Purpose: To determine the spectrum, clinical profile and risk factors for poor visual outcome in patients of post cataract surgery endophthalmitis. Methods: Data from 124 eyes were analysed. Various clinical and microbiological parameters were evaluated and risk factors for unfavourable outcome identified. Results: The mean age of the patients was 59.50±13.75 years; 60.5% were males. The median surgery-symptom interval was 7 days (mean 15.81±24.01) and the medium symptom-presentation interval 7.5 days (mean 14.19±19.13). Corneal infiltrates were seen in 29%, hypopyon in 62 (50%). Smear positivity was 52.5% and culture positivity 38%. Equivocal microbiological positivity was seen in 22 (18%), bacterial 12 (10%), fungal 27 (21.5%), polymicrobial 8 (6.5%) and negative 55 (44%). 20% eyes had total loss of vision at last follow-up. Poor visual acuity at presentation, presence of intraocular lens, shorter surgery-symptom interval, corneal and surgical wound infiltrates, loss of red reflex, microbiological positivity of the vitreous tap and systemic diabetes mellitus were significant risk factors for unfavourable outcome. Conclusion: Our data highlights a low culture positivity and a predominance of fungal pathogens as a cause of post cataract surgery endophthalmitis. The visual outcome in these patients is still dismal and better treatment strategies should be evolved keeping in mind the microbiological spectrum. The risk factors identified may be helpful in prognosticating the outcome in such patients.

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Purpose: Postoperative infections can be caused by a contaminated environment, unsterile equipment, contaminated surfaces, and infected personnel as well as contaminated disinfectants. In order to establish guidelines for microbiological monitoring, a detailed microbiological surveillance was carried out in an ophthalmic hospital. Method: Over a period of 21 months, we assessed environmental Bacteria Carrying Particle (BCP) load and surface samples weekly (n=276); the autoclaving system once a month and repeated whenever the process failed (n= 24); the air conditioning filters for fungal growth once in four months (n = 15), and the disinfectant solution for contamination once in two months (n = 10). Additionally, the personnel involved directly in surgery were screened for potential pathogens such as Staphylococcus aureus and β haemolytic streptococci. Result: On 14 (5.07%) occasions the environment in the operating rooms had a significant risk of airborne infections. Sterilisation of instruments in the autoclaves was unsatisfactory on 4 (16.66 %) occasions. Samples from the filters of the air-conditioning units yielded potentially pathogenic fungi on 3 (20%) occasions. Personnel sampling revealed that 5 (8.77%) individuals harboured β haemolytic Streptococci in the throat and 4 (7.01 %) harboured S. aureus in the nasal cavity. The samples of disinfectant in use were not contaminated. Conclusion: There is a need to standardise microbiological evaluation protocols for operating rooms.

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Pterygium is known to affect refractive astigmatism, which can have a significant impact on vision. This study was undertaken to evaluate the effect of pterygium excision on refractive astigmatism. Thirty-six eyes with primary pterygium with astigmatism of 2D or more were analysed before and after pterygium excision. Astigmatism increased with the increase in the grade of pterygium (P = 0.000001). The preoperative refractive cylinder decreased from 4.60±2D to 2.20±2.04D (P = 0.00001) after pterygium excision.

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Purpose: To evaluate the outcome of phacoemulsification in eyes with subluxated cataract. Materials and Methods: This retrospective study comprised 22 eyes of 20 consecutive patients with subluxated cataracts of varying aetiology operated between March 1998 and March 2001. Detailed preoperative assessment included visual acuity (VA), slitlamp examination, presence of vitreous in anterior chamber, extent of subluxation, intraocular pressure (IOP) and detailed fundus examination. Phacoemulsification was done to retain the natural bag support and all patients had acrylic foldable Acrysof IOL implantation either in-the-bag or by scleral fixation. Postoperative observations included best-corrected visual acuity (BCVA), IOP, pupillary reaction and the IOL position. Results: The aetiology of the subluxation was traumatic in 11 patients and non-traumatic in 9 patients. Fifteen were males and 5 were females. Mean follow-up was 11.7 ± 9.71 months (range 4-39). The average age was 39.15 ± 16.33 (range 5 - 74). A 2-port anterior chamber vitrectomy was performed in 6 eyes (27.2%). Capsule tension ring (CTR) was implanted in 15 eyes (68.18%). Twelve eyes (54.5%) had in-the-bag implants, while 5 (22.72%) had scleral fixation. The remaining 5 eyes (22.72%) had one haptic in-the-bag and another sutured to sclera. No major intraoperative complications were noted. Twelve eyes (54.5%) had clinically and geometrically well centered IOLs while 9 eyes (40.9%) had geometrically decentered IOLs. One patient was lost to follow-up. Fifteen eyes (55.55%) had postoperative BCVA of 6/12 - 6/6 while 2 eyes (7.40%) had BCVA of 6/18. The remaining 4 eyes (14.81%) had less than 6/24 BCVA due to pre-existing posterior segment pathology. Postoperative complications included rise in IOP in 1 eye (4.54%), pupillary capture of the IOL optic in 2 eyes (9.09%); the same 2 eyes (9.09%) required redialing of IOL. One eye (4.54%) had to undergo refixation (one haptic was fixed to sclera) year after cataract surgery. Postoperative retinal detachment was noticed in one patient after a month of phacoemulsification. Conclusion: In subluxated cataracts it is essential to have appropriate parameters depending on the grade of cataract. This contributes to a safe and predictable outcome in subluxated cataract surgery.

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Purpose: To study the role of vitamin E in preventing cataract formation in experimental animals. Methods: An experimental model (selenite cataract) was selected for this study. Selenite cataract was produced in rats by subcutaneous administration of sodium selenite. Biochemical and histological changes following induction of selenite cataract in weanling wistar rats were studied vis-à-vis the role of vitamin E in attenuating or preventing cataractogenesis. Results: Vitamin E was capable of preventing selenite cataractogenesis. Selenite cataract did not develop in 91.6% (11 of 12) and 76.7% (8 of 12) vitamin E treated rats, when administered on the 12th and 10th post partum day respectively. Conclusion: The study confirmed that selenite induced cataract in wistar rats is attenuated by vitamin E.

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Morning glory disc anomaly (MGDA) is usually known to be unilateral. We report an unusual case of a bilateral form of the disorder with an aim to distinguish it from other bilateral optic nerve head anomalies.

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Purpose: To estimate pulsatile ocular blood flow (POBF) among normal subjects and to compare various parameters in eyes of primary open angle glaucoma with high intraocular pressure (IOP). Methods: POBF was estimated in 95 eyes of 95 normal subjects above the age of 40 years and in 35 eyes of 35 primary open angle glaucoma patients using the OBF system (OBF Labs Ltd., UK). Correlation of age, gender, IOP, pulse amplitude, pulse volume and pulse rate with POBF was studied. POBF values were measured in glaucomatous patients before IOP control and one month later after control of IOP to <22mmHg. Results: The mean POBF among normal subjects was 1382.2 + 413ml/min (range 636-2291m/min). Females had a significantly higher mean POBF (1512 + 347ml/min) than males (1193 + 312ml/min). The mean IOP among normal subjects was 12.6mmHg and in glaucoma patients, 29.1mmHg. Mean POBF in glaucomatous eyes with initially elevated IOP was 718.9 + 322.6 ml/min, which improved after IOP control to 1129 + 291ml/min. IOP had a strong (P<.01) negative correlation with POBF (r = -0.667) Conclusions: POBF among eyes of normal subjects in this study is higher than reported among Caucasian eyes. Primary open angle glaucoma eyes with high IOP have significantly reduced ocular blood flow. Therapy aimed at lowering IOP has a positive effect on ocular haemodynamics.

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Silicone oil adherence to silicone IOLs after silicone oil removal is a known complication in pseudophakic patients. Droplet removal is difficult and may require IOL exchange. We describe two cases in which silicone oil droplets were observed early in the postoperative period in PMMA pseudophakic eyes and disappeared during silicone oil-fluid exchange--a phenomenon that has not been reported earlier in human PMMA pseudophakic eyes.

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Ehlers-Danlos Syndromes are a rare group of inherited connective tissue disorders of defective collagen synthesis. They predominantly involve the skin, joints and vessels. Ocular involvement in the form of blue sclera, microcornea and susceptibility to trauma is a common feature of EDS type VI. A minor ocular trauma in these patients can cause globe rupture. We herein report simple and successful management of a case of traumatic subconjunctival dislocation of lens in a patient of EDS type VI.

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Purpose: To compare the short-term efficacy and safety of topical latanoprost and brimonidine in Indian eyes. Materials and Methods: Twenty-eight patients with ocular hypertension, primary open-angle, pseudoexfoliation or pigmentary glaucoma were enrolled. Following baseline measurements, latanoprost was applied topically once daily in the evening for 12-weeks. After a washout period, brimonidine was applied twice daily in all patients for 6 weeks; 16 patients continued for 12 weeks. Patients were examined at 2, 6 and 12 weeks. The primary outcome measure was the difference in mean intra ocular pressure (IOP) reduction at 6 and 12 weeks. The mean diurnal variation of IOP at baseline and at 12 weeks was also compared. Results: Twenty-six of 28 enrolled patients completed the study. One randomly selected eye of each patient was used for analysis. At 6 weeks, the mean IOP reduction was 11.2 mm Hg (± 2.9 mmHg) with latanoprost and 6 mmHg (± 3.3 mmHg) with brimonidine. At 12 weeks this was 10.8 mmHg (± 2.8 mmHg) and 6.9 mmHg (± 3.1 mmHg) respectively. At 6 weeks 85.7% (24) eyes obtained more than 25% reduction in IOP with latanoprost compared to 13 (46.4%) with brimonidine. IOP reduction was maintained with both drugs throughout the study period. Two eyes did not show any response to brimonidine. Latanoprost reduced the diurnal variation of IOP from 5.10 to 2.90 mmHg; brimonidine reduced it from 4.70 to 3.90 mmHg. Conjunctival hyperaemia was present in one patient on latanoprost and three patients on brimonidine. Two patients experienced drowsiness with brimonidine. Neither drug produced side effects necessitating withdrawal from the study. Conclusion: In this short-term study, both latanoprost and brimonidine effectively reduced IOP and stabilised the diurnal curve in Indian eyes. Latanoprost was more effective than brimonidine.

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Purpose: To study the patterns of uveitis in the paediatric age group in a referral eye care centre in south India. Materials and Methods: Thirty-one patients 15 years or younger with uveitis, examined in the year 2000, were included in this study. The uveitis was classified according to the anatomical site of ocular involvement and the most probable aetiological factor. The final diagnosis was based on clinical manifestations and results of specific laboratory investigations. Results: A total 31 (6.29%) paediatric uveitis cases were seen among the 493 uveitic cases in the year 2000. The male: female ratio was 17:14. Anterior (9 cases), intermediate (9 cases) and posterior uveitis (9 cases) were seen in equal number. Four patients had panuveitis. Twenty-seven patients had visual acuity of 6/36 or better at presentation. Approximately 25% (8 of 31) patients had cataract secondary to inflammation. Immunosuppressives were administered in 4 patients and one patient required cataract surgery. Conclusion: Uveitis in children comprises approximately 6% of uveitis cases in a referral practice in south India. Anterior, intermediate and posterior uveitis are seen in equal numbers. We recommend that intermediate uveitis be ruled out in all cases of anterior uveitis by careful clinical evaluation including examination under anesthesia (EUA) when required.

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Purpose: To determine the magnitude of ocular complications that present in incident cases of relapsed borderline lepromatous (BL) and lepromatous leprosy (LL) patients. Method: From 1991 to 1997, all new BL and LL patients who had relapsed from an earlier disease, detected by active case finding in the geographically defined area of Gudiyattam taluk, were invited for ocular examination after their leprosy status was confirmed clinically and histopathologically. Results: Sixty relapsed lepromatous patients, 45 male and 15 females, were examined. Fifty-two patients had relapsed after receiving only dapsone mono-therapy, 4 after receiving paucibacillary multi-drug therapy (PB-MDT) preceded by dapsone mono-therapy and 4 after only PB-MDT. Three (5%) patients had lagophthalmos, 1 (1.6%) patients each had ectropion and trichiasis, 32 (53%) patients had impaired corneal sensation in both eyes, 2 (3.3%) patients each had corneal opacity (associated with reduced vision), corneal nerve beading, punctate keratitis, keratic precipitates, and iris atrophy, 4 (6.6 %) patients had cataract associated with decreased vision, 1 (1.6%) patient had blocked naso-lacrimal duct and 13 (21.7%) patients had pterygium. Seven (12%) patients had a visual acuity of 6/18 or less, 4 (6.7%) patients had 6/60 or less and one patients had vision below 3/60. General ocular complications rather than leprosy-related ocular complications were responsible for reduced vision. Lagophthalmos was associated with increased duration of the disease (P=0.009), Grade II deformity (P=0.001), punctate keratitis (P<0.001) and cataract (P<0.001). Beaded corneal nerves were associated with lepromatous leprosy (P<0.001) and high mycobacterial infection (P=0.05). Patients whose initial disease was categorised as BL and LL had greater impairment of vision (P=0.037), more iris atrophy (P=0.013), increased keratic precipitates (P=0.013) and more corneal nerve beading (P=0.013), when compared with the group comprising Tuberculoid-tuberculoid (TT), Borderline-tuberculoid (BT) and Intermediate (IND). Conclusion: This first report on ocular complications in relapsed lepromatous patients demonstrates that general and leprosy-related ocular complications occur in these patients. However, they are not in excess of those reported in other leprosy groups. Borderline and lepromatous leprosy patients tend to have had more ocular complications than patients with tuberculoid leprosy.

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Retained intraocular organic foreign bodies, particularly wooden bodies, are frequently encountered in ophthamlologic practice. We treated a patient with a retained intraocular foreign body - a single splinter from a broom - which had remained in the eye for 25 years.

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Intravitreal corticossteroids have been used for therapeutic purposes in optimum doses and adverse reports have not been described. To best of our knowledge, this entity has never been reported as a problem. We report a case of successful management of iatrogenic intravitreal triamcinolone acetonide for intermediate uveitis. This case study highlights the strategy of appropriate and timely surgical management.

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Post-traumatic subconjunctival dislocation of an intraocular lens (pseudophacocele) is a rare but serious complication following cataract surgery. All the previously reported cases were managed by removal of the IOL rendering the eye aphakic. We report a case of traumatic pseudophacocele which was successfully managed by an IOL exchange.

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