PURPOSE: To assess the safety and efficacy of Manual Small Incision Cataract Surgery (MSICS) in cases of white cataract with the use of trypan blue as an adjunct for performing continuous curvilinear capsulorthexis (CCC). MATERIALS AND METHODS: Prospective observational study on 100 consecutive eyes of 100 patients with white cataract who had undergone MSICS with trypan blue assisted CCC. The nucleus was prolapsed into anterior chamber by using a sinskey hook and extracted out of the eye using irrigating vectis. Intraoperative and postoperative findings (according to OCTET classification) as well as postoperative visual outcomes were used as main measures to report the safety and efficacy of the surgery. RESULTS: Of the 100 eyes, 16 had intumescent, 67 had mature and 17 had hypermature cataract. Intraoperatively CCC was incomplete in 4 eyes (4%) and had to be converted to canopener capsulotomy. None of the eyes had posterior capsular rupture or zonular dialysis and no eyes were converted to conventional Extra Capsular Cataract Extraction (ECCE). Postoperatively, 6 eyes (6%) developed corneal oedema with >10 Descemets folds and 7 eyes (7%) had corneal oedema with < 10 Descemets folds. Mild iritis was seen in 6 eyes (6%) and moderate iritis with fibrin membrane was seen in 3 eyes (3%). Iridodialysis was observed in 1 eye (1%). Of the 99 patients (99%) categorised under good visual outcomes category, 94 patients (94%) had a best-corrected visual acuity of 6/9 or better on the 40th post-operative day. CONCLUSION: In developing countries like India where phacoemulsification may not be affordable to a majority of those requiring cataract surgery, MSICS proves to be a safe and efficacious alternative for white cataracts especially with the adjunctive use of trypan blue dye.

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To compare the astigmatism induced by a superior, supero-temporal and temporal incision in manual small incision cataract surgery. Induced astigmatism was analysed by Cartesian coordinates based analysis, using Holladay's system. Mean astigmatism induced by surgery was 1.28 D x 2.9 degrees for superior incision, 0.20 D x 23.7 degrees for supero-temporal incision and 0.37 D x 90 degrees for temporal incision. The study found that induced astigmatism was lower in the temporal and superotemporal groups compared to that in the superior group.

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We report a case of intermittent tonic conjugate eye deviation due to nonketotic hyperglycaemia induced focal seizure.

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PURPOSE: To explore the awareness of glaucoma amongst the rural population of Andhra Pradesh, India. MATERIALS AND METHODS: A total of 7775 subjects of all ages, representative of the rural population of Andhra Pradesh, participated in the Andhra Pradesh Eye Disease Study. The responses of subjects older than 15 years (n = 5573) who completed a structured questionnaire regarding awareness (heard of glaucoma) and knowledge (understanding of disease) of glaucoma formed the basis of this study. RESULTS: Awareness of glaucoma (n = 18; 0.32%) was very poor in this rural population, and females were significantly less aware (p = 0.007). Awareness of glaucoma was also significantly less among illiterate persons (p < 0.0001), and socially backward population (p < 0.0001). Majority of the respondents who were aware of glaucoma (n = 10; 55.6%) did not know if visual loss due to glaucoma was permanent or reversible. The major source of awareness of glaucoma in this population was TV/magazines and other media followed by information from a relative or acquaintance suffering from the disease. CONCLUSION: Awareness of glaucoma is very poor in the rural areas of southern India. The data suggest the need for community-based health education programmes to increase the level of awareness and knowledge about glaucoma.

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PURPOSE: Fluoroquinolones are antimicrobial agents that have a broad spectrum of activity and are widely used against many of the ocular pathogens, responsible for conjunctivitis, blepharitis, corneal ulcers etc. The aim of our study was to evaluate the ocular pharmacokinetics of sparfloxacin (0.3% w/v) in the aqueous humour of rabbits. MATERIALS AND METHODS: Pharmacokinetics of topically administered sparfloxacin were determined after a single application of 50 µl topically. The aqueous humour samples were collected at 0, 0.25, 0.5, 1, 2, 3, 4, 5 or 6 hours after instillation. High Performance Thin Layer Chromatographic method was used to analyse the drug concentration in the aqueous humour samples. RESULTS: Fifteen minutes after the instillation of 50 µl of sparfloxacin 0.3% solution, the mean concentration in aqueous humour was found to be 1.4 µg/ml, which reaches the peak level of 3.7 µg/ml after 1.3 hours. At 6 hours, the sparfloxacin aqueous levels were 0.562 µg/ml. The clinical efficacy was predicted based on the Maximum Concentration (Cmax): Minimum Inhibitory Concentration (MIC) and Area Under the Concentration-time curve (AUC):MIC ratios. CONCLUSION: The sparfloxacin levels in aqueous humour of rabbits are sufficiently high up to the 6 hours after instillation in the conjunctival sac to provide bactericidal effect against most of the ocular pathogens. Both Cmax:MIC and AUC:MIC ratios are high enough to provide bactericidal effect against most of the ocular pathogens. Sparfloxacin (0.3%) ophthalmic preparation has excellent penetration through cornea.

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The case history of a sixty-two-year-old lady, who presented with a bleb in the upper part of her left eye following cataract surgery was studied. The patient had no prior history of any glaucoma surgery. Gonioscopy revealed fishmouthing of the internal aspect of the scleral tunnel incision. The diagnosis of post-cataract filtering bleb was made which was managed by resuturing the wound. This case highlights the use of gonioscopy to visualise and evaluate the internal wound and discusses intraoperative recognition of internal leak and its management with horizontal sutures.

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PURPOSE: Leber's hereditary optic neuropathy (LHON) presents in early adulthood with painless progressive blindness of one or both eyes. Usually there is a positive family history of similar disease on the maternal side. Definitive diagnosis can be established by finding the change in the mitochondrial gene. No molecular studies have been reported from India. MATERIAL AND METHODS: Clinical, ophthalmologic and molecular studies were carried out in two patients from different families and available first degree relatives. The subjects were tested for the three common mutations seen in LHON by molecular techniques of polymerase chain reaction using mutation specific primers. RESULTS: The mutations G3460A and G11778A in the mitochondrial genes MTND1 and MTND4, known to be causative for LHON, were found in one family each. CONCLUSION: Diagnosis of LHON should be considered in familial cases and in young adults with optic atrophy. Confirmation of diagnosis should be sought by molecular gene analysis. Genetic counselling should be offered to all 'at risk' relatives of a patient harbouring the mutation.

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PURPOSE: Optical coherence tomography (OCT) is an established method for visualising macular pathology and for measuring the thickness of parapapillary retinal nerve fibre layer. The purpose of the present study was to compare OCT measurements of the optic disc with those obtained by planimetry of fundus photographs and to investigate whether OCT measurements are influenced by the amount of parapapillary atrophy or pigmentary conus at the disc margin. MATERIALS AND METHODS: Eighty-two eyes of 41 randomly selected Asian-Indian subjects were included.The mean age was 44.2 ± 14.3 years (mean ± SD). All eyes underwent optic disc assessment by OCT (fast optical disc protocol) and digital 20 degree disc photos.. Planimetry of the discs were performed by outlining the disc and the cup. The amount of parapapillary atrophy (zone beta) was quantified as the number of clock-hours around the disc with adjacent parapapillary atrophy. The same procedure was performed to quantify the amount of pigmentary conus around the disc. RESULTS: Mean + SD disc size and mean + SD cup size in OCT measurements (2.37 + 0.51, 1.29 + 0.55) were significantly smaller than in photographic planimetry (2.83 + 0.62, 1.56 + 0.5: P < 0.001, P < 0.001). Optic discs with parapapillary atrophy (n = 38) and without parapapillary atrophy (n = 44) though smaller on OCT analysis, did not differ significantly ( P = 0.2) in their relative difference of disc sizes between OCT and planimetry. Similarly, optic discs with pigmentary conus (n = 12) and discs without pigmentary conus (n = 70) did not differ significantly ( P = 0.65). The relative difference in disc size between the two measurement modalities did not correlate with the amount of parapapillary atrophy (r = -0.17, P = 0.29) or with the amount of pigmentary conus (r = -0.04, P = 0.9). CONCLUSION: OCT analysis of the optic disc produces significantly smaller parameters, compared to the established method of optic disc planimetry. Neither presence, nor extent of parapapillary atrophy zone beta and pigmentary conus seems to produce a systematic error in measurements of disc size with the OCT.

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Takayasu's arteritis is an auto-immune disorder of the large and medium-sized arteries, commonly involving the heart and its main vessels. It is now recognised that the inflammatory process of the large arteries affects regions of the walls supplied by the vasa vasorum, suggesting that primary small vessel involvement may contribute to the development of the clinico-pathological features of Takayasu aorto-arteritis. Classical ophthalmic features of the disease result from reduced ocular perfusion, which manifests as hypoxic retinal changes such as microaneurysms, arterio-venous anastomosis and non-perfused areas. Branch retinal artery occlusion has not been previously described in this condition. This case illustrates retinal arterial occlusion as the presenting feature of Takayasu's arteritis.

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PURPOSE: To describe the visual outcome of internal limiting membrane (ILM) peeling for macular hole of various aetiologies and ultrastructural features of the ILM. MATERIALS AND METHODS: The study was conducted on 40 eyes of 38 patients. Thirty eyes with full thickness macular hole were treated with vitrectomy and removal of ILM. Ten eyes with retinal detachment served as negative controls and these patients underwent vitrectomy and ILM removal. The surgical specimens were examined by transmission electron microscopy. RESULTS: The anatomical success rate of the first operation was 90% in idiopathic and myopic groups, whereas it was 100% in traumatic macular hole group. Visual improvement of ³ two lines was noted in 80% of the cases. Electron microscopy revealed the presence of ILM in all surgical specimens. Proliferation of astrocytes and synthesis of new collagen along the inner surface of ILM was noted in the surgical specimens. CONCLUSION: Our findings suggest that the ILM removal helps in closure of the macular hole and retinal reattachment. Vitrectomy with ILM peeling is a reasonable surgical approach to treat macular holes of idiopathic, myopic and traumatic aetiology.

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PURPOSE: To evaluate the initial results of pilot study of indocyanine green dye enhanced laser photocoagulation for juxtafoveal choroidal neovascularisation (CNV). MATERIALS AND METHODS: The study was conducted on eleven eyes of 11 patients of CNV during the period 2001 and 2002. Two to three minutes after the injection of 5 ml of 25 mgm of indocyanine green (ICG) dye, 810 nm diode laser was used to treat the choroidal neovascular lesions. RESULTS: The age of the patients ranged from 45 to 80 years. All patients completed 12 months of follow-up. Eight eyes (72.7%) had neovascular age related macular degeneration, 2 eyes (18.2%) had myopic CNV and one eye (9.09%) had CNV secondary to angioid streak. The presenting visual acuity was £ 6/60 in seven, 6/36 in one and ³ 6/12 in three patients. The final visual acuity at the end of at least 12 months follow-up was 6/12 or better in one eye (9%); 6/18-6/36 in 3 eyes (27.27%) and £ 6/60 in 7 eyes (63.64%). In four patients the vision improved whereas it worsened or remained same in 7 eyes. CONCLUSION: ICG dye enhanced diode laser photocoagulation appears to be a potential option for juxtafoveal CNV.

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Presence of exfoliation syndrome (XFS) is associated with an increased risk of complications during cataract surgery. This risk is, in part, dependent on the severity of XFS. We describe a central bulge ("lenticonus") in the anterior lens capsule of some eyes with XFS. This finding is associated with very fragile zonules and a high risk for intraoperative zonular dialysis.

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A morphological peculiarity was observed in the form of an aberrant lateral bony attachment of the orbital part of the Orbicularis oculi muscle on the zygomatic bone, during routine dissection of a cadaver of an adult male of Indian origin. Fibers of this part of the muscle are not known to show any lateral attachment on bone. This paper discusses the presentation, probable embryological cause and clinical implications of this unusual finding.

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