Purpose: To study the characteristics of the optic nerve head using a scanning laser ophthalmoscope, the Heidelberg Retina Tomograph II (HRT II), in a normal population and to determine the specificity of HRT II diagnostic indices in the study population. Methods: The optic nerve heads from 275 consecutive, randomly selected normal subjects were imaged on HRT II. Stereometric parameters were studied with respect to baseline variables such as age, gender, refractive error and disc size. The stereometric parameters and the results of Moorfields regression analysis (MRA) and discriminant function analysis were recorded. Results: The average disc size in the population under study was 2.34 + 0.47 mm[2]. Age and gender had no significant effect on stereometric parameters. Myopic discs were larger than hypermetropic discs. MRA had a specificity varying between 85.5% and 98.2% depending upon the criteria used to define an abnormal disc. The specificity of MRA decreased with increasing disc size. The RB (R Bathija) and FSM (F S Mikelberg) discriminant functions had specificities of 96.4% and 87.3% respectively. Conclusions: Estimation of stereometric parameters of a normal disc can be used to indicate an abnormal one. Moorfields regression analysis and discriminant functions have a high specificity in our normal population; however, caution must be exercised in interpreting the results for a disc area larger than 3 mm ².

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Purpose: To determine the efficacy of prophylactic intravitreal antibiotics in reducing the incidence of endophthalmitis after trauma. Methods: This was a prospective, randomised, case control study of 70 consecutive patients with open globe injury. The patients were prospectively randomised into group I (32 eyes) and group II (38 eyes). Group I patients were given prophylactic intravitreal injection of vancomycin 1 mg and ceftazidime 2.25 mg at the conclusion of primary repair. Group II patients were not given prophylactic intravitreal antibiotics. All the patients received intravenous ciprofloxacin. Results: The incidence of endophthalmitis was higher in group II (7 of 38 eyes; 18.42%) compared to group I (2 of 32 eyes; 6.25%). Both the patients who developed endophthalmitis despite prophylactic intravitreal antibiotics in group I had an initially undetected intraocular foreign body (eyelash) in the vitreous cavity. Conclusions: Prophylactic intravitreal broad spectrum antibiotic injection decreases the risk of post-traumatic endophthalmitis.

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One of the important functions of the cornea is to maintain normal vision by refracting light onto the lens and retina. This property is dependent in part on the ability of the corneal epithelium to undergo continuous renewal. Epithelial renewal is essential because it enables this tissue to act as a barrier that protects the corneal interior from becoming infected by noxious environmental agents. The renewal process also maintains the smooth optical surface of the cornea. This rate of renewal is closely maintained by an integrated balance between the processes of corneal epithelial proliferation, differentiation, and cell death. Attempts to understand this complex cascade make it evident that the appropriate integration and coordination of corneal epithelial renewal depends on the actions of a myriad of cytokines. We have attempted in this review to collate the receptor and cell signaling events and cytokine studies that are responsible for mediating corneal wound healing.

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Retinopathy of Prematurity (ROP) is one of the major emerging causes of childhood blindness. A well organised screening strategy and timely intervention can to a large extent prevent blindness due to ROP. This communication proposes a screening strategy and management plan to develop a model for the care of babies with ROP.

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Purpose: To determine the incidence of vitreous loss in patients undergoing cataract surgery and the visual outcome in a tertiary teaching hospital. Methods: Hospital records of 2095 consecutive patients undergoing cataract surgery between July 1999 and June 2000 were reviewed in this non-concurrent cohort study. Incidence and visual outcome of vitreous loss managed using standard vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, Blumenthal technique and phacoemulsification) as well as at different levels of surgical training. The outcome was compared with matched cases without vitreous loss (controls). Results: Vitreous loss occurred in 160 of 2095 eyes (7.63%; CI -7 to 9.3): 8.3% for ECCE, 8.1% for the Blumenthal technique and 5% with phacoemulsification. Vision ž 6/18 was achieved in 85% of cases and 95% of controls. For experienced surgeons, 95% of the cases and controls had vision ž 6/18. 5.8 % of cases and 0.7% of controls had vision < 6/60. One patient in each group was blind following cataract surgery; both had operable cataracts in the fellow eye. Conclusions: The vitreous loss rate in this tertiary teaching hospital is relatively high. This complication, managed with standard surgical techniques, is compatible with good visual outcome. In eyes with vitreous loss, the final visual acuity achieved by experienced surgeons was similar to that in uncomplicated cases.

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Purpose: To evaluate the diagnostic usefulness of enzyme linked immuno-sorbent assay (ELISA) in single serum samples to associate herpes simplex virus (HSV), varicella zoster virus (VZV) or cytomegalovirus (CMV) with viral retinitis as against polymerase chain reaction (PCR) on intraocular specimens. It was also designed to study the seroprevalence in normal healthy individuals, and the genomic prevalence of HSV, VZV and CMV in patients without an active viral inflammatory process. Methods: PCR for the detection of HSV, VZV and CMV genomes was done on 33 and 90 intraocular fluids from viral retinal patients and non-viral controls respectively. ELISA was done on 30 and 100 serum samples from viral retinitis patients and normal healthy controls respectively. Results: PCR did not detect HSV, VZV and CMV genomes except one, in which VZV-DNA was detected. ELISA showed prevalence rates of 28%, 83% and 90% for antibodies against HSV, VZV and CMV respectively in the normal population. In the 30 viral retinitis patients, PCR detected HSV-DNA in 2 (6.7%), VZV-DNA in 7 (23.3%) and CMV-DNA in 6 (20.0%) patients, while ELISA detected antibodies against HSV, VZV and CMV in 13 (43.3%), 24 (80.0%) and 23 (76.7%) patients respectively. ELISA was of value in indirect diagnosis only in 6 (20.0%) as compared to 15 (50.0%) of 30 patients by PCR, this difference was statistically significant (McNemar test, P value = 0.005). Conclusion: Serology by ELISA is no longer a useful diagnostic tool to associate HSV, VZV and CMV viruses with viral retinitis.

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Purpose: To evaluate the safety and efficacy of single-drop instillation of mitomycin C (MMC) in pterygium surgery and to compare the results with both postoperative and intraoperative application of MMC. Methods: Eighty eyes of 72 patients with pterygium were randomised into 4 equal groups: group 1 - control - bare scleral excision (BSE); group 2 - BSE with single-drop instillation of mitomycin C (MMC) 0.02% at the end of the surgery; group 3 - BSE with postoperative MMC 0.02% drops twice a day for 5 days; and group 4 - BSE with intraoperative MMC 0.02%. Results: The recurrence of pterygium was observed in 14 (70%), 4 (20%), 4 (20%) and 3 (15%) eyes of group 1, 2, 3, and 4 respectively. The recurrence rate after BSE with single drop MMC regime (group 2) was significantly lower than group 1 recurrence ( P = 0.001) and was statistically comparable to that of group 3 and 4. Scleral defects in the bare area occurred in 4 (20%), 16 (80%) and 16 (80%) eyes of group 2, 3, and 4 respectively. The incidence of scleral defects was significantly lower in group 2 compared to group 3 (P=0.0001) and group 4 (P=0.0001). Compared to group 1 and 2, a significant delay in wound epithelialisation occurred in group 3 ( P=0.003) and 4 ( P=0.004). An ischaemic area in the bare sclera developed in 8 (40%) and 6 (30%) eyes of group 3 and 4 respectively, while ischaemic area did not develop in group 1 and 2. Conclusion: Single-drop instillation of 0.02% mitomycin C following pterygium excision appears both safe and efficacious.

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A patient of papillary thyroid carcinoma, who initially presented with a choroidal metastasis and secondary intractable glaucoma is reported. The orange-coloured tumour posed a diagnostic difficulty, until histopathology of the enucleated eye confirmed the metastasis from the thyroid. The initial presentation of distant metastasis in patients with thyroid cancer is rare.

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We describe a case with non-responding polymicrobial spontaneous corneal ulceration in an HIV-positive patient. Acanthamoeba was among the microorganisms isolated.

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Purpose: To determine "awareness of eye donation" and corneal transplantation in an adult population of southern India. Methods: 507 participants chosen by systematic random sampling were interviewed using a structured questionnaire. Participants were selected among patients attending two community outreach programmes at different sites, and from patients presenting directly to the hospital. Results: 257 participants (50.69%) were aware of eye donations. The major source of awareness was publicity campaigns (n=105). Only 22 (4.34%) participants were aware that eye donation had to be done within 6 hours of death. Four hundred and three (79.50%) participants were not aware of corneal transplantation. Illiteracy and rural residence were more likely predictors of ignorance. Conclusion: Although multiple strategies are currently followed to increase awareness of eye donations and corneal transplants, more innovative strategies have to be developed, especially to target illiterate and rural populations.

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Wooden intraorbital foreign body is characteristic for delayed manifestation, silent progression and unpredictable outcome. A silent wooden intraorbital foreign body is difficult to diagnose clinically. Spontaneous expulsion of entire foreign body is rare.

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We describe the occurrence of anterior uveitis with healed retinal vasculitis in an Asian-Indian woman. She had features of anterior uveitis and healed retinal vasculitis. This rare disease in India may be associated with intraocular inflammation.

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Purpose: To illustrate an approach to evidence-based medical practice by reporting the Collaborative Ocular Melanoma Study (COMS) randomised clinical trials and cohort studies of choroidal melanoma. Methods: COMS randomised clinical trials of Iodine-125 (I-125) brachytherapy, adjunctive cohort study of visual acuity in eyes treated with brachytherapy and adjunctive natural history study. COMS randomised clinical trial of pre-enucleation radiation. Results: The COMS I-125 brachytherapy trial (N = 1,317 patients) of medium-sized choroidal melanoma showed 5-year all-cause mortality of 18% [95% Confidence Interval (CI), 16-20%] and no statistically significant difference in mortality following 1-125 brachytherapy or enucleation. Adjunctive cohort natural history study (N-42 patients) of patients eligible for the I-125 brachytherapy trial who deferred treatment or had no melanoma treatment had a 5-year all-cause mortality of 30% (95% CI, 18-47%). The COMS pre-enucleation radiation trial (N = 1,003 patients) of large-sized choroidal melanoma showed 5-year all-cause mortality of 40% (95% CI, 37-44%). Conclusions: Evidence derived from randomised clinical trials and cohort studies shows the need for longterm (ž 5 years) follow-up to determine the efficacy of treatment for choroidal melanoma by any modality. The rather similar 5-year mortality for treated and untreated medium melanoma patients suggests that metastatic dissemination may occur at an early stage of choroidal melanoma. To increase longterm survival, ocular treatment of choroidal melanoma must strive for diagnosis and treatment of melanoma at an early stage when metastasis is less likely and be combined with measures to detect and treat micrometastasis

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Purpose: The study aimed to compute and compare the keratometric astigmatism induced by wound closure with continuous and interrupted sutures in conventional extracapsular cataract extraction with intraocular lens implantation at a single centre in eastern Nepal. Methods: Sixty eyes of 60 patients were included in the study. All patients received conventional extracapsular cataract extraction and single piece modified C-loop posterior chamber intraocular lens. Thirty eyes were sutured with continuous (Group 1) and 30 eyes with interrupted sutures (Group 2). The results were analysed by the unpaired student's t-test. Results: At the end of 6 weeks, Group 1 patients had significantly higher astigmatism (3.53 ± 2.19D) compared to Group 2 patients (1.7 ± 1.35). A majority of patients in both groups had with-the-rule astigmatism throughout the postoperative period. Conclusion: Interrupted sutures cause less astigmatism than continuous suture. The factors responsible for high astigmatism in continuous sutures call for further analysis.

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Purpose: To compare Humphrey Visual Field Analyzer (HVF) and Frequency Doubling Perimetry (FDP) testing in the diagnosis of early glaucoma. Methods: We performed HVF (24-2 standard full threshold) and FDP (N-30) evaluations in 34 consecutive patients with early primary glaucoma and 96 normal subjects. Early glaucoma was defined on the basis of disc changes of glaucoma; the mean deviation on white-on-white perimetry had to be no worse than 6 decibels. Glaucomatous optic neuropathy was defined as a combination of cup-disc asymmetry of more than 0.2, notching, excavation, thinning or pallor of superior or inferior neuroretinal rims, retinal nerve fibre layer defects of the wedge or diffuse type and neuroretinal rim haemorrhage. Both the glaucoma patients and normal subjects had vision better than 6/9 with correction. They had no media opacities other than early nuclear sclerosis and no fundus pathology. Further, normal subjects were free of systemic diseases known to affect the retina or optic nerve, The sensitivity and specificity of HVF and FDP were calculated. Results: There were 44 eligible eyes among the 34 subjects. The glaucomatous disc findings included notch (n=8), pallor (n=21), thinning (n=23) and haemorrhage (n=1) of the neuroretinal rim. The sensitivity and the specificity of the HVF were 52.3% and 57.3% respectively. The sensitivity and the specificity of FDP were 65.9% and 61.5% respectively. Conclusion: The difference between FDP and HVF in the diagnosis of early glaucoma is not marked.

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Though penetrating keratoplasty for keratoconus secondary to vernal keratoconjunctivitis (VKC) invariably carries a good prognosis, the postoperative course may be complicated by recurrent epitheliopathy. Despite good medical control of VKC shield ulcer is still a possibility.

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Myxomas are rare, benign neoplasms of mesenchymal origin that usually develop in soft tissues. As the clinical manifestations are non-specific, it is difficult to diagnose the tumour without biopsy and histopathological examination. We report a case of orbital myxoma with histopathological correlation.

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Purpose: To evaluate the efficacy of low molecular weight heparin (LMWH) in prevention of postoperative fibrin formation following vitreoretinal surgery with proliferative vitreoretinopathy (PVR). Material and Methods: Thirty consecutive patients of retinal detachment with advanced PVR were enrolled in the study. They were randomised to study and control groups (n = 15 each). Study group patients received vitreoretinal surgery with 5 IU/cc of LMWH in vitrectomy infusion fluid. The control group patients received vitroretinal surgery without heparin in the infusion fluid. Patients were followed up at 1 week, 1 month and 3 months after surgery. Postoperative bleeding, media clarity, best-corrected visual acuity and success of the surgery at the end of 3 months were compared between the two groups. Results: At each follow-up visit, the study group showed a better media clarity, which was statistically significant ( P = 0.0042). The study group had a 50% better chance of retinal reattachment compared to the control group. Five patients had intraoperative bleeding in the study group (33%) compared to 3 patients in the control group (20%). Conclusion: Use of intravitreal LMWH prevents postoperative fibrin formation and is beneficial in repair of retinal detachments with PVR.

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