PURPOSE: To determine the normative values for macular thickness and volume by Optical Coherence Tomography (OCT 3) in healthy Indian subjects. METHODS: The macula of 170 consecutive, randomly selected normal subjects was imaged on OCT 3 in this cross-sectional study. OCT parameters of macular thickness were analysed with baseline variables including age, gender, axial length and refractive error. RESULTS: The average foveal thickness in the population under study was 149.16 +/- 21.15 micro. Macular thickness and volume parameters of OCT correlated significantly (Pearson's Correlation coefficient) with age (r=0.23, P<0.01), but not with gender, axial length and refraction. CONCLUSIONS: The macular thickness and volume parameters have a significant correlation with age. This normative database of macular thickness by OCT in Indian eyes may be a useful guideline for management and further research in diseases of the macula and glaucoma.

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Glaucoma is one of the most common causes of visual loss despite successful congenital cataract surgery. The overall incidence does not appear to have decreased with modern microsurgical techniques. The onset of glaucoma may be acute or insidious and notoriously refractory to treatment. Angle closure glaucoma may occur in the early postoperative period; but the most common type of glaucoma to develop after congenital cataract surgery is open angle glaucoma. Several risk factors have been identified and both chemical and mechanical theories have been proposed for its pathogenesis. Unlike children with congenital glaucoma, those with paediatric glaucoma following congenital cataract surgery are usually asymptomatic despite high intraocular pressure. They may require regular evaluation under anaesthesia, whenever there are any suspicious findings. Unlike congenital glaucoma, the first line of treatment for glaucoma in aphakia/pseudophakia may be medical. Traditional trabeculectomy in paediatric glaucoma following congenital cataract surgery has met with limited success. The addition of antimetabolites to trabeculectomy is known to inhibit fibrosis and enhance the success, but carries the lifelong risk of bleb-related endophthalmitis. Drainage implant surgery is a viable option to achieve longterm intraocular pressure control in this refractory group of patients. Cycloablative procedures may provide temporising treatment and should be reserved for patients with low visual potential. Diagnosis of glaucoma following congenital cataract surgery requires lifelong surveillance and continuous assessment of the problem. Further research is needed to understand the pathophysiology, prevention and treatment of this sight-threatening complication following successful cataract surgery in children.

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A case of dermoid cyst with intracranial extension in a 10-year-old boy is reported. Intracranial extension of dermoid is not very common.

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This study was conducted to determine awareness and practices relating to diabetic retinopathy among non-medical persons in a south Indian population. In this population-based cross-sectional study, trained social workers conducted face-to-face interviews using a semi-structured questionnaire with 200 randomly selected paramedical personnel and 204 persons randomly selected from the community. Responses were graded on a five-point scale. Over half of respondents were not aware of risk factors for diabetic retinopathy. Only one-fifth of paramedics and one-tenth of persons from the community were aware that uncontrolled diabetes was a risk factor for retinopathy. Over 75% of respondents were not aware of either laser or surgery as an intervention for retinopathy. Although 80% of respondents from the community felt that yearly eye examinations were essential, only 43.5% had ever visited an ophthalmologist. Nearly three-fourths of paramedical personnel did not have any material related to diabetes for health education. It is evident that considerable effort is required to improve awareness of diabetic retinopathy, and to translate this improved awareness to actual utilisation of services.

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PURPOSE: Implant motility and cosmetic appearance of the eye after enucleation have remained major considerations whenever mycoconjunctival enucleation is planned. Despite major advances in surgical technique and the availability of a variety of implant materials and shapes, there is lack of consensus on the best material and type of implant. This study was conducted to compare routine and myoconjunctival techniques of enucleation in terms of motility index. METHODS: Thirty consecutive patients scheduled for enucleation for non-malignant indications were randomly assigned to one of the two groups- routine and myoconjunctival techniques. The postoperative results were compared for the motility of implant and the complications. RESULTS: The two techniques showed no difference in rates of complications, but implant motility was significantly better with the myoconjunctival technique. Implant extrusion or migration was not seen. CONCLUSION: We recommend the use of myoconjunctival enucleation for enhanced motility and cosmesis.

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We report the learning curves of three eye surgeons converting from sutureless extracapsular cataract extraction to phacoemulsification using different teaching methods. Posterior capsule rupture (PCR) as a per-operative complication and visual outcome of the first 100 operations were analysed. The PCR rate was 4% and 15% in supervised and unsupervised surgery respectively. Likewise, an uncorrected visual acuity of > or = 6/18 on the first postoperative day was seen in 62 (62%) of patients and in 22 (22%) in supervised and unsupervised surgery respectively.

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PURPOSE: To determine whether diabetic macular ischaemia is associated with ischaemic heart disease (IHD), hyperlipidaemia, hypertension (HTN) and nephropathy. METHODS: Prospective case-control study from January to December 2001, involving 102 type 2 diabetic patients (aged 40-80 years), 59 with unilateral / bilateral macular ischaemia and 43 concurrent controls. Diabetic retinopathy was graded and macular ischaemia assessed by fundus examination, central fundus photography and fluorescein angiography. Systemic examination and laboratory investigations were done to evaluate systemic diseases. The associations were analysed by Chi-square test and Student's t-test. The significance of the variables as independent risk factors was tested by logistic regression analysis. RESULTS: Macular ischaemia was not associated with IHD (P=1.00); HTN (P=1.00) and hyperlipidaemia (P=0.30). Nephropathy was significantly associated with macular ischaemia (P=0.025; odds ratio [OR]: 2.62; 95% confidence interval [CI]: 1.16-5.9). The association remained significant after controlling for age, gender, duration of diabetes, severity of retinopathy, HTN, IHD and hyperlipidaemia. Further, the association with nephropathy was not affected by the presence of macular isachaemia in one or both the eyes (P=0.39). CONCLUSION: Macular ischaemia may serve as a marker for nephropathy in type 2 diabetes mellitus irrespective of the severity of retinopathy.

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The following is a case report of a 19-year-old male who presented with unilateral acute angle-closure glaucoma. Posterior scleritis was diagnosed based on clinical features and ultrasound B-scan. The acute angle closure attack and exudative retinal detachment completely resolved with use of oral corticosteroids.

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PURPOSE: To compare modified needle drainage (MND) with conventional drainage (CD) of subretinal fluid (SRF) as described by Schepens in surgery for primary rhegmatogenous retinal detachment. METHODS: Prospective randomised clinical trial of 80 patients undergoing scleral buckling with subretinal fluid drainage for primary rhegmatogenous retinal detachment. In 40 patients modified needle drainage of subretinal fluid (SRF) was done using a perpendicular trans-scleral entry with a 26-gauge needle and the appearance of SRF in the hub of needle as end point. In 40 patients conventional drainage was done as described by Schepens using a diathermy needle. Adequacy of SRF drainage, intraoperative complications, anatomical and functional outcome were noted. RESULTS: 100% adequate drainage was achieved in all cases. The complication rate was 32.5% (n=13) in the CD group and 15% (n=6) in the MND group. In the CD group, 17.5% (n=7) patients had subretinal haemorrhage and in 2 eyes it was clinically significant. In the MND group 15% (n=6) of cases had subretinal haemorrhage and in one patient it was clinically significant. In the CD group, more serious SRF drainage complications were observed; these were absent in the MND group. CONCLUSION: Modified needle drainage is a safe and effective procedure for SRF drainage. In comparison with CD, MND is technically easy, less cumbersome and requires no special equipment.

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This report describes a case of dirofilariasis of the upper eyelid of a young female patient from Kerala. This is probably the first reported case from India in which a live dirofilarial worm was recovered from the subcutaneous tissues of the eyelid.

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PURPOSE: To obtain retinal nerve fiber layer (RNFL) measurements in normal Indian subjects of different age groups; and to determine the differences between the right and the left eye of a subject and variations between male and female gender using the scanning laser polarimeter GDx. MATERIALS AND METHODS: Prospective cross-sectional study of 180 eyes of 94 subjects. The RNFL values were obtained with the nerve fiber analyser GDx using default quadrant positions supplied by the manufacturer. Fourteen parameters were studied. Of these 6 were average-based parameters (average thickness, superior maximum, inferior maximum, ellipse average, superior average, inferior average), 4 ratio-based parameters (symmetry, superior ratio, inferior ratio, superior/nasal), 4 "other" parameters (maximum modulation, number, ellipse modulation, superior integral). The main outcome measures were effect of age on RNFL values, comparison of males and females and the right and the left eye of a subject. RESULTS: There was a negative linear correlation with age. Three ratio-based parameters showed a statistically significant negative correlation with age. "Number" increased with age. Superior maximum, superior average, superior integral, symmetry and superior ratio were higher for the left eye. 'Number' was higher for the right eye. Superior ratio and maximum modulation were more in females than males, no difference was noted with other parameters. CONCLUSION: There was a gradual decrease of RNFL values with increasing age - the superior quadrant values were higher for the left eye than the right eye, suggesting asymmetry. No significant differences were detected between males and females.

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Lattice corneal dystrophy is a distinct clinical entity characterised by amyloid deposits in the corneal stroma. We report a patient who presented with a corneal fistula in the right eye and thick lattice lines involving the peripheral cornea in both eyes suggestive of type III lattice dystrophy. The association of corneal fistula with lattice corneal dystrophy type III makes this a unique case.

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A rare case of choroidal melanoma with exudative retinal detachment and a full-thickness macular hole is reported in an Indian patient.

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PURPOSE: To investigate the 12 months' follow-up outcome of photodynamic therapy (PDT) with verteporfin for CNV in pathologic myopia in pigmented eyes of patients from the Indian subcontinent. METHODS: Nine eyes of 9 consecutive patients were included in the study. Patients with a spherical equivalent of - 6 diopter or more and baseline visual acuity of 6/60 or better were included. All patients received ETDRS visual acuity test (including letter acuity) and fluorescein angiography both before and after PDT. All patients had at least 12 months of follow up. RESULTS: The final visual acuity was unchanged 8 eyes (88.8% had VA of 6/30 or better) at the end of 12 months. Six eyes (66.7%) lost < or = 8 letters and three eyes (33.3%) lost < or = 15 letters at the end of 12 months from the baseline. CONCLUSION: Photodynamic therapy with verteporfin for subfoveal choroidal neovascularisation secondary to high myopia tends to stabilise the vision at 12 months follow up in Indian eyes. Longer follow up is necessary to understand the natural history of CNV treated with PDT in high myopia in Indian eyes.

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