Aims: To evaluate the relationship between amplitude of accommodation and refractive errors in the peri-presbyopic age group. Materials and Methods: Three hundred and sixteen right eyes of 316 consecutive patients in the age group 35-50 years who attended our outpatient clinic were studied. Emmetropes, hypermetropes and myopes with best-corrected visual acuity of 6/6 J1 in both eyes were included. The amplitude of accommodation (AA) was calculated by measuring the near point of accommodation (NPA). In patients with more than ± 2 diopter sphere correction for distance, the NPA was also measured using appropriate soft contact lenses. Results: There was a statistically significant difference in AA between myopes and hypermetropes ( P <0.005) and between myopes and emmetropes ( P <0.005) in the 35-39 year age group. In the 40- 44 year age group, there was a significant difference in AA between emmetropes and hypermetropes ( P <0.0001), emmetropes and myopes ( P <0.01) and hypermetropes and myopes ( P <0.0001). In patients above 45 years of age there was no significant difference ( P >0.5). Conclusion: Our study showed higher amplitude of accommodation among myopes between 35 and 44 years compared to emmetropes and hypermetropes

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Purpose: To study the prevalence of dry eye in a hospital-based population and to evaluate the various risk factors attributable to dry eye. Materials and Methods: In this cross-sectional study, 500 patients above 20 years of age were screened randomly for dry eye. A 13-point questionnaire, Lissamine Green test, Tear film break-up time (TBUT), Schirmer's test and presence of strands/filaments were used to diagnose dry eye. The diagnosis was made when at least three of the tests were positive. The role of air pollution, sunlight, excessive winds, smoking, drugs and refractive status as dry eye risk factors was assessed. Results: Ninety-two (18.4%) patients had dry eye. Dry eye prevalence was maximum in those above 70 years of age (36.1%) followed by the age group 31-40 years (20%). It was significantly higher ( P = 0.024) in females (22.8%) than in males (14.9%), more common in rural residents (19.6%) than in urban (17.5%) and highest among farmers/labourers (25.3%). A 2.15 fold increase was found in the odds for dry eye in those exposed to excessive wind, 1.91 fold to sunlight exposure, 1.42 to smoking, 1.38 to air pollution and 2.04 for persons on drugs. Dry eye prevalence was 14% in emmetropes, 16.8% in myopes and 22.9% in hypermetropes. It was 15.6% in those with corrected and 25.3% in those with uncorrected refractive errors. Conclusion: Dry eye is an under-diagnosed ocular disorder. Reduction in the modifiable risk factors of dry eye is essential to reduce its prevalence

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Purpose: To assess the visual outcomes at one-year follow-up after pan-retinal photocoagulation (PRP) in type 2 diabetes mellitus subjects with proliferative diabetic retinopathy (PDR) and associated risk factors. Materials and Methods: A retrospective study, using data from medical records of 5000 Type 2 diabetic patients who underwent a retinal examination between 1995 and 1999 at a diabetic centre. Ocular, clinical and biochemical parameters were assessed at baseline and at one-year follow-up after PRP. Diabetic retinopathy (DR) was documented by colour photography and PRP was performed according to the ETDRS criteria. Results : PRP was done in 413 eyes, of which 261 eyes of 160 subjects were eligible for the study. One hundred and forty eyes (73%) of 191 eyes with good visual acuity (6/9) at baseline maintained the same vision at one-year follow-up. Of the 53 eyes with visual acuity of 6/12-6/36 at baseline, 58.5% (31 eyes) maintained same vision and 18.9% (10 eyes) improved their vision at one-year follow-up. Of the 17 eyes with visual acuity £6/60 at baseline, 12 maintained the same vision and the remaining 5 improved their vision. The causes of visual loss included vitreous haemorrhage in 20 subjects (31.7%), progression of cataract in 19 (30%), chronic macular oedema in 15 (23.8%), pre-retinal haemorrhage in the macula in 6 (9.5%) and pre-retinal fibrosis in the macula in 3 (4.7%) subjects. On multiple logistic regression analysis, diastolic blood pressure ( P =0.03), duration of diabetes ( P =0.006), fasting blood glucose ( P =0.02) and nephropathy ( P =0.01) were associated with decreased vision after PRP. Glycated haemoglobin (HbA1c) ( P <0.001), serum creatinine ( P =0.03), HDL cholesterol ( P =0.05), diabetic neuropathy ( P <0.001), hypertension ( P =0.01) and diabetic nephropathy ( P <0.001) showed a significant association with PDR. Conclusion: Visual acuity at baseline, the duration of diabetes and proteinuria played a significant role in determining the post-PRP visual acuity.

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PURPOSE: To systematically evaluate the quality of ophthalmology training in India. METHODS: Questionnaires were sent to existing medical schools and accredited training institutions. Institutions were followed up thrice to obtain responses. Data were analysed using Stata 8.0. RESULTS: Responses were received from 128 (89.5%) of the 143 institutions. Each year, 900 training slots were available across the country. Faculty: student ratios were better in accredited training institutions than in postgraduate medical schools. Fifty three (41.4%) of 128 institutions subscribed to more than 2 international journals. Fewer than 1 in 6 institutions conducted research projects. 11 (8.6%) institutions reported more than five publications in international peer- reviewed journals over three years. Only a third of the responding institutions had a wet lab. CONCLUSIONS: There is a need to improve the training facilities and optimally utilise the infrastructure available in postgraduate medical schools.

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Purpose: Retinal pigment epithelial (RPE) cells grow well on surfaces that provide an extracellular matrix. Our aim was to establish primary adult human RPE cell cultures that retain their epithelial morphology in vitro using human amniotic membrane (hAM) as substrate. Materials and Methods: Human cadaver eyeballs (16) were obtained from the eye bank after corneal trephination. RPE cells were harvested by a) mechanical dissection of the inner choroid surface (10, group 1) or by b) enzymatic digestion using 0.25% Trypsin/0.02% EDTA (6, group 2). The cells were explanted onto de-epithelialized hAM, nourished using DMEM/HAMS F-12 media and monitored for growth under the phase contrast microscope. Cell cultures were characterised by whole mount studies and paraffin sections. Growth data in the two groups were compared using the students' 't' test. Results: Eleven samples (68.75%) showed positive cultures with small, hexagonal cells arising from around the explant which formed a confluent and progressively pigmented monolayer. Whole mounts showed closely placed polygonal cells with heavily pigmented cytoplasm and indistinct nuclei. The histologic sections showed monolayers of cuboidal epithelium with variable pigmentation within the cytoplasm. Growth was seen by day 6-23 (average 11.5 days) in the mechanical group, significantly earlier ( P <0.025) than in the enzymatic group (day 29-35, average 31.6 days). Conclusions: Primary adult human RPE cell cultures retain epithelial morphology in vitro when cultured on human amniotic membranes . Mechanical dissection of the inner choroid surface appears to be an effective method of isolating RPE cells and yields earlier growth in cultures as compared to isolation by enzymatic digestion

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Purpose: To evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series. Materials and Methods: We retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002. Results: Nine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow- up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin. Conclusion: PDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated

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Purpose : To determine safety, clinical and visual results, and potential complications of early radial optic neurotomy (RON) surgery in eyes with central retinal vein occlusion (CRVO), with relative afferent pupillary defect and visual acuity < 6/60. Materials and Methods : This prospective, interventional case-series included 24 patients of CRVO who underwent RON within 2 months of disease onset. The preoperative examination included slitlamp biomicroscopy, fundus photography and fluorescein angiography. Foveal thickness was measured using optical coherence tomography (OCT) in the last 6 eyes only. In each case, RON was performed after informed consent. Two radial incisions were placed in the nasal quadrant of the optic disc, using a micro-vitreoretinal blade. The postoperative change in vision, clinical picture, fundus photographs, angiograms and foveal thickness by OCT were the main outcome variables studied. The Wilcoxan signed test was used to assess the results. Results : Average symptom duration was 37.8 ± 15.2 days (range 15-60 days, median: 34.5 days) and follow-up 7.7 ± 2.1 months (range 1-12 months, median: 8 months). Visual outcome: 2 (8.33%) eyes each had fall and preservation of pre-RON visual acuity respectively. Twenty eyes (83.33%) showed increase in vision (of average 3 lines). Pre and postoperative vision ranged from 0.017-0.1 (average:0.061) and 0.017-0.667 (average: 0.17) respectively ( P < 0.05). Clinical and angiographic outcome: Decline in macular oedema, decreased or resolved intraretinal haemorrhages, resolution of venous dilatation and disc oedema could be appreciated in all cases. Foveal thickness: Average pre and postoperative foveal thickness was 834.17 µm and 556.17 µm respectively ( P < 0.05) in the 6 eyes where it was measured before and after RON. One eye developed retinal-detachment. Conclusion : Radial optic neurotomy is better than the natural course in eyes with CRVO, with vision <6/60.

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An 82-year-old healthy man with unilateral chronic stromal keratitis, initially diagnosed to have viral keratitis and refractory to medical therapy, showed numerous oval, microsporidial organisms, measuring 4-5 m in length in the corneal biopsy. Penetrating keratoplasty, followed by treatment with systemic albendazole and topical propamidine isethionate resulted in resolution of the infection. Electron microscopy of the keratoplasty specimen demonstrated sporoblasts with diplokaryotic nuclei and multiple coils of the filament. The light and electron microscopic features were consistent with microsporidial keratitis.

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There is increasing evidence in the literature implicating the use of exogenous steroids through various routes as a risk factor for the development of idiopathic central serous chorioretinopathy (ICSC). We report a case of acute bilateral ICSC following intra-articular injection of corticosteroids.

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We report a patient who had earlier penetrating keratoplasty with amniotic membrane transplant and autologous limbal cell transplant for chemical injury who underwent cataract surgery by phacoaspiration. A posterior limbal incision with corneal valve was made superotemporally with extreme caution to avoid damage to the limbal graft. Aspiration flow rates and vacuum were kept low to avoid any turbulence during surgery. A 6.0 mm optic diameter acrylic foldable intraocular lens was inserted in the bag. The patient achieved a best-corrected visual acuity of 6/12 at 10 months' follow-up with a clear corneal graft. We conclude that caution during wound construction and phacoaspiration can help preserve corneal and limbal graft integrity in patients undergoing cataract surgery after corneal graft and limbal transplantation.

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Prepapillary arterial loops are congenital vascular anomalies that have been noted to cause arterial occlusions. We report a case of superior branch macular artery occlusion in an eye with two independent prepapillary arterial loops, following a Valsalva-like mechanism.

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The authors present a patient with posttraumatic choroidal neovascular membrane (CNVM) treated with PDT resulting in regression of the CNVM.

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A 26-year-old woman presented with sudden defective vision in the right eye following lifting a heavy bucket of water. Examination showed a dense premacular subhyaloid haemorrhage associated with arteriovenous communications of the retina (AVCRs). Spontaneous absorption of the premacular haemorrhage with consequent improvement in the visual acuity was seen after two months. The possible aetiopathogenesis of the case is also discussed.

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