Blue Sclera and Iron Deficiency Anaemia- A Case Report

Blue sclera is associated with congenital and hereditary diseases like osteogenesis imperfecta, Marfans syndrome, Ehlers Danlos syndrome, Van der heave syndrome and incontinentia pigmenti.1 It has also been reported in autoimmne conditions like rheumatoid arthritis, polyarthritis, relapsing polychondrtis and granulomatosis.2 It is due to thinning of the collagen fibres and increased transparency of the underlying uvea seen in conditions having defective type 1 collagen formation

A RANDOMISED, COMPARATIVE STUDY OF GRID LASER AND SUBTHRESHOLD MICROPULSE DIODE LASER IN THE TREATMENT OF DIFFUSE DIABETIC MACULOPATHY

Objective: Diabetic retinopathy is a major cause of visual impairment in both developing and developed countries. The two important complicationsare macular edema and proliferative diabetic retinopathy. Laser treatment can reduce vision loss in both proliferative diabetic retinopathy anddiabetic macular edema. Early treatment of diabetic retinopathy study shows that immediate laser treatment reduces the risk of moderate visualloss by at least 50%. Thermal tissue damage is the main cause of many potential complications of conventional photocoagulation that may lead toimmediate and late visual loss. A subthreshold diode micropulse (SDM) laser targets retinal pigment epithelium (RPE); it is maximally absorbed bythe melanosomes of the RPE and underlying choroid while sparing the neurosensory retina. SDM laser minimizes chorioretinal damage as there isno thermal effect or injury despite achieving photocoagulation effects. To compare, the effectiveness of SDM laser versus grid laser photocoagulationfor the treatment of clinically significant macular edema in diabetic patients. To study, the outcome and adverse effects of laser treatments in bothmodalities.Methods: All Type 2 diabetic patients presenting to the ophthalmology department outpatient department were screened for diffuse diabetic macularedema and 60 eyes were enrolled in the study. They were divided into two groups of 30 eyes each and randomly assigned to receive either conventionalgrid laser or SDM laser. A detailed clinical examination which included visual acuity, color vision, visual fields (central 10°), fundus photos, and fundusflourescein angiography were done prior to the laser treatment and at 6 weeks and 3 months follow-up.Results: Conventional grid laser caused a significant resolution of macular edema, angiographically, whereas SDM laser showed worsening at3 months follow-up. Our study did not show an alteration of central 10° of visual field or color vision defects in both the groups, which suggestsignificant functional damage is not caused by both treatment modalities. We found in our study that conventional Grid laser was better at 3 monthsfollow-up in improving/stabilizing visual acuity and macular edema (angiographically). A single sitting of grid laser is better than SDM laser in diffusediabetic maculopathy.Keywords: Diabetic retinopathy, Diabetic macular edema, Grid laser, Subthreshold micropulse diode laser

BILATERAL ACUTE ANGLE CLOSURE GLAUCOMA IN A COVID 19 PATIENT FOLLOWING HEPARIN THERAPY- A CASE REPORT

Acute angle closure glaucoma is an ophthalmic emergency and can lead to blindness if left untreated. Pupillary block is the most common mechanism. Drug induced angle-closure has been reported to cause a significant proportion of these cases particularly in developing countries. The common drugs implicated are antidepressants, antipsychotics, antihistamines, anticonvulsants like topiramate, sulfa based drugs namely acetazolamide and hydrochlorothiazide, nebulized ipratropium bromide and salbutamol. Anticoagulants have also been reported to cause AACG in predisposed eyes As the COVID-19 pandemic has spread throughout the world, a high rate of thrombotic complications has been described, including deep vein thrombosis Although the mechanisms of thrombosis are unclear, anticoagulation with high doses of heparin has been proposed for these patients. Critically ill patients with COVID-19 develop life-threatening coagulopathy and thromboembolic complications that justify aggressive anticoagulation with close monitoring. We report a patient who developed bilateral angle closure glaucoma following heparin therapy who was misdiagnosed as having conjunctivitis by treating physicians which is an ocular manifestation of COVID 19.</jats:p

A STUDY OF THE POTENTIATING EFFECT OF TOPICAL PROPARACAINE 0.5% ON TROPICAMIDE 0.8% AND PHENYLEPHRENE 5% INDUCED MYDRIASIS IN A SOUTHINDIAN POPULATION

Objectives: Pupillary dilatation is an integral part of comprehensive ophthalmic examination. It is also essential for cataract surgery and outpatient laser procedures. Rapid and sustained dilatation is often required. It has been proposed that prior instillation of proparacaine 0.5% can potentiate the effect of the routinely used tropicamide 0.8% phenylephrine 5% combination mydriatic agent. However, certain studies have shown that it is not effective in dark colored iris as compared to light colored iris; hence, this study was done on a predominantly South Indian population with dark iris.&#x0D; Methods: Hundred eyes of 50 patients requiring pupillary dilatation as part of routine ophthalmic evaluation were included in the study. The patients were divided into two groups. The study group was given 0.5% proparacaine before instillation of mydriatic agent and the control group was given only tropicamide 0.8% and phenylephrine 5% eye drops. Pupillary dilatation was measured after 15 min and 30 min in both eyes. The end point was taken as 6 mm pupillary dilatation.&#x0D; Results: There was a statistically significant difference in the rate of pupillary dilatation between the control and the study group at 15 min and 30 min after instillation of eye drops.&#x0D; Conclusion: The study concluded that prior instillation produced faster dilatation even in patients with dark colored iris; hence, we suggest the use of topical anesthetic proparacaine 0.5% in situations where rapid mydriasis is required.</jats:p

A STUDY OF THE POTENTIATING EFFECT OF TOPICAL PROPARACAINE 0.5% ON TROPICAMIDE 0.8% AND PHENYLEPHRENE 5% INDUCED MYDRIASIS IN A SOUTHINDIAN POPULATION

Objectives: Pupillary dilatation is an integral part of comprehensive ophthalmic examination. It is also essential for cataract surgery and outpatient laser procedures. Rapid and sustained dilatation is often required. It has been proposed that prior instillation of proparacaine 0.5% can potentiate the effect of the routinely used tropicamide 0.8% phenylephrine 5% combination mydriatic agent. However, certain studies have shown that it is not effective in dark colored iris as compared to light colored iris; hence, this study was done on a predominantly South Indian population with dark iris. Methods: Hundred eyes of 50 patients requiring pupillary dilatation as part of routine ophthalmic evaluation were included in the study. The patients were divided into two groups. The study group was given 0.5% proparacaine before instillation of mydriatic agent and the control group was given only tropicamide 0.8% and phenylephrine 5% eye drops. Pupillary dilatation was measured after 15 min and 30 min in both eyes. The end point was taken as 6 mm pupillary dilatation. Results: There was a statistically significant difference in the rate of pupillary dilatation between the control and the study group at 15 min and 30 min after instillation of eye drops. Conclusion: The study concluded that prior instillation produced faster dilatation even in patients with dark colored iris; hence, we suggest the use of topical anesthetic proparacaine 0.5% in situations where rapid mydriasis is required

CARDIOVASCULAR DISEASES ASSOCIATED WITH PSEUDOEXFOLIATION SYNDROME – A PROSPECTIVE CROSS-SECTIONAL STUDY

Objectives: In recent years, pseudoexfoliation syndrome (PXF) is recognized as a systemic disorder and as an independent risk factor for cardiovascular diseases including hypertension, angina, myocardial infarction, and stroke. We studied the prevalence of cardiovascular diseases associated in patients with PXF. Methods: It was a prospective cross-sectional study done over a period of 2 years from January 2017 to December 2018 at the Department of Ophthalmology in Sree Balaji Medical College and Hospital. A total of 100 patients with PXF both male and female above the age of 50 were included in the study. They were given a standard questionnaire to evaluate common cyclic vomiting syndrome symptoms and a history of angina, myocardial infarction, and cerebrovascular accident was noted. All patients underwent blood pressure (BP) measurement and electrocardiogram (ECG) recording. Results: In our study which included 100 patients with PXF there were 57 male patients and 43 female patients. Most of the patients (59%) were above 65 years of age and 36 patients were diagnosed with open-angle glaucoma. A total of 62 patients had persistently elevated BP on three different occasions. Only five patients gave a positive history of angina at some point in their lives and among them, only four patients showed demonstrable changes in ECG. One patient gave a history of myocardial infarction (two showed changes in ECG) and none of the patients had cerebrovascular accidents. Conclusion: Our study showed that more than 60% of patients with PXF had hypertension; however, a statistically significant association with other conditions was not noted

CARDIOVASCULAR DISEASES ASSOCIATED WITH PSEUDOEXFOLIATION SYNDROME – A PROSPECTIVE CROSS-SECTIONAL STUDY

Objectives: In recent years, pseudoexfoliation syndrome (PXF) is recognized as a systemic disorder and as an independent risk factor for cardiovascular diseases including hypertension, angina, myocardial infarction, and stroke. We studied the prevalence of cardiovascular diseases associated in patients with PXF.&#x0D; Methods: It was a prospective cross-sectional study done over a period of 2 years from January 2017 to December 2018 at the Department of Ophthalmology in Sree Balaji Medical College and Hospital. A total of 100 patients with PXF both male and female above the age of 50 were included in the study. They were given a standard questionnaire to evaluate common cyclic vomiting syndrome symptoms and a history of angina, myocardial infarction, and cerebrovascular accident was noted. All patients underwent blood pressure (BP) measurement and electrocardiogram (ECG) recording.&#x0D; Results: In our study which included 100 patients with PXF there were 57 male patients and 43 female patients. Most of the patients (59%) were above 65 years of age and 36 patients were diagnosed with open-angle glaucoma. A total of 62 patients had persistently elevated BP on three different occasions. Only five patients gave a positive history of angina at some point in their lives and among them, only four patients showed demonstrable changes in ECG. One patient gave a history of myocardial infarction (two showed changes in ECG) and none of the patients had cerebrovascular accidents.&#x0D; Conclusion: Our study showed that more than 60% of patients with PXF had hypertension; however, a statistically significant association with other conditions was not noted.</jats:p