Differences in the Stimulus Accommodative Convergence/Accommodation Ratio using Various Techniques and Accommodative Stimuli

Purpose: To investigate differences in the stimulus accommodative convergence/accommodation (AC/A) ratio using various techniques and accommodative stimuli, and to describe a method for determining the stimulus AC/A ratio.

Methods: A total of 81 subjects with a mean age of 21 years (range, 20–23 years) were enrolled. The relationship between ocular deviation and accommodation was assessed using two methods. Ocular deviation was measured by varying the accommodative requirement using spherical plus/minus lenses to create an accommodative stimulus of 10.00 diopters (D) (in 1.00 D steps). Ocular deviation was assessed using the alternate prism cover test in method 1 at distance (5 m) and near (1/3 m), and the major amblyoscope in method 2. The stimulus AC/A ratios obtained using methods 1 and 2 were calculated and defined as the stimulus AC/A ratios with low and high accommodation, respectively, using the following analysis method. The former was calculated as the difference between the convergence response to an accommodative stimulus of 3 D and 0 D, divided by 3. The latter was calculated as the difference between the convergence response to a maximum (max) accommodative stimulus with distinct vision of the subject and an accommodative stimulus of max minus 3.00 D, divided by 3.

Results: The median stimulus AC/A ratio with low accommodation (1.0 Δ/D for method 1 at distance, 2.0 Δ/D for method 1 at near, and 2.7 Δ/D for method 2) differed significantly among the measurement methods (P < 0.01). Differences in the median stimulus AC/A ratio with high accommodation (4.0 Δ/D for method 1 at distance, 3.7 Δ/D for method 1 at near, and 4.7 Δ/D for method 2) between method 1 at distance and method 2 were statistically significant (P < 0.05), while method 1 at near was not significantly different compared with other methods.

Conclusions: Differences in the stimulus AC/A ratio value were significant according to measurement technique and accommodative stimuli. However, differences caused by measurement technique may be reduced by using a high accommodative stimulus during measurements.     

Strabismus and Near Point of Convergence and Amblyopia in 4–6 Year-Old Children

Purpose: To determine the prevalence of strabismus and amblyopia, and the distribution of the near point of convergence (NPC), in a population of children aged 4 to 6 years.

Methods: In this cross-sectional study, preschoolers in Mashhad were sampled using a random multistage cluster sampling approach. Examinations were done after obtaining parental consent. All participants had measurements of uncorrected visual acuity, corrected visual acuity, and non-cycloplegic refraction, and they had near and far cover tests to determine tropia and phoria.

Results: Of the 3765 selected children, 3701 participated in the study. The prevalence of tropia was 1.21% (95% confidence interval [CI]: 0.86–1.57). Near and near/far tropia was observed in 0.83% (95% CI: 0.53–1.12) and 0.39% (95% CI: 0.18–0.59), respectively. Tropia was significantly more prevalent in boys (P=0.005). The most common type of tropia was esotropia, 0.22% (95% CI: 0.07–0.37). Among participants, 63.92% (95% CI: 62.36–65.48) had phoria; prevalence of far, near, and near/far phoria was 0.22% (95% CI: 0.07–0.37), 60.47% (95% CI: 58.88–62.07), and 3.22% (95% CI: 2.65–3.8), respectively. Mean NPC was 5.1 cm (95% CI: 5.05–5.14). NPC increased by 0.08 cm per month of age (P=0.033) and was 0.10 cm higher in boys compared to girls (P=0.027). Based on NPC, 61.58% (95% CI: 59.99–63.17) were symptomatic. The prevalence of amblyopia was 0.41% (95% CI: 0.20–0.61). The type of amblyopia was anisometropic, strabismic, and isoametropic in 75%, 11.1%, and 8.5%, respectively.

Conclusion: The prevalence of amblyopia in this study population was not high; however, the prevalence of tropia was average compared to previous studies in Iran. Describing NPC in a 4- to 6-year-old Iranian population for the first time, we found that NPC increased with age in this sample.     

Accommodative Anomalies in a Sample of Black High School Students in South Africa

Purpose: Accommodative anomalies cause asthenopia and affect student reading efficiency and academic performance. The aim of conducting this study was to determine the prevalence and distribution of accommodative anomalies (insufficiency, excess and infacility) in relation to demographic variables (sex, age, school grade level and study location).

Methods: Study participants comprised 1,211 children (481 male and 730 female), with age range 13-19 years. Visual functions evaluated included refractive error, accommodative amplitude, accuracy, facility and relative accommodation.

Results: A total of 242 participants (20.2%) had accommodative anomalies. Prevalence estimates were; accommodative infacility 12.9% (95% confidence interval, CI, 10.9-14.7%), accommodative insufficiency 4.5% (95% CI 3.4-5.8%) and accommodative excess 2.8% (95% CI 1.9-3.8%). There were no significant differences based on sex, school grade level or study site, except in the prevalence of accommodative infacility, which was significantly higher in the younger grade level than the older (P=0.027).

Conclusion: The study fills a gap in the literature in providing data on predominantly black South African students. The prevalence estimates for accommodative insufficiency and excess found in the sample studied are relatively low, while that of accommodative infacility is high. Accommodative anomalies were not markedly associated with demographic variables except for the prevalence of accommodative infacility, which was significantly higher in the younger grade level than the older. Identification and referral are important steps towards diagnosis and treatment of accommodative anomalies. Future studies on differences in prevalence of accommodative anomalies among different racial populations will be relevant.     

Television Video Games in the Treatment of Amblyopia in Children Aged 4–7 Years

Aim: To investigate the role of television video games in childhood amblyopia treatment.

Method: This prospective, randomized, interventional study included 40 patients between 4-7 years of age, with unilateral amblyopia (visual acuity in amblyopic eye between 1-0.6 LogMAR equivalents) attending the squint clinic at a tertiary eye hospital.

All patients were prescribed optimal spectacle correction and occlusion therapy, i.e. full time patching according to patient’s age, was initiated after six weeks.; full-time patching according to patient’s age was initiated after 6 weeks. Subjects were randomly divided into two groups of 20 each. Patients in the first group, Group A (control), were prescribed patching alone. Patients in the second group, Group B (study), were made to play action video games, with the help of a commercial television set, along with patching. They attended 12 half-hour sessions each, at weekly intervals. Follow-up assessments included best corrected visual acuity (BCVA) (both distance and near) and stereoacuity measurements at 3, 6, 9, and 12 weeks.

Results: The mean age of patients was 6.03 ± 1.14 years. The distance BCVA in the amblyopic eye showed a significant improvement at final follow-up (12 weeks) in both groups: from 0.84 ± 0.19 to 0.55 ± 0.21 LogMAReq in Group A and 0.89 ± 0.16 to 0.46 ± 0.22 LogMAReq in Group B. However, improvement in BCVA was significantly better in group B at all visits (P=0.002, 12 weeks). The study group also had a significantly better outcome in terms near visual acuity improvement (P = 0.006, 12 weeks). There was also greater stereoacuity improvement in group B, with 7 patients improving to 100 secs of arc or better.

Conclusion: Video games supplemental to occlusion may be considered favorable for visual development in amblyopic children, and the study encourages further research on this subject.     

Adjustable Strabismus Surgery under Topical Anesthesia: Alignment in Supine vs Seated Position

Purpose: To compare ocular deviation in the operating room depending on whether the patient is in supine decubitus or seated after single-stage adjustable strabismus surgery under topical anesthesia.

Material and method: We performed a prospective observational study of 30 patients with horizontal and/or vertical strabismus who underwent single stage adjustable strabismus surgery under topical anesthesia. Both distance and near deviation were evaluated before surgery, during surgery in both positions (seated and supine), and at 1 day, 1 month, and 3 months after surgery. A final horizontal deviation <10 pd and a vertical deviation <5 pd without diplopia was considered to be a good outcome (3 months after surgery).

Results: The mean age of the sample was 55 years and 76.7% were women. Most had esotropia (70%). The most frequently used surgical combination was the medial rectus and lateral rectus (36.7%). Surgical adjustment was necessary in 40% of cases. Mean preoperative deviation was 21.9 ± 12.63 pd (distance) and 20.66 ± 4.76 (near). Deviation with the patient supine was 8 ± 8.25 pd (distance) and 7.26 ± 5.81 (near). Deviation with the patient seated was 8.13 pd±8.38 (distance) and 8.5 ± 7.41 (near). There was no significant difference between the positions. Outcome was favorable in 70% of patients; this percentage increased to 83.33% at 1 day, 1 month, and 3 months after surgery.

Conclusions: No statistically significant differences were found between ocular deviations in the seated or supine position in the operating room. Outcome was favorable in most cases 3 months after surgery. Intraoperative ocular deviation was not a predictor of outcome.     

Evaluating Choroidal Characteristics in Systemic Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography

Purpose: To evaluate choroidal thickness (CT) and investigate the involvement of choroidal circulation in patients with systemic sclerosis (SSc).

Methods: A total of 120 eyes of 60 SSc patients and 60 eyes of 30 healthy controls were evaluated. CT measurements were performed at the subfoveal region, 1000 µm nasal and 1000 µm temporal to the fovea, using enhanced depth imaging optical coherence tomography. CT measurements were compared between the patients and controls.

Results: The average subfoveal, parafoveal nasal and parafoveal temporal CT were significantly thinner in SSc patients when compared with healthy controls (297.77 ± 60.8 µm vs 339.8 ± 50.4 µm; 267.32 ± 51.1 µm vs 308.65 ± 49.9 µm; 270.63 ± 46.3 µm vs 309.22 ± 42.4 µm, respectively; p<0.001 for all).

Conclusions: Reduced CT in SSc patients supports the hypothesis of widespread vascular injury, including the ocular microcirculation.     

Assessment of Central Corneal Thickness in Different Subtypes of Systemic Sclerosis

Purpose: To compare central corneal thickness between patients with diffuse cutaneous systemic sclerosis and limited cutaneous systemic sclerosis.

Methods: A total of 53 consecutive patients with systemic sclerosis were enrolled in this study. All subjects were screened for age, gender, classification of disease subtype, autoantibody profile, duration of disease, organ involvement, current treatment, tear break-up time, Schirmer test, and measurement of the central corneal thickness with an ultrasonic pachymeter.

Results: No statistically significant differences were found in terms of age, sex, and duration of the disease, and dry eye evaluation between systemic sclerosis subsets. The mean central corneal thickness was 535.3 ± 37.6 µm (range, 471–619 µm) in diffuse cutaneous systemic sclerosis patients, and 539.3 ± 37.1 µm (range, 484–651 µm) in limited cutaneous systemic sclerosis (p = 0.71).

Conclusions: Central corneal thickness in patients with diffuse cutaneous systemic sclerosis is not different from the one in limited cutaneous systemic sclerosis.     

The Brazilian Amazon Region Eye Survey: Design and Methods

Purpose: To describe the study design, operational strategies, procedures, and baseline characteristics of the Brazilian Amazon Region Eye Survey (BARES), a population-based survey of the prevalence and causes of distance and near visual impairment and blindness in older adults residing in the city of Parintins.

Methods: Cluster sampling, based on geographically defined census sectors, was used for cross-sectional random sampling of persons 45 years and older from urban and rural areas. Subjects were enumerated through a door-to-door survey and invited for measurement of uncorrected, presenting and best-corrected visual acuity and an ocular examination.

Results: Of 9931 residents (5878 urban and 4053 rural), 2384 individuals (1410 urban and 974 rural) were eligible and 2041 (1180 urban and 861 rural) had a clinical examination (response rate 85.6%). The majority of participants were female (1041, 51.0%); the average age was 59.9 ± 11.1 years (60.2 ± 11.2 years for urban and 59.4 ± 11.1 years for rural); 1360 (66.6%) had primary schooling or less (58.1% in urban and 78.4% in rural) and 57.8% were resident in urban areas. The age distribution between sexes was similar (p = 0.178). Both sex and age distributions of the sample were comparable to that of the Brazilian Amazon Region population.

Conclusions: The BARES cohort will provide information about the prevalence and causes of near and distance vision in this underprivileged and remote population in Brazil.     

Choroidal Neovascularization Associated with Multiple Evanescent White Dot Syndrome Treated with Intravitreal Ranibizumab

Purpose: To describe the clinical outcomes of intravitreal ranibizumab treatment for subfoveal choroidal neovascularization (CNV) associated with multiple evanescent white dot syndrome (MEWDS).

Methods: This is a prospective, interventional, case series. All recruited patients underwent a baseline intravitreal ranibizumab injection and were monitored monthly over a 12-month follow-up, following a pro-re-nata regimen.

Results: Four patients (four eyes) were included in the study. Mean best-corrected visual acuity (BCVA) changed from 0.60 ± 0.20 at baseline to 0.07 ± 0.05 logMAR at 12-month examination. Baseline central macular thickness reduced from 330 ± 32 µm to the final value of 228 ± 14 µm at the 1-year follow-up. Overall, a mean number of 2.2 ranibizumab injections were administered at the end of 12 months.

Conclusions: Intravitreal ranibizumab treatment represents a valuable therapeutic option for the management of CNV associated with MEWDS.     

Serum Vitamin D Levels in Children with Vernal Keratoconjunctivitis

Purpose: To evaluate serum 25-hydroxyvitamin D [25(OH)D3] levels of vernal keratoconjunctivitis (VKC) children.

Methods: A total of 62 non-atopic healthy children (64.5% male, mean age 10.79 ± 3.3 years) and 29 VKC children (75.9%, mean age 12.17 ± 2.7 years) were included in the study. Serum 25(OH)D3 levels measured by HPLC were compared between the two groups and a p value of <0.05 was considered as statistically significant.

Results: The mean serum 25(OH)D3 level of VKC group was significantly lower than in the control group (11.02 ± 5.16 ng/mL and 15.99 ± 7.36 ng/mL, respectively) (p = 0.002). Severe vitamin D deficiency (<10 ng/mL) was detected in 48.3% of VKC children and 22.6% of the controls (p = 0.017). Time spent outdoors during daylight was higher in the control group (229.5 ± 101.2 min) compared with the VKC group (160.7 ± 65.9 min) (p = 0.008), and showed a significant correlation with serum 25(OH)D3 levels (Spearman rho = 0.812) (p<0.001).

Conclusions: Children with VKC should be evaluated for vitamin D deficiency, which might occur secondary to sun avoidance.     

Impact of Superior Oblique Transposition on Primary Position Deviation,a Pattern and Intorsion in Third Nerve Palsy

Purpose: To evaluate the role of superior oblique transposition on primary position alignment, A pattern, and intorsion in third nerve palsy.

Methods: Ten patients with isolated, unilateral third nerve palsy were included in this prospective study. The patients were treated by conventional surgery on horizontal recti together with superior oblique transposition by Scott’s procedure in the paretic eye.

Results: Pre-operative primary horizontal deviation was 60-80 PD (mean 70.00±7.45 PD). Pre-operative primary hypotropia was 15-22 PD (mean 18.80±2.48 PD). Mean A-pattern was 17.80±2.65 PD. All patients included in the study had some degree of objective torsion as measured by Guyton’s method. One patient had grade I objective intorsion, 2 had grade II, 6 had grade III, and 1 had grade IV objective intorsion.

Primary position horizontal alignment (up to ±8 PD) was achieved in 9 patients. Primary position vertical alignment (up to ±8 PD) was achieved in all 10 patients.

Only 2 of 10 patients had A-pattern of 10 PD, in the remaining 8 patients it was eliminated (P<0.05). Postoperatively, 5 patients had no objective intorsion and 5 had grade I intorsion, and none of the patients had hypertropia or paradoxical eye movements.

Conclusion: Superior oblique transposition by Scott’s procedure along with conventional surgery on horizontal recti in third nerve palsy results in better horizontal and vertical alignment, and improves A-pattern and intorsion, thus leading to better binocular interaction.     

Effect of Systemically Used Anti-Tumor Necrosis Factor-α Medication on the Corneal Epithelium and Stroma of Patients with Ankylosing Spondylitis

Purpose: To evaluate the effect of systemically used anti-tumor necrosis factor alpha (TNF-α) medication on the thickness of corneal epithelium and stroma in patients with ankylosing spondylitis (AS).

Methods: A total of 125 eyes of 69 participants were included in this retrospective study of three groups: healthy participants (Group 1), AS patients receiving anti–TNF-α medication (Group 2), and AS patients receiving a nonsteroidal anti-inflammatory medication (Group 3).

Results: According to anterior segment optical coherence tomography, the mean thickness of the corneal epithelium was significantly thicker in Group 2 than in Group 3 (51.6 ± 3.2 µm versus 50.4 ± 3 µm, p = 0.01), as was that of the stroma (475 ± 33 µm versus 443 ± 29 µm, p = 0.002).

Conclusions: Anti–TNF-α medication and/or avoidance of nonsteroidal anti-inflammatory drugs could improve the thickness of both the corneal epithelium and stroma in AS patients.     

Chronic Non-infectious Uveitis in Patients with Juvenile Idiopathic Arthritis

Purpose: To describe clinical findings and analyze treatment evolution of chronic, non-infectious uveitis in patients with juvenile idiopathic arthritis (JIA).

Methods: A total of 82 patients (147 eyes) with JIA-related uveitis treated for ≥2 months were included (78% females; 79% bilateral uveitis; 74% anterior uveitis). Outcome measures were visual acuity (VA), inflammation control, side-effects, and surgical procedures.

Results: Mean ± SD age at diagnosis was 4.9 ± 3.8 years; mean ± SD follow-up time was 8.7 ± 7.8 years. Mean VA did not significantly change throughout the study. Three (2%) eyes resulted in no light perception (NLP) vision. Thirty (37%) patients underwent 69 procedures. In total, 41 (50%) patients achieved inflammation control. TNF-α inhibitors were significantly associated with inflammation control. Seven (8.5%) patients stopped treatment due to side-effects.

Conclusions: JIA is a cause of significant ocular morbidity. TNF-α inhibitor use was associated with inflammation control. Prospective, randomized, double blind clinical trials in this regard are warranted.     

Changes in Inflammatory Activity after Glaucoma Filtration Surgery in Children with Chronic Anterior Uveitis

Purpose: To evaluate changes in inflammatory activity over time in patients with juvenile idiopathic arthritis (JIA)-associated anterior uveitis after two different types of glaucoma surgery.

Methods: Retrospective analysis of 32 patients with JIA who had trabeculectomy (TE, 21 eyes) or Ahmed glaucoma valve implantation (AGV, 11 eyes). Inflammatory activity and use of anti-inflammatory medication were evaluated 1 year prior to surgery and in the first, third, and fifth years after surgery.

Results: In both groups IOP decreased significantly from pre-surgery to 2 years after surgery (TE, 31.1 ± 6.7 to 12.8 ± 6.1 mmHg, p<0.0001; AGV, 28.5 ± 8.5 to 14.9 ± 6.6 mmHg, p<0.001). In the TE group flare, anterior chamber cells, and uveitis activity decreased significantly after surgery, whereas with AGV there was no sustained reduction of flare.

Conclusions: The degree of inflammation in JIA-associated uveitis is significantly reduced after trabeculectomy.     

Long-term Surgical Outcomes in the Sagging Eye Syndrome

Background/aims: Strabismus due to sagging eye syndrome (SES) caused by age-related connective tissue involution is now an established cause of diplopia in older people. High suspicion of the condition results in early recognition, often obviating extensive neurological investigations and enabling surgical correction of the strabismus.

Methods:This retrospective study reviewed surgical results in 93 patients (40 males) of average age 68 ± 12 years, who had small-angle strabismus due to SES, during the 20-year period 1994–2014.

Results: In central gaze, mean distance pre-operative esotropia was 4.2 ± 7.5Δ (mean, SD), while mean hypertropia was 4.7 ± 5.9Δ. Surgeries comprised medial rectus (MR) recession; lateral rectus (LR) resection; plication, imbrication, and superior transposition of the LR to the superior rectus (SR) for esotropia; and graded vertical rectus tenotomy (GVRT) or vertical muscle recession for hypertropia. Mean post-operative immediate and long-term deviation after 316 ± 265 months average follow-up was 0.2 ± 1.2Δ and 1.1 ± 2.7Δ esotropia (both distance), respectively, and 0.00Δ and 1.1 ± 2.7Δ, respectively, for hypertropia. Strabismus recurred in 19 cases.

Conclusions: Progressive connective tissue involution in SES may occasionally result in symptomatic recurrences of the small-angle strabismus in about 20% of patients, irrespective of surgical procedures performed, possibly because of progressive involutional changes. This risk should be disclosed pre-operatively.     

The Impact of Visual Impairment on Health-related Quality of Life in Rural Africa

Purpose: To assess the impact of visual impairment (VI) on utility values in Sub-Saharan Africa and compare findings with other studies from low- and high-income countries.

Methods: Patients with normal vision and various levels of VI were recruited from a secondary eye clinic in rural Kenya and interviewed using time trade-off (TTO). VI was classified using the World Health Organization definition of (normal vision, visual acuity ≥20/60, VI 20/80–20/200, severe VI 20/240–20/400, and blindness <20/400).

Results: Mean age of the total sample (N?=?303) was 50.3 years (standard deviation, SD, ±18.17 years), and 51.5% of patients were male. Most were small-scale farmers and illiteracy was high at 40%. Mean TTO scores per group were: normal vision 0.93 (SD?±?0.10), VI 0.88 (SD?±?0.14), severe VI 0.86 (SD?±?0.13), blindness 0.73 (SD?±?0.17; p?≤?0.001). Lower TTO scores were independently associated with worse visual acuity (p?≤?0.001), longer duration of disease (p?≤?0.001) and illiteracy (p?=?0.011), but not with cause of VI, age, sex, marital status, socioeconomic status, or systemic comorbidities in multivariate analyses. Overall, TTO scores were considerably higher than those reported from high-income countries at similar levels of VI.

Conclusion: In this rural African population, duration and extent of vision loss, rather than cause, socioeconomic factors and comorbidities affected vision-related quality of life. Our findings underline the importance of providing sight-restoring treatment as timely as possible and the necessity of enhancing rehabilitation efforts for those with non-curable eye diseases.     

Serum Vitamin D Levels in Patients with Acute Anterior Uveitis

Purpose: To evaluate serum 25-hydroxyvitamin D levels in patients with acute anterior uveitis (AAU).

Methods: This observational case–control study involved 20 patients with AAU, and 20 consecutive, age and sex-matched healthy subjects without any ocular or systemic diseases. Serum 25-hydroxyvitamin D was quantified with electrochemiluminescence technique.

Results: No significant differences were found between the groups with respect to age (p = 0.185) and sex (p = 0.465). Serum vitamin D levels of the subjects with AAU (mean 5.75 ± 4.50 ng/mL, median 4.00 ng/mL, range: 3.00–19.00 ng/mL) were significantly lower than the control group (mean 12.96 ± 5.89 ng/mL, median 11.00 ng/mL, range: 5.20–25.92 ng/mL) (p<0.001).

Conclusions: We found significantly low serum levels of vitamin D in patients with AAU, which suggest that vitamin D deficiency may play a role in the pathogenesis of anterior uveitis. Further studies are necessary to demonstrate the efficacy of vitamin D supplementation in the management of patients with anterior uveitis.     

Development of Strabismus in Children Initially Diagnosed with Pseudostrabismus

Purpose: To evaluate the incidence of strabismus in children initially diagnosed with pseudostrabismus and to identify risk factors for the development of strabismus.

Methods: The medical records of patients who were diagnosed with pseudostrabismus at initial examinations in outpatient clinic were reviewed retrospectively. Follow-up examinations were made at the strabismus department. Age at first examination, gender, family and developmental history, ophthalmic and orthoptic findings including orbit, and eyelid pathologies were investigated.

Results: Sixty-five patients with the diagnosis of pseudostrabismus were identified; 2 patients (3.1%) had pseudoexotropia, and 63 patients (96.9%) had pseudoesotropia. The mean age at the initial exam was 29.26±26.68 months (range; 4–120 months). Epicanthal skin folds (n=35), flat broad nasal bridge (n=17), blepharophimosis syndrome (n=1), hypertelorism (n=1), telecanthus (n=1), and multiple pathologies (n=10) were the reasons for pseudostrabismus. Six patients (9.2%) had clinically significant hypermetropia. Anisometropia and amblyopia were detected in 1 (1.5%) and 3 patients (4.6%), respectively, at the initial examination. The mean follow-up period was 25.2±23.28 months (range; 1–154 months). During the follow-up period, true strabismus was detected in 8 cases (12%); of these, 5 cases had non-refractive esotropia, 2 cases had refractive accommodative esotropia, and 1 case had exotropia. Binocular single vision was not developed following amblyopia therapy and refractive correction in esotropic cases. Binocular single vision and best corrected visual acuity were statistically significant risk factors for the development of strabismus (P=0.001).

Conclusion: The pseudostrabismic children with subnormal binocular single vision or low visual acuity require follow-up for the risk of development of true strabismus.     

The Role of Dexamethasone Implant in the Management of Tubercular Uveitis

Purpose: To study the safety and efficacy of intravitreal injection of dexamethasone implant in the management of posterior segment involvement in tubercular uveitis (TBU).

Methods: In this study, retrospective analysis of safety and efficacy of intravitreal injection of dexamethasone implant for various indications such as cystoid macular edema (CME), vitritis, or paradoxical worsening in TB-related intermediate uveitis, retinal vasculitis, and multifocal serpiginoid choroiditis (MSC) was performed.

Results: The study included 17 patients (19 eyes; 7 males). IOP increased from 14.88 ± 2.68 mm Hg to 16.4 ± 5.82 mm Hg (p = 0.18) at 3 months. BCVA improved from 0.37 ± 0.35 to 0.27 ± 0.21 at 3 months (p = 0.03). CME resolved at 3 months and two patients with paradoxical worsening showed resolution within 1 month.

Conclusion: Intravitreal dexamethasone implant is safe and efficacious as an adjunct to ATT in reducing the central macular thickness, vitritis, and progression of choroiditis lesions in paradoxical worsening of MSC.     

Scanning laser ophthalmoscopy in an elderly Indian population

Purpose: To study optic nerve head (ONH) characteristics using scanning laser ophthalmoscopy, Heidelberg retina tomograph (HRT), in an elderly population.

Methods: A population-based, cross-sectional study included 1460 eyes of 1460 consecutive, subjects >60 years, in North India. All subjects underwent a detailed ophthalmic evaluation and imaged on HRT. Stereometric parameters, Moorfields regression analysis (MRA) and discriminant function analysis were analyzed. Correlation between ONH parameters and disc area, age, sex, and intraocular pressure was analyzed.

Results: Disc size had a normal Gaussian distribution (2.22 ± 0.48 mm²), but all other stereometric parameters showed a wide variation.

MRA found 1320 (90.4%) eyes within normal limits, 71 (4.86%), borderline limits, and 69 (4.73%) outside normal limits.

Comparison of eyes meeting International Society of Geographical and Epidemiological Ophthalmology criteria for a glaucoma suspect, C:D > 0.7, with those that did not show a statistically significant difference in the cup area, rim area, rim disc ratio, and cup volume (p = 0.02, 0.02, 0.02, 0.03, respectively).

An Intraocular pressure (IOP) ≥21 mmHg was seen in 3.01%, and only 12 eyes out of 1460, 0.82%, had an IOP ≥21 mmHg and a cup:disc ratio of more than 0.7. A van Herick estimation of < Grade 3 was seen in 19.4%

Conclusions: Stereometric parameter data, MRA, and clinical examination in this population at high risk for glaucoma found that about 10% of individuals over 60 years of age could be classified as glaucoma suspects and would need further evaluation.