International Journal of Anatomy Radiology and Surgery, 2016
Introduction: Glaucoma is the second leading cause of blindness. Early identification of disease ... more Introduction: Glaucoma is the second leading cause of blindness. Early identification of disease is important, as treatment can slow the disease progression and preserve vision. The purpose of our study was to evaluate the Retinal Nerve Fibre Layer (RNFL) and Optic nerve head (ONH) using Optical Coherence Tomography (OCT) in primary open angle glaucoma (POAG) and to determine if any correlation exists between the two. In a Cross-sectional study including, 73 eyes of 39 patients with POAG, aged 40 years and above, we evaluated retinal nerve fiber layer (RNFL) and optic nerve head (ONH) changes using optical coherence tomography (OCT). The statistical analysis was done using Epi Info software. The mean age was 62.82±9.78 years and IOP was 24.25±3.685 mmHg. Mean thickness of RNFL was 101.67±25.8μm, 60.21±14.02μm, 98.67±25.10μm, 72.44±21.914μm of superior, temporal, inferior and nasal quadrants respectively. The ONH parameters and the RNFL thickness were quantified and analyzed. It was found that most of the patients had more thinning in the superior and inferior quadrants. Superior RNFL and the vertical ONH parameters showed best correlation (-0.439, p-value 0.005). SD-OCT is a powerful objective and structural assessment tool in diagnosing and managing glaucoma and hence should be a part of routine glaucoma evaluation. Correlation of ONH topography with RNFL thickness may be of value in patients with suspicious disc picture. Superior quadrant of the RNFL was found to be the most reliable parameter in primary open angle glaucoma.
Visual improvement after cataract surgery in one eye diminishes the incentive for second-eye cata... more Visual improvement after cataract surgery in one eye diminishes the incentive for second-eye cataract surgery (SECS). This observational study aimed to determine if patients report for SECS with more advanced cataracts than for the rst eye. Further, to explore the time gap between rst-eye and SECS and factors in uencing it. Adults requiring cataract surgery were included. Demographics, ocular and systemic conditions and perioperative ndings were compared between 'First-eye cataract surgery' and 'SECS' groups. Time elapsed since rst-eye surgery and reasons thereof were analyzed in SECS group. Of 891 eyes operated, 376 (42.2%) were SECS. Frequency of advanced cataracts was comparable between the groups (p = 0.11), while ocular comorbidities was lower in SECS group (p < 0.05). Both groups encountered similar intra-operative (p = 0.72) and post-operative (p = 0.13) complications. Postoperative visual acuity was signi cantly better in SECS group (p = 0.007). Mean time interval between rst-eye and SECS was 2.07 ± 1.8 years. A longer gap was associated with increased incidence of intraoperative complications (p = 0.04). Reasons for the time interval to SECS included "good vision in fellow eye", "non-availability of caregiver" and "unsatisfactory outcomes with rst-eye surgery". Patients undergoing SECS did not have a higher incidence of advanced cataracts. Almost half the patients reported for SECS within 1 year. Experience of rst-eye surgery in uenced the decision to undergo SECS.
TNOA journal of ophthalmic science and research, 2019
The incidence of eclampsia in developed countries is 1 in 3000 and the incidence of posterior rev... more The incidence of eclampsia in developed countries is 1 in 3000 and the incidence of posterior reversible encephalopathy syndrome (PRES) is 1 in 400 eclampsia patients. Not many cases of PRES have been reported from Tamil Nadu. This can be an eye opener for ophthalmologists if a patient comes with a sudden loss of vision. PRES is also known as reversible posterior leukoencephalopathy syndrome. It is a cliniconeuroradiological syndrome associated with various clinical conditions presenting with headache, seizures, and cortical visual disturbance. Imaging predominantly shows parieto-occipital white matter changes with vasogenic edema being the most accepted pathophysiology. We report a 25-year-old primigravida who presented in term pregnancy with pregnancy-induced hypertension, seizures, and blindness. Magnetic resonance imaging showed subcortical signal abnormalities in the occipital lobes, which is a sign of PRES. She was managed by controlling her blood pressure levels, and emergency cesarean section was done. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment.
TNOA Journal of Ophthalmic Science and Research, 2019
Aim: The aim is to study the correlation of macular thickness and sensitivity in type 2 diabetes ... more Aim: The aim is to study the correlation of macular thickness and sensitivity in type 2 diabetes mellitus patients. Materials and Methods: A cross-sectional comparative study was done on 77 eyes with diabetic retinopathy. Patients were divided into three groups as follows: Group 1 – Diabetic retinopathy without maculopathy, Group 2 – Diabetic maculopathy without clinically significant macular edema (CSME), and Group 3 – CSME. Microperimetry was used to assess macular sensitivity, and optical coherence tomography (OCT) was used to measure retinal thickness. Comparison of retinal sensitivity and thickness was done between groups. Correlation of these parameters to duration of diabetes was also done. Results: The mean macular sensitivity (in dB) in Groups 1, 2, and 3 was 11.57, 11.51, and 8.03, respectively. The mean central macular thickness in Groups 1, 2, and 3 was 199.33, 208.62, and 334.25 μm, respectively. There was statistically significant difference in macular thickness and in macular sensitivity between Groups 1 and 3 (P < 0.001) and between Groups 2 and 3 (P < 0.001). This difference was not statistically significant between Groups 1 and 2 (P > 0.09). Macular sensitivity had a moderate correlation with macular thickness, which was statistically significant (P < 0.001). Conclusions: Macular sensitivity was found to decrease with increasing macular thickness.
Introduction: Ocular trauma is an important worldwide preventable public health problem which may... more Introduction: Ocular trauma is an important worldwide preventable public health problem which may lead to permanent visual impairment. This study aims to determine the demographics, clinical profile and visual outcome of severe eye injuries. Methods: This study was conducted at a tertiary centre from January 2013 to August 2014. Cases of severe eye injuries hospitalized at or presenting to emergency/OPD were included in the study. All cases underwent detailed examination and necessary intervention. Cases were followed upto 3 months and final visual outcome was evaluated. Results: The study comprised of 60 individuals (65 eyes); 76.7% males and 23.3% females. Out of 60 cases, the age group 1-9 years had the highest occurrence with 23.33% followed by 20-29 years with 20% and majority were students 45%. Impact with stone was the commonest cause of injury reported on 21.7% followed by road traffic accident (RTA) 20%. Closed-globe injuries accounted for 36.6% and open-globe injuries for ...
TNOA Journal of Ophthalmic Science and Research, 2018
Chemical fumes are known to cause eye injury resulting in disablement. A mass casualty (group of ... more Chemical fumes are known to cause eye injury resulting in disablement. A mass casualty (group of 17 filmmakers) reported with severe irritation, watering, redness, photophobia, and blepharospasm in their eyes following approximately 12 hours after exposure to fumes of Japan black mixed with kerosene after film shooting with intense arc light. Examination revealed chemical conjunctivitis, keratoconjunctivitis, dermatitis, and eyelid edema. Symptoms resolved within 48 hours in all except 1, with supportive treatment, lubricant eye drops, and rest in the darkened room. This case report underlines the need for healthy industrial practices to avoid chemical injuries from volatile chemicals among filmmakers.
Indian Journal of Clinical and Experimental Ophthalmology, 2019
Ischaemic optic neuropathy is defined as an infarction of the retrolaminar part of optic nerve. T... more Ischaemic optic neuropathy is defined as an infarction of the retrolaminar part of optic nerve. This is caused due to hypoperfusion of optic disc leading to short posterior artery occlusion. Giant cell arteritis assumes first and foremost importance as a prominent cause of anterior ischaemic optic neuropathy. Carotid artery dissection is an uncommon aetiological factor. Carotid artery dissection presents with a constellation of ocular features like Horner's syndrome, amaurosis fugax, hemianopia, sixth cranial nerve palsy and ischaemic optic neuropathy. Ischaemic optic neuropathy has been reported in patients who suffered from dissection of carotid artery and it could be a preliminary manifestation. Suspicion of internal carotid artery (ICA) dissection should be raised in cases of anterior ischaemic optic neuropathy (AION) associated with severe unilateral cephalic pain. Dissection of carotid artery can cause cerebral and retinal ischaemia, especially in young adults, resulting in ischaemic symptoms. An array of investigations were performed to eliminate other triggers of optic neuropathy. Carotid Doppler helps to confirm the diagnosis. This article highlights a patient with a rare presentation of anterior ischaemic optic neuropathy resulting from dissection of internal carotid artery. A high index of suspicion should be entertained by symptoms like severe unilateral headache followed by diminution of vision. Prompt diagnosis and management can prevent visual loss in the fellow eye as well as life threatening complications of ICA dissection such as stroke.
Charles Bonnet Syndrome (CBS) is a common cause of visual hallucinations seen in elderly people w... more Charles Bonnet Syndrome (CBS) is a common cause of visual hallucinations seen in elderly people with visual impairment. Well-formed visual hallucinations in clear consciousness with preserved insight are commonly reported in literature. We report a case of CBS having multisensory hallucinations. An elderly patient with visual impairment fulfilling the criteria of CBS presents with various modalities of hallucinations viz. visual, auditory and tactile hallucinations improved completely with low dose of antipsychotics. Atypical features are common in CBS and thus often make it difficult to diagnose this condition.
Journal of Clinical Ophthalmology and Research, 2016
Trauma-related visual impairment is an unrecognized public health problem. Insufficient epidemiol... more Trauma-related visual impairment is an unrecognized public health problem. Insufficient epidemiological data on eye injuries underlies the prevailing apathy. We conducted PubMed search for articles on prevalence/incidence, and epidemiology of eye injuries/ocular trauma in India published from year 2000 to 2014 and included for analysis the studies with sufficient statistical power. We also retrieved data from National Sample Survey Organization (NSSO) and Census of India. Book chapters were also searched for relevant references. Available data throw light on the magnitude and dimensions of trauma-related visual impairment. Andhra Pradesh eye diseases study recorded history of eye injuries in 7.5% of a South Indian population, resulting in unilateral blindness in 0.6% of eye-injured. NSSO 1991 too has recorded high prevalence (35/1000 in rural areas, and 32/1000 in urban areas) of injury-related visual impairment. Results reveal the majority of injuries occur at work in an unorganized sector where Occupational Safety and Health (OSH) cover are almost nonexistent. Data on eye injuries at home, at sports, and combat-related injuries are incomplete. Due to their cataract-centric design, rapid assessment of avoidable blindness surveys fails to reveal injury-related visual impairment. To estimate injury-related visual impairment, we recommend the establishment of a National Ocular Trauma Registry. Comprehensive population-based surveys shall provide additional sources of data. Compliance with OSH measures, education of workforce, provision of eye protective device for hazardous occupations, mandatory reporting, and monitoring and audit of eye injuries should go hand-in-hand.
Combat-related eye injuries are common among the soldiers. They often render combatants unfit for... more Combat-related eye injuries are common among the soldiers. They often render combatants unfit for military service and many civil occupations [1]. With each succeeding war, injuries to the eyes have been increasing [2]. Combat-related eye injuries are frequently bilateral and associated with globe perforation, retained intraocular foreign bodies (IOFBs), and visual impairment [1]. Unlike the data from Western world and the Middle East, data on combat-related eye injuries among Indian soldiers are scarce. There are no data either from the counterinsurgency operations on Indian soil [3]. This study aims to review the combat-related eye injuries and the status of combat eye protection among Indian soldiers. We also aim to briefly review the global practices of Military Combat Eye Protection (MCEP). Based on review of available literature we offer our recommendations for Indian soldiers. combat Eye injuries: changing Scenario Eye injuries are an important source of morbidity among military personnel during peace and war [4]. Estimated incidence of eye injuries in warfare is 20-50 times as high as what is found in civilian situations [5]. Combat-related eye injuries are generally secondary to Improvised Explosive Device (IED) explosion [6]. IED blasts are also associated with increase in the incidence and severity of eye injuries. Gunshot wound, fragments of shell, grenade, and bombs, and mine blasts are other sources of combat-related eye injuries. In the 19 th century, less than 1% of all battle casualties suffered eye injuries [7]. Wars in the 20 th century have shown an increasing trend of eye injuries. In the ground phase of gulf war, the number of combat-related eye injuries accounted for 13% of the patient volume at a major combat support hospital [8]. Among the British Armed Forces deployed in Iraq or Afghanistan (2004-08), 10% of cases of major trauma suffered eye injuries [9]. In fact, with the advent of body armour and the helmet, injuries to the head, chest, and upper abdomen have decreased to some extent; the face, eyes, and extremities may be more susceptible to injuries [10]. Advances Ophthalmology Section
Introduction: Gonioscopy is the gold standard in assessing anterior chamber angles. However, inte... more Introduction: Gonioscopy is the gold standard in assessing anterior chamber angles. However, interobserver variations are common and there is a need for reliable objective method of assessment. Aim: To compare the anterior chamber angle by gonioscopy and Spectral Domain Optical Coherence Tomography (SD-OCT) in individuals with shallow anterior chamber. materials and methods: This comparative observational study was conducted in a rural tertiary multi-speciality teaching hospital. A total of 101 eyes of 54 patients with shallow anterior chamber on slit lamp evaluation were included. Anterior chamber angle was graded by gonioscopy using the shaffer grading system. Angles were also assessed by SD-OCT with Trabecular Iris Angle (TIA) and Angle Opening Distance (AOD). Chi-square test, sensitivity, specificity, positive and negative predictive value to find correlation between OCT parameters and gonioscopy grading. Results: Females represented 72.7%. The mean age was 53.93 ±8.24 years and mean anterior chamber depth was 2.47 ± 0.152 mm. Shaffer grade ≤ 2 were identified in 95(94%) superior, 42(41.5%) inferior, 65(64.3%) nasal and 57(56.4%) temporal quadrants. Cut-off values of TIA ≤ 22° and AOD ≤ 290 µm were taken as narrow angles on SD-OCT. TIA of ≤ 22° were found in 88(92.6%) nasal and 87(87%) temporal angles. AOD of ≤ 290 µm was found in 73(76.8%) nasal and 83(83%) temporal quadrants. Sensitivity in detecting narrow angles was 90.7% and 82.2% for TIA and AOD, while specificity was 11.7% and 23.4%, respectively. Individuals were found to have narrow angles more with SD-OCT. Sensitivity was high and specificity was low in detecting narrow angles compared to gonioscopy, making it an unreliable tool for screening.
International Journal of Anatomy Radiology and Surgery, 2016
Introduction: Glaucoma is the second leading cause of blindness. Early identification of disease ... more Introduction: Glaucoma is the second leading cause of blindness. Early identification of disease is important, as treatment can slow the disease progression and preserve vision. The purpose of our study was to evaluate the Retinal Nerve Fibre Layer (RNFL) and Optic nerve head (ONH) using Optical Coherence Tomography (OCT) in primary open angle glaucoma (POAG) and to determine if any correlation exists between the two. In a Cross-sectional study including, 73 eyes of 39 patients with POAG, aged 40 years and above, we evaluated retinal nerve fiber layer (RNFL) and optic nerve head (ONH) changes using optical coherence tomography (OCT). The statistical analysis was done using Epi Info software. The mean age was 62.82±9.78 years and IOP was 24.25±3.685 mmHg. Mean thickness of RNFL was 101.67±25.8μm, 60.21±14.02μm, 98.67±25.10μm, 72.44±21.914μm of superior, temporal, inferior and nasal quadrants respectively. The ONH parameters and the RNFL thickness were quantified and analyzed. It was found that most of the patients had more thinning in the superior and inferior quadrants. Superior RNFL and the vertical ONH parameters showed best correlation (-0.439, p-value 0.005). SD-OCT is a powerful objective and structural assessment tool in diagnosing and managing glaucoma and hence should be a part of routine glaucoma evaluation. Correlation of ONH topography with RNFL thickness may be of value in patients with suspicious disc picture. Superior quadrant of the RNFL was found to be the most reliable parameter in primary open angle glaucoma.
Visual improvement after cataract surgery in one eye diminishes the incentive for second-eye cata... more Visual improvement after cataract surgery in one eye diminishes the incentive for second-eye cataract surgery (SECS). This observational study aimed to determine if patients report for SECS with more advanced cataracts than for the rst eye. Further, to explore the time gap between rst-eye and SECS and factors in uencing it. Adults requiring cataract surgery were included. Demographics, ocular and systemic conditions and perioperative ndings were compared between 'First-eye cataract surgery' and 'SECS' groups. Time elapsed since rst-eye surgery and reasons thereof were analyzed in SECS group. Of 891 eyes operated, 376 (42.2%) were SECS. Frequency of advanced cataracts was comparable between the groups (p = 0.11), while ocular comorbidities was lower in SECS group (p < 0.05). Both groups encountered similar intra-operative (p = 0.72) and post-operative (p = 0.13) complications. Postoperative visual acuity was signi cantly better in SECS group (p = 0.007). Mean time interval between rst-eye and SECS was 2.07 ± 1.8 years. A longer gap was associated with increased incidence of intraoperative complications (p = 0.04). Reasons for the time interval to SECS included "good vision in fellow eye", "non-availability of caregiver" and "unsatisfactory outcomes with rst-eye surgery". Patients undergoing SECS did not have a higher incidence of advanced cataracts. Almost half the patients reported for SECS within 1 year. Experience of rst-eye surgery in uenced the decision to undergo SECS.
TNOA journal of ophthalmic science and research, 2019
The incidence of eclampsia in developed countries is 1 in 3000 and the incidence of posterior rev... more The incidence of eclampsia in developed countries is 1 in 3000 and the incidence of posterior reversible encephalopathy syndrome (PRES) is 1 in 400 eclampsia patients. Not many cases of PRES have been reported from Tamil Nadu. This can be an eye opener for ophthalmologists if a patient comes with a sudden loss of vision. PRES is also known as reversible posterior leukoencephalopathy syndrome. It is a cliniconeuroradiological syndrome associated with various clinical conditions presenting with headache, seizures, and cortical visual disturbance. Imaging predominantly shows parieto-occipital white matter changes with vasogenic edema being the most accepted pathophysiology. We report a 25-year-old primigravida who presented in term pregnancy with pregnancy-induced hypertension, seizures, and blindness. Magnetic resonance imaging showed subcortical signal abnormalities in the occipital lobes, which is a sign of PRES. She was managed by controlling her blood pressure levels, and emergency cesarean section was done. Clinical improvement with complete resolution of visual disturbances was observed with supportive treatment.
TNOA Journal of Ophthalmic Science and Research, 2019
Aim: The aim is to study the correlation of macular thickness and sensitivity in type 2 diabetes ... more Aim: The aim is to study the correlation of macular thickness and sensitivity in type 2 diabetes mellitus patients. Materials and Methods: A cross-sectional comparative study was done on 77 eyes with diabetic retinopathy. Patients were divided into three groups as follows: Group 1 – Diabetic retinopathy without maculopathy, Group 2 – Diabetic maculopathy without clinically significant macular edema (CSME), and Group 3 – CSME. Microperimetry was used to assess macular sensitivity, and optical coherence tomography (OCT) was used to measure retinal thickness. Comparison of retinal sensitivity and thickness was done between groups. Correlation of these parameters to duration of diabetes was also done. Results: The mean macular sensitivity (in dB) in Groups 1, 2, and 3 was 11.57, 11.51, and 8.03, respectively. The mean central macular thickness in Groups 1, 2, and 3 was 199.33, 208.62, and 334.25 μm, respectively. There was statistically significant difference in macular thickness and in macular sensitivity between Groups 1 and 3 (P < 0.001) and between Groups 2 and 3 (P < 0.001). This difference was not statistically significant between Groups 1 and 2 (P > 0.09). Macular sensitivity had a moderate correlation with macular thickness, which was statistically significant (P < 0.001). Conclusions: Macular sensitivity was found to decrease with increasing macular thickness.
Introduction: Ocular trauma is an important worldwide preventable public health problem which may... more Introduction: Ocular trauma is an important worldwide preventable public health problem which may lead to permanent visual impairment. This study aims to determine the demographics, clinical profile and visual outcome of severe eye injuries. Methods: This study was conducted at a tertiary centre from January 2013 to August 2014. Cases of severe eye injuries hospitalized at or presenting to emergency/OPD were included in the study. All cases underwent detailed examination and necessary intervention. Cases were followed upto 3 months and final visual outcome was evaluated. Results: The study comprised of 60 individuals (65 eyes); 76.7% males and 23.3% females. Out of 60 cases, the age group 1-9 years had the highest occurrence with 23.33% followed by 20-29 years with 20% and majority were students 45%. Impact with stone was the commonest cause of injury reported on 21.7% followed by road traffic accident (RTA) 20%. Closed-globe injuries accounted for 36.6% and open-globe injuries for ...
TNOA Journal of Ophthalmic Science and Research, 2018
Chemical fumes are known to cause eye injury resulting in disablement. A mass casualty (group of ... more Chemical fumes are known to cause eye injury resulting in disablement. A mass casualty (group of 17 filmmakers) reported with severe irritation, watering, redness, photophobia, and blepharospasm in their eyes following approximately 12 hours after exposure to fumes of Japan black mixed with kerosene after film shooting with intense arc light. Examination revealed chemical conjunctivitis, keratoconjunctivitis, dermatitis, and eyelid edema. Symptoms resolved within 48 hours in all except 1, with supportive treatment, lubricant eye drops, and rest in the darkened room. This case report underlines the need for healthy industrial practices to avoid chemical injuries from volatile chemicals among filmmakers.
Indian Journal of Clinical and Experimental Ophthalmology, 2019
Ischaemic optic neuropathy is defined as an infarction of the retrolaminar part of optic nerve. T... more Ischaemic optic neuropathy is defined as an infarction of the retrolaminar part of optic nerve. This is caused due to hypoperfusion of optic disc leading to short posterior artery occlusion. Giant cell arteritis assumes first and foremost importance as a prominent cause of anterior ischaemic optic neuropathy. Carotid artery dissection is an uncommon aetiological factor. Carotid artery dissection presents with a constellation of ocular features like Horner's syndrome, amaurosis fugax, hemianopia, sixth cranial nerve palsy and ischaemic optic neuropathy. Ischaemic optic neuropathy has been reported in patients who suffered from dissection of carotid artery and it could be a preliminary manifestation. Suspicion of internal carotid artery (ICA) dissection should be raised in cases of anterior ischaemic optic neuropathy (AION) associated with severe unilateral cephalic pain. Dissection of carotid artery can cause cerebral and retinal ischaemia, especially in young adults, resulting in ischaemic symptoms. An array of investigations were performed to eliminate other triggers of optic neuropathy. Carotid Doppler helps to confirm the diagnosis. This article highlights a patient with a rare presentation of anterior ischaemic optic neuropathy resulting from dissection of internal carotid artery. A high index of suspicion should be entertained by symptoms like severe unilateral headache followed by diminution of vision. Prompt diagnosis and management can prevent visual loss in the fellow eye as well as life threatening complications of ICA dissection such as stroke.
Charles Bonnet Syndrome (CBS) is a common cause of visual hallucinations seen in elderly people w... more Charles Bonnet Syndrome (CBS) is a common cause of visual hallucinations seen in elderly people with visual impairment. Well-formed visual hallucinations in clear consciousness with preserved insight are commonly reported in literature. We report a case of CBS having multisensory hallucinations. An elderly patient with visual impairment fulfilling the criteria of CBS presents with various modalities of hallucinations viz. visual, auditory and tactile hallucinations improved completely with low dose of antipsychotics. Atypical features are common in CBS and thus often make it difficult to diagnose this condition.
Journal of Clinical Ophthalmology and Research, 2016
Trauma-related visual impairment is an unrecognized public health problem. Insufficient epidemiol... more Trauma-related visual impairment is an unrecognized public health problem. Insufficient epidemiological data on eye injuries underlies the prevailing apathy. We conducted PubMed search for articles on prevalence/incidence, and epidemiology of eye injuries/ocular trauma in India published from year 2000 to 2014 and included for analysis the studies with sufficient statistical power. We also retrieved data from National Sample Survey Organization (NSSO) and Census of India. Book chapters were also searched for relevant references. Available data throw light on the magnitude and dimensions of trauma-related visual impairment. Andhra Pradesh eye diseases study recorded history of eye injuries in 7.5% of a South Indian population, resulting in unilateral blindness in 0.6% of eye-injured. NSSO 1991 too has recorded high prevalence (35/1000 in rural areas, and 32/1000 in urban areas) of injury-related visual impairment. Results reveal the majority of injuries occur at work in an unorganized sector where Occupational Safety and Health (OSH) cover are almost nonexistent. Data on eye injuries at home, at sports, and combat-related injuries are incomplete. Due to their cataract-centric design, rapid assessment of avoidable blindness surveys fails to reveal injury-related visual impairment. To estimate injury-related visual impairment, we recommend the establishment of a National Ocular Trauma Registry. Comprehensive population-based surveys shall provide additional sources of data. Compliance with OSH measures, education of workforce, provision of eye protective device for hazardous occupations, mandatory reporting, and monitoring and audit of eye injuries should go hand-in-hand.
Combat-related eye injuries are common among the soldiers. They often render combatants unfit for... more Combat-related eye injuries are common among the soldiers. They often render combatants unfit for military service and many civil occupations [1]. With each succeeding war, injuries to the eyes have been increasing [2]. Combat-related eye injuries are frequently bilateral and associated with globe perforation, retained intraocular foreign bodies (IOFBs), and visual impairment [1]. Unlike the data from Western world and the Middle East, data on combat-related eye injuries among Indian soldiers are scarce. There are no data either from the counterinsurgency operations on Indian soil [3]. This study aims to review the combat-related eye injuries and the status of combat eye protection among Indian soldiers. We also aim to briefly review the global practices of Military Combat Eye Protection (MCEP). Based on review of available literature we offer our recommendations for Indian soldiers. combat Eye injuries: changing Scenario Eye injuries are an important source of morbidity among military personnel during peace and war [4]. Estimated incidence of eye injuries in warfare is 20-50 times as high as what is found in civilian situations [5]. Combat-related eye injuries are generally secondary to Improvised Explosive Device (IED) explosion [6]. IED blasts are also associated with increase in the incidence and severity of eye injuries. Gunshot wound, fragments of shell, grenade, and bombs, and mine blasts are other sources of combat-related eye injuries. In the 19 th century, less than 1% of all battle casualties suffered eye injuries [7]. Wars in the 20 th century have shown an increasing trend of eye injuries. In the ground phase of gulf war, the number of combat-related eye injuries accounted for 13% of the patient volume at a major combat support hospital [8]. Among the British Armed Forces deployed in Iraq or Afghanistan (2004-08), 10% of cases of major trauma suffered eye injuries [9]. In fact, with the advent of body armour and the helmet, injuries to the head, chest, and upper abdomen have decreased to some extent; the face, eyes, and extremities may be more susceptible to injuries [10]. Advances Ophthalmology Section
Introduction: Gonioscopy is the gold standard in assessing anterior chamber angles. However, inte... more Introduction: Gonioscopy is the gold standard in assessing anterior chamber angles. However, interobserver variations are common and there is a need for reliable objective method of assessment. Aim: To compare the anterior chamber angle by gonioscopy and Spectral Domain Optical Coherence Tomography (SD-OCT) in individuals with shallow anterior chamber. materials and methods: This comparative observational study was conducted in a rural tertiary multi-speciality teaching hospital. A total of 101 eyes of 54 patients with shallow anterior chamber on slit lamp evaluation were included. Anterior chamber angle was graded by gonioscopy using the shaffer grading system. Angles were also assessed by SD-OCT with Trabecular Iris Angle (TIA) and Angle Opening Distance (AOD). Chi-square test, sensitivity, specificity, positive and negative predictive value to find correlation between OCT parameters and gonioscopy grading. Results: Females represented 72.7%. The mean age was 53.93 ±8.24 years and mean anterior chamber depth was 2.47 ± 0.152 mm. Shaffer grade ≤ 2 were identified in 95(94%) superior, 42(41.5%) inferior, 65(64.3%) nasal and 57(56.4%) temporal quadrants. Cut-off values of TIA ≤ 22° and AOD ≤ 290 µm were taken as narrow angles on SD-OCT. TIA of ≤ 22° were found in 88(92.6%) nasal and 87(87%) temporal angles. AOD of ≤ 290 µm was found in 73(76.8%) nasal and 83(83%) temporal quadrants. Sensitivity in detecting narrow angles was 90.7% and 82.2% for TIA and AOD, while specificity was 11.7% and 23.4%, respectively. Individuals were found to have narrow angles more with SD-OCT. Sensitivity was high and specificity was low in detecting narrow angles compared to gonioscopy, making it an unreliable tool for screening.
Uploads
Papers by Kirti Nath Jha