International Journal of Clinical and Experimental Ophthalmology
Published by: Heighten Science Publications Corporation
Total articles ≅ 42
Latest articles in this journal
Published: 22 November 2022
International Journal of Clinical and Experimental Ophthalmology, Volume 6, pp 038-044; https://doi.org/10.29328/journal.ijceo.1001049
Aim and objective: 1. To study the manifestations of fungal corneal ulcer in different age groups and sex 2. To study the distribution of fungal corneal ulcer in relation to occupation 3. To know the effect of Natamycin and Fluconazole as anti-fungal agents. Materials and methods: This is a retrospective analysis of microbiology records of patients presenting with suspected microbial keratitis seen between January 2021 and June 2021. Patients with positive fungal cultures were analyzed in detail for the type of fungus isolated. Results: 90 patients with suspected microbial keratitis were reviewed. A microbiological diagnosis of mycotic keratitis was established 9 (10%) patients over a period of 6 months, based on positive fungal cultures. Filamentous fungi were isolated more often than yeasts. Aspergillus species followed by Fusarium species were the commonest filamentous fungi isolated. Conclusion: Over a period of 6 months, the cumulative incidence of mycotic keratitis was 10%. The pathogenic organisms most frequently responsible for mycotic keratitis were Aspergillus species. When beginning an empirical therapy for mycotic keratitis, etiological factors were helpful. Eight of the 90 patients with corneal ulcers who were admitted to the patient department for treatment had positive fungal cultures in Sabouraud’s media. The age range of 50 to 60 years had a high prevalence of illness. There were 90 total cases of corneal ulcers. Out of those there were 8 (8.8%) incidences of fungal ulcers. More men than women were impacted. Workers in agriculture are more impacted than others. The main cause of a fungus-induced corneal ulcer was trauma. Natamycin was the better option for the treatment of fungal keratitis. Filamentous fungi (Aspergillus species, fusarium, and curvularia) responded effectively to Natamycin 5% eyedrop.
Published: 27 September 2022
International Journal of Clinical and Experimental Ophthalmology, Volume 6, pp 035-037; https://doi.org/10.29328/journal.ijceo.1001048
Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood and is very rare in the neonatal period. At this age, the alveolar type is a remarkably uncommon variety. We report a 56 days old female with alveolar RMS of the right eye noted since the age of 7 days with fast progression and unfavorable prognosis. Congenital alveolar RMS is an important cause of neonatal onset rapidly progressive proptosis. Early onset, alveolar type, and late diagnosis were poor prognostic factor.
Published: 2 August 2022
International Journal of Clinical and Experimental Ophthalmology, Volume 6, pp 031-034; https://doi.org/10.29328/journal.ijceo.1001047
Given improvements in neonatal care and the increased survival rates of infants born pre-term, Cortical Visual Impairment (CVI) is now the leading cause of visual impairment (VI) in the developed world. In this study, Step VEPS, transient VEPS and Vernier Sweep VEPs all demonstrated unbiased relationships with Preferential looking (PL) cards over the whole range of Visual Acuity (VA) in children with CVI, allowing equations for clinical use to be derived. The results also suggested that a slower, vernier steady-state stimulus of 80% contrast and presented with the Step VEP algorithm could further improve VA agreement with PL and optimise developmental sensitivity. An eye tracking device has proved very useful in the clinical assessment of this cohort. It is also now known that children can have good VA and CVI, and that sweep VEPS can highlight higher processing deficits. As well as negative findings, compensatory neuroplasticity is thought to occur during maturation and it is now realistic to study this mechanism, and other age-related changes across VI with functional tests and neuroimaging (including VEPS). A cross-sectional study of adults would highlight CVI’s ultimate functional limitations.
Published: 27 June 2022
International Journal of Clinical and Experimental Ophthalmology, Volume 6, pp 026-030; https://doi.org/10.29328/journal.ijceo.1001046
Steady-state VEPs, have been used to estimate visual acuity since the 1970s and allow responses to a range of stimulus sizes to be collected rapidly- with particular utility in infants. However, the assessment of children with cortical visual impairment is a bigger challenge that lead to the development of the Step VEP. Its initial evaluation revealed that accuracy and precision were poorer for pediatric patients than for optically degraded normal adults and that it was not necessarily successful in every child. Statistical models generated the equations: VAO = 0.56 VAStep (r2 = 0.75, F = 60.93, p = 0.000) and VAPL = 0.45 VAStep (r2 = 0.82, F = 156.85, p = 0.000), supported by a recent a systematic review of VA comparisons showing that recognition VA (optotypes) agrees more closely than discrimination VA (PL) with VEP VA. In combination, Step VEPS and subjective tests allowed complete assessment in 96% of patients, with incomplete Step VEPS much more likely to be partially successful than not, and more likely to be partially successful than incomplete subjective tests. This supports the rationale that Step VEPs maintain attention by limiting the time spent stimulating away from an individual’s threshold of spatial resolution. For the small number of patients in whom VA cannot be estimated, alternative stimuli and methods of presentation are proposed.
Published: 6 May 2022
International Journal of Clinical and Experimental Ophthalmology, Volume 6, pp 015-025; https://doi.org/10.29328/journal.ijceo.1001045
Commonly referred to as an ecstatic, non-inflammatory disease, Keratoconus, usually bilateral and asymmetric, is characterized by progressive steeping and thinning of the cornea. This results in irregular astigmatism which compromises vision [1,2]. Traditionally, early Keratoconus stages have been treated by prescribing a hard contact lens to obtain a regular anterior optical surface. This tendency was discontinued when contact lens intolerance in advanced stages required the use of penetrating keratoplasty (PKP) or deep anterior lamellar Keratoplasty (DALK). An alternative technique of corneal cross-linking was designed in 2003 as a treatment option for keratoconus. The cornea measured at least 400 um thickness after epithelium removal and pre-operative maximum keratometry (Kmax) measured 58D or less. As a result, no corneal transplantation was required or postponed .
Published: 25 April 2022
International Journal of Clinical and Experimental Ophthalmology, Volume 6, pp 013-014; https://doi.org/10.29328/journal.ijceo.1001044
Papilledema is optic disc swelling due to high intracranial pressure. Possible conditions causing high intracranial pressure and papilledema include intracerebral mass lesions, cerebral hemorrhage, head trauma, meningitis, hydroce-phalus, spinal cord lesions, impairment of cerebral sinus drainage, anomalies of the cranium, and idiopathic intracranial hypertension (IIH) .
Published: 7 April 2022
International Journal of Clinical and Experimental Ophthalmology, Volume 6, pp 007-012; https://doi.org/10.29328/journal.ijceo.1001043
Background: Cerebral visual impairment (CVI) is a bilateral visual impairment that affects children in all industrialized countries. It has become more common in low-income countries as a result of the increased survival rates of children who suffer from severe neurological conditions during the perinatal period. The purpose of this study was to determine the characteristics of children with CVI in a tertiary children’s eye care center population. Methods: From October 2020 to September 2021, a cross-sectional study was conducted to select all consecutive patients with a diagnosis of cerebral visual impairment aged 6 months to 16 years. On the neurological deficit, information was gathered from the patient’s referral: parental interviews, observations, and direct assessment were used for functional vision characteristics, and an ophthalmic examination was performed for eye findings. The interviewees’ responses were matched to the ten specific behavioral characteristics shared by children with CVI. Cortical visual impairment was diagnosed using three criteria: [the vision loss is not explained by abnormalities found on the eye examination, a neurological medical diagnosis, and the child exhibits one of the unique visual and behavioral characteristics described by Roman Lantz]. A descriptive statistical analysis (frequency, mean, and range) was calculated. Results: Forty children with CVI (1.96% of total children) were seen. The mean age was 2.56 ( 1.98) years. There were 24 (60%) males. On a referral paper of 28, hypoxic-ischemic encephalopathy was the commonest cause mentioned (70.0%). Seizures were the most frequent neurological deficit at presentation. Ophthalmic and neurologic impairments were found in 42.5% of children with CVI. Based on Roman-Lantzy’s three phases of the CVI Range, 90% of children with CVI at the test time had Phase I or Phase II vision. Conclusion: According to the findings of this study, visual impairment is critical in the diagnosis of CVI. The prevalence of CVI as a cause of childhood vision impairment is significant. Hypoxic-ischemic encephalopathy is the most common cause of CVI. All children with CVI have serious neurological issues, and the majority have associated ophthalmic abnormalities.
Published: 9 March 2022
International Journal of Clinical and Experimental Ophthalmology, Volume 6, pp 001-006; https://doi.org/10.29328/journal.ijceo.1001042
Aim: Accumulating data imply that glaucoma may represent a neurodegenerative disorder affecting the entire visual system. We evaluated retrobulbar glaucomatous damage with favorable techniques for 1.5T diffusion-tensor magnetic resonance imaging and we compared those techniques with clinical data in a large case series. Material and methods: This Cross-sectional study included 130 eyes of 65 patients with primary open-angle glaucoma. Patients with no known ocular or systemic concomitant disorders, neurological diseases, previous glaucoma surgeries, or antioxidant usage were selected. A decrease in thickness and deterioration in the optic nerve diffusion of severely glaucomatous eyes of patients with asymmetrical involvement was observed in optic nerve tractography. Optical coherence tomography and visual field results of the subjects were recorded. Glaucoma analysis with optical coherence tomography and standard automated perimetry results of the subjects were recorded. Diffusion-tensor magnetic resonance imaging analysis of optic nerves and radiations were performed, computing fractional anisotropy, apparent diffusion coefficient, axial diffusivity, and radial diffusivity. Correlation between the diffusion-tensor magnetic resonance imaging and clinical eye parameters of glaucomatous neurodegeneration were statistically evaluated. Results: The correlations between diffusion parameters and age were highly significant. Statistically significant correlations were found between ganglion cell complex and apparent diffusion coefficient, axial and radial diffusivities of optic nerves. Conclusion: Eye-brain connection in glaucoma can be evaluated with routine clinical instruments. Our study also revealed a limited correlation of retrobulbar glaucomatous neurodegeneration with ophthalmic damage. A better understanding of retrobulbar damage will enable us to develop more efficient strategies and a more accurate understanding of glaucoma.
Published: 14 December 2021
International Journal of Clinical and Experimental Ophthalmology, Volume 5, pp 029-038; https://doi.org/10.29328/journal.ijceo.1001041
Background: Diabetic retinopathy (DR) is one of the most common causes of preventable blindness. Patients with Diabetes Mellitus (DM) develop not only DR but also corneal endothelial damage leading to anatomical and physiological changes in cornea. Central corneal thickness (CCT) is a key parameter of refractive surgery and Intraocular pressure (IOP) estimation. The role of CCT and higher glycemic index in DR needs to be researched upon. Objectives: To identify the corneal endothelial morphology in patients with type 2 DM, to measure the Central Corneal thickness (CCT) in patients with type 2 Diabetes Mellitus, to assess the relationship of CCT with HbA1C levels in the study group and to correlate the CCT with the severity of Diabetic retinopathy in the study group. Methods: A cross-sectional observational study was conducted between January 2018 and June 2019 in Vydehi Institute of Medical Sciences and Research Centre, Bangalore. The study included 100 subjects with type 2 DM for 5 years or more. Patients with comorbidities that may affect the severity of DR or alter CCT and other corneal endothelial parameters such as glaucoma, previous ocular surgery or trauma, corneal degenerations and dystrophies, chronic kidney disease and Hypertension were excluded. DR was assessed by dilated fundoscopy, fundus photography and optical coherence imaging of the macula and graded as per the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification. CCT and other corneal endothelial parameters were measured through specular microscopy. Relevant blood investigations including blood sugar levels were done for all patients. Statistical analysis: Relationship between CCT and grades of DR and HbA1c levels were established using the Chi-Square test. The level of significance was set at p < 0.05. Results: The mean CCT in patients with no diabetic retinopathy, very mild and mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe and very severe NPDR and PDR was 526.62 ± 8.084 μm, 542.07 ± 8.713 μm, 562.16 ± 8.255 μm, 582.79 ± 7.368 μm and 610.43 ± 18.256 μm respectively. Analysis of the relationship between CCT and severity of DR showed a statistically significant positive correlation between the two parameters (Pearson r = 0.933, P=0.001). Beyond this, a correlation was found between all the corneal endothelial parameters and severity of DR. Multivariate analysis showed that advanced DR was positively correlated with CV (r = 0.917) and CCT (r = 0.933); while it was negatively correlated with ECD (r = -0.872) and Hex (r = -0.811). A statistically significant correlation was also found between CCT and HbA1c. Also increasing age, duration of DM and higher glycemic index were positively correlated with severity of DR. Conclusion: This study, by demonstrating a strong correlation between the central corneal thickness to the severity of DR and HbA1c levels emphasizes the importance of evaluation of corneal endothelial morphology in the early screening and diagnosis of microvascular complications of DM.
Published: 11 November 2021
International Journal of Clinical and Experimental Ophthalmology, Volume 5, pp 025-028; https://doi.org/10.29328/journal.ijceo.1001040
Progeria syndromes are very rare genetic diseases characterized by premature aging changes. There are several phenotypes and variables noted in literature in some cases difficult to specifically classify a specific syndrome. It occurs due to mutation in DNA repair genes. The most common ocular findings are loss of eyebrow and eyelashes, brow ptosis, lid margin changes, entropion, Meibomian gland dysfunction, severe dry eye, corneal opacity, cataract, poor mydriasis, and rod-cone dystrophy. We report this case with all the above ocular manifestations in 19year old teenager with additional finding being retinal detachment.