Department of Ophthalmology

A One-Year Prospective Study To Evaluate The Efficacy Of Intraoperative Application Of 20% Ethanol As An Adjuvant In Pterygium Excision With Conjunctival Autograft

2024-01-01T00:00:00Z

A One-Year Prospective Study To Evaluate The Efficacy Of Intraoperative Application Of 20% Ethanol As An Adjuvant In Pterygium Excision With Conjunctival Autograft Shilpa, K BACKGROUND Pterygium is a common ocular surface disorder. It is a slow growing, wing shaped proliferation of fibrovascular tissue, araising from the subconjunctival tissue and encroaching over the cornea.[1] It is more common on the nasal side. It causes foreign body sensation, redness, visual impairment, and diplopia. Surgical excision is the treatment of choice for pterygium. Conjunctival autografting has been used frequently following pterygium excision. Recurrence is one of the most common complication of pterygium. Several methods like amniotic membrane implantation, use of adjuvants such as beta- irradiation, thiotepa, 5-Fluorouracil, mitomycin C were used for the treatment of pterygium surgery. Ethanol is an alternate adjuvant which can be used in the pterygium excision. Ethanol causes rapid denaturation of proteins, including cytokines, enzymes, and growth factors involved in pterygium formation and recurrence after excision. Application of ethanol at a concentration 20% less than the 60s on the cornea appears to be safe. It helps to identify the plane between the pterygium and underlying cornea during surgery. Only a few studies have been conducted regarding the use of ethanol in pterygium excision. AIM AND OBJECTIVE OF THE STUDY To study the efficacy and safety of 20% ethanol as an adjuvant in pterygium excision with conjunctival autograft implantation and to evaluate the surgical outcomes of using 20% ethanol as an adjuvant in pterygium surgery. METHODS This is a prospective interventional study conducted among 30 patients with primary pterygium August 2022 to December 2023. Patient were evaluated preoperatively for anterior segment, posterior segment, visual acuity and corneal astigmatism Pterygium is excised using 20% ethanol as an adjuvant and conjunctival autograft was placed over bare sclera withoutsuture. Patients were evaluated postoperatively on day 1, day 8, day 30 and day 90 for condition of graft, visual acuity, corneal astigmatism, and associated complications. RESULT After 3 months of follow up, the mean visual acuity improved to Logmar 0.46 ±0.35 (p=0.001) which was statistically significant and corneal astigmatism improved from 3.36 ± 2.87 to 0.87±0.57 (p=0.001). No recurrence noted within 3 months of follow up. CONCLUSION This study has shown that using 20% ethanol as an adjuvant for pterygium excision helps in easy and clean dissection of pterygium head from underlying cornea and the pterygium induced corneal astigmatism has significantly reduced which was associated with improvement in visual acuity.

A Prospective Cross-Sectional Study Of Correlation Of Ocular Pseudoexfoliation With Systemic Vascular Diseases

2024-01-01T00:00:00Z

A Prospective Cross-Sectional Study Of Correlation Of Ocular Pseudoexfoliation With Systemic Vascular Diseases Vaishnavi, Patil Background: Pseudoexfoliation syndrome [PEX] is characterized by a powdery substance in the anterior chamber, composed of various glycoproteins, which have an unclear origin. Its deposition is observed on the pupillary margin, lens zonules, and trabecular meshwork. Proteomic studies have identified numerous proteins in affected individuals, suggesting associations with systemic conditions like heart disease, stroke, and Alzheimer’s disease. However, the systemic associations of PEX remain inconclusive, particularly in regions like southern India. Materials and Methods: A cross-sectional study was conducted on 114 participants. Pseudoexfoliation was graded as mild, moderate and severe per a standard photographic grading. Systemic examinations included blood pressure measurements, electrocardiography, and blood investigations for serum lipid profile, fasting and postprandial blood sugar levels, and serum C-reactive protein levels. All the patients underwent small incision cataract surgery. Intraoperative complications and postoperative status were noted down. Results: Thirty-eight patients (33.3%) had mild PEX, 44 (38.6%) had moderate PEX, and 32 (28.1%) had severe PEX. Hypertension was present in 54 participants (47.4%), diabetes in 21 (18.4%), coronary artery disease in 9 (7.9%), and cerebrovascular accidents in 3 (2.6%). The mean systolic blood pressure was 140.39 mmHg, and the mean diastolic blood pressure was 90.37 mmHg. Systolic blood pressure exceeded 140 mmHg in 29 participants (90.6%) with severe PEX, while diastolic blood pressure surpassed 90 mmHg in 26 (81.3%) participants with severe PEX, with a p-value of 0.001. Mean fasting and postprandial blood sugar levels were 103.80 ± 31.81 mg/dl and 131.72 ± 48.24 mg/dl, respectively. Electrocardiographic results indicated that 54 participants (47.37%) had abnormal ECGs, including rate, conduction, ischemic, and structural defects. Of these, 13.2% had rate defects, 12.3% had conduction defects, 10.5% had ischemic changes, and 11.4% had structural defects. Conclusion: This study highlights the significantly elevated parameters of systemic vascular diseases in PEX patients, like elevated blood pressure and more frequent cardiac abnormalities, emphasizing the need for comprehensive systemic evaluation and careful preoperative assessments for ocular complications

A Study Of Diabetic Retinopathy In Patients With Diabetic Foot Ulcer Disease

2024-01-01T00:00:00Z

A Study Of Diabetic Retinopathy In Patients With Diabetic Foot Ulcer Disease Amala, Krishna M AIMS AND OBJECTIVES: The goal of this study was to compare and analyze the grades of Diabetic Foot Ulcer (DFU) with the severity of Diabetic Retinopathy (DR). MATERIAL AND METHODS: A cross-sectional study was carried out on 234 eyes of 117 subjects with various grades of DFU consulting BLDE (Bijapur Lingayat District Educational) (Deemed to be University)’s Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, from August 2022 to August 2023. A detailed history was taken, including demographics. Snellen’s visual Acuity, anterior segment examination under slit lamp, mydriatic fundus examination with indirect ophthalmoscopy, and digital fundus photography were performed on all the subjects. DFU grading was done using the “Wagner’s classification system of diabetic foot ulcers”1. Diabetic Retinopathy (DR) grading was based on the Early Treatment Diabetic Retinopathy Study (ETDRS) classification2. Optical Coherence Tomography (OCT) scanning of the macula was performed in all subjects using Spectral Domain- OCT (SD-OCT). Biochemical parameters HbA1C (%), Serum uric acid (mg/dl), Blood urea (mg/dl), Serum creatinine (mg/dl) were all compared against the grade of retinopathy along with the grade of DFU. SPSS (Statistical package for social sciences) software version 20 was used to present descriptive statistics for categorical parameters using frequency and percentage. Mean and standard deviation were used for continuous parametric data. Dependent and independent variables are differentiated using the ANOVA (Analysis of Variance) test.The chi-square test was used to find out the association between the parameters. P value < 0.001 was considered highly statistically significant. RESULTS: The mean age of the patients was 55.63+/- 12.820 years. There were 80 males (68.4%) and 37 females (31.6%). Duration of diabetes mellitus (DM), biochemical parameters like HbA1C (%), Serum Creatinine (mg/dl), Blood Urea (mg/dl), and Serum Uric acid (mg/dl) were all directly proportionate to the severity of retinopathy, which was significant statistically with a P value < 0.001. Comparison of DFU grade with the severity of retinopathy showed a strong positive correlation with a P value < 0.001, which was highly statistically significant. Also, a comparison of DFU grade with OCT measured Central Foveal Thickness (CFT) and Total macular volume, overall average macular thickness showed a strong positive correlation with a P value < 0.001. CONCLUSION: Our study reports a highly statistically significant correlation between the grades of DFU and severity of DR in all the subjects, thus concluding that patients with DFU have a higher risk of DR and vice-versa, pointing the significance of prompt and early screening for these two DM consequences to prevent further serious outcomes.

A One-Year Prospective Study To Evaluate The Efficacy Of Intraoperative Subtenon Injection Of 0.01 % Mitomycin-C As An Adjunct To Trabeculectomy In Patients Admitted To Shri Bm Patil Medical College And Research Centre, Vijayapura

2024-01-01T00:00:00Z

A One-Year Prospective Study To Evaluate The Efficacy Of Intraoperative Subtenon Injection Of 0.01 % Mitomycin-C As An Adjunct To Trabeculectomy In Patients Admitted To Shri Bm Patil Medical College And Research Centre, Vijayapura . Arkaprava, Ray Background: Glaucoma, characterised by optic neuropathy and elevated intraocular pressure (IOP), is a leading cause of global blindness, affecting 3.54% of individuals aged 40 to 80. Trabeculectomy, enhanced with antimetabolites like Mitomycin C (MMC), has long been the gold standard filtering surgery for glaucoma. The conventional method of MMC application involves using soaked sponges over the subconjunctival space. However, this approach can result in complications such as blebitis and foreign-body granuloma due to residual sponges. Recent research has explored intraoperative MMC injection to improve outcomes and reduce complications. This study aims to assess the safety and efficacy of a low dose (0.1 mg/ml) of MMC administered through subtenon injection during trabeculectomy, with a follow-up period of over 6 months. Materials and Methods: It is a prospective interventional study on patients who underwent trabeculectomy with a subtenon injection of 0.1mg/ml of Mitomycin C combined with Small incision cataract surgery with intraocular lens implantation and were followed up over 6 months. Efficacy was determined in terms of intraocular pressure reduction, bleb architecture was graded using the Indiana Bleb Appearance Grading System (IBAGS), and safety was commented upon regarding postoperative complications. Results: Thirty patients were enrolled, with the majority having primary open-angle glaucoma (63.33%), while 36.67% had primary angle-closure glaucoma. Baseline intraocular pressure (IOP) was 31.40 (± 10.38) mmHg. It significantly reduced to 14.60 (± 3.75) mmHg on the first postoperative day, decreasing to 9.55 (± 1.57) mmHg by the 6th postoperative month (p = 0.001). The percentage reduction in IOP was substantial, 69.57%, by the 6th postoperative visit. Bleb morphology assessment using IBAGS revealed significant improvements in bleb height, extent, and vascularity over the 6-month follow-up (p = 0.001). Out of the total patients,93.33% achieved controlled IOP without antiglaucoma medications, while 6.67% required one medication for IOP control. Complications were minimal, with transient corneal oedema in six patients and manageable postoperative hypotony in one case. Conclusion: A sub-tenon injection of MMC effectively reduces intraocular pressure and promotes favourable bleb architecture, offering a safe and minimally complicated alternative to the conventional approach. It can be safely considered in high-risk patients as an alternate route of MMC application during trabeculectomy.