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Purpose: To compare the safety and efficacy of subconjunctival injection (MMC: 0.02%) to those with subconjunctival application of sponges soaked in Mitomycin C (MMC: 0.02%) intra-operatively in patients who underwent phacotrabeculectomy. Methods: A total of 68 patients undergoing phacotrabeculectomy were randomized into two groups; the sponge group received 0.02% MMC-soaked sponges (n = 38), and the injection group received subconjunctival injection of 0.02% MMC (n = 30). The primary outcome was post-operative mean intra-ocular pressure reduction (IOP). The secondary outcomes were bleb morphology using Indiana Bleb Appearance Grading Score (IBAGS) and anterior segment optical coherence tomography (AS-OCT), post-operative use of 5-fluorouracil, and complications rates. These were compared at 1 week and 1, 3, and 6 months post-operatively. Complete success was defined as ≥30% reduction in IOP without anti-glaucoma medications. Results: In sponge and injection groups, the mean pre-operative IOP was 29.1 ± 8.1 and 29.8 ± 8.8 mmHg, respectively. At 6 months, IOP in sponge and injection groups reduced by 52% (14 ± 3.6 mmHg, P < 0.001) and 50% (15.2 ± 4.1 mmHg, P < 0.001), respectively. Complete success was observed in 90.9% in the sponge group and 95.83% in the injection group. Both groups had diffuse, shallow, relatively avascular blebs at 6 months using IBAGS and AS-OCT. A few complications were seen in the sponge group during this period, which were not vision-threatening. Conclusion: Subconjunctival MMC injection is an effective, safe, convenient, and time-saving alternative to sponge-soaked delivery of MMC in phacotrabeculectomy. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the relationship between amplitude of accommodation and refractive errors in the peri-presbyopic age group. Materials and Methods: Three hundred and sixteen right eyes of 316 consecutive patients in the age group 35-50 years who attended our outpatient clinic were studied. Emmetropes, hypermetropes and myopes with best-corrected visual acuity of 6/6 J1 in both eyes were included. The amplitude of accommodation (AA) was calculated by measuring the near point of accommodation (NPA). In patients with more than ± 2 diopter sphere correction for distance, the NPA was also measured using appropriate soft contact lenses. Results: There was a statistically significant difference in AA between myopes and hypermetropes ( P P P P P P >0.5). Conclusion: Our study showed higher amplitude of accommodation among myopes between 35 and 44 years compared to emmetropes and hypermetropes

Purpose: To compare the short-term efficacy and safety of topical latanoprost and brimonidine in Indian eyes. Materials and Methods: Twenty-eight patients with ocular hypertension, primary open-angle, pseudoexfoliation or pigmentary glaucoma were enrolled. Following baseline measurements, latanoprost was applied topically once daily in the evening for 12-weeks. After a washout period, brimonidine was applied twice daily in all patients for 6 weeks; 16 patients continued for 12 weeks. Patients were examined at 2, 6 and 12 weeks. The primary outcome measure was the difference in mean intra ocular pressure (IOP) reduction at 6 and 12 weeks. The mean diurnal variation of IOP at baseline and at 12 weeks was also compared. Results: Twenty-six of 28 enrolled patients completed the study. One randomly selected eye of each patient was used for analysis. At 6 weeks, the mean IOP reduction was 11.2 mm Hg (± 2.9 mmHg) with latanoprost and 6 mmHg (± 3.3 mmHg) with brimonidine. At 12 weeks this was 10.8 mmHg (± 2.8 mmHg) and 6.9 mmHg (± 3.1 mmHg) respectively. At 6 weeks 85.7% (24) eyes obtained more than 25% reduction in IOP with latanoprost compared to 13 (46.4%) with brimonidine. IOP reduction was maintained with both drugs throughout the study period. Two eyes did not show any response to brimonidine. Latanoprost reduced the diurnal variation of IOP from 5.10 to 2.90 mmHg; brimonidine reduced it from 4.70 to 3.90 mmHg. Conjunctival hyperaemia was present in one patient on latanoprost and three patients on brimonidine. Two patients experienced drowsiness with brimonidine. Neither drug produced side effects necessitating withdrawal from the study. Conclusion: In this short-term study, both latanoprost and brimonidine effectively reduced IOP and stabilised the diurnal curve in Indian eyes. Latanoprost was more effective than brimonidine.

Aim: To study the relationship between ocular parameters and amplitude of accommodation (AA) in the peri-presbyopic age group (35-50 years). Materials and Methods: Three hundred and sixteen right eyes of consecutive patients in the age group 35-50 years, who attended our outpatient clinic, were studied. Emmetropes, hypermetropes and myopes with best-corrected visual acuity of 20/20, J1 in both eyes were included. The AA was calculated by measuring the near point of accommodation. The axial length (AL), central anterior chamber depth (CACD) and lens thickness (LT) were also measured. Results: There was moderate correlation (Pearson′s correlation coefficient r = 0.56) between AL and AA as well as between CACD and AA (r = 0.53) in myopes in the age group 35-39 years. In the other age groups and the groups taken as a whole, there was no correlation. In hypermetropes and emmetropes, there was no correlation between AA and the above ocular parameters. No significant correlation existed between LT and AA across different age groups and refractive errors. Conclusion: There was no significant correlation between AA and ocular parameters like anterior chamber depth, AL and LT.

Introduction: Central Corneal Thickness (CCT) affects measurement of Intraocular Pressure (IOP) using Goldmann Applanation Tonometry (GAT). Variation in CCT with blood sugar levels in diabetics could affect IOP measurement and subsequent glaucoma management. CCT has been described to vary with glycaemic levels in diabetics but variation in CCT in the same individuals with variation in the blood sugar levels has not been adequately described. Aim: To study for changes in CCT in patients with Type 2 Diabetes Mellitus (Ty2DM) during hyperglycaemic blood sugar levels in comparison to euglycaemic blood sugar levels and to look for co-relation if any between changes in blood sugar levels and CCT. Materials and Methods: This was a non-interventional crosssectional observational study. Ty2DM patients with Post-Prandial Blood Sugar (PPBS) =200 mg/dL underwent CCT measurements using optical biometry. CCT was re-measured a month later when they returned for repeat PPBS estimations. Those patients achieving PPBS values <200 mg/dL and a minimum drop of 50 mg/dL were included for analysis. CCT at each visit was measured within 30 minutes of blood sugar measurement. Paired t-test was used to compare mean changes in CCT and PPBS levels. Pearson correlation coefficient was used to assess the relationship between CCT and PPBS levels. Results: The mean CCT of 89 Ty2DM patients with PPBS =200 mg/dL was 501.38±25.28 µm. When the PPBS reduced to <200 mg/dL, the CCT was 502.20±25.05 µm. The difference was not statistically significant (p=0.167). There was no correlation between change in blood sugar levels and CCT (Pearson's r=0.148). Conclusion: The present study demonstrated no significant change in CCT with varying blood sugar levels in Ty2DM patients. Therefore, in routine clinical practice, the correction for GAT IOP based on a single CCT measurement on one occasion, does not have to be revised depending on glycaemic control in Type 2 diabetics. [ABSTRACT FROM AUTHOR]

Purpose: To identify children with low vision from two local schools for the blind, to provide low vision devices (LVD) to those who may benefit from it, and to encourage them to learn print.Methods: A prospective study was conducted among children from two local schools for the blind. Best-corrected visual acuity (BCVA) was done using the Snellen chart. Children with BCVA of counting finger (CF) 1/2 meter or more in the better eye underwent low vision assessment. Distant vision was assessed using the Feinbloom chart and near vision was assessed using the Lea symbol chart. Low vision devices (LVD) were prescribed as required.Results: Among 185 children enrolled, 31 children had BCVA of >CF ½ meter. Using a telescope, distant vision was better than 3/36 in 48.4%, 3/36-3/12 in 16.2%, and 3/9.5 to 3/3 in 35.4%. Among 23 children who read 1M at <10 cm, 22.6% could read 0.6-0.8M, and 25.8% could read 1M using LVD.Conclusion: Regular screening of children in schools for the blind could identify children who might benefit from LVD. A review of protocols for the entry of children in schools for the blind by screening these children by a specialist team prior to admission should be made mandatory. [ABSTRACT FROM AUTHOR]

Introduction: World Health Organisation's (WHO) "Vision 2020" right to sight programme gives high priority towards control of ChildHood Blindness (CHB). Blind school screening provides data on the causes of CHB to focus on health care programmes towards prevention of CHB. Aim: To determine the causes of CHB seen in local schools for the blind, to compare these with reports from India and focus on changes in the causes of CHB over the years. Materials and Methods: A cross-sectional study was conducted in two schools for the blind in Tamil Nadu, India. Children less than 18 years were included. Best Corrected Visual Acuity (BCVA), anterior segment and dilated fundus examination was done for all children. Information was gathered as per WHO prevention of blindness (WHO/PBL) form. Results: BCVA in the better eye was 6/24 to 3/60 in 31 children (16.8%), <3/60 to no perception of light in 154 children (83.2%). The causes of blindness based on anatomical site were retina 77(41.5%), whole globe 59(32%), cornea 14(7.5%), optic nerve 14(7.5%), lens 10(5.7%), refractive error in 7(3.8%) and uvea in 4(2%). Hence, 14(7.5%) of the causes were preventable and 21(11.4%) were treatable; thus 35(18.9%) were avoidable causes of blindness. Conclusion: Retinal dystrophies were the major cause of CHB in our study. Posterior segment anomalies contributed to 50% of the causes for CHB. Our study showed that one-fifth of children had avoidable blindness. Regular screening in well baby clinics, schools and in the community is needed for early identification of avoidable blindness in children. [ABSTRACT FROM AUTHOR]