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Purpose: To study clinical profile and burden of primary glaucoma in rural camp patients attending a tertiary care center. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital of a single academic institute after ethical approval. Primary glaucoma patients aged ≥40 years, referred from the outreach camps, were included for a period of 12 months (2016–2017). A detailed history was recorded. Ocular examination included visual acuity, slit-lamp examination, disc evaluation, gonioscopy, intraocular pressure (IOP), and visual fields. Glaucoma was defined according to the International Society Geographical and Epidemiological Ophthalmology. Results: Out of 4204 referred cases from community program, 115 cases had primary glaucoma. Open-angle group had 63 (54.78%) cases whereas narrow-angle group had 52 (45.22%). The hospital-based prevalence for open-angle glaucoma was 1.11% (95% confidence interval [CI]: 0.8, 1.44) and for narrow-angle glaucoma was 1.07% (95% CI: 0.76, 1.38). The mean IOP was higher in narrow-angle group (P < 0.0001). The proportion of unilateral blindness was significantly high in narrow-angle category (P = 0.0203). Conclusions: The ratio of open-angle glaucoma to narrow-angle glaucoma was 1.2:1. Associated risk factors were age, gender, high IOP, refractive errors, and systemic illness. Narrow-angle glaucoma was more blinding as compared to open-angle glaucoma. Majority of the primary glaucoma found in camp patients was undiagnosed.

Purpose: To study ocular blood flow velocity in the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery in patients with Type 2 diabetes. Materials and Methods: The retrobulbar circulation in 46 eyes of Type 2 diabetic patients was compared with age-matched 21 nondiabetic eyes. The diabetic subjects were further divided into diabetics with no-clinical retinopathy (n = 24) and with either preproliferative or proliferative retinopathy (n = 22). Philips HD11XE machine was used for performing Color Doppler imaging. Results: The end-diastolic velocity (EDV) in OA was 3.21 cm/s in the preproliferative/proliferative group as compared to 6.0 and 8.5 cm/s in no-retinopathy and control group, respectively. The peak systemic velocities and EDVs of CRA in the diabetic group were significantly lower than those of normal subjects regardless of the retinopathy. The resistivity index (RI) of CRA was 0.81 in diabetic group and 0.70 in control group, which was statistically significant. Conclusion: The study showed reduced blood flow velocity and increased RI in Type 2 diabetic patients as compared to normal healthy individuals. There are significant changes noted in retrobulbar flow in patients with diabetic retinopathy as compared to patients without retinopathy.

Background: In India, there is an unequal distribution of eye health care, and tele-ophthalmology promises to be a potential tool to provide accessible, affordable, and good-quality health care to the population residing in the rural and remote areas of our country. AIMS: The aim of the study was to study the accuracy of smartphone imaging versus clinical examination in the diagnosis of ocular disorders at a rural-based hospital. Setting and Design: A hospital-based descriptive study was conducted for 18 months. The study was carried out in the outpatient department (OPD) of ophthalmology at a rural health training center (RHTC), attached to a tertiary care hospital. MATERIALS AND METHODS: Inclusion-A routine examination was carried out in the ophthalmology OPD at the RHTC. The off-site assessment was done based on the smartphone camera (iPhone Xs Max) images and videos captured on-site, which were remotely shared with two independent blinded observers to make the diagnosis which was compared with the clinical (on-site) diagnosis. Statistical Analysis: The agreement between the expert’s finding and the clinical examination finding was determined using Light’s Kappa coefficient. Accuracy of the photographic method was carried out in terms of sensitivity and specificity, considering clinical findings as the gold standard. Results and Conclusion: The diagnostic accuracy of smartphone imaging was the highest for the diagnosis of cataracts, followed by anterior segment conditions. The clinical diagnosis and smartphone imaging agreement were almost perfect for anterior segment disorders, while it was moderate for glaucoma and other disc pathologies.

Purpose: To evaluate the factors influencing final visual outcome after surgical repair of open globe injuries (OGIs) and to correlate the Ocular Trauma Score (OTS) system., Methods: Prospective cross-sectional study of patients with OGIs from International Globe and Adnexal Trauma Epidemiology Study (IGATES) database at a tertiary referral eye centre in Central India over 2 years. Pre-operative factors affecting final visual outcome and correlation with OTS were evaluated., Results: 208 patients had ocular trauma, of which data from 42 eyes with OGIs were reviewed. The majority of the patients were men (32, 76.2%) below the age of 40 (31, 73.8%). Patients were followed up for at least 6 months. Initial visual acuity (VA) was ≥ 20/40; 2 (4.8%), 20/200 to 20/50; 2 (4.8%), 1/200 to 19/200; 7 (16.7%), LP to HM; 26 (61.9%) and NLP (5, 11.9%). Final VA was ≥ 20/40; 1 (2.4%), 20/50 to 20/200; 8 (19.1%), 1/200 to 19/200; 9 (21.4%), LP to HM; 17 (40.5%) and NLP; 7 (16.7%). Univariate analysis of pre-operative variables showed initial VA (p = 0.0004), presence of hyphaema (p = 0.0323), laceration involving cornea visual axis (p = 0.0192) and retinal detachment (p = 0.0299) were significant prognostic factors in final visual outcome. OTS in our study does not fully correlate with international OTS system., Conclusions: Initial VA, hyphaema, visual-axis involving cornea laceration and retinal detachment are significant prognostic factors in OGIs. OTS remains a largely effective tool in counselling trauma patients.

Purpose: To compare the efficacy of 0.2 mg/ml Mitomycin C (MMC) applied for 1-minute versus 2-minutes in patients undergoing combined surgery for primary glaucoma coexistent with cataract. Materials and methods: This was a randomized controlled clinical trial of 63 patients operated on for primary glaucoma (POAG or PACG) with visually significant cataract. All patients underwent safe surgery system trabeculectomy with manual small incision cataract surgery (MSIC) and implantation of PC IOL. Patients were randomized into intra-operative MMC 0.2 mg/ml for 1-minute (study group) and MMC 0.2 mg/ml for 2-minutes (control group). Success was measured on the basis of two different intraocular pressure (IOP) goals (IOP ≤21 mmHg, IOP ≤18 mmHg) and mean IOP reduction from baseline at the end of 12 months. Results : At 12 months, significant decreases in mean IOP were observed in both groups ( P <0.001).The mean IOP reduction was 31.33±9.06% in the study group, as compared to 43.32±9.38% in the control group ( P <0.001). The overall success for IOP ≤21 mm Hg was 80.5% in the study group and 90.9% in the control group ( P <0.05). Kaplan-Meier analysis showed an insignificant difference in overall success rates of the two groups. Conclusion: The IOP reduction with 2-minute MMC (0.2 mg/ml) is more effective than 1-minute MMC after 12 months. It offers a decrease in anti-glaucoma medications and substantial visual recovery in combined surgery done for primary glaucoma coexistent with cataract., Competing Interests: The authors report no conflicts of interest in this work.

Traumatic hyphemas present dilemmas to physicians. There are numerous controversies pertaining to the optimal approach to traumatic hyphema and no standardized guidelines for its management. We address some of these controversies and present a pragmatic approach. We discuss various medical agents and surgical techniques available for treatment, along with the indications for their use. We address the complications associated with hyphema and how to diagnose and manage them and consider the management of hyphema in special situations such as in children and sickle-cell anemia and in rare clinical syndromes such as recurrent hyphema after placement of anterior chamber intraocular lenses., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: To investigate the amount of intraocular pressure (IOP) asymmetry in a large group of ethnically diverse patients with and without glaucoma, and to delineate the risk for glaucoma which increasing amounts of IOP asymmetry confer upon the patient., Patients and Methods: Collaborative retrospective study of 326 glaucoma patients and 326 controls. Former Wills Eye Institute fellows collected single pre-treatment measurements of IOP on patients diagnosed as having definite glaucoma based on characteristic optic nerve damage and confirmatory visual field damage. Patients with a normal eye examination who had normal-appearing optic discs and no apparent glaucoma, or who had a normal eye examination in association with refractive error or cataract, were used as controls., Results: Intraocular pressure asymmetry is a significant risk factor for having glaucoma (odds ratio, 2.14; 95% confidence interval, 1.86-2.47; P<0.001). Absence of IOP asymmetry between the fellow eyes is associated with a 1% probability of having glaucoma. A difference of 3 mm Hg is associated with a 6% probability of having glaucoma, and a difference of >6 mm Hg with a 57% probability of having glaucoma. The association between IOP asymmetry and glaucoma status is significant for subjects with both elevated IOP (P=0.014) and statistically normal IOP (maximum IOP ≤ 21 mm Hg; P<0.001)., Conclusions: Inter-eye asymmetry of IOP is a common finding in patients with glaucoma. There is a direct relationship between the amount of IOP asymmetry between the fellow eyes and the likelihood of having glaucoma.

Badminton is a famous sport usually played without any protective eyewear. Ocular injury from one's own partner in a doubles game, with the shuttlecock, is rare. Two untrained badminton players presented with severe ocular trauma during a smash shot from the partner in a 'doubles' game. Both the players developed blind eye (vision <3/60) in spite of immediate treatment. This article describes an unusual mode of severe blunt trauma with a shuttlecock while playing a 'doubles' game, leading to coup-countercoup injury. In addition, the article highlights the need for awareness of the fatal ocular complications and life-long visual disability, especially in untrained badminton enthusiasts.

A 35-year-old male patient presented with a right upper eyelid mass with mechanical ptosis. The patient gave no history of trauma or surgery. On examination, there was a huge cystic mass fixed to the tarsal plate. Excisional biopsy with tarsectomy was done. Histopathology sections demonstrated a keratin-filled cyst arising from the tarsus. A thorough Pubmed search did not reveal an epidermal cyst of the tarsal plate of this size which was successfully managed. The incision was made in such a way that postoperative ptosis would be avoided. Excess skin was removed during the surgery.