039885   BANSAL R, MOHARANA B, KATOCH D, GUPTA V, DOGRA M R, GUPTA A (Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, Email: drreemab@rediffmail.com) : Outcome of pars plana vitrectomy in patients with retinal detachments secondary to retinal vasculitis. Indian J Ophthalmol 2018, 68(9), 1905-11.

Retinal detachments (RD) secondary to retinal vasculitis are highly complex. We report the clinical profile and outcome of vitrectomy in RDs secondary to retinal vasculitis in terms of intraoperative findings, final anatomical, and functional outcome. In a retrospective review of 68 patients (6 with bilateral RD; 74 eyes) undergoing pars plana vitrectomy (PPV) between 2000 and 2015 for vasculitic RD,tractional RD was present in 50 (67.57 %) eyes and combined RD in 24 (32.43 %) eyes. Results: The mean agewas 31.54 ± 9.95 years (62 males, 6 females). Fibrovascular proliferations (FVPs) involved major vasculararcades (22.98 %), optic disc (10.81 %), both arcades and disc (20.27 %), peripheral retina (32.43 %), and arcades with peripheral retina (13.51%). A total of 14 (18.92 %) eyes had retinal folds, of which 9 had macular drag.Of 24 eyes with combined RD, 3 (12.5 %) eyes had macular hole, 15 (62.5 %) eyes had the primary retinal break anterior to equator, and 6 (25 %) eyes had the primary break posterior to equator. Twenty‑one (28.38 %)eyes had iatrogenic retinal breaks. Thirty‑eight (51.35 %) eyes required an internal tamponade [gas in31 (81.57 %) eyes and silicon oil in seven (18.42 %) eyes]. A scleral buckle was additionally required in26 (35.14 %) eyes. Postoperative complications included vitreous hemorrhage (27.03 %), re‑RD (12.16 %),and iris neovascularization (9.46 %). The median follow‑up was 18 months (range 6‑122 months).Sixty‑eight (91.9 %) eyes achieved final anatomical success. Fifty‑two (70.27 %) eyes had ≥2 lines visual improvement. Vasculitic RDs are complicated by tractional/combined RDs, peripherally located FVPs, retinal folds and iatrogenic retinal breaks, and carry a moderate prognosis.

4 illus, 4 tables, 16 ref

039883   CHATTERJEE S, AGRAWAL D, PARCHAND S M, SAHU A (MGM Eye Institute, Chhattisgarh - 493 111, Email: samrat@mgmeye.org) : Visual outcome and prognostic factors in cataract surgery in ocular tuberculosis. Indian J Ophthalmol 2018, 68(9), 1894-900.

To analyze the outcome of cataract surgery in patients with ocular tuberculosis (OTB). Medical records of patients with OTB who underwent cataract surgery between 2005 and 2018 were retrospectively reviewed. The primary outcome measure was corrected distant visual acuity (CDVA), and a good outcome was defined as CDVA 20/40 or better. There were 35 patients (41 eyes), of whom 13 (37.1 %) were males and 22 (62.9 %) were females. The mean age was 41.6 ± 13.8 (range 18–65) years. Anterior uveitis was present in 24 (58.5 %) eyes, intermediate uveitis in 5 (12.2 %) eyes, posterioruveitis in 6 (14.6 %) eyes, and panuveitis in 6 (14.6 %) eyes. Posterior sub‑capsular cataract (51.2 %) was the most common type of cataract. Total cataract was present in 9 (22 %) eyes. The two most common ocularcomorbidities were small pupil (85.4 %) and glaucoma (17.1 %). Phacoemulsification was performed in 36 (87.8 %) eyes and ECCE was performed in 5 (12.2 %) eyes. Intraoperatively the pupil was mechanically dilated in 36 (87.8 %) eyes. Overall 26 (63.4 %) and 23 (56.1 %) eyes achieved CDVA 20/40 or better at 1‑ and 6‑month follow‑up visit, respectively. The mean preoperative LogMAR CDVA significantly improved from 1.28 ± 0.57 to 0.38 ± 0.36 at 1‑month (P < 0.0001). One eye had fibrinous anterior chamber reaction and 24 (58.5 %) eyes had 1 or more episodes of reactivation of uveitis in the follow‑up period. The three commonest complications were glaucoma (26.8 %), posterior capsule opacification (19.5 %), and epiretinal membrane (17.1 %). Postoperative posterior segment complications like epiretinal membrane formation, vitreous inflammation and cystoid macular edema affected final visual acuity (P < 0.002). The visual outcome after cataract surgery in OTB was satisfactory as significant number of patients achieved agood final visual acuity.

3 illus, 4 tables, 30 ref

039880   UCAR D, MERGEN B, GONEN B, OZGULER Y, SEYAHI E, HAMURYUDAN V, OZYAZGAN Y (Ophthalmology Dep, Istanbul Univ, Istanbul, Turkey, Email: didarucar@gmail.com) : Investigation of clinical profile of behcet's syndrome-related versus idiopathic branch retinal vein occlusion. Indian J Opthalmol 2020, 68(9), 1876-80.

To compare the long‑term results of the patients with branch retinal vein occlusion (BRVO) secondary to Behçet’s syndrome (BS) with the patients with unknown etiology. Medical records and optical coherence tomography (OCT) imaging results of the patients with BRVO secondary to BS and with unknown etiology were reviewed retrospectively between 2016 and 2018 at a single center. The anatomical location of the BRVO, involvement of the macula, application of laser photocoagulation, and intravitreal injection were evaluated.Twenty‑eight eyes of 23 patients with BRVO secondary to BS as the study group and 22 eyes of 19 idiopathic BRVO patients as the control group were included in the study. The mean duration of follow‑up after the development of BRVO was 74.6 ± 57.4 months in the study group and 63.6 ± 59 months in the control group. The rate of bilaterality, macular involvement, and application of laser photocoagulation was not statistically significantly different between the groups.However, the frequency of injection requirement was significantly lower in the patients with BRVO secondary to BS in comparison to the control group (P = 0.009). Although the treatment of BRVO is laser photocoagulation and intravitreal injection of anti‑VEGF agents or dexamethasone implant, the patients with BS might respond very well to systemic immunomodulatory agents in case of BRVO.Thus, rearrangement of the immunomodulatory treatment before starting intravitreal injections should be considered in the patients with BRVO secondary to BS.

2 illus, 2 tables, 34 ref

039879   THAPA S, KHAREL R, SHRESTHA J B (Ophthalmology Dep, Tribhuvan Univ, Kathmandu, Nepal, Email: helloranju50@gmail.com) : Role of choroidal thickness assessment in unilateral acute anterior uveitis. Indian J Opthalmol 2020, 68(9), 1869-74.

The aim of our study was to investigate the change in the subfoveal choroidal thickness in unilateral acute anterior uveitis with treatment. Choroidal inflammation is uncommon but can occur in the acute stage of anterior uveitis.  All diagnosed patients with the first episode of unilateral acute anterior uveitis were included in the study conducted for a period of July 2017–July 2018. Choroidal thickness at subfoveal region was measured with spectralis spectral domain optical coherence tomography using enhanced depth‑imaging scans. Standardized, masked manual measurement of the choroidal thickness was performed in the center of the ETDRS fields. The unaffected fellow eye of the same patient was taken as a control group and their subfoveal choroidal thickness was measured. Follow up of the patients was done at 2 weeks post treatment to reevaluate the choroidal thickness. A total of 61 eyes of 61 patients with unilateral acute anterior uveitis were included in the study. The mean central subfoveal choroidal thickness was significantly higher (304.82 ± 73.17 μm) as compared to that of controls (251.28 ± 66.38 μm) at presentation (P < 0.001). Following treatment and at two weeks follow up, the subfoveal choroidal thickness significantly reduced from 304.82 ± 73.17 to 274.46 ± 63.82 μm (P < 0.001). Also the subfoveal choroidal thickness was positively correlated with visual acuity (r = 0.22, P < 0.251) before treatment.  Acute anterior uveitis is associated with an increase in the subfoveal choroidal thickness followed by the significant decrease in choroidal thickness with treatment, suggesting that choroidis also inflamed along with anterior segment inflammation.

4 illus, 3 tables, 11 ref

039877   AGRAWAL H, DOAN H, PHAM B, KHOSLA A, BABU M, MCCLUSKEY P, NGUYEN Q D, SANGWAN V, REDDY S, SAWHNEY S, TYAGI M (L V Prasad Eye Institute, Hyderabad, Telangana, Email: drmudittyagi@gmail.com) : Systemic immunosuppressive therapies for uveitis in developing countries. Indian J Opthalmol 2020, 68(9), 1852-62.

There are multiple approaches to inhibit inflammatory molecules and pathways in noninfectious uveitis.The cornerstone of local and systemic anti‑inflammatory treatment is corticosteroid therapy. Corticosteroids remain the most potent and efficacious drugs for treating intraocular inflammation. However, their long‑term use is limited by their medium‑ and long‑term side effects, which are a major concern. The approach taken to limit corticosteroid side effects is to introduce steroid‑sparing agents that suppress the inflammatory pathways and immune response differently than corticosteroids. There are several classes of such drugs that are affordable, effective, and generally well‑tolerated. Relatively recently, an increasing range of biologic agents has become available to treat intraocular inflammation. However, the relatively expensive cost of these therapies limits their use in the developing world. This systemic review aimst to discuss the use of corticosteroids and different immunosuppressive regimens in the management of various uveitides.

2 illus, 5 tables, 100 ref

039876   BANSAL R, DOGRA M, CHAWLA R, KUMAR A (Post Graduate Institute of Medical Education and Research, Chandigarh- 160 012, Email: drreemab@rediffmail.com) : Pars plana vitrectomy in uveitis in the era of microincision vitreous surgery. Indian J Opthalmol 2020, 68(9), 1844-51.

Pars plana vitrectomy (PPV) in uveitis is indicated for various diagnostic and therapeutic indications. With the advent of microincision vitreous surgery (MIVS), the use of PPV in uveitis has increased with a widerspectrum of indications due to shorter surgical time, less patient discomfort, less conjunctival scarring, and a decreased rate of complications as compared to standard 20G vitrectomy. Because of faster post‑operative recovery in terms of visual improvement and reduction of inflammation, and reduced duration of systemic corticosteroids, MIVS has gained popularity in uveitis as an adjunctive therapy to the standard of care medical therapy. The safety and efficacy of MIVS is related to the emerging vitrectomy techniques with better and newer cutters, illuminating probes, and accessory instruments. Because of the instrumentation and fluidics of MIVS, PPV is emerging as a safe and useful alternative for diagnostic challenges in uveitis,aiding in earlier diagnosis and better outcome of inflammatory disease, even in the presence of severe and active inflammation, which was once considered a relative contraindication for performing vitreous surgery.However, for surgical interventions for the rapeutic indications and complications of uveitis, it is advisableto achieve an optimum control of inflammation for best results. The increasing reports of the use of MIVS in uveitis have led to its wider acceptance among clinicians practicing uveitis.

4 illus, 103 ref

039870   SUDHARSHAN S, NAIR N, CURI A, BANKER A, KEMPEN J H (Uveitis Dep, Medical Research Foundation, Chennai- 600 006, Tamil Nadu, Email: drdharshan@gmail.com) : Human immunodeficiency virus and intraocular inflammation in the era of highly active anti retroviral therapy: An update. Indian J Opthalmol 2020, 68(9), 1787-98.

Intraocular inflammation in patients with human immunodeficiency virus (HIV) infection is commonly due to infectious uveitis. Ocular lesions due to opportunistic infections (OI) are the most common and have been described extensively in the pre highly active antiretroviral therapy (HAART) era. Many eye lesions were classified as acquired immunodeficiency syndrome (AIDS) defining illnesses.HAART‑associated improvement in immunity of the individual has changed the pattern of incidence of these hitherto reported known lesions leading to a marked reduction in the occurrence of ocular OI. Newer ocular lesions and newer ocular manifestations of known agents have been noted. Immune recovery uveitis (IRU), the new menace, which occurs as part of immune recovery inflammatory syndrome (IRIS) in the eye, can present with significant ocular inflammation and can pose a diagnostic and therapeutic challenge. Balancing the treatment of inflammation with the risk of reactivation of OI isa task by itself. Ocular involvement in the HAART era can be due to the adverse effects of some systemic drugs used in the management of HIV/AIDS. Drug‑associated retinal toxicity and other ocular side effects are being increasingly reported. In this review, we discuss the ocular manifestations in HIV patients and its varied presentations following the introduction of HAART, drug-associated lesions, and the current treatment guidelines.

6 illus, 3 tables, 36 ref

039868   BABU K, KONANA V K, GANESH S K, PATNAIK G, CHAN N S W, CHEE S, SOBOLEWSKA B, ZIERHUT M (Uveitis and Ocular Inflammation Dep, Medical Research Foundation, Bangalore- 560 070, Karnataka, Email: kalpanababumurthy@gmail.com) : Viral anterior uveitis. Indain J Opthalmol 2020, 68(9), 1764-73.

Viral anterior uveitis (VAU) needs to be suspected in anterior uveitis (AU) associated with elevated intraocular pressure, corneal involvement, and iris atrophic changes. Common etiologies of VAU include herpes simplex, varicella‑zoster, cytomegalovirus, and rubella virus. Clinical presentations can vary from granulomatous AU with corneal involvement, Posner‑Schlossman syndrome, Fuchs uveitis syndrome, and endothelitis. Due to overlapping clinical manifestations between the different viruses, diagnostic tests like polymerase chain reaction and Goldmann‑Witmer coefficient analysis on the aqueous humor may help inidentifying etiology to plan and monitor treatment.

4 illus, 1 table, 110 ref

039865   MURALIDHAR A, DAS S, TIPLE S (Dr Shroff’s Charity Eye Hospital, Patparganj, New Delhi, Email: contactsima@gmail.com) : Clinical profile of thyroid eye disease and factors predictive of disease severity. Indian J Ophthalmol 2020, 68(8), 1629-34.

To describe the clinical features of thyroid eye disease (TED) in patients presenting at a tertiary eye care centre in North India and to identify factors predictive of severe disease. This observational cross-sectional study involved clinical evaluation of all patients with TED who presented at the oculoplastic clinic based on the ITEDS VISA proforma. Risk factors for the severe disease were assessed using univariate and multivariate logistic regression. A total of 106 patients (50 males,56 females; mean age 41.30 ± 14.76 years) were identified during the study period, 46.23 % hyperthyroid, 33.96 % hypothyroid and 19.81 % euthyroid. The proportion of the patients with hypothyroid was higher as compared with prior studies and most patients with hypothyroid had the mild disease (63.89 %). Orbitopathy symptoms were the presenting feature leading to the diagnosis of systemic thyroid abnormality in 25 % of the patients with hypothyroid and 59.18 % of the patients with hyperthyroid, respectively (P < 0.05). Eyelid and orbitopathy signs were more common in the patients with hyperthyroid (51.2 % and 87.7 %) as compared with hypothyroid where the commonest presenting symptoms were related to dry eye (50.1 %). Active disease was seen in 22.6 % of the patients. Mild, moderate to severe and sight‑threatening disease was seen in 54.7 %, 37.7 % and 7.5 %, respectively.On multivariate analyses, hyperthyroid status and activity was associated with severe disease. Smoking was not associated with activity or severity.There is no significant difference in the gender profile of the patients with TED in this cohort. The patients with hypothyroid have a milder disease compared to the patients with hyperthyroid, and dry eye symptoms are the commonest presenting symptoms in hypothyroid subjects.Hyperthyroidism and activity were associated with severe and sight‑threatening disease.

1 illus, 4 tables, 23 ref

039864   GUPTA R, THOMAS R, ALMUKHTAR F, KIRAN A (Narayana Nethralaya, Bengaluru, Karnataka, Email: roshmi_gupta@yahoo.com) : Visual morbidity in thyroid eye disease in Asian Indian patients. Indian J Ophthalmol 2020, 68(8), 1622-7.

To describe visual morbidity in thyroid orbitopathy in Asian Indians and the factors influencing itsonset.  A retrospective chart review was performed for patients with thyroid related orbitopathy seen between May 2014 and April 2019. Three hundred and one patients were included in the study. Relevant history, clinical findings, investigations, and treatment were documented.Nineteen percent of patients had at least 1 visual morbidity feature such as compressive optic neuropathy, exposure keratopathy or diplopia, requiring intravenous glucocorticoid. Male gender, older age, and diabetes were the significant risk factors for high visual morbidity (all P < 0.05). Systemic thyroid status, degree of proptosis, and duration of disease were not significant. Average dose of intravenous glucocorticoid needed was 3.8 g; 24 (7.9 %) patients required orbital decompression, and 13 (4.3 %) needed eyelid surgery. At the last follow‑up, 97 % of patients had vision 6/12 or better in both eyes. There is significant visual morbidity found in Indian patients with TED, even with moderate proptosis and systemic control of thyroid status. This is the first set of data on the subject.

5 illus, 3 tables, 29 ref

039863   DELAMPADY K, REDDY S V B, YADAV S B (Endocrinology Dep, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow- 226 014, Uttar Pradesh, Email: subhash70@gmail.com) : Assessing the quality of life in Indian graves' orbitopathy patients and validation of hindi version of GO-QOL questionnaire. Indian J Ophthalmol 2020, 68(8), 1617-21.

To validate the GO‑specific quality of life (QOL) questionnaire in Hindi language and to determine the correlation of scores (visual functioning and appearance) with disease severity and activity. We recruited 114 consecutive patients with GO attending Endocrinology Clinic at tertiary care center. Eye examination was performed, and QOL was assessed by questionnaire.  The questionnaire was validated by 50 GO patients and test‑retest reliability was performed in 15 patients. Hindi version GO‑QOL was administered in 49 GO patients. GO was mild in 51.0 % and sight‑threatening in only 2.0 % of cases.Orbitopathy was clinically active in only 10 (20.4 %) cases. The GO‑QOL scores (median) for visual function and appearance were 81.3 and 62.5, respectively. Patients with moderate‑to‑severe and sight‑threatening GOhad significantly lower median appearance scores (56.3 vs. 68.5, P = 0.01) compared to mild disease but no difference in visual scores. Patients with active disease had significant lower median visual function (53.1 vs.85.7, P = 0.009) and psychosocial (appearance) scores (40.6 vs. 68.8, P = 0.03) compared to in active disease.On multivariate regression analysis of GO‑QOL scores, extraocular eye movement involvement (EOM), proptosis, and severity of eye disease were significantly associated with visual functioning while appearance was significantly associated only with the severity of eye disease.  GO‑QOL scores were significantly reduced in patients with GO.

2 illus, 3 tables, 23 ref

039862   PRADHAN A, GANGULY A, NAIK M N, NAIR A G, DESAI S, RATH S (L V Prasad Eye Institute, Bhubaneswar, Odisha, Email: suryasnata@lvpei.org) : Thyroid eye disease survey: An anonymous web-based survey in the Indian subcontinent. Indian J Ophthalmol 2020, 68(8), 1609-14.

To evaluate the current practice patterns in the treatment of thyroid eye disease (TED) in Indian subcontinent through a web‑based survey of members of Oculoplastics Association of India (OPAI). This was an online web‑based questionnaire survey disseminated via monkey survey.com to all ratified active members of OPAI between May 1, 2016 and June 30, 2016. Questions encompassed the background, training, region, and experience of oculoplastic surgeons along with the management protocol of TED.  Of the 435 emails sent to OPAI members, 9 bounced and 180 (42.3 %) responded within the study period. A large majority (96 %) of respondents were oculoplastic surgeons practicing in India and the remaining practiced within South‑East Asia. Two‑thirds of respondents were oculoplastic surgeons with less than 10 years of clinical experience; 82 % were fellowship trained in Oculoplasty. Almost all (99 %) favored a multidisciplinary management of TED. A large majority routinely grade the severity (89 %) and activity (87 %) of disease before management. While corticosteroid remained the treatment of choice, 54 % preferred immune‑modulators as the second‑line of therapy for recalcitrant TED. Three‑quarters did not use orbital radiotherapy as a management modality in active TED owing to concerns over its efficacy and/or safety. The survey gives useful insights to the practice patterns of TED management in Indian subcontinent. Multidisciplinary approach and grading of disease severity and activity were the rulerather than exception among OPAI members. Immune modulation was the preferred steroid‑sparing agentin recalcitrant disease. Orbital radiotherapy was an uncommon treatment choice.

4 illus, 28 ref

039861   KOKA K, ALAM M S, SUBRAMANIAN N, SUBRAMANIAN K, BISWAS J, MUKHERJEE B (Sankara Nethralaya, Kolkata, West Bengal, Email: mshahidalam@gmail.com) : Clinical spectrum and management outcomes of langerhans cell histiocytosis of the orbit. Indian J Ophthalmol 2020, 68(8), 1604-8.

To describe the clinical spectrum and management outcomes of Langerhans cell histiocytosis (LCH) involving the orbit.  Retrospective review of patients with orbital LCH presenting at the Sankara Nethralaya, Chennai, India, over the past 15 years. Demographic details, presenting features, radiology, histopathology, immunohistochemistry, and management outcomes were analyzed.Nine patients were reviewed. The mean age of presentation was 10.12 ± 14.31 years (range: 6 weeks to 35 years). Eyelid swelling was the most common presenting feature (4, 44.4 %), followed by proptosis (3, 33.3 %). The mean duration of the presentation was 2.21 ± 2.77 months. Radiological investigations revealed orbital roof osteolytic defects in six (66.6 %) patients. Six patients underwent near‑complete excision of the mass while three underwent incisional biopsy. Histopathology revealed histiocytes with nuclear grooving and numerous eosinophils characteristic of LCH. The cells were positive for CD1a and S 100 antigens. None of the patients had any systemic involvement. Three received systemic steroids and four received systemic chemotherapy. At a mean follow‑up of 17.85 ± 23.46 months, all had complete remission without any signs of recurrence. One patient was lost to follow‑up after near‑complete excision while one adult patient with a mass in the intraconal space had no recurrence after near‑complete excision. LCH is a rare disorder of the orbit that commonly occurs in children and should be considered a differential for osteolyticlesions involving the orbit. All patients should undergo a systemic evaluation to rule out multifocal disease.The treatment depends upon disease extent and risk factors.

2 illus, 2 tables, 22 ref

039860   PANDEY N, AGRAWAL S, SRIVASTAVA R M, SINGH V (Ophthalmology Dep, King George’s Medical Univ, Lucknow- 226 003, Uttar Pradesh, Email: agrawalsiddharth@rediffmail.com) : Short-term outcome of botulinum neurotoxin A injection with or without sodium hyaluronate in the treatment of infantile esotropia- A prospective interventional study. Indian J Ophthalmol 2020, 68(8), 1600-3.

To compare the short‑term outcome of botulinum neurotoxin A (BoNT‑A) with or without sodium hyaluronate in the treatment of infantile esotropia (IE). In this tertiary care hospital‑based prospective, interventional, non‑randomized study on infants with IE below one year of age, 25 cases were enrolled in the sodium hyaluronate (SH) group to receive 2.5 U BoNT‑A injection combined with SH in each medial rectus muscle (MR). Thirty patients were enrolled in the control group to receive 2.5 UBoNT‑A injection with normal saline in each MR. The change in mean primary ocular deviation (POD) and complications were assessed at 2 weeks, 1 month, 3 months, and 6 months post injection. Mann–Whitney Utest was used for non‑parametric unpaired data. Chi‑square test and Fisher’s exact test were used to test forthe strength of the association between the two categorical variables. Satisfactory ocular alignment was achieved in 76 % in SH group and 73 % in the control group (P value = 0.80). While the change in mean POD was comparable (29.2 prism diopters [PD] vs 29.3 PD; P value = 0.65), the complication rates were significantly lesser in SH (16 % vs 33.3 %; P value = 0.14).  BoNT‑A combined with SH is equally effective with lesser complications as compared to botulinum toxin alone in the treatment of IE.

2 illus, 3 tables, 19 ref

039859   PANDA L, NAYAK S, KHANNA R C, DAS T (L V Prasad Eye Institute, Hyderabad - 500034, Telangana, Email: tpd@lvpei.org) : Tribal Odisha eye disease study (TOES) # 7. Prevalence of refractive error in children in tribal Odisha (India) school screening. Indian J Ophthalmol 2020, 68(8), 1596-9.

To describe the prevalence of refractive error in school children in a tribal district, Rayagada, Odishastate, India. In a cross‑sectional school eye health study, the students with diminished vision and other ocular abnormalities were referred for a further eye examination to the vision technicians after initial screening by the trained school teachers. The examination by vision technicians consisted of an external eye examination, photo refraction using a Spot screener and subjective correction. Those not improving with subjective correction were referred to the ophthalmologist for further examination. The school teachers measured vision in 153,107 children; 5,990 students reached a vision technician. There was a nearequal number of boys (50.06 %) and girls (49.94 %). The average age was 10.5 ± 2.63 (range: 5–15) years. Theprevalence of refractive error was 9.7 % (95 % [CI]; 9.0–10.5 %) in the vision technician‑examined children.Myopia (4.9 %) and astigmatism (5.4 %) were more common than hyperopia (0.2 %). The presenting visualacuity (PVA) was worse in children with hypermetropia (PVA 20/100‑20/200 in 40 % of children). Spherical equivalent of refractive error did not have a good correlation with age (R2 = 1.3); but increasing age was associated with increased risk of myopia (odds ratio 1.14; 95 % CI 1.09–1.20; P < 0.001).  The quantum of refractive error was close to other similar studies in India but the prevalence of myopia was relatively less.

2 illus, 3 tables, 29 ref

039858   RAEVIS J J, KARL M D, PARENDO A M, ASTAFUROV K, DUGUE A G, AGEMY S A, RIZZUTI A E, SENG J T, SCOTT W, REANEY-PERROTTI K, LAUDI J, SHRIER E M (SUNY Downstate Medical Center, Madison- 53703, USA, Email: jjr223@georgetown.edu) : Eyelid retraction discomfort with cotton-tipped applicator, unimanual and speculum intravitreal injection techniques: Eyelid retraction technique randomized comparison trial (Eyelid RETRACT). Indian J Ophthalmol 2020, 68(8), 1593-5.

The aim of this study was to test the discomfort experienced during intravitreal injections with eyelid retraction between an eyelid speculum, cotton‑tipped applicator (CTA), and unimanual eyelid retraction techniques. In total, 99 patients receiving intravitreal bevacizumab were enrolled into this prospective study. Participants were randomized to one of the three methods, given subconjunctival 2 % lidocaine and then injected in the superior temporal quadrant. Immediately after the procedure, each patient was given a visual analog scale (VAS) to rate their discomfort.The mean pain scores for eyelid retraction with unimanual, CTA, and speculum groups were 0.788 (standard deviation [SD] 0.70,95 % confidence interval [CI] 0.448–1.128), 0.945 (SD 1.28, 95 % CI 0.600–1.291), and 1.561 (SD 1.28, 95 % CI1.210–1.912), respectively. A one‑way analysis of variance (ANOVA) test revealed a significant difference between the groups (P = 0.006). Post hoc analysis also revealed a difference in mean pain scores between the speculum and both the CTA and the unimanual methods. Our study shows that the unimanual and CTA methods for eyelid retraction are significantly less painful for patients compared to the speculum method. Patient comfort is of the utmost importance as intravitreal injections are performed millions of times a year with most patients requiring multiple injections.

2 illus, 10 ref

039857   DAVE V P, PAPPURU R R, KHADER M A, BASU S, TYAGI M, PATHENGAY A (L V Prasad Eye Institute, Hyderabad- 500 034, Telangana, Email: rajeevkrp@gmail.com) : Endophthalmitis with opaque cornea managed with primary endoscopic vitre ctomy and secondary keratoplasty: Presentations and outcomes. Indian J Ophthalmol 2020, 68(8), 1587-92.

To describe the outcomes of endophthalmitis with opaque cornea managed with primary endoscopic vitrectomy and secondary keratoplasty. Retrospective consecutive interventional case series. All cases of endophthalmitis with opaque cornea which underwent endoscopic vitrectomy followed by secondary keratoplasty were analyzed. The study period was from Jan 2015 to March 2019. The outcome measures were resolution of infection, the magnitude of unnecessary keratoplasties avoided and corneal graft survival. The final anatomic and functional outcomes were reported and compared with relevant literature. Seventy‑eight eyes of 78 patients underwent endoscopic pars planavitrectomy for endophthalmitis with the opaque cornea, of these 14 eyes of 14 patients were deemed eligible for further corneal intervention and were included in the study. The mean age at presentation was 42.27 ± 21.6 years (median 36 years). Etiology‑wise, eight cases (57.14 %) were post‑trauma, three cases (21.42 %) post‑keratoplasty, two cases (14.28 %) were endogenous, and one case (7.14 %) following corneal dermoid excision and wound melt. Culture positivity was in 5/14 (35.71 %). The mean interval between endoscopic vitrectomy and keratoplasty was 5.42 ± 2.69 months (median 3.5 months). The mean follow‑up noted was 20.42 ± 11.45 months (median 17.5 months). The infection resolved in 100 % of cases. Unnecessary keratoplasties were avoided in 64/78 (82 %) cases due to the primary endoscopic intervention.The favorable anatomic outcome was seen in 11/14 (78.57 %) of cases and favorable functional outcome in 8/14 (57.14 %) cases.  Endoscopic vitrectomy allows for early intervention in endophthalmitis with the opaque cornea. This facilitates early settlement of infection, globe preservation, greater graft survival, and lesser repeat posterior segment procedures.

4 illus, 2 tables, 18 ref

039856   PORWAL S, NITHYANANDAM S, JOSEPH M, VASNAIK A K (Ophthalmology Dep, Christian Medical Coll, Vellore - 632 001, Tamil Nadu, Email: porwal.sonika02@gmail.com) : Correlation of axial length and peripapillary retinal nerve fiber layer thickness measured by Cirrus HD optical coherence tomography in myopes. Indian J Ophthalmol 2020, 68(8), 1584-6.

To evaluate the RNFL thickness by optical coherence tomography (OCT) and correlate it with the axial length and refractive error in myopes. Patients with myopia −1D to −10D attending ophthalmology OPD at a tertiary hospital from October 2013 to April 2015 for evaluation underwent ophthalmic examination including refraction, axial length, and OCT RNFL thickness measurements. The patients were divided into two groups; group A included patients with AL ≤ 24 mm and group B AL > 24 mm. The study included 100 eyes with myopia ranging from −1D to −10D. The mean (±SD) age was 26.87 (±5.93) years with a range of 21–48 years and male: female ratio of 2:3. There was a statistically significant difference in the average peripapillary RNFL thickness between the two axial length groups (P = 0.01); RNFL thickness in group A being 91.40 (±10.17) and group B 86.06 (±10.09); and in the average RNFL thickness between the 3 degrees of myopia groups, with higher myopic group having thinner RNFL (P = 0.001).  There is a significant decrease in RNFL thickness with an increase in the grade of myopia and axial length. This polar RNFL thinning could be wrongly attributed to glaucomatous change. We recommend careful interpretation of RNFL data in myopes with axial length >24 mm, when applying the current OCT nomograms.

2 tables, 22 ref

039855   CANKURTARAN V, OZATES S, OZATES M E, OZLER S (Ophthalmology Dep, Medical School of Mustafa Kemal UnIv, 36200 Merkez, Kars, Turkey, Email: serdarozates@ gmail.com) : Influence of visual acuity level on sexual function in patients with cataract. Indian J Ophthalmol 2020, 68(8), 1579-83.

To assess the association of sexual function with visual acuity. Patients were included in the mild to moderate visual impairment (MVI), severe visual impairment (SVI), and profound visual impairment (PVI) groups based on bilateral corrected distance visual acuity. All patients completed the Turkish version of the International Index of Erectile Function (IIEF) and Glombok‑Rust Inventory of Sexual Satisfaction (GRISS) scales before and at 1 month after the cataract surgery. Mean IIEF scores did not improve after cataract surgery in the MVI group (P > 0.05). Sexual desire, intercourse satisfaction,overall satisfaction, and total IIEF score were significantly improved after cataract surgery in both the SVIand PVI groups (P < 0.05). Mean GRISS subscale scores did not improve after cataract surgery in the MVI group (P > 0.05). Non‑sensuality, avoidance, dissatisfaction, infrequency, noncommunication, and total GRISS score were significantly improved after cataract surgery in both the SVI and PVI groups (P < 0.05). The study results documented the association of low visual acuity and decreased sexual desire and satisfaction and revealed the beneficial effect of visual improvement.

5 tables, 25 ref

039851   ALBA-LINERO C, MORA M R C D, VALENZUELA R L, CASCON M J P, CEREZO A R M, PEREZ M A, RECIO L V, ARAGONES J M J, CAMPOS J M G (Ophthalmology Dep, Plaza del Hospital Civil s/n 29009, Malaga, Spain, Email: Carmen.alba.linero@gmail. com) : Ocular surface characterization after allogeneic stem cell transplantation: A prospective study in a referral center. Indian J Ophthalmol 2020, 68(8), 1556-62.

To characterize anatomical and functional changes in the ocular surface after hematopoieticstem cell transplantation. Three groups of patients were included in the study. Group 1:patients who had undergone allogeneic hematopoietic stem cell transplantation (HSCT) (n = 26). Group 2:patients who developed chronic graft versus host disease (GvHD) after HSCT (n = 14). Group 3: healthy subjects (n = 20). A complete ophthalmological examination was undertaken in all subjects, including Schirmer’s test, TBUT (break‑up‑time) test, Oxford scale, OSDI test, corneal tomography, and conjunctival CD8+ lymphocyte detection. In Branch 1 (comparative analysis before and after HSCT in Group 1), statistically significant differences were found in the following variables: best‑corrected visualacuity (BCVA) OD (P = 0.08), OSDI test (P = 0.003), TBUT OU (OD P = 0, OS P = 0.0003), Oxford test OU (ODP = 0.01, OS P = 0.0049), and CD8+ lymphocytes OU (OD P = 0.003, OS P = 0.01). In Branch 2 (comparative analysis between Group 2 and 3), the variables with statistically significant differences (P < 0.001) in OU were: BCVA, OSDI test, Schirmer’s test OU, TBUT test, Oxford test, and CD8+ lymphocytes. Finally, in Branch 3 (comparative analysis between Group 1 after HSCT and Group 2), statistically significant differences (P < 0.001) were found OU: in OSDI test, Schirmer’s test, and Oxford test OU; and with P < 0.005 in TBUT test OU. In our study, statistically significant changes were observed in the OSDI test, TBUT test, Oxford Scale, and the detection of CD8+ lymphocytes in patients who underwent HSCT. Differences were more significant in those patients who had developed GvHD after HSCT compared to those without GvHD.

3 illus, 2 tables, 20 ref

039850   KRITZINGER A, ZABOROWSKI A G, SIBANDA W, VISSER L (Ophthalmology Dep, KwaZulu-Natal Univ, Durban- 4041, South Africa, Email: aninekritzinger@gmail.com) : The role of human immunodeficiency virus in the pathogenesis of vernal keratoconjunctivitis-like disease in adults: A demographic and epidemiological study. Indian J Ophthalmol 2020, 68(8), 1551-4.

The purpose was to identify and describe patients with new‑onset vernalkerato conjunctivitis‑like (VKC‑like) disease after puberty. The study consisted of two parts: aprospective observational descriptive study of patients with new‑onset VKC‑like disease, and a case‑control study to determine the relationship of a CD4 count with VKC‑like disease in adults, in the setting of human immunod eficiency virus (HIV). Patients were recruited between January 2016 and November 2017 from a Provincial Eye hospital, one of two large referral hospitals in KwaZulu‑Natal, South Africa. Patients presenting to the eye clinic were screened and diagnosed at the Primary Eye Care Unit. Inclusion criteria: age 15 years and older with signs and symptoms of new‑onset VKC‑like disease. Exclusion criteria: a history of childhood atopic diseases, atopic keratoconjunctivitis and patients who declined HIV testing. Data collected included HIV status,CD4 count, anti nuclear antibodies and total serum immunoglobulin E. Thirty‑three patients wereincluded; females n = 16 and males n = 17. The mean age at presentation was 32.45 ± 9.93 years, 95 % CI = 28.94–35.97. Twenty‑six patients (78.8 %) were HIV positive, 95 % CI (62–89). The proportion of HIV positive patients was statistically different from the HIV negative group, Chi‑squared = 21.866, P value <0.0001. In the group of HIV positive patients, 72% were classified as immunod eficient according to their CD4 counts. An association was proven between severely immuno deficient patients and the risk of VKC‑like disease (Chi‑squared = 4.992,P value = 0.0255).  In this cohort, a statistically significant association was found between VKC‑like disease in adults and an HIV positive status. This association calls for more research on the subject.

3 tables, 19 ref

039848   BABU N, KOHLI P, MISHRA C, SEN S, ARTHUR D, CHHABLANI D, BALIGA G, RAMASAMY K (Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, Email: kohli119@gmail.com) : To evaluate the effect of COVID-19 pandemic and national lockdown on patient care at a tertiary-care ophthalmology institute. Indian J Ophthalmol 2020, 68(8), 1540-4.

To evaluate the effect of COVID‑19 pandemic and national lockdown on patient care at atertiary‑care ophthalmology institute. Records of all the patients who presented from March 25th to May 3rd, 2020 were scanned to evaluate the details regarding the presenting complaints, diagnosis, advised treatment and surgical interventions. The number of outpatient department visits, retinal laser procedures, intravitreal injections and cataract surgeries during this lockdown decreased by 96.5 %, 96.5 %, 98.7 % and 99.7 % respectively compared from the corresponding time last year. Around 38.8 % patients could be triaged as non‑emergency cases based on history alone while 59.5 % patients could betriaged as non‑emergency cases after examination. Only eighty‑four patients opted for video‑consultation from April 15th to May 3rd, 2020. Nine patients presented with perforated corneal ulcer, but could not undergo penetrating keratoplasty due to the lack to available donor corneal tissue. One of these patients had to undergo evisceration due to disease progression. Two patients with open globe injury presented late after trauma and had to undergo enucleation. Around 9 % patients could not undergo the advised urgent procedure due to logistical issues related to the lockdown. A significant number of patients could not get adequate treatment during the lockdown period. Hospitals need to build capacity to cater to the expected patient surge post‑COVID-19‑era, especially those requiring immediate in‑person attention. A large number of patients can be classified as non‑emergency cases. These patients need to be encouraged to follow‑up via video‑consultation to carve adequate in‑person time for the high-risk patients.

1 illus, 4 tables, 18 ref

039847   MORYA A K, GOGIA S, GUPTA A, PRAKASH S, SOLANKI K, NAIDU A D (Ophthalmology Dep, AIIMS, Jodhpur- 342 005, Rajasthan, Email: moryaak@aiimsjodhpur.edu.in) : Motherhood: What every ophthalmologist needs to know. Indian J Ophthalmol 2020, 68(8), 1526-32.

The aim of this review article is to summarize the available literature on physiologic and pathologic ocular changes during pregnancy and the effect of diseases in pregnancy. A literature search was conducted using PUBMED, MEDLINE, and Cochrane library in English. In addition, the cited references in the published articles were manually reviewed for the relevant results. Pregnancy encompasses a multitude of changes in all body systems, including the visual system of the female. The changes can be physiological, i.e., changes occurring in the lids and adnexa, cornea, conjunctiva, changes in tear film composition and intraocular pressure, retina, choroid,and visual field. Pathological changes in a pregnant woman’s eye include changes related to preeclampsia and eclampsia, central serous chorioretinopathy, retinal artery or vein occlusions, and disseminated intravascularcoagulation. Preexisting diseases like diabetic retinopathy, Graves’ disease, idiopathic intracranial hypertension, various inflammatory conditions can undergo changes in their course during pregnancy. Ophthalmic medications can have an effect on both mother and the baby and hence should be used cautiously. In addition,intrauterine infections play a major role in causing inflammation in the eye of the baby. Hence, vaccination of the mother prior to pregnancy plays an important role in preventing intrauterine infections in the neonate. A regular eye examination in the perinatal period plays a vital role in recognizing ophthalmic pathologies which mightrequire a prompt medical intervention. Pathological ocular diseases should be discriminated from physiologic changes to establish an individualized treatment or preventive plan. This approach to ocular benefits of treatment to the mother should always weigh against the potential harm to the fetus.

5 illus, 75 ref

039844   KUMAR K, KOHLI P, BABU N, KHARE G, RAMASAMY K (Vitreo-Retinal Services Dep, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, Email: kohli119@gmail.com) : Incidence and management of rhegmatogenous retinal detachment after pars plana vitrectomy and sutureless scleral-fixated intraocular lens. Indian J Ophthalmol 2020, 68(7), 1432-5.

To evaluate the incidence, risk factor(s), and surgical outcomes of rhegmatogenous retinal detachment (RRD) in patients undergoing pars plana vitrectomy (PPV) with sutureless scleral‑fixated intraocular lens implantation (SFIOL). Records of patients (1311 eyes, 1234 patients) who underwent PPV and sutureless SFIOL from 2017 to 2018 were retrospectively analyzed. The indications SFIOL were subluxated lens (33.7 %), dislocated IOL (21.7 %), surgical aphakia (20.1 %), congenitallens subluxation (11.1 %), nucleus drop (6.9 %), and post‑open globe injury (OGI) repair (6.5 %). History of closed‑globe injury (CGI) was present in 27.2 % eyes.Twenty‑two eyes (1.7 %) developed RRD. The incidence of RRD in eyes, which underwent SFIOL surgery for subluxated lens, dislocated IOL, surgical aphakia, congenital lens subluxation, nucleus drop, and post‑OGI repair was 1.4 % (n = 6), 2.5 % (n = 7), 1.1 % (n = 3),3.4 % (n = 5), 0 and 1.2 % (n = 1), respectively (P = 0.382). The incidence of RRD in eyes with and without CGI was 1.7 % each (P = 0.996).Twenty‑one eyes underwent RD surgery. Retinal reattachment was achieved in 76.2 % eyes, while 66.7 % eyes required only one surgery. The eyes in which retina failed to reattach had a high grade of proliferative vitreoretinopathy present at the time of presentation. Final best‑corrected visual acuity of ≥20/60 and <20/60 to ≥20/200 and <20/200 was seen in 38.1 %, 19.0 %, and 42.9 % eyes. Eyes with the congenital subluxated lens are at a marginally higher risk of developing post‑SFIOL RRD. The surgical outcome of RD surgery in these eyes is good.

1 illus, 2 tables, 25 ref

039842   SINGH R, VANATHI M, KISHORE A, TANDON R, SINGH D (All India Institute of Medical Sciences, Ansari Nagar, New Delhi- 110 029, Email: mvanathi.rpc@gmail.com) : An anterior segment optical coherence tomography study of the anterior chamber angle after implantable collamer lens-V4c implantation in Asian Indian eyes. Indian J Ophthalmol 2020, 68(7), 1418-23.

To quantitatively assess anterior chamber and angle parameters by anterior segment optical coherence tomography (AS‑OCT) in myopic eyes undergoing Implantable Collamer Lens (ICL V4c) implantation. Prospective noncomparative observational case series. Pre and postoperative (1st and 3rd month) AS‑OCT angle parameters (anterior chamber depth [ACD], anterior chamber angle [ACA], Angle opening distance [AOD], trabecular iris space area [TISA], scleral spur angle [SSA]) were evaluated in 32 eyes (16 patients). SPSS version 20 with paired t‑test for intragroup and Mann‑Whitney U value test for intergroup comparisons. It included 6 (37.5 %) males and 10 (62.5 %) females. Preoperative ACAof 34.6 ± 2.3° reduced to 32.2 ± 2.4°, 31.9 ± 2.5° at 1 and 3 months postoperatively (P = 0.001). Preoperative mean AOD500, AOD750, TISA500, TISA750, SSA of 0.34 ± 0.06 mm, 0.52 ± 0.15 mm, 0.09 ± 0.02 mm2, 0.20 ± 0.04 mm2, 34.27 ± 4.6° decreased to 0.32 ± 0.06 mm, 0.48 ± 0.15 mm, 0.08 ± 0.02 mm2, 0.17 ± 0.05 mm2,32.5 ± 4.3° at 1‑month (P = 0.001); 0.32 ± 0.06 mm, 0.47 ± 0.13 mm, 0.08 ± 0.02 mm2, 0.17 ± 0.05 mm2 and32.4 ± 4.6° (P = 0.001) at 3‑months, respectively. Correlation analysis between preoperative ACD/intraocular pressure (IOP) was − 0.62 (P = 0.0002) [1st month], −0.40 (0.024) [third month]; between IOP/postoperative ACA, AOD500, AOD750, TISA500, TISA750, SSA was − 0.04 (0.81), −0.03 (0.85), −0.08 (0.64), −0.12 (0.48),−0.10 (0.57), −0.06 (0.73) at 1 month; −0.09 (0.58), 0.04 (0.78), 0.12 (0.48), −0.02 (0.9), −0.04 (0.79), 0.02 (0.88) at 3 months; between ICL vault/ACA, AOD500, AOD750, TISA500, TISA750, SSA was 0.38 (0.02), 0.24 (0.17),0.21 (0.25), 0.05 (0.75), 0.15 (0.41), 0.27 (0.13) at 1st month; 0.19 (0.28), 0.06 (0.71), −0.03 (0.85), 0.005 (0.97),0.05 (0.78), 0.07 (0.68) at 3rd month. Postoperatively significant angle narrowing was noted. There was a negative correlation between IOP and preoperative ACD. There was no significant correlation between IOP and ICL vault with postoperative AS‑OCT angle parameters.

4 illus, 3 tables, 18 ref

039841   GUPTA N, DHASMANA R, MAITREYA A, BADAHUR H (Ophthalmology Dep, AIIMS, Rishikesh- 249 203, Uttarakhand, Email: neeti.oph@aiimsrishikesh.edu.in) : Glycerol-preserved corneal tissue in emergency corneal transplantation: An alternative for fresh corneal tissue in COVID-19 crisis. Indian J Ophthalmol 2020, 68(7), 1412-6.

Due to the COVID‑19 pandemic, most of the eye banks have limited/stopped corneal collection, as this is a highly contagious disease. This has led to shortage of donor corneas worldwide. Glycerol preservation of tissue remains a viable option in this scenario. The objective is to compare fresh corneal tissue (FCT) with glycerol‑preserved cornea (GPC) in emergency corneal transplantation. This was a retrospective cohort study conducted in a tertiary care centre of Uttarakhand. Medical records of the patients who underwent therapeutic penetrating keratoplasty (TPK) were reviewed. FCT group included patients who underwent TPK with fresh corneal tissue and GPC group included patients who underwent TPK with glycerol preserved cornea. The indications and outcomes of TPK in the terms of therapeutic success were analysed and compared between both the groups. A total of 94 eyes of 91 patients underwent TPK from October 2011 to August 2017. FCT group included 60 eyes of 57 patients and GPC group included 34 eyes of 34 patients. The primary indication of TPK was infectious keratitis in both the groups (FCT‑81.6 %; GPC ‑ 91.2 %) There was no significant difference in the therapeutic success in both the groups (P = 0.741, Odds ratio‑ 1.59 with 95 % CI‑ 0.39‑6.44). Complications included glaucoma (FCT‑21.7 %; GPC‑ 35.2 %) graft infection (FCT‑ 18.33 % GPC‑ 2.9 %); graft rejection (FCT‑11.66 %,GPC‑ 0 %); and graft failure (FCT‑88.33 %, GPC‑100 %). The GPC is comparable to FCTs in therapeutic transplant and can be a useful interim procedure in saving the eyes in cases of infective keratitis in the time of crisis.

2 illus, 5 tables, 21 ref

039837   DESHMUKH A V, BADAKERE A, SHETH J, BHATE M, KULKARNI S, KEKUNNAYA R (L V Prasad Eye Institute, Hyderabad, Telangana, Email: rameshak@lvpei.org) : Pivoting to teleconsultation for paediatric ophthalmology and strabismus: Our experience during COVID-19 times. Indian J Ophthalmol 2020, 68(7), 1387-91.

The objective is to analyse and report the data of teleconsultations provided to paediatricophthalmology and strabismus patients during COVID‑19 times and to elaborate our experience for guiding future teleconsultation practices to General, paediatric Ophthalmologists and Strabismologists. Retrospective analysis of electronic medical record data of teleconsultations provided in the department of Strabismus, Paediatric and Neuro‑ophthalmology was done. Patients with optic nerve related disorders were excluded. Study period was one month. Statistical analysis of collected data was done using Microsoft excel. A total of 198 patients were provided teleconsultations (an average of seven teleconsultations/day). The final analysis included 161 patients after excluding opticnerve related disorders. The median age was seven years. We had a near equal gender distribution (53 % males and 47 % females) of whom a third were new cases. Video calling was used in 14 %, review of clinical photos shared was used in 53 %. Rest of the 33 % were given telephonic advice. Allergic conjunctivitis (14 %), pseudophakia (9 %), strabismus (12 %), status post strabismus surgery (8 %), cranialnerve palsies (11 %) were common diagnoses. 19 % (n = 30) were advised/needed visit in emergency services on same or next day. Our experience of teleconsultation during COVID‑19 times for paediatric ophthalmology and strabismus patients was very encouraging. Pivoting teleconsultation platform can provide primary eye care to most of the patients and work as essential forward triage forrest. As we continue to further explore the currently available avenues in multimedia such as video conferencing and web/mobile based applications, we believe that tele‑ophthalmology platform can provide a reliable service in patient care.

4 illus,10 ref

039836   PANDEY N, SRIVASTAVA R M, KUMAR G, KATIYAR V, AGRAWAL S (Ophthalmology Dep, King George’s Medical Univ, Lucknow, Uttar Pradesh, Email: agrawalsiddharth@rediffmail.com) : Teleconsultation at a tertiary care government medical university during COVID-19 lockdown in India: A pilot study. Indian J Ophthalmol 2020, 68(7), 1381-4.

COVID‑19 related pan‑ India lockdown brought teleophthalmology to the forefront. The study ventures to understand the relevance of this modality in a government setup. The objective is to understand the feasibility, clinical profile and addressability of patients using teleconsultation in ophthalmology at atertiary care government medical university during the COVID‑19 Lockdown in India. An online survey targeting faculty members and resident doctors in a tertiary eye center in a government medical university in north India was conducted. Various aspects of teleconsultation were analyzed including the number and preferential mode of consultations, commonest complaints and diagnoses made. Frequency and factors mandating physical examination of patients was also analyzed. The questionnaire was sent to 40 ophthalmologists of whom 38 responded. A total of 4880 teleconsultations were given.The commonest mode of communication was by WhatsApp messages (65.6 %) and E‑mail was the least preferred medium. More than 80 % consultations were from previously seen patients. Red eye was the commonest presenting complaint (22.8 %), followed by watering (18.7 %) and foreign body sensation (14.5 %).Computer vision syndrome was the commonest diagnosis (25.9 %) followed by conjunctivitis (17.7 %) and refractive error (17.7 %). About 40 % required physical examination, mostly due to uncertain diagnosis (22 %)or inadequate response to prescribed treatment (19 %). Teleconsultation was feasible in a government medical university for providing ophthalmic services during lockdown. WhatsApp was the preferred communication modality, computer vision syndrome was the most frequent tentative diagnosis and approximately 60 % did not require in‑person physical examination.

4 illus,16 ref

039833   DUTT S, SIVARAMAN A, SAVOY F, RAJALAKSHMI R (Ophthalmology Dep, Dr. Mohan’s Diabetes Specialities Centre Madras Diabetes Research Foun, Chennai, Tamil Nadu, Email: drraj@drmohans.com) : Insights into the growing popularity of artificial intelligence in ophthalmology. Indian J Ophthalmol 2020, 68(7), 1339-46.

Artificial intelligence (AI) in healthcare is the use of computer‑algorithms in analyzing complex medical data to detect associations and provide diagnostic support outputs. AI and deep learning (DL) find obvious applications in fields like ophthalmology wherein huge amount of image‑based data need tobe analyzed; however, the outcomes related to image recognition are reasonably well‑defined. AI and DL have found important roles in ophthalmology in early screening and detection of conditions such asdiabetic retinopathy (DR), age‑related macular degeneration (ARMD), retinopathy of prematurity (ROP), glaucoma, and other ocular disorders, being successful in roads as far as early screening and diagnosis are concerned and appear promising with advantages of high‑screening accuracy, consistency, and scalability. AI algorithms need equally skilled man power, trained optometrists/ophthalmologists (annotators) to provide accurate ground truth for training the images. The basis of diagnoses made by AI algorithms is mechanical, and some amount of human intervention is necessary for further interpretations. This review was conducted after tracing the history of AI in ophthalmology across multiple research databases and aims to summarise the journey of AI in ophthalmology so far, making a close observation of most of the crucial studies conducted. This article further aims to highlight the potential impact of AI in ophthalmology, the pitfalls, and how to optimally use it to the maximum benefits of the ophthalmologists, the healthcare systems and the patients, alike.

1 illus, 4 tables, 38 ref

039832   MEHTA J N, KAMAT H, GANJIWALE J (KM Patel Institute of Physiotherapy, Karamsad, Gujarat, Email: jigarnm@charutarhealth.org) : Maximum inspiratory pressure of the patients after open-heart surgery following physiotherapy. Natl J Physiol Pharm Pharmac 2020, 10(2), 155-8.

After open-heart surgery, various complications require specific care, especially in the respiratory system. To reestablish it, several strategies should be used, such as respiratory muscle training, which aims to improve respiratory muscle strength, leading to a reduction in post-operative pulmonary complications in patients undergoing cardiac surgery. The objective of the study was to measure and compare maximum inspiratory pressure (MIP) in open heart surgery patients following conventional physiotherapy group and conventional physiotherapy plus inspiratory muscle training (IMT) group. The study was an experimental design and it was a prospective randomized control study where participants were taken from cardiac hospital using balance block computer-generated randomization method. Fifty participants were divided into two groups of 25 each. Group A received conventional physiotherapy and group B received conventional plus inspiratory muscle exercise (B) by pressure threshold IMT instrument. Physiotherapy treatment was delivered by qualified physiotherapy, twice a day preoperatively and after extubation, 4–5 sessions per day were given until they discharged. The pre-operative, at discharge, and at the 1st follow-up, patient MIP was measured. There was no statistically significant change in inspiratory muscle strength in patients exposed to an IMT program compared to the control group (P > 0.05).  There was no difference in MIP in conventional physiotherapy and conventional plus inspiratory muscle trainer group in “pre-operative,” “discharged,” and “1st follow-up” in open-heartsurgery patient.

1 illus, 3 tables, 15 ref

039831   JASANI K, PATEL N, HARKHANI J, RANA D A, MALHOTRA S D (Smt. Nathiba Hargovandas Lakhmichand Municipal Medical Coll, Ahmedabad, Gujarat, Email: devangandu@gmail.com) : Variability in digital blood pressure measurement and normal sphygmomanometer- A randomized study. Natl J Physiol Pharm Pharmac 2020, 10(2), 159-63.

Hypertension is one of the most common comorbidity across the whole world so its true measurement is important for its diagnosis as well as management. For diagnosis of estimating blood pressure (BP), the most common non-invasive modalities are manual mercury sphygmomanometer and digital BP monitor device. The objective of the study was to comparative evaluation between normal sphygmomanometer and digital BP instrument in normal healthy volunteers. The study begins after obtaining permission from the Institutional Ethics Committee. The written consent of the individual was obtained. Persons above 18 years of age, who gave their written consent and receiving anti hypertensive treatment, are included in the study. Persons having diabetes, severe hypertension, psychiatric disorders, and smoked before 30 min are excluded from the study. BP is measured according to JNC-8 criteria. The study was a cross-sectional observational study. A total of 102 individuals were analyzed age group accordingly. The data were analyzed by unpaired t-test for comparing BP measured by mercury and digital sphygmomanometer with a significance value set at P < 0.05 as significant. The comparison of each modality was done using an unpaired t-test and P values were found as follows: Systolic BP, P = 0.1856, and diastolic BP, P = 0.891. BP is one of the most common and must necessary medical procedure done in each and every person before any medical and surgical procedure. As there is no significant difference between digital and manual sphygmomanometer, so we can use digital as an alternative option of manual carefully as per need.

1 illus, 2 tables, 16 ref

039830   ARRTHY S, SARAVANAN S, ARKANSHU ATHA (Akash Institute of Medical Science and Research Centre, Bengaluru, Karnataka, Email: drs.arrthy@yahoo.com) : Association between cross-dominance and visual memory- A cross-sectional study. Natl J Physiol Pharm Pharmac 2020, 10(2), 164-7.

Ocular dominance plays an important role in visual memory. Although many studies are done to find the relationship between cross-dominance and their performance in sports, little was known about the effect of cross dominance in visual memory. The present study was aimed to find if there exists an association between cross-dominance and visual memory.  In this study, 40 above average subjects in the age group 18–30 years of both genders with cross-dominance is taken as study group and 40 above average subjects with complete lateral dominance who are age and sex matched is taken as control. A detailed history of the subjects was collected and they are subjected to complete ophthalmological and neurological examination to rule out any neurological deficits. Dominant eye was found using miles test and visual memory was evaluated using Benton’s visual retention test. In this study, it was found that though cross dominant subjects had less score than complete lateral dominant subjects, the difference is statistically insignificant. There is no significant difference in visual memory between the complete lateral dominance and cross dominant subjects.

1 illus, 2 tables, 14 ref

039829   JASANI K, JAIN P, PATEL D, PANDYA S, RANA D A, MALHOTRA S D (NHL Municipal Medical Coll, Ahmedabad, Gujarat, Email: devangandu@gmail.com) : Evaluation of drug use pattern and quality of life in patients suffering from rheumatoid arthritis- A cross-sectional study at a tertiary care teaching hospital. Natl J Physiol Pharm Pharmac 2020, 10(2), 168-72.

Rheumatoid arthritis (RA) is the most common autoimmune arthritis and it affects 1 % of the adult population in India. It is an inflammatory disease which leads to bilateral joint pain and swelling. The swelling destroys joints and results in permanent deformities like ankylosis. The objectives of this study were to study and evaluate the prescribing pattern in patients suffering from RA and to evaluate the quality of life (QoL) in RA patients. After getting permission from the Indian Council of Medical Research and Institutional Review Board, the study was started. Informed consent form of individual patient was obtained. All the patients of either sex attending rheumatology department and diagnosed with RA and receiving anti rheumatoid drugs for 1 month were matriculate in the study and patients suffering along with osteoarthritis, and the newly diagnosed patient was excluded from the study. A total of 50 patients were enrolled for the study which shows middle-aged people suffered more with female dominance and mostly used drug being methotrexate and hydroxychloroquine. RAQoL average being 17 which showed impaired QoL. Prescribing pattern in RA relied more on disease-modifying anti rheumatoid agents. Commonly used drugs were disease modifying anti rheumatoid agents. It was found that the majority of the cost is borne by the patient as there are few drugs available at the hospital pharmacy which can be given free. Polypharmacy was common, being the cost burden to the patients.

2 illus, 3 tables, 13 ref

039828   YADAV B S, VISHWAKARMA R K (Banaras Hindu Univ, Varanasi, Uttar Pradesh, Email: bhupendra.georgian@gmail.com) : Wearable and chest size-adjusted 12-lead electrode array system to record electrocardiogram: A novel design. Natl J Physiol Pharm Pharmac 2020, 10(2), 173-6.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. Majority of human loss caused due to cardiovascular issues can be saved if diagnosed early and treated appropriately. Electrocardiogram(ECG) is the basic screening tool for cardiac ailments. Cumbersome technique, inconvenience to the patients and lack of trained workforce to obtain record, makes ECG a challenge, especially at peripheral rural health centers. Making ECG recording simpler, available, and recordable by even untrained persons can help cardiac patients get timely screened for needful treatment. This study aims to design a wearable, 12-lead, electrode array system for ECG recording. Data of 250 adult men in the age group of 30–70 years were collected. We measure chest circumference and distance of points on chest wall from the midline (anterior chest wall), where chest lead electrodes need to be placed for ECG recording and correlated this value with the height, age, weight, and body mass index (BMI) of the subjects. The mean distances (± standard deviation) of the chest lead electrodes from the midline (cm) were 2.8 ± 0.39 (right to the midline), 2.8 ± 0.39, 6.09 ± 0.59, 11.81 ± 1.43, 20.43 ± 2.38, and 25.10 ± 2.10 for V₁, V₂, V₃, V₄,V₅, and V₆, respectively. This distance was significantly correlating with subject’s weight and BMI. BMI and body weight of the individuals, irrespective of their age, can be considered to design different size wearable electrode array system. A prototype of the chest size-adjusted electrode array system to record ECG is developed.

2 illus, 2 tables, 12 ref

039827   BANERJEE G, KUMAR R, BASU D, CHAKRABORTY S N, HANDSA K, MUNSHI B D (IQ City Medical Coll and Narayana Multispecialty Hospital, Durgapur, West Bengal, Email: dr.rakeshkr082@gmail.com) : Physical activity pattern and its impact on glycemic control among patients with type-2 diabetes mellitus attending an integrated diabetes and gestational diabetes clinic of Eastern India. Natl J Physiol Pharm Pharmac 2020, 10(2), 177-83.

India is popularly known as “world diabetes capital” and is presently home of about 72.9 million diabetes patients. Physical activity (PA) is defined as “Bodily movement produced by the contraction of skeletal muscle that requires energy expenditure in excess of resting energy expenditure” and exercise is defined as “A subset of PA: planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness. This study aims to assess the PA level of type 2 diabetes mellitus (T2DM) patients and its impact on their glycemic control attending integrated diabetes and gestational diabetes clinic (IDGDC) of a tertiary health-care facility of Eastern India. An institution-based, observational, cross-sectional study was conducted among 347 T2DM patients attending IDGDC from May 2019 to June 2019. Venous blood sample for glycated hemoglobin(HbA1c) estimation was collected and medical records were reviewed to collect data regarding clinic social data. Data were analyzed using the Statistical Package for the Social Sciences for Windows (version 20.0). All statistical tests were two tailed and P < 0.05 was considered statistically significant. About 50.0 % of male had good glycemic control and only 32.1 % of female had good glycemic control. About 34.9 % of the study population had high PA followed by 34.0 % and 31.1 % who had low and moderate PA, respectively. There is high frequency of poor glycemic controlas about 57.1 % of study populations had HbA1c >7.0 %. About three-fifth of the study population had either moderate or high PA.

1 illus, 2 tables, 40 ref

039826   CHANDRAKANTHA T, RAJESH B, NEHA K (Santhiram Medical Coll, Nandyal, Andhra Pradesh, Email: drrajeshb83@gmail.com) : Pattern of analgesic usage among post-operative patients in orthopedics department in a rural tertiary care hospital: A prospective study. Natl J Physiol Pharm Pharmac 2020, 10(2), 184-7.

To improve the therapeutic advantage and decrease the undesired effects, of drugs, the periodic evaluation of drug utilization pattern enables to make suitable and rational modification in the current prescribing trend. The objectives of the study were to evaluate the pattern of the usage of analgesics in post-operative pain management in the department of orthopedics. A prospective observational study was conducted for a period of 6 months by analyzing the case records of patients who have undergone surgery in the departments of orthopedics. The data regarding prescription of analgesics on the 0, 1^st, 2^nd, and 3^rd post-operative days, their dose, preferred route of administration, and mono/combined therapy were collected from case sheets. The data were analyzed and the results were presented using Microsoft Excel. Diclofenac, a non-opioid analgesic was prescribed commonly (75.4 % and 83.7 %) on day 0 and day 1 post-operative period, respectively, through parenteral routes. Tramadol (22.2 % and 15.4 %) was preferred among opioids. Aceclofenac and paracetamol combination through oral route was preferred for multidrug therapy. Oral route of drug administration was preferred from the 2^nd post-operative day onward. Monotherapy was employed during early post-operative period and multidrug therapy on days 2 and 3 during the post-operative period. Generic drugs were prescribed to only 12.06 %. Post-operative pain can be managed by non-opioid analgesics such as diclofenac as a monotherapy and combination with opioids such as tramadol can be used for patients not responding well to diclofenac alone. Drugs should be ideally prescribed by generic names.

1 illus, 6 tables, 18 ref

039825   VISHWAKARMA R K, YADAV B S (Banaras Hindu Univ, Varanasi, Uttar Pradesh, Email: bhupendra.georgian@gmail.com) : Physiological variations in nerve conduction velocity does not follow diurnal trend. Natl J Physiol Pharm Pharmac 2020, 10(2), 188-93.

Nerve conduction studies (NCSs) are performed for diagnosis and prognosis of disorders of the peripheral nervous system. Most physiological parameters show diurnal fluctuations. The time at which nerve conduction velocity(NCV) is performed may influence the recorded values if there are diurnal variations in NCV. Diurnal variations in NCV have not been studied in detail and there is a paucity of literature for the same. This study aims to investigate the diurnal variations in ulnar motor NCV (MNCV). NCSs were performed on 89 healthy volunteers (76 males and 13 females) of age range from 18 to 22 years. The mean age, height, weight, and body mass index of our study group were 20.68 ± 1.77 years, 168.02 ± 8.03 cm, 59.57 ± 10.31 kg, and 21.11 ± 3.11 kg/m², respectively. Motor NCSs for ulnar nerve revealed no statistically significant diurnal variation in either limb. MNCV was also found to be similar for both genders. Increasing height of the subjects was associated with decrease in MNCV for ulnar nerve while raised pulse rates were found associated with increasing MNCVs. Our study suggests that there is no significant diurnal variation in ulnar MNCVs.

6 illus, 2 tables, 18 ref

039824   WANKHEDE S G, UDHAN V D, SHINDE P (NAMO Medical Education and Research Institute, Dadra and Nagar Haveli, Email: vishnu.udhan@gmail.com) : Assessment of long-term yoga training as a complementary therapeutic measure for anxiety, depression, and psychological distress in healthy individuals. Natl J Physiol Pharm Pharmac 2020, 10(2), 99-103.

Sustained increase in disturbed psychological health is a global concern at present. Complementary therapies in addition to pharmacological interventions are frequently advised to prevent consequential systemic and psychological disorders. However, data pertaining to long-term yoga practice as a complementary therapeutic intervention in healthy adults with large sample size are least available, indicating the significant gap in the scientific literature. The present study aims to assess the usefulness of yoga as complementary measure for anxiety, depression, and psychological distress in healthy individuals. The pre- and post-interventional yoga interventional study was conducted on healthy individuals (n = 200) with age ranging from 30 to 50 years (mean age = 39.95 years). Yoga intervention was given for 6 months (1 h/day; 6 days/week). Baseline and post-interventional anxiety, depression, life satisfaction, loss of emotional control, general positive affect, emotional ties, psychological distress, and well-being scores were measured using a questionnaire-based mental health inventory-38. The data were collected in SPSS and analyzed using paired t-test. Significance was established at 5 % P-value. An intervention of yoga for 6 months caused highly significant (P < 0.0001) reduction in anxiety, depression, and psychological distress scores and improvement in the loss of emotional control, general positive affect, life satisfaction, and psychological well-being scores. Positive results indicate the usefulness of long-term yogic exercise modality as a complementary therapeutic intervention for anxiety, depression, and psychological distress in healthy individuals.

1 table, 29 ref

039823   DUTTA A, KUMAR A, KUMARI S (Vardhman Institute of Medical Sciences, Pawapuri, Bihar, Email: abhi83feb22@gmail.com) : Correlation between non-diabetic fasting blood glucose levels and 2-h post loading blood sugar levels with waist-to-height ratio in rural population of Malwa region of Central India. Natl J Physiol Pharm Pharmac 2020, 10(2), 104-8.

Prediabetes is a stage of glucose tolerance between normal glucose tolerance and diabetes and is characterized by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). The prevalence of diabetes and prediabetes is rapidly rising in India, in both urban and rural sectors. Obesity represents one of the major modifiable risk factors of the disease and waist-to-height ratio (WHtR) accounts as being one of the indicators of obesity and its association with IFG and IGT in nondiabetics needs to be studied. This study aims to assess if a correlation exists between IFG and IGT and W: Ht ratio in a non-diabetic population. A total of 150 subjects, over the age of 20 years from village Hatpiplia, district Dewas, Madhya Pradesh, who were not known cases of diabetes mellitus were evaluated. Anthropometric measurements included waist circumference (in cm) and height (in cm) and WHtR was calculated. Blood samples for fasting blood sugar and 2-h post-glucose blood sugar were taken and analyzed on fully automated analyzer MERCK Microlab 300 LX by enzymatic colorimetric method. The prevalence of IFG was found to be 18 % (95 % confidence interval [CI] 12.68–24.92) and 15.3 % (95 % CI 10.44–21.96) had IGT based on their 2-h post-glucose loading blood sugar levels. About 74 % of the subjects who had IFG and 69 % of the subjects with IGT were also found to have impaired WHtR. Moreover, more than 80 % of the patients with newly detect diabetes had an impaired WHtR. Prediabetes is a growing concern in rural India and if we aim to control the epidemic of diabetes then focus has to be directed toward the stage of IFG and IGT where awareness and lifestyle intervention programs need to implement at basic levels. There is a strong association between impaired WHtR and prediabetes marking it as a very important prognostic indicator in the occurrence of the disease.

3 tables, 26 ref

039822   PATEL U, JOSHI A S, GANJIWALE J, GANGULY B (Pramukhswami Medical Coll, Karamsad, Gujarat, Email: annuradhaj7@gmail.com) : Impact of antimicrobial stewardship program on prescribing pattern of cephalosporins in the department of surgery. Natl J Physiol Pharm Pharmac 2020, 10(2), 109-15.

Cephalosporins are one of the widely prescribed antibiotics in clinical settings. Despite several years of its use, little is known about their prescribing pattern, especially in reference to antimicrobial stewardship program(ASP). Evaluation of cephalosporin prescribing pattern, prior to and after implementation of ASP. This was an observational study on both prospective and retrospective data from surgery wards at a tertiary care teaching hospital. Data were collected from surgery case files and analyzed for demographic details, cephalosporin prescribing pattern, and its appropriateness in relation to ASP. Data were selected from a total of 300 surgery case files (n = 150 each of year 2012 and 2014). Overall, there were 68 % of male and 32 % of female patients.Cephalosporins were prescribed, generation wise, i.e., the 1st generation in 34.7 %, the 2nd in 1.3 %, the 3rd in 63.3 %, and the 4th in 0.7 %, in 2012, while in 2014, they were prescribed as follows: 55.3 % (1st), 0.7 % (2nd), 44 % (3rd), and 0.0%(4th). In 2012, various types of treatments were advocated consisting of cephalosporins, i.e., 73.3 % (prophylactic), 26.7 %(empirical), while none were rendered definitive treatment. In 2014, 91.3 % of patients were treated prophylactically, 6.7 %were treated empirically, and 2.0 % were on definitive therapy. About 77.3 % of patients were switched over from parental to oral in 2012 while 78 % in 2014. The data revealed significant impact of ASP (P < 0.05), in terms of appropriate prescribing of cephalosporin’s, i.e., 13.3 % in 2014 and 6.7 % in 2012, respectively. Successful implementation of ASP can improve antibiotic prescribing in clinical practice.

3 illus, 3 tables, 24 ref

039821   FAITH M, JARED S R, SELVAKUAR D, VYAS R (Christian Medical Coll, Vellore, Tamil Nadu, Email: silviyajared@cmcvellore.ac.in) : Application of horizontal integration module within traditional teaching to enhance active learning of first year allied health science students. Natl J Physiol Pharm Pharmac 2020, 10(2), 122-8.

Allied health science (AHS) courses in India include degree, diploma, and certificate courses in various disciplines that support the practice of medicine to make the health-care team function efficiently as they provide assistance in the laboratory, technical, and other support services. Many of the AHS courses have basic medical sciences that are taught in a compartmentalized manner as traditional method. However, horizontal integration module is not included for AHS. The objective of this study was to analyze the performance of the 1st year AHS students to the application of horizontal integration as a small module within traditional teaching in physiology. Thirty-three students underwent 12 lectures in physiology in the topic of “The Gastrointestinal Tract (GIT)” in a traditional teaching method of didactic lectures. The students then had an interactive 2-h horizontally integrated modular session on “Biochemical principles of diet-nutrition.” The interrelated topic from biochemistry and physiology was incorporated as horizontal integration. The students’ performance was assessed with a pre-test and post‑test, structured viva voce in diet-nutrition and a traditional viva voce in the traditionally taught GIT topic. The results showed that the post-test mark was higher than the pre-test mark; the performance of students who scored <60 % termed as average and below-average students with 50 %: Being cutoff for passing in health professions education in India improved in the structured viva voce in diet-nutrition when compared to traditional viva voce in GIT. We conclude this integrated module demonstrated enhanced learning performance of students with high scores in post-test, the better performance in the structured viva voce showing improved understanding and learning ability.

2 illus, 1 tables, 25 ref

039820   CHANDRA D B, KULKARNI S, DESAI H T (Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, Email: chandra.drdeepa@gmail.com) : Parametric correlation of arterial blood gas status with the duration of stay in hospital in cases of acute severe asthmatic children. Natl J Physiol Pharm Pharmac 2020, 10(2), 129-33.

Asthma is one of the common causes of chronic illness in early childhood having frequent admitting diagnosis in pediatric ward. It needs proper evaluation for their treatment and management. Determination of arterial blood gas (ABG) analysis plays important role as pulmonary function test; it is important laboratory test for critically ill asthmatic patients where acid-base status interpretation is needed for their hospital admission and proper management. The aims of the study were to assess the severity of disorders with the parameters of ABG report with their hospital stay of severe asthmatics pediatric patients during their acute exacerbations. A hospital-based prospective study conducted in forty-three severe acute bronchial asthmatic patients of 1–17 years done using automated ABG analyzer machine (COMBISYS-II), analysis of ABG report done using mean, median, and standard deviation. Their comparison with the dysfunction of ABG report with their hospital stay showed positive correlation. Our study supported the hypothesis of enhanced hospital stay with abnormal and mixed type of ABG report.

3 tables, 17 ref

039819   SHIVALEELA K, KUMAR M P (BKL Walawalkar Rural Medical Coll, Shimoga, Karnataka, Email: shilpa.kalshetty32@gmail.com) : Comparative study of efficacy of latanoprost (0.005 %) and dorzolamide (2 %), in primary open-angle glaucoma patients, as monotherapy. Natl J Physiol Pharm Pharmac 2020, 10(2), 134-40.

Glaucoma is the second most common cause of blindness worldwide and also in India and its prevalence is increasing. Raised intraocular pressure (IOP) is most important and directly related to development of primary open-angle glaucoma (POAG). Hence, the present study carried out to compare the efficacy between latanoprost and dorzolamide for reducing IOP in POAG as monotherapy. The objectives are as follows: (i) To compare the efficacy between topical latanoprost (0.005 %) and topical dorzolamide (2 %) in POAG as monotherapy, and (ii) to evaluate the adverse effects of latanoprost and dorzolamide. The present prospective, open-labeled study was conducted in 80 patients males and females which were selected randomly with POAG diagnosis and divided into two groups. One group received latanoprost (0.005 %) topical eye drops once a day and other group received dorzolamide (2 %) eye drops 3 times a day. All participants were followed up for three visits at 2 weeks, 4 weeks, and 8 weeks. Before starting on treatment baseline, IOP was recorded by Perkins Hand Held Tonometer. Again during each follow-up visit, IOP was recorded to know the response of drugs. The informed consent was taken from all patients and ethical clearance was taken from institution. The mean IOP reduction for latanoprost group was 9.5 ± 3.56 and dorzolamide group was 7.89 ± 3.56. Both drugs were effective in reducing IOP. The difference in IOP reduction between latanoprost and dorzolamide was statistically significant (P = 0.02). Both drugs were well tolerated during study period, maximum side effects seen in latanoprost group (n = 9) compared to dorzolamide group (n = 7). The present study concludes that both latanoprost (0.005 %) and dorzolamide (2 %) topical eye drops effectively reduce IOP in POAG. The latanoprost is more efficacious compared to dorzolamide in reducing IOP.

7 tables, 31 ref

039818   NANAWARE N L, GAVKARE A M (Maharashtra Institute of Medical Sciences and Research Medical Coll, Latur, Maharashtra, Email: drajaygavkare1998@gmail.com) : Impact of early clinical exposure to boost applicative aspects of learning in first MBBS physiology students. Natl J Physiol Pharm Pharmac 2020, 10(2), 141-3.

The primary objective of medical education is to prepare students for a lifetime of patient care. One of the key requisites of a curriculum is providing relevance to learning. Early clinical exposure (ECE) introduces some aspects of clinical and social contexts of patient care into the 1st year of undergraduate teaching program so as to provide a reference to basic science learning to understand applicative aspects of learning. The aims of the study were (i) to compare conventional lecture methods with ECE as a relevance to diagnosis, patient care, and treatment. (ii) To assess the development of attitude, ethics, and professionalism as integral to doctor-patient relationship. The study group consisted of 150 voluntary participants of 1st year MBBS 2019 batch. These students were arranged into two groups, Group A (ECE group) and Group B (non-ECE group). Group A was exposed to ECE method of teaching of 1 h session in the medicine outpatient department by faculty from the medicine department. Group B was exposed to same topic by traditional teaching method (didactic lecture) for 1 h session in the department of physiology. Both groups were assessed. Knowledge was tested by multiple-choice questions, skills were tested by objective structured practical examination, and attitudinal domain was tested by perception-based questionnaire using Likert scale. Performance of Group A (ECE group) students in terms of knowledge, skills, and attitude has been found to be statistically significant compared to group B (non-ECE group). From the present study, we found that ECE was a better T-L methodology than traditional teaching in medical students and will prepare students for a lifetime of patient care.

1 table, 13 ref

039817   VINAYAK A , KAVITHA RAJARATHNA , RAGHAVENDRA B S (Bangalore Medical Coll and Research Institute, Bengaluru, Karnataka, Email: vinayak6491@gmail.com) : Effect of clonidine as an add-on to fentanyl premedication on post-operative pain in patients undergoing spine surgeries: A randomized study. Natl J Physiol Pharm Pharmac 2020, 10(2), 144-8.

Effective post-operative pain (POP) management begins in the pre-operative period as analgesics administered before surgical incision prevent central sensitization to pain. Fentanyl is a potent synthetic opioid, a most commonly used pre-anesthetic medication. Clonidine is an alpha-2 adrenoceptor agonist, used as a pre-anesthetic medication due to its nonopiate antinociceptive property that provides analgesia in the post-operative period. The aims of the study were to study the effect of intravenous clonidine as an add-on to intravenous fentanyl premedication on POP inpatients undergoing spine surgeries. Forty patients of the American Society of Anesthesiologists status I and II, aged 18–60 years of either sex, undergoing elective spine surgeries were randomized into two groups to receive premedications 30 min before anesthetic induction. Group C received intravenous infusion of clonidine 1.5 mcg/kg over 10 min along with slow intravenous injection of fentanyl 1 mcg/kg. Group F received slow intravenous injection of fentanyl 1 mcg/kg alone. After completion of surgery, patients were shifted to the post-operative recovery ward and on attaining modified Ramsay sedation score of 1, pain was assessed and recorded using numerical rating scale (NRS). All the study participants completed the study and data were analyzed using per-protocol analysis. Baseline characteristics were comparable between the groups in terms of age, gender, body weight, and total duration of surgery. Sedation levels were found to be comparable between the groups. In Group C, all 20 patients had NRS score of either 4 or<4 and did not require rescue analgesia. In Group F, 8 patients had NRS score of more than 4 and required rescue analgesia. Absolute risk reduction was 40 % (P = 0.0014) and number needed to treat was 3. No adverse drug reactions were reportedfor the entire study period. Intravenous clonidine 1.5 mcg/kg as an add onto premedication with intravenous fentanyl 1 mcg/kg decreased POP thus reducing requirement of rescue analgesia in patients undergoing spine surgeries.

3 illus, 3 tables, 19 ref

039816   SHARMA M, JAIN N, RANGANATHAN S, SHARMA N, HONAVAR S G, SHARMA N, SACHDEV M S (Ophthalmology Dep, Tirupati Eye Centre, Noida- 201 301, Uttar Pradesh, Email: drmohita@tirupatieye.org) : Tele-ophthalmology: Need of the hour. Indian J Ophthalmol 2020, 68(7), 1328-38.

Telemedicine and tele‑ophthalmology have been in existence since many years, but have recently gained more importance in the present scenario of pandemic COVID‑19. The attitude and perception of the doctors and patients has been changing gradually. Telemedicine has many advantages including providing care ininaccesible areas.In the present scenario, tele‑ophthalmology gives an oppurtunity to patient for seeking consultation while also protecting against the contagion. There are many barriers faced by the patients and doctors that have restricted use of this technology in the past. However, with a systematic approachto designing the best suited technology, these barriers can be overcome and user friendly platforms canbe created. Furthermore, the demand and use of teleconsulation had increased presently in this area of pandemic. Recent survey conducted by the All India Ophthalmological Society also reveals that many ophthalmologists who have not used tele‑ophthalmology in the past are more keen to use it presently. In this article, we have reviewed telemedicine and tele‑ophthalmology literature on Google and PubMed to get a holistic idea towards teleconsultation, its advantages, increased importance and prefrence during COVID‑19 pandemic and various barriers faced so that the known challenges can be understood, which canpave way for better understanding and future incorporation into practice.

5 illus, 3 tables, 61 ref

039815   GOPALAKRISHNAN S, SUWALAL S C, BHASKARAN G, RAMAN R (Bio-Chemistry Dep, Sankara Nethralaya, Chennai- 600 006, Tamil Nadu, Email: rajivpgraman@gmail.com) : Use of augmented reality technology for improving visual acuity of individuals with low vision. Indian J Ophthalmol 2020, 68(6), 1136-42.

The objective of this study was to analyze the visual acuity improvement in patients with low vision using augmented reality device who presented to the low vision care (LVC) clinic at a tertiary eyecare center. A prospective study of 100 patients with low vision who were referred to the LVC clinic between July and December 2018 was done. Demographic data and visual acuity improvement assessed using augmented reality (AR) technology paired with Samsung Gear headset were documented. Out of 100 patients, 74 were male and 26 were female. The median age of the overall patients was 36 (25.5) years. In 100 patients, 21 % patients were found to have central field loss (CFL), 35 % patients have peripheral field loss (PFL), and 44 % patients were found to have overall blurred vision (OBV). Majority of the subjects with CFL (47 %) and OBV (37 %) has a moderate visual impairment and in PFL group (26 %), severe visual impairment was more. Cone dystrophy (9 %) was found to be the major cause of CFL group, retinitispigmentosa (22 %) in the case of PFL group, and optic atrophy (10 %) in the case of OBV group. The median distance visual acuity 0.9 log MAR improved to 0.2 log MAR (P < 0.0001) and median near visual acuity 0.4log MAR improved to 0.1 log MAR with a P value of < 0.0001 using AR device. The use of an AR device can help patients with low vision to improve their residual vision for better visual performance.

5 tables, 27 ref

039814   ALAM M S, NISHANTH S, RAMASUBRAMANIAN S, SWAMINATHAN M, MUKHERJEE B (Pediatric Ophthalmology and Strabismus Dep, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, Email: mshahidalam@gmail.com) : The rare phenomenon of Marcus-Gunn jaw winking without ptosis: Report of 14 cases and review of the literature. Indian J Ophthalmol 2020, 68(6), 1132-5.

To report a rare case series of 14 patients of the Marcus‑Gunn jaw‑winking phenomenon (MGJWP) without ptosis. This was a retrospective non interventional case series. The medical records of all patients diagnosed with MGJWP over the past 10 years were retrieved. Patients with documented evidence of absence of ptosis were segregated and analyzed for visual acuity, the severity of Marcus‑Gunn,the presence of squint and amblyopia, and the presence of other aberrant regenerations. A total of 207 patients were diagnosed with MGJWP, out of which 14 (6.76 %) patients had isolated MGJWP without blepharoptosis. The mean age of presentation was 9.5 years and males and females were equally affected. The left eye was involved more commonly (57.2 %) than the right eye. Twelve patients were congenital and two were presumed to be of traumatic origin. The most common refractive error in this cohort was astigmatism (10, 71.42 %), followed by hyperopia (5, 35.71 %). One patient had anisometropicamblyopia. Marcus‑Gunn was found to be mild (≤2 mm of lid excursion) in all cases. None of the patients had strabismus or any other aberrant innervations. None of the patients underwent surgery and did not develop ptosis or worsening or improvement of Marcus‑Gunn after a mean follow‑up period of 2.3 years. Isolated MGJWP in the absence of ptosis is a very rare entity and this is the largest series to date to report such an occurrence. All patients had a mild form of MGJWP with no intervention requiredin any of the cases.

2 illus, 1 table, 29 ref

039813   RAMAMURTHY L B, RANGARAJAN V, SRIRAO N, MALINI B, BANSAL R, YUVARAJAN K (Orbit and Oculoplasty Dep, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, Email: lakshmibr24@gmail.com) : Severity of thyroid eye disease and type-2 diabetes mellitus: Is there a correlation?. Indian J Ophthalmol 2020, 68(6), 1127-31.

To study the correlation between thyroid eye disease (TED) with type‑2 diabetes mellitus. A cross‑sectional cohort study was conducted from Jan 2018 to Dec 2018, in patients presenting with thyroid eye disease to orbit and oculoplasty clinic of a tertiary eye care hospital. A total of 105 patients were included in the study. All patients underwent detailed ophthalmic evaluation and thyroid eye disease workup. Patients were categorized into mild, moderate, and severe/sight‑threatening TED based on EUGOGO classification. Systemic history of diabetes was noted. RBS was done in all patients. Mild disease was noted 61 patients of which 11 were diabetics, moderate in 26 patients (8 diabetics), and severe disease in 18 patients (14 diabetics). All patients were treated accordingly. Among the TED patients, the percentage of diabetic patients was noted to be in increasing order toward the severity spectrum of TED.The prevalence of severe TED was found to be much higher in diabetic patients accounting upto 77.77 % of 18 patients. A statistically significant correlation was noted (P = 0.014) between severe TED and type‑2 diabetes mellitus. In addition, early onset of thyroid eye disease was noted in type‑2 diabetes patients. Even though female preponderance was noted, severe TED was more in men (66.6 %).  Anautoimmune etiology for the association of thyroid and type‑1 diabetes has been well established. This study shows that type‑2 diabetic patients can have more severity in the clinical presentation of TED. Therefore, the presence of type‑2 DM in patients with TED can be a predictive factor for onset, progression, and severity of disease. Hence, a high concern of interest among treating ophthalmologists and endocrinologists regarding this entity would help in early prediction and decreased morbidity among such patients.

4 illus, 4 tables, 16 ref

039812   SABHERWAL S, CHAKU D, MATHUR U, SANGWAN V S, MAJUMDAR A, GANDHI A, DUBEY S, SOOD I (Community Ophthalmology and Public Health Research Dep, Dr. Shroff’s Charity Eye Hospital, Daryaganj, New Delhi- 110 002, Email: shalinder.sabherwal@ sceh.net) : Are High-Efficiency Particulate Air (HEPA) filters and laminar air flow necessary in operating rooms to control acute post-operative endophthalmitis?. Indian J Ophthalmol 2020, 68(6), 1120-5.

To compare the five‑year incidence of acute post‑operative endophthalmitis following cataracts urgery, between centers with and without laminar air flow and high-efficiency particulate air (HEPA)filters in operating rooms. Retrospective analysis of medical records of patients operated in a single network of a tertiary and four secondary hospitals across north India. Cases of endophthalmitis were identified from the records between January 2013 and June 2018. Protocols and consumables were standardized across all hospitals. The only infrastructural difference being the presence of laminar air flow and high energy particulate air filters in operating rooms of the tertiary center. The type of surgery,along with the demographic and socio‑economic details, were captured and analyzed, using z‑test for proportions and logistic regression. Out of 88,297 cataract surgeries conducted, 36 cases ofendophthalmitis were reported. The incidence of endophthalmitis across the network was estimated to be 0.041 %, (95 % CI: 0.027 to 0.054). There was no statistically significant difference between the incidence of POE at the tertiary (0.042 %) and secondary centers (0.039 %). Certain risk factors for high endophthalmitis incidence were identified, namely patients undergoing small incision cataract surgery and belonging to lower socio‑economic status. However, for both factors the difference was not statistically significant. The five‑year incidence of acute post‑operative endophthalmitis in our network was found comparable to the best reported in literature. Incidence at secondary centers, without laminar air flow and high energy particulate air filters was found comparable to that in the tertiary center having these facilities.

4 tables, 33 ref