|Year : 2020 | Volume
| Issue : 1 | Page : 59-60
Niranjan Karthik Senthil Kumar, Sharmila Devi Vadivelu
Department of Ophthalmology, RIO GOH, Chennai, Tamil Nadu, India
|Date of Submission||31-Jan-2020|
|Date of Acceptance||03-Feb-2020|
|Date of Web Publication||04-Mar-2020|
Dr. Niranjan Karthik Senthil Kumar
F3, Godavari Apartments, No 30, Sannadhi Street, Ganapathipuram, Chrompet, Chennai - 600 044, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Senthil Kumar NK, Vadivelu SD. Journal scan. TNOA J Ophthalmic Sci Res 2020;58:59-60
| Tuck-In Tenon Patch Graft in Corneal Perforation|| |
Sharma N, Singhal D, Maharana PK, Vajpayee RB. Tuck-in tenon patch graft in corneal perforation. Cornea 2019;38:951-4.
Purpose:The purpose of this study is to describe the outcomes of tuck-in tenon patch graft (TPG) in the management of corneal perforation up to 5 mm size. Methods: Thirty-one cases of sterile corneal perforation (3–5 mm) underwent autologous TPG. The technique included freshening of the edges, measuring the size of the defect, creating a 360° stromal pocket around the perforation margin, harvesting the tenon graft followed by tucking into the stromal pocket, and application of cyanoacrylate glue or suturing the graft using 10-0 monofilament nylon suture. The main outcome measure was the rate of healing (percentage of cases healed). Results: The mean age was 52.3 ± 8.9 years, with 22 male and 9 female patients. The various etiologies of corneal perforation included trauma (n = 10), neurotrophic keratitis (n = 11), and peripheral ulcerative keratitis (n = 10). The mean size of corneal perforation was 4.2 ± 0.6 mm (range 3–5 mm). The mean duration of epithelial healing was 25.7 ± 6.7 days. Best-corrected visual acuity improved from 1.8 ± 0.4 to 1.2 ± 0.4 logarithm of the minimum angle of resolution units at 4 weeks after surgery (P ≤ 0.01). Twenty-seven (87.1%) cases healed with the formation of the leucomatous scar at 16.9 ± 2.7 weeks, whereas four cases had a flat anterior chamber. In three-fourths of the cases, a corneal graft was performed. In one case, graft resuturing was performed for postoperative aqueous leak, which healed with the formation of a corneo-iridic scar.
Take clinic message
With the restoration of globe integrity and allowing healing of the defect while still maintaining the viability of cornea for future transplantation, TPG proves to be a safe, simple, inexpensive, and effective technique for the management of corneal perforations. Various advantages, including the autologous nature of the graft, cost-effectiveness, and easy availability, make it an ideal choice for the indication.
| Lacrimal Sac Rhinosporidiosis: Clinical Profile and Surgical Management by Modified Dacryocystorhinostomy|| |
Nuruddin M, Mudhar HS, Osmani M, Roy SR. Lacrimal sac rhinosporidiosis: Clinical profile and surgical management by modified dacryocystorhinostomy. Orbit 2014;33:29-32.
Purpose: The purpose of this study is to describe the clinical profile and surgical management of patients with lacrimal sac rhinosporidiosis. Methods: This is a retrospective, interventional case series. Eighteen patients, who were clinically diagnosed with isolated lacrimal sac rhinosporidiosis between October 2009 and January 2012, were included in this study. Detailed history, including whether there was exposure to stagnant bathing water, was noted. All patients underwent modified dacryocystorhinostomy (DCR) under general anesthesia. Results: Out of 18 patients, 14 were male and 4 were female. Rhinosporidiosis was more prevalent in the age group of 25–34 years. The most common clinical presentation was a doughy swelling over the lacrimal sac area, present in all cases. Twelve patients (66.67%) had a history of bathing in stagnant water. After a modified DCR operation, all patients were followed for 1 year, and only two patients had a recurrence of their disease.
Take clinic message
On encountering a doughy swelling over the lacrimal sac area, a strong suspicion of lacrimal sac rhinosporidiosis is crucial. It emphasizes the importance of eliciting a history of bathing in stagnant water to rule out the source. Modified DCR is an excellent treatment option in such a case. The use of povidone-iodine plays a vital role in preventing the recurrence of the disease.
| Incidence, Demographics, Types, and Risk Factors of Dry Eye Disease in India: Electronic Medical Records Driven Big Data Analytics Report I|| |
Donthineni PR, Kammari P, Shanbhag SS, Singh V, Das AV, Basu S. Incidence, demographics, types, and risk factors of dry eye disease in India: Electronic medical records driven big data analytics report I. Ocul Surf 2019;17:250-6.
Purpose: The purpose of this study is to describe the incidence, demographics, types, and risk factors of dry eye disease (DED) in patients presenting to a multi-tier ophthalmology hospital network in India. Methods: This was an observational, hospital-based study of 1,458,830 new patients presenting between 2010 and 2018. Patients with a recent onset of both symptoms and signs, as defined by the Tear Film and Ocular Surface Society Dry Eye Workshop II guidelines, were considered as DED participants. The data were prospectively collected using an electronic medical record system. Multiple logistic regression with odds ratio (OR) estimation was performed to identify the high-risk factors of DED. Results: Overall, 21,290 (1.46%) patients were diagnosed with recent-onset DED. The incidence of DED was 2688 and 16,482/million population in children and adults, respectively (P < 0.0001). While the incidence was significantly greater in males in the third, fourth, ninth, and tenth decades (P < 0.03), it was greater in females in the 5th and 6th decades (P < 0.0001) of life. Classified etiologically 35.5%, 20.6%, and 39.9% of patients had evaporative, aqueous deficient, and mixed type of DED, respectively. Age (OR: 3.7–13.5), urban residence (OR: 1.6), professional work (OR: 1.5), homemaking (OR: 1.42), retirement/unemployment (OR: 1.24), and socioeconomic affluence (OR: 1.6–3.2) were identified as the high-risk factors for developing DED.
Take clinic message
While higher middle age group in their fifth decade of life are affected predominantly, it is interesting to note the gender-based difference in the peaking of incidence among men and women in different decades. Predominant involvement of the urban population and those belonging to higher economic strata with increased involvement among homemakers is a pattern worth noting. With a big proportion of the Indian population entering the aging category, it is crucial to deal with this issue of high priority giving special attention to the high-risk population.
| Reversibility of Dry Eye Deceleration After Topical Cyclosporine 0.05% Withdrawal|| |
Rao SN. Reversibility of dry eye deceleration after topical cyclosporine 0.05% withdrawal. J Ocul Pharmacol Ther 2011;27:603-9.
Purpose: The purpose of this study is to assess the reversibility of clinical benefits of cyclosporine (Cs) 0.05% (Restasis; Allergan, Inc., Irvine, CA, USA) therapy and the therapeutic gain after its delayed use by switching treatment modalities in patients with dry eyes who completed a 1-year course of therapy with artificial tears (Ats) (Refresh Endura; Allergan, Inc., Irvine, CA, USA) or Cs 0.05%. Methods: This was a single-center, prospective, investigator-masked, longitudinal extension trial. Patients who had been treated with Cs 0.05% in the 1st year of study were randomized in a 2:1 ratio to either Cs 0.05% (Cs–Cs; n = 20) or Ats (Cs–At; n = 8), and those who had been originally randomized to Ats were switched to Cs 0.05% (At–Cs; n = 20) in the 2nd year of study. Patients received study drugs twice daily for 12 months. Disease severity was assessed according to the International Task Force consensus guideline at months 0 and 12. Signs and symptoms were evaluated at baseline (month 0) and months 4, 8, and 12. Results: At baseline, most patients with Cs–Cs and Cs–At (>90%) had level 2 disease severity, whereas almost half of the patients with At–Cs had level 3 disease severity. At month 12, a statistically significantly higher percentage of patients with Cs–Cs and At–Cs than patients with Cs–At had the same or lower disease severity (P< 0.001), whereas half of patients with Cs–At, compared with patients with no Cs–Cs and At–Cs, had disease progression at month 12. Throughout the study, dry eye signs and symptoms continuously improved in patients with Cs–Cs and At–Cs, whereas they constantly worsened in patients with Cs–At. At month 12, patients with Cs–Cs and At–Cs had a statistically significantly greater mean percentage improvement from baseline than did patients with Cs–At in Schirmer test scores, tear breakup time, Oxford staining scores, Ocular Surface Disease Index scores, and conjunctival goblet cell density (P< 0.001). Overall, sign and symptom scores of patients with At–Cs did not improve as much as they did for patients with Cs–Cs.
Take clinic message
With the underlying pathology of DED, continues to be a problem unsolved, this study with such a large size of study population conducted in a tertiary care hospital emphasizes that early and timely initiation of cyclosporine therapy proves to be reliable in reducing the underlying cycles of inflammation and bring about an impact in the prognosis of the condition which has not been provided by artificial tears. It also has promising safety profiles in long term use in the form of maintenance therapy, which appears to be necessary for a chronic disease like DED.
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Conflicts of interest
There are no conflicts of interest.