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   2020| January-June  | Volume 12 | Issue 1  
    Online since August 27, 2020

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A prospective evaluation of ocular toxicity in patients receiving ethambutol as anti-tubercular therapy
Sabyasachi Bandyopadhyay, Sambit Banerjee, Samir Kumar Bandyopadhyay, MC Shamantha, Saikat Biswas
January-June 2020, 12(1):12-16
Purpose: The purpose of this study was to detect the early ocular toxicity of ethambutol in tuberculosis patients. Materials and Methods: This was a prospective, nonrandomized noncomparative cross-sectional cohort study of consecutive 93 patients (186 eyes) getting anti-tubercular therapy, including ethambutol (15–20 mg/kg/day) along with isoniazid, rifampicin, and pyrazinamide. The duration of the study was 1 year from June 1, 2018 to May 31, 2019. Best-corrected visual acuity (BCVA), color vision, visual field, contrast sensitivity, pattern-reversal visual evoked responses (VER), and retinal nerve fiber layer (RNFL) thickness measurements were done in both eyes of each patient at baseline and thereafter at 1st, 2nd, and 6th months of therapy. Results: Mean age of the patients was 29.38 ± 8.43 years (range 11–58 years). Among them, 53 were male and 40 were female. All the visual parameters were normal at baseline and 1st month of therapy. Mean BCVA was significantly decreased at the 2nd month but improved at the 6th month. In the 2nd month of treatment, abnormal color vision was detected in 8 patients (16 eyes; 8.6%). Three patients developed bilateral central scotoma, which persisted in two patients even after 6 months of follow-up. The mean latency in VER was significantly increased from baseline at 2nd and 6th months of therapy. The mean contrast sensitivity in both eyes was significantly decreased from baseline at the 2nd month of therapy but improved at 6th month. Mean temporal RNFL thickness was significantly reduced from baseline assessment after 2 and 6 months of treatment. Conclusion: The assessment of BCVA, Colour vision, Visual field, Contrast sensitivity, VER, and RNFL thickness measurements are essential at baseline and thereafter at monthly intervals to detect early ocular ethambutol toxicity.
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Study of Glaucoma s prevalence in Atbara locality, Sudan, from 2009 to 2016
Mussa Atif Mohammed, Hakim Maha Hamdi Haj
January-June 2020, 12(1):1-6
Context: Sudan is one of the largest countries in Africa with about 40 million people. Glaucoma is the second cause of blindness, responsible for 15% of blindness in Africa. Black-skinned peoples have the greatest prevalence of glaucoma. Aims: To reflect the prevalence and epidemiology of glaucoma to help decision-makers to develop the appropriate ophthalmic health strategic plan. Settings and Design: Retrospective study of the recorded data about glaucoma in Atbara Locality, Sudan, from 2009 to 2016. Subjects and Methods: Electronic and hard copy records of the Ministry of Health and its facilities, in Atbara locality, were collected and entered into SPSS version 23 (IBM SPSS Corporation., NY, USA) and were analyzed and interpreted. Statistical Analysis Used: The statistical tools that were used to analysis and interpret the data are the prevalence, ratio, percentages, and cross tabulation and the Chi-square statistics (P value used to indicate the significant of the different results). Results: The total number of glaucoma patients per year ranges from 717 to 2696 with a mean ± standard deviation of 1878 ± 643.39. The percentage of all glaucoma patients among the total population in Atbara locality per year ranges from 0.49% to 1.97% with an average of 1.34%. However, in those who aged 45 years and more, the percentage ranges from 3.58% to 17.13% with an average of 10.89%, which is higher than many population-based studies. The prevalence of glaucoma is increasing with age and more females were affected than males. Conclusions: Glaucoma was found to be more in Atbara locality than many other regions worldwide, so it needs more awareness, care, and a high priority in any sight-saving programs.
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Higher-order aberrations in keratoconus suspect
Engy Mohamed Mostafa, Mariam Vector, Ismail Moussa, Mohamed Anber
January-June 2020, 12(1):7-11
Purpose: The aim of this study was to assess the pattern of higher-order aberrations (HOAs) in keratoconus suspect (KCS) eyes using Scheimpflug–Placido topography (Sirius, CSO, Italy) and also to detect the sensitivity and specificity of all parameters to discriminate subclinical keratoconus (KC), and normal eye was investigated. Patients and Methods: This was a retrospective, cross-sectional study of 100 eyes of KCS patients along with 50 normal eyes as a control group. The following parameters were evaluated: sphere, cylinder, spherical equivalent, flat and steep keratometry (K), mean K, total root mean square (RMS), RMS coma, RMS spherical aberration, and anterior and posterior corneal elevation in the most curved part of the cornea. All eyes underwent Sirius Scheimpflug–Placido topography evaluation. Results: The KCS group showed significantly higher values for cylinder, mean flat, steep, and mean keratometry (K) compared to the control group. There were statistically significant differences in all aberrometric parameters in KCS compared with the control group except for spherical aberration. The optimum cutoff point and area under receiver operating characteristic curve of both RMS and elevation (anterior and posterior) achieved larger than 90% in both sensitivity and specificity. Conclusion: HOAs and corneal elevation (anterior and posterior) of the most curved part of the cornea proved to be able to distinguish KCS from the normal control group. Higher amounts of vertical coma and larger values of coma-like RMS have been found in patients with suspect KC when compared to normal corneas.
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Evaluation of role of ophthalmic ultrasonography in ophthalmic examination precataract surgery
Raghda F Mutwaly, Yazan S Gammoh, Mustafa Abdu
January-June 2020, 12(1):23-26
Aim: The aim of this study is to determine the importance of ophthalmic ultrasonography in investigation before cataract surgery, with a view to identify common posterior segment lesions in elderly patients. Subjects and Methods: A cross-sectional prospective study was conducted at AlNeelain University Eye Hospital, Khartoum, Sudan, on 220 eyes of 220 elderly patients (50–90 years) with senile cataract in one eye in the period from January to September 2018. Grade of cataract was evaluated using the slit-lamp examination. A-scan biometry and B-scan ultrasonography were taken before cataract surgery using Echo Scan (Nidek, US-4000). High gain (80–120 dB) and medium gain (50–70 dB) sensitivity were used. Dynamic B-scan was used to enhance differential diagnosis in cases with vitreous changes. Results: The mean age of the sample was 60.46 ± 10.64 years with 120 males and 100 females. Grade of cataract reported was as follows: 40% Grade II, 50% Grade III, and 10% Grade IV. Visual acuity (VA) had a negative correlation with grade of cataract (P < 0.001). All patients had visual impairment before cataract surgery with a mean VA of 0.10 ± 0.17. Posterior lesions detected were as follows: Asteroid hyalosis (22.73%), vitreous haemorrhage (10%), posterior staphyloma (7.27%), posterior vitreous detachment (6.36%), retinal detachment and retinoschisis (4.55% each), and ciliary body tumor (1.82%). Conclusion: Most common posterior segment lesion found in elderly patients is asteroid hyalosis, while ciliary body tumor is the only neoplastic lesion found. Ophthalmic ultrasonography is essential for the detection of undetected posterior segment lesions in eyes with dense cataract and is recommended to be done routinely before cataract surgery.
  1,229 114 -
Superior sagittal sinus thrombosis presenting as diplopia in pregnancy
Sucheta Parija, Aparajita Banerjee, Suprava Naik
January-June 2020, 12(1):27-29
Cerebral sagittal sinus thrombosis is a very rare condition and presents as diagnostic challenge due to its varied presentations. Most common signs and symptoms are headache, blurring of vision, diplopia, and papilledema. Pregnancy and puerperium constitute one of its rare etiological factors. A high index of clinical suspicion of the disease is important when a pregnant female presents with stroke like symptoms of headache, hemiparesis, diplopia, and seizures in the early stages of pregnancy because early neuroimaging can clinch the diagnosis. Management with adequate dosage of anticoagulants can be life-saving and can prevent severe visual loss. Here, we report and discuss the presentation and management of a case of cerebral superior sagittal sinus thrombosis presenting as diplopia in a young primigravid in the first trimester of pregnancy.
  1,065 106 -
Prospective analysis of optic nerve head parameters before and after trabeculectomy at a tertiary institute of the Himalayan foothills (optical coherence tomography-based study)
Yashpal Sharma, Vinod Sharma, Ram Lal Sharma, Mohan Lal Pandey, Kalpana Sharma
January-June 2020, 12(1):17-22
Introduction: Glaucoma is a group of acute and chronic, progressive, multifactorial optic neuropathies in which intraocular pressure (IOP) and other contributing factors are responsible for a characteristic, acquired loss of retinal ganglion cell axons leading to atrophy of the optic nerve. Early detection of glaucoma through the use of optical coherence tomography (OCT) and perimetry and intervention through trabeculectomy in patients showing deterioration can avoid further damage to vision. Objective: The objective of the study was to analyze the optic nerve head (ONH) pParameters before and after trabeculectomy. Materials and Methods: This study was to prospectively study ONH before and after trabeculectomy using OCT in primary open-angle glaucoma in patients attending the Department of Ophthalmology, Indira Gandhi Medical College, Shimla. Results: The IOP decreased from 26.93 ± 2.786 mm to 11.81 ± 3.552mm Hg (P < 0.05) in the 3rd month. The rim area preoperatively was 0.5037 ± 0.27646 and at 3 months postoperatively was 0.6707 ± 0.29319 (P = 0.008), which was statistically significant. The mean value of rim volume preoperatively was 0.0463 ± 0.01904 and at 3 months was 0.0630 ± 0.0336 (P = 0.036), showing statistical significance. The preoperative cup area was 2.064 ± 0.5043, and at the 3rd month, it was 1.9393 ± 0.58619 (P = 0.027), showing statistical significance. The mean value of cup volume preoperatively was 0.6981 ± 0.33874 and at 3-month postoperative was 0.5933 ± 0.31274 (P = 0.000). Cup volume also showed a significant improvement postoperatively. Conclusion: ONH changes, being the physical manifestations of the IOP force distribution in the tissues, are essential to glaucoma pathophysiology. The early detection of glaucoma through the use of OCT and intervention through trabeculectomy in patients showing deterioration (progressive patients) can avoid further damage to the vision.
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Posterior scleritis: Cause of diagnostic confusion
Abdi Rhizlane, Chariba Siham, Maadan Asmae, Sekhsoukh Rachid
January-June 2020, 12(1):30-32
Posterior scleritis can occur in isolation or concomitantly with anterior scleritis. Some investigators include posterior scleritis as an anterior variant of inflammatory pseudotumor. The main clinical manifestations are pain, exophthalmia, decreased visual acuity, and occasionally, restricted ocular motility. Choroidal folds, exudative retinal detachment, papillary edema, and angle-closure glaucoma secondary to choroidal thickening may be observed. The diagnosis can be missed in the absence of associated anterior scleritis. Demonstration of thickened posterior sclera by echography, computed tomographic scan, or magnetic resonance imaging may be helpful in establishing the diagnosis. Often, no related systemic disease can be found in patients with posterior scleritis.
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Corneal fistula in a phthisical eye: Presentation and management
Siddharth Madan, Rajiv Garg
January-June 2020, 12(1):33-34
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