Praveen Kumar K V

Abstract

Introduction: Elevated levels of VEGF is implicated in the pathogenesis of ocular neovascular diseases such as exudative age-related macular degeneration, proliferative diabetic retinopathy, diabetic macular edema, central and branch retinal vein occlusion, neovascular glaucoma, and retinopathy of prematurity. Bevacizumab a full- length humanized murine monoclonal antibody is being used as an off-label drug in the treatment of above disorders. When administered intravitreally, bevacizumab may have a therapeutic effect in the uninjected fellow eye. The objective of the present study is to determine the effects in the untreated fellow eye of intravitreal bevacizumab after a single dose in the contralateral affected eye in patients with similar retinal pathology. Materials and Methods: The study was a non-randomized, interventional prospective study. Thirty consecutive patients with similar retinal pathologies in both the eyes were enrolled. All patients in the study underwent a  detailed ophthalmic examination including a dilated fundus examination. All patients underwent fundus fluorescein angiography and optical coherence tomography of macula. All suitable patients identified were given intravitreal injections of 1.25 mg bevacizumab. The eye to be injected was selected based on the severity of pathology, affecting the macular status, as depicted by the clinical picture, visual acuity, OCT and FFA. The injections were given under topical anaesthesia. Patients were subsequently followed up on day 2, day 7 and day 21. After 4 weeks FFA and OCT were repeated. The results were tabulated and statistical analysis was done. Results: The study included 30 eyes of 30 patients with similar retinal pathology in both the eyes the mean age of patients was 64 yrs. 10 eyes had AMD, 9 eyes had PDR, 5 eyes had CNVM, 3 eyes had CME, 2 eyes had myopic CNVM, 1 eye had CRVO. The mean visual acuity at presentation in the uninjected fellow eye was 0.69 ± 0.41 log MAR units. All patients received atleast one intravitreal injection of bevacizumab 1.25mg in one of the affected eyes and the response was observed in the fellow eye. Among the 30 patients who received injection, 29(72.5%) patients showed some improvement in visual acuity chart after the first injection in the fellow eye and in 11(27.5%) patients vision remained same. The initial improvement was seen within one week in most patients. The mean central macular thickness in the fellow eye on OCT at baseline 515.64 + 1. Keywords: Bevacizumab, CRVO, PDR.

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Abstract

Introduction: Several local and systemic disorders predispose to the development of dry eye disease, common among them being diabetes mellitus. This study aims to assess the incidence of dry eye in diabetics and analyse the factors worsening dry eye in these patients. Materials and Methods: A total of 200 patients were included in the study. The participants were grouped under two groups- diabetics and non- diabetics group (control). All patients underwent a thorough ophthalmic examination including visual acuity, slit lamp biomicroscopy of anterior segment. Corneal sensation, tear film break up time, schirmers test, flourescein staining, Rose Bengal and lissamine green staining were also done. Results: Four hundred eyes of two hundred patients were included. There were a total of 86 (43%) males and 114 (57%) females in the study. The mean age of males was 50.13 years and the mean age of females was 50.27 years. In diabetics, 38 eyes (19%) had dry eye, out of which 24 eyes (63.15) were outdoor workers and 14 eyes (36.84%) were indoor workers and in non-diabetics, 14 eyes (7%) had dry eye out of which 12 eyes (85.71%) were of outdoor workers and 2 eyes (14.28%) were of indoor workers. Outdoor workers had statistically significant high risk of developing dry eye compared to indoor workers. Out of 52eyes with dry eye, 23 (88.46%) out of the 26 affected individuals were above 50 years of age and 3 (11.53%) were below 50 years of age. TBUT test was positive in 18 eyes (9%) in non-diabetics and 38 eyes (19%) in diabetic group. The schirmers values were significantly lower in diabetics compared to non-diabetics. Conclusion: Diabetic patients are at more risk of developing dry eye compared to controls. Keywords: Diabetes mellitus, Dry eye, Schirmers test.

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Introduction: Cognitive impairment may be present at birth or can occur later in adulthood. Few studies have shown correlation of cognition with retinal nerve fiber layer thickness (RNFL). The present study was planned to analyse RNFL thickness in disorders of cognition. Materials and Methods: 60 eyes of cognitive impairment were included. All patients underwent RNFL thickness measurement by OCT at initial visit and after 3 months. Statistical analysis was done with a p value less than 0.05 to be significant. Results: 60 eyes of cases of cognitive impairment were included. 16 (53%) cases had cognitive impairment following traumatic brain injury and 14 (47%) cases were secondary to Alzheimer’s disease. The mean RNFL thickness in the superior quadrant was 105.92 µm ±28.343µm at initial visit and at 3 months follow up was 105.72 µm±27.916 µm, in the nasal quadrant was 69.17 µm ± 13.199µm at initial visit and at 3 months follow up was 68.97 µm± 13.119 µm, in the inferior quadrant RNFL thickness was 111.03 µm±22.558 µmat initial visit and at 3 months follow up was 110.92 µm±22.372 µm, in the temporal quadrant was 59.35 µm ±11.333 µm at initial visit and at 3 months follow up was 59.18 µm ±11.247 µm but the difference was not statistically significant. Subgroup analysis of cases also did not show any statistically significant difference in RNFL thickness. Conclusion: RNFL thickness remains unaffected in cognitive disorders. However studies on a large sample of patients with a longer follow up are needed. Keywords: Cognitive impairment, RNFL thickness, Optical coherence tomography.

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