Dheerendra Singh

Abstract

Background: The present study is aimed to assess the prevalence of steroid-induced glaucoma in vernal kerato-conjunctivitis patients treated with topical steroids and to determine the association between different types of topical steroids and the presence of steroid-induced glaucoma. Methodology: This study was conducted as a hospital-based cross-sectional study on patients belonging to the age range of 8 years to18 years who were already diagnosed with vernal kerato-conjunctivitis and were using topical steroids as treatment. Detailed clinical history and ophthalmologic examination were done. Depending upon the potency of steroids and their intra-ocular pressure raising potential, patients were categorized into one of the 4 groups (A, B, C, D). Results: Intra-ocular pressure levels were raised in 32.9% of the patients managed with topical corticosteroids. Steroid-induced glaucoma was observed in 15 (6.1%) of the patients with vernal kerato-conjunctivitis. Steroid-induced glaucoma was significantly associated with prolonged duration of corticosteroids and high potency corticosteroid use (p Conclusion: Steroid-induced glaucoma is one of the common complications of injudicious and long-term use of topical corticosteroids particularly high potency steroids. Approximately one-third of the patients on treatment for vernal kerato-conjunctivitis are corticosteroid responders. High potency steroids and prolonged use of steroids are factors associated with steroid-induced glaucoma.   Keywords: Steroid-induced glaucoma (SIG), Vernal kerato-conjunctivitis (VKC), Topical corticosteroids, Intra- ocular pressure (IOP), Potency, Duration

View Article

Abstract

Introduction: Traumatic optic neuropathy (TON) refers to an acute injury to the optic nerve secondary to ocular trauma. The study was conducted to evaluate the visual outcome in cases of TON and to study reversal of optic nerve function after emergency ophthalmic intervention. Objectives: To evaluate the visual outcome in cases of TON, study the factors affecting final visual outcome and to evaluate the optic nerve function in cases of TON. Methodology: The present study was a Prospective observational study, 49 patients presented after ocular trauma in the Department of Ophthalmology, Gandhi Medical College and Associated Hamidia Hospital, Bhopal during January 2018 to June 2019. A detailed history was taken and examination was done. Time since injury was noted and optic nerve functions were assessed using modes such as VEP, perimetry, color vision, contrast sensitivity and presence/absence of RAPD. Partcipants were subjected to CT scan of head to assess associated injuries. The patients were managed medically by giving 5 doses of IV methylprednisolone for five days with tapering oral tablet prednisolone and observed for 3 months of followup from the initiation of treatment. All the data entered in proforma and results obtained on the basis of variables were discussed. Results: Most common mode of injury was RTA 68.4%.VEP improved significantly following steroid. Visual recovery was observed in 37.1% patients. The present study observed statistically significant association of final visual outcome was observed with time elapsed between injury and treatment and associated skull/maxilla or orbital bone fractures. Conclusion: The pattern of visual recovery depends upon the visual acuity at presentation, type of injury, time elapsed between injury and initiation of treatment, associated skull or orbital fractures and patient compliance as better is the visual acuity at presentation, better is the visual recovery. Keywords: Optic nerve functions, Recovery, Traumatic optic neuropathy, Time elapsed, Visual outcome.

View Article

Abstract

Paediatric onset multiple sclerosis (POMS) patients usually present with a diminution of vision pertaining to optic neuritis and experience a more aggressive disease onset with disabling clinical symptoms, a polyfocal presentation at disease onset, and a higher relapse rate early in the disease course. We are reporting a unique presentation of bilateral ptosis with external ophthalmoplegia in a patient of a 17-year-old female patient who came with chief complaint of drooping of lids in both eyes for 3 years. Complete ophthalmic and systemic examination was done. Patient was diagnosed as MS according to the revised Mcdonald criteria and was given Methylprednisolone Pulse therapy. We concluded that acquired bilateral ptosis with ophthalmoplegia externa should be given special attention to rule out systemic associations. Timely diagnosis and early management of multiple sclerosis in the pediatric age group with DMT may reduce relapse frequency and functional disability.   Keywords: Paediatric Onset multiple sclerosis, POMS, Bilateral ptosis, Ophthamoplegia externa

View Article