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Balwir, Dhiraj

Correlation between Central Corneal Thickness and Intraocular Pressure among Normal IOP, Ocular Hypertensive and Primary Open Angle Glaucoma Patients

Abstract Views :231 | PDF Views:71

Authors

Mrunal Patil ¹, Dhiraj Balwir ², Hardik Jain ³

Affiliations
1 Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
3 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Source

MVP Journal of Medical Sciences, Vol 4, No 2 (2017), Pagination: 144-147

Abstract

Background: Glaucoma is an optic neuropathy characterized by a typical appearance of optic nerve head and characteristic visual field loss. The diagnosis of primary glaucoma, normal tension glaucoma and ocular hypertension is made on the basis of an IOP cut-off point of 21 mmHg. Thus, any factor that alters the value of the IOP can lead to a misclassification of the patient. There is a growing consensus that assessment of Central Corneal Thickness (CCT) has become an important element of the clinical evaluation of the glaucoma patient. This study intends to analyse the CCT trends amongst three study groups: Normal subjects; Primary Open Angle Glaucoma subjects; and Ocular Hypertension subjects. It also intends to explore the relationship between CCT and GAT IOP amongst the three study groups. Lastly, this study aims to evaluate if CCT can be used as a useful tool for prognostication of disease progression in ocular hypertensives, and for glaucoma diagnosis. Aims and Objective: 1. To study and compare the CCT amongst patients with Normal IOP, ocular hypertension and glaucoma. 2. To study and compare the correlation between CCT and IOP amongst patients with Normal IOP, ocular hypertension and glaucoma. Material and Methods: IOP was measured using Goldmann’s Applanation Tonometer and CCT was measured using the ultrasound pachymeter in 60 eyes of 30 normal subjects, 60 eyes of 30 glaucoma patients and 60 eyes of 30 ocular hypertensive patients. A correction factor based on the CCT was applied and corrected IOP values were calculated for the three cohorts. Analysis of Variance and Pearson Correlation Test was used to determine any significant difference in CCT, the correction factors and the CCT adjusted IOPs between the three groups. The study was conducted between November 2014 to November 2016. Results: There was a statistically significant difference in the mean CCT of the normals (554.38 + 17.67μm) as compared to the glaucomas (554.15 + 16.39μm) and ocular hypertensives (568.18 + 30.52 μm). Applying the described correction factor for corneal thickness, 40% of eyes with ocular hypertension were found to have a corrected IOP of 21mmHg or less. Conclusion: Increased corneal thickness in ocular hypertension may lead to an overestimation of IOP in 39% of cases. Measurement of central corneal thickness is advisable when the clinical findings do not correlate with the applanation IOP.

Keywords

Glaucoma, Ocular Hypertension, CCT, GAT, IOP.

Full Text

References

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Moses RA. The Goldman applanation tonometer. Am J Ophthalmol. 1958; 46:865–9. https://doi.org/10.1016/00029394(58)90998-X

Johnson M, Kass MA, Moses RA, Grodzki WJ. Increased corneal thickness simulating elevated intraocular pressure.Arch Ophthalmol. 1978; 96:664–5. https://doi.org/10.1001/ archopht.1978.03910050360012 PMid:646694

Hansen FK. A clinical study of the normal human corneal thickness. Acta Ophthalmol. 1971; 49:82–8.

Ehlers N, Bramsen T, Sperling S. Applanation tonometry and central corneal thickness. Acta Ophthalmol. 1975; 53:34–43. https://doi.org/10.1111/j.1755-3768.1975.tb01135.x

Herdon LW, Choudhri S A, Cox T, Damji KT, Shields MR, Allingham RR. Central corneal thickness in normal, glaucomatous and ocular hypertensive eyes. Arch Ophthalmol.1997; 115:1137–41. https://doi.org/10.1001/archopht.1997.01100160307007

Copt RP, Thomas R, Mermoud A. Corneal thickeness in ocular hypertension, primary open angle and normal pressure glancoma. Arch Ophthalmol. 1999; 117:14–6. https://doi.org/10.1001/archopht.117.1.14 PMid:9930155

Wolfs RCW, Klaver CCW, Vingerling JR, Grobbee DE, Hofman A, de Jong PT. Distribution of central corneal thickness and its association with intraocular pressure: The Rotterdam study. Am J Ophthalmol. 1997; 123:767–72.https://doi.org/10.1016/S0002-9394(14)71125-0

Bhuyan J, Borkotoky R. A comparative study on the Central Corneal Thickness (CCT) readings and Intraocular Pressure (IOP) changes in primary open angle glaucoma patients and age matched general population. Sch J App Med Sci. 2016; 4(3D):887–98.

Fibrin Glue Vs Vicryl (10-0) Suture in Limbo Conjunctival Autograft in the Management of Primary Pterygium : A Prospective Comparative Study

Abstract Views :198 | PDF Views:75

Authors

Kshitij Parekh ¹, Mrunal S. Patil ², Dhiraj Balwir ¹

Affiliations
1 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Source

MVP Journal of Medical Sciences, Vol 4, No 2 (2017), Pagination: 148-151

Abstract

Background: Pterygium is a wing shaped fibrovascular tissues proliferation from the conjunctiva on to the cornea. There is no satisfactory treatment for pterygium available yet. Among the available treatments, surgical treatment is better than medical treatment. Pterygium excision with graft placement is the preferred technique. Here, a comparative study is done between graft placement by suture and glue technique. Aims and Objective: To compare fibrin glue and suture technique for the treatment of pterygium in terms of: 1. operation time. 2. Post operative comfort level 3. Recurrence. Material and Methods: Total of 60 patients with primary pterygium, 30 in each group with fibrin glue -Group A and 10-0 vicryl suture -Group B were taken in the study. The study was conducted between august 2014 to September 2016. Results: Mean operating time was 30 minutes in fibrin glue group and 47 minutes in suture group.post operative comfort level was significantly different in second follow up recurrence rate was 0 in both group. Conclusion: Fibrin glue is a better technique in terms of operating time and post operative comfort level of the patient.

Keywords

Fibrin Glue, Pterygium, Suture Technique.

Full Text

References

Zaky KS, Khalifa YM. Efficacy of preoperative injection versus intraoperative application of mitomycin in recurrent pterygium surgery. Indian J Ophthalmol. 2012; 60:273–6.https://doi.org/10.4103/0301-4738.98703 PMid:22824595 PMCid:PMC3442461

Tan DTH, Lein ASM. Abnormal expression of the P53 tumor expression gene in the conjunctiva of patients with pterygium.AJO. 1997; 123(3):404–5. https://doi.org/10.1016/ S0002-9394(14)70141-2

Chowers I, Pe’er J, Zamir E, Livni N, Ilsar M, Frucht-Pery J. Proliferative activity and p53 expression in primary and recurrent pterygia. Opthalmology. 2001 May; 108(5):985–8.https://doi.org/10.1016/S0161-6420(00)00651-5

Chui J, Di Girolamo N, Wakefield, Coroneo MT. The pathogenesis of pterygium current concepts and their therapeutic implications. Ocul Surf. 2008 Jan; 6(1):24–43. https://doi.org/10.1016/S1542-0124(12)70103-9

Majoros J. Conjunctival transplantation for treatment of pterygium. Am J Ophthalmol. 1950; 61:1289. https://doi.org/10.1016/0002-9394(50)91005-1

Kenyon KR., Wagoner MD., Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium.Ophthalmology. 1985; 92:1451–70. https://doi.org/10.1016/S0161-6420(85)33831-9

Youngson RM. Recurrence of pterygium after excision.BJO. 1972; 56:120–5. https://doi.org/10.1136/bjo.56.2.120

Hirst LW. The treatment of pterygium. Surv Ophthalmol.2003; 48(2):145–80. https://doi.org/10.1016/S00396257(02)00463-0

Ang LP, Chua JL, Tan DT. Current concepts and techniques in pterygium treatment. Curr Opin Ophthalmol.2007; 18(4):308–313. https://doi.org/10.1097/ICU.0b013e3281a7ecbb PMid:17568207

Starck T, Kenyon KR, Serrano F. Conjunctival autograft for primary and recurrent pterygia: Surgical technique and problem management. Cornea. 1991; 10(3):196–202.https://doi.org/10.1097/00003226-199105000-00002 PMid:2055023

Rubin MR, Dantas PE, Nishiwaki-Dantas MC, Felberg S. Efficacy of fibrin tissues adhesive in the attachment of autogenous conjunctival graft on primary pterygium surgery. Arq Bras Oftalmol.2011; 74(2):123–6. https://doi.org/10.1590/ S0004-27492011000200011 PMid:21779669

Pan HW, Zhong JX, Jing CX. Comparision of fibrin glue versus suture for conjunctival autografting in pterygium surgery: A meta-analysis. Ophthlmology. 2011;118(6):1049– 54. https://doi.org/10.1016/j.ophtha.2010.10.033 PMid:21292327

Ti SE, Tseng SC. Management of primary and recurrent pterygium using amniotic membrane transplantation.Curr Opin Ophthalmol. 2002; 13(4):204. https://doi.org/10.1097/00055735-200208000-00003

Hirst LW, Sebban A, Chant D. Pterygium recurrence time. Ophthalmology 1994; 101(4):755–8. https://doi.org/10.1016/S0161-6420(94)31270-X

Kenyon KR, Wagoner MD, Hettinger ME. Conjunctival autograft transplantation for advanced and recurrent pterygium.Ophthalmology. 1985; 92:1451–70. https://doi.org/10.1016/S0161-6420(85)33831-9

Koranyi G, Seregard S, Kopp ED. The cut-and-paste method for primary pterygium surgery: Long term follow up.Acta Ophthalmol Scand. 2005; 83(3):298–301. https://doi.org/10.1111/j.1600-0420.2005.00465.x PMid:15948780

Nieuwendaal CP, van der Meulen IJ, Mouritis M, Lapid-Gortzak R. Long term follow up of pterygium surgery using conjunctival autograft and Tissucol. Cornea. 2011; 30(1):34–6. https://doi.org/10.1097/ICO.0b013e3181dea7f0

Coral-Ghanem R, Oliveria RF, Furlanetto E, Ghanem MA, Ghanem VC. Conjunctival autologus transplantation using fibrin glue in primary pterygium. Arq Bras Optalmol.2010; 73(4):350–3. https://doi.org/10.1590/S000427492010000400010

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Rao SK, Lekha T, Mukesh BN. Conjunctival limbal autografts for primary and recurrent pterygia: Technique and results. IJO. 1998; 46:203–9.

Varssano D, Michaeli-Cohen A, Loewenstein A. Excision of pterygium and conjunctival autograft. Isr Med Assoc J. 2002 Dec; 4(12):1097–100. PMid:12516899

Young AL, Leung GYS, Wong AKK, Cheng LL, Lam DS. CA randomised trial comparing 0.02% mitomycin C and limbal conjunctival autograft after excision of primary Pterygium.Br J Ophthalmol. 2004; 88:995–7. https://doi.org/10.1136/ bjo.2003.036830 PMid:15258011 PMCid:PMC1772290

Dry Eye and its Relationship with Status of Serum Calcium in the Body at a Tertiary Care Institute: A Case Control Study

Abstract Views :222 | PDF Views:79

Authors

Mrunal Patil ¹, Dhiraj Balwir ¹, Ajit Khune ¹, Saurabh Dhewale ¹

Affiliations
1 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik - 422003, IN

Source

MVP Journal of Medical Sciences, Vol 5, No 1 (2018), Pagination: 82-86

Abstract

Background: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of dryness, grittiness, redness, burning sensation or any discomfort, visual disturbance and tear film instability leading to potential damage to ocular surface. The tear film consists of three layers starting from within outwards mucus, the aqueous layer and the lipid layer. The tear film and ocular surface form a complex and stable system that can lose its equilibrium through numerous disturbing factors. Studies which also involve tests of tear functions including Schirmer’s test, Tear break-up time, Fluorescein staining for determination of dry eye have found generally low prevalence rates.Hence the physiology of tear film and its binding with the eye shows that there is some involvement of serum calcium level with dry eye. The present study encourages us to assess the role of serum calcium level with patients of dry eye. Aims and Objective: To assess the role of calcium with dry eye. Material and Methods: Total 90 subjects (30 cases and 60 controls) who met the selection criteria were included in the study. Serum analysis has been done for calcium level in the body in the patients of dry eye.The study was conducted between August 2014 to November 2016. Results: The lower serum level of calcium was significantly associated with dry eyes in the study. Conclusion: Calcium plays an important role in the causative mechanism of dry eye in the patients of dry eye disease.

Keywords

Calcium, Dry Eye, Serum Level, Tear Film.

Full Text

References

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Pseudoexfoliation Syndrome:Clinical Profile and Visual Outcome after Manual Small Incision Cataract Surgery

Abstract Views :296 | PDF Views:82

Authors

Mrunall Arun Borrse ¹, Sanjay Mahadik ², Dhiraj Balwir ³

Affiliations
1 PG Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nasik – 422003, Maharashtra, IN
2 Senior Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nasik – 422003, Maharashtra, IN
3 Professor and Head, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College and Hospital, Research Centre, Nasik – 422003, Maharashtra, IN

Source

MVP Journal of Medical Sciences, Vol 6, No 2 (2019), Pagination: 195-201

Abstract

Background: Pseudoexfoliation (PXF) is an age related, systemic, elastic fibrillopathy causes serious complications during cataract surgery such as zonular dialysis, capsular rupture and vitreous loss. Aim: To study the profile of eyes with pseudoexfoliation syndrome and outcome after Manual Small Incision Cataract Surgery. Materials and Methods: This was a hospital based, prospective study was conducted at Tertiary Care Hospital between August 2016 to September 2018. PXF was diagnosed on slit lamp examination by the presence of white dandruff like material in anterior segment. Gonioscopy was done to know the status of angles, pigmentation and presence of PXF material. Results: Out of 80 patients with PXF who underwent manual small incision cataract surgery (MSICS), 17 patients had complications. Zonular Dialysis alone was found in 3 eyes (17.65%) and Zonular Dialysis with Vitreous Loss was seen in 4 eyes (23.53%). Only Posterior Capsular Rent (PCR) was found in 2 eyes (11.76%) and PCR with Vitreous Loss was found in 4 eyes (23.53%). Sphincter Tear was noted in 3 eyes (17.65%) and Iridodialysis was seen in one eye (5.88%). Conclusions: Ophthalmologists should focus on the detection of PXF especially considering the risks for intraoperative complications related to PXF. The diagnosis of PXF may also be important in the management of cataract in these patients.

Keywords

Complications, Pseudoexfoliation, SICS, Vitreous Loss, Zonular Dialysis.

Full Text

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A Study of Ocular Fundus Findings in Hypertension during Pregnancy in a Tertiary Care Hospital

Abstract Views :156 | PDF Views:96

Authors

Chetan Gaikwad ¹, Ajit Khune ², Sanjay Mahadik ³, Dhiraj Balwir ⁴

Affiliations
1 Former PG Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
2 Associate Professor, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
3 Senior Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
4 Professor and Head, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN

Source

MVP Journal of Medical Sciences, Vol 8, No 2 (2021), Pagination: 163-170

Abstract

Introduction: Hypertension is one of the most common medical disorders during pregnancy, affecting 6-8% of all pregnancies. Around 16-25% of 1st pregnancy &12-15% of subsequent pregnancies8 . Ocular fundus changes are found in 40% to 100% of pregnant women with raised blood pressure, whose severity correlates with pre-eclampsia or eclampsia. In hypertensive disorders in pregnancy, ophthalmic manifestations include conjunctival vasculopathy, hypertensive retinopathy, exudative retinal detachment, hypertensive choroidopathy. The retina is involved due to the basic pathology of vasospasm and increased capillary permeability, the consequences of vascular endothelial dysfunction. Rare complications were reversible cortical blindness, and extra-ocular muscle palsy have been documented. Methodology: The present study was conducted in the Outpatient Department (OPD) of Ophthalmology at Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik , Maharashtra. All the 182 cases included in this study underwent indirect ophthalmoscopy during the study period of 2 years (August 2018 to December 2020). Patients were collected from ANC clinic of department of obstetrics and Gynaecology OPD. Results: Prevalence of abnormal fundus findings was 10.1% in grade I hypertension while it was 100% in cases with grade II and III hypertension. A significant association was observed between severity of hypertension and abnormal fundus findings (p0.05). Conclusion: As these vascular changes in the retina usually correlate with the severity of the systemic hypertension, the eyes can truly be considered a mirror to the otherwise elusive vascular changes occurring elsewhere in the body. It thus stands to reason that observing the retinal changes holds the ability to prognosticate and also determine the severity of the disease. Fundoscopy is an essential investigation that needs to be done in all cases of hypertensive disorders of pregnancy with special emphasis in younger and primigravida women.

Keywords

Conjunctival Vasculopathy, Fundus, Hypertension, Ocular, Pregnancy

Full Text

References

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Intraoperative Complications during Phacoemulsification in Cataract Surgery at a Tertiary Care Hospital

Abstract Views :277 | PDF Views:87

Authors

Rajas Premraj Daware ¹, Dhiraj Balwir ², Shweta Kokas ³

Affiliations
1 Former PG Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
2 Professor and Head, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
3 Associate Professor, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN

Source

MVP Journal of Medical Sciences, Vol 8, No 2 (2021), Pagination: 209-218

Abstract

Background: Intraoperative and postoperative complications do occur in phacoemulsification technique especially with inexperienced individuals. Being a tertiary care centre, we perform a number of phacoemulsification surgeries every year. Aims and Objectives: The present study was planned to assess the intraoperative complications during phacoemulsification in cataract surgery and determine the visual outcomes after phacoemulsification for cataract. Material and Methods: It was a prospective observational study involving patients undergoing cataract surgery, conducted at Department of Ophthalmology, at Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra. The study was conducted over two years between August 2018 to November 2020 among 186 eyes. Results: Rate of intraoperative complication in our study was 9.1%. Among the complications, difficulty in nucleus emulsification (5.4%) was most common followed by posterior capsular rent (2.2%), CCC-related complication (1.6%). Iris prolapse occurred in 1.1% whereas detachment of Descemet’s membrane, vitreous loss and nucleus drop were noted in one (0.5%) patient each. Conclusions: In our study, rates of intraoperative complication was 9.1% that is comparable to previous reports. Difficulty in nucleus emulsification was most complication

Keywords

Cataract, Intraoperative Complications, Phacoemulsification

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Clinical Profile of Patients with Primary Glaucoma in Tertiary Care Centre

Abstract Views :137 | PDF Views:67

Authors

Pranjali Pawar ¹, Shweta Bandopadhyay ², Dhiraj Balwir ³

Affiliations
1 Former PG student, Department of Opthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422203, Maharashtra, India ., IN
2 Associate Professor, Department of Opthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422203, Maharashtra, India ., IN
3 Professor and Head, Department of Opthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422203, Maharashtra, India., IN

Source

MVP Journal of Medical Sciences, Vol 9, No 1 (2022), Pagination: 9 - 17

Abstract

Aim: To study the clinical profile of patients with primary glaucoma in a tertiary care hospital. Method: In a descriptive study of 130 patients, detailed family history, history of systemic illness and previous treatment in past was noted in detailed. Detail ophthalmic examination with visual acuity, anterior segment examination with slit lamp, intraocular pressure measurement with applanation tonometry, fundus examination and perimetry of every patient was done. Result: A total of 130 patients were examined the prevalence of glaucoma was 2.92%. The risk factors and their relevance to open angle glaucoma as compared to narrow angle glaucoma, taking recourse to multiple logistic regression. The Odds Ratio (OR) for age was obtained as 0.978 [95% CI: 0.937, 1.021], indicating that the odds are unchanged with the unit change in the age (p=0.304). For gender, with male as reference, OR for females was 1.676 [95% CI: 0.645, 4.355], indicating that the odds in favour of open angle decreases for females as compared to males (p=0.289). Further, the odds of open angle glaucoma with the presence of hypermetropia decreased with OR 0.098 [95% CI: 0.031, 0.311] (p=0.00). The presence of myopia increased the odds in favour of open angle glaucoma 4.785 [95% CI: 1.497, 15.295] times, which was statistically significant (p=0.008). The presence of systemic illness like hypertension and diabetes increased the risk of open angle glaucoma with OR of 1.694 [95% CI: 0.608, 4.719] and 1.017 [95% CI: 0.288, 3.592] respectively. The correlation of pretreatment IOP and visual field defect was statistically significant for PACG and not with POAG the correlation of VCDR and visual field defect was statistically significant for both POAG and PACG.9 eyes were blind in POAG and 17 eyes were blind in PACG. Conclusion: Patient with family history of glaucoma; history of DM, HTN, myopia, hypermetropia; and patient above 40 years of age should be screened for glaucoma for early detection and prompt treatment. Awareness of glaucoma is needed in the country as it is one of the leading causes of blindness .

Keywords

Clinical Profile, Primary Glaucoma, Risk Factors, Visual Impairment

Full Text

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