Heat Shock Proteins

Shakeel T.

Sana Z., Javed S.A., Ziya S.

Abstract Background: One of the often-seen consequences of the aging process is the development of senile cataracts, a disease that affects one of our most precious gifts, that of sight. Many factors such as aging, changes in blood electrolyte levels, and possibly family history are involved in senile cataract formation. Changes in serum electrolyte levels can induce changes in aqueous electrolyte levels and affect lens metabolism and probably cataract formation. Aims: We aimed to measure the level of serum albumin, serum cholesterol, and liver enzymes in senile cataractous lens and normal crystalline lens. To analyze the correlation of serum albumin, serum cholesterol, and liver enzymes with cataractogenesis. Materials and Methods: This prospective case–control study was performed on 160 patients who presented to the Ophthalmology Outpatient Department of Jawaharlal Nehru Medical College and Hospital in collaboration with the Department of Biochemistry, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, over 2 years (from December 2016 to December 2018), study group comprised of 100 patients and the control group comprised of 60 patients. Statistical Package for Social Sciences software was used for data analysis. Results: The two groups were comparable concerning age. There were no significant statistical differences between the groups in terms of age. However, there was a statistically significant difference in intraocular pressure (IOP) and visual acuity (P < 0.05) in IOP and a highly significant difference (P < 0.001) in best corrected visual acuity (BCVA right eye), BCVA (left eye) between the study group and control group, though IOP was within the normal limit in both the groups. Conclusion: This study demonstrates that deranged liver enzymes have some role in cataract formation, and are associated with decreased serum albumin levels and it increases the chances of cortical cataract followed by nuclear cataract. Increased serum cholesterol levels are also associated with increased chances of mixed cataracts followed by cortical cataracts.

Vats V., Shakeel T., Singh A.

Abstract Background: Age-related macular degeneration (ARMD) is a degenerative disease associated with aging, with a higher prevalence in regions such as Africa (17.4%). Reported prevalence in various Indian studies ranges from 1.1% in southern India to 4.7% in northern India. Smoking, diabetes mellitus (DM), hypertension (HTN), and body mass index (BMI) are the factors that have been correlated with ARMD. Aim and Objective: This study aims to evaluate the association of systemic factors such as smoking, DM, HTN, and BMI with ARMD. Materials and Methods: It is a hospital-based cross-sectional study with patients aged over 40 years visiting the outpatient ophthalmology department who were screened for ARMD for a duration of 6 months from January 2024 to June 2024. All patients aged over 40 years were screened for ARMD. Patients with ocular trauma, congenital ocular anomalies, immunocompromised status, or active ocular inflammation were excluded from the study. The presence of even a single “Drusen” in the macula was considered the diagnostic criterion for ARMD. Diagnosed cases of ARMD were assessed for DM, HTN, BMI, and smoking. The data were recorded and analyzed to identify any associations. Results: The prevalence of ARMD among patients screened over 1 year was found to be 1.40%. Among 40 patients with ARMD, 24 (60%) patients reported a positive history of smoking, which was statistically significant with a P value of 0.00442. Out of the 40 patients, 37 (92.5%) patients had a BMI within the normal range of 18.5–24.9 kg/m2. No significant association was found between BMI, DM, and HTN with ARMD in this study. Conclusion: Our study from Uttarakhand indicates a low prevalence of ARMD and shows a positive and significant association with smoking. Furthermore, evaluation of other systemic factors is required to provide more consistent evidence of correlation.

Vats V., Shakeel T., Bhatla T.

Abstract Context: Small incision cataract surgery (SICS) is a popular technique for the management of cataracts as it is fast, efficient, and less costly than other surgical methods. It can be done with different types of incisions like a frown, “V,” straight for making the sclerocorneal tunnel. Postoperative changes in the corneal surface are an important concern for both the patient and the surgeon. Aims: In this study, we aim to compare the corneal surface changes between two surgical hands in the eyes undergoing SICS with frown incision. Settings and Design: It is a hospital-based, prospective, cross-sectional study. Materials and Methods: It is a cross-sectional, prospective, hospital-based study. A total of 120 eyes undergoing SICS were taken, and divided into two groups according to the two expert surgeons. The frown incision was given in all eyes. Results: In a cross-sectional study of 120 patients, we found that there was no significant difference in the demographic profile of patients in the two groups. The changes in K1 and K2 after frown incision were insignificant in group 1 with a P value of 0.08 and 0.2, respectively. Similarly, keratometric changes in group 2 were insignificant with a P value of 0.05 and 0.06 for K1 and K2, respectively. Conclusion: The study shows that frown incision leads to insignificant keratometric changes even when the surgical hand is different. However, refraction could vary according to the surgeon and the patient’s optical medium.

Parri M., Kiran V.J., Dinesh M., Patil G.R.

Abstract Acute myeloid leukemia (AML) is one of the causes of Roth spots. Here, we report a female patient in her early 30s of Asian origin presented to our ophthalmology outpatient clinic with chief complaints of decreased visual acuity (VA) in the right eye along with generalized weakness, palpitations, and colored stools. The best corrected VA in the right eye was counting fingers 1 m and 6/6 in the left eye. Fundus examination revealed Roth spots and subhyaloid hemorrhages in the right eye and Roth spots in the left eye. Peripheral smear revealed few blasts, and bone marrow showed 58% blasts, with increased cellularity suggestive of AML. Currently, the patient is on an induction chemotherapy course under oncologist treatment. The presence of Roth spots in the fundus picture may require a complete blood picture examination as they may be present in leukemia also.

Chand S., Waghamare S., Mallik K.B., Singh A.

Abstract Superglue injury is a form of accidental chemical injury encountered in an ophthalmic emergency department. It is more commonly caused by an accidental splash of superglue to the eye due to incautious and improper handling, requiring immediate medical attention. A 21-year-old male presented to the ophthalmic emergency department had a history of an accidental squirt of superglue in his right eye while repairing his broken spectacle half an hour before his presentation, followed by foreign body sensation and watering from his right eye. A thorough irrigation of the right eye with 2 L of ringer lactate solution was done. Upon fluorescein staining, it was negative. The patient was medically managed with frequent early topical steroids, topical antibiotics, and lubricant. On the very next day, the corneal epithelial defect was noted, hence, the frequency of topical steroids was reduced to six times per day. The symptoms of the patient improved significantly within a few hours of the incident. Through this case report, we recommend frequent but judicious use of topical steroids in the early phase of superglue injury to combat the discomfort of the insult.

Shrinkhal, Garg P., Shukla R., Singh S.P., Shukla A.

Khurana M., Chawla O., Singh A., Panda P.K., Sharawat I.K., Mittal S.K., Kumar B.

Abstract Purpose: The purpose of this study is to explore any association between body mass index (BMI) and anthropometric parameters and amblyopia in children and adolescents. Materials and Methods: A total of 82 participants, aged 4–18 years, were included in this cross-sectional, observational study. The anthropometric parameters, which included height, weight, and BMI Z score, were assessed in a subset of amblyopic children and adolescents. We compared these parameters with the healthy age and gender-matched control group. Results: The results revealed that out of all 82 participants, the mean age of 55 amblyopes was 9.11 ± 4.06 years (range, 4–18 years), and that of controls was 8.44 ± 3.69 years (range, 4–17 years). The mean ± standard deviation (SD) of height (cm) and weight (kg) in amblyopia was 129.69 ± 19.01 cm and 29.27 ± 12.01 kg, respectively, and in controls, it was 124.43 ± 13.83 cm (P = 0.159) and 27.01 ± 9.89 kg (P = 0.399). The median (25th–75th percentile) of the BMI Z score in the amblyopia group was -0.27 (-1.365 to 0.885), and in controls was 0.00.01 (-0.85885; P = 0.399). We did not find any clinically or statistically significant difference in the above parameters between cases and controls. Conclusion: This study concludes that amblyopes do not have deranged BMI and anthropometric parameters in the early years of life. Ophthalmologists are the primary healthcare professionals who have a crucial role in prompt identification and intervention to prevent long-term vision impairments in patients with amblyopia. Enhancements in visual acuity are expected to improve their overall quality of life and social well-being, which may reduce the other negative consequences in the form of deranged BMI and other related morbidities in their adulthood.

Singh H.N., Dogra N., Shelly D., Das A.K., Pant M.

Abstract Purpose: Eccrine hidrocystomas are a rare, benign cystic lesion of the skin primarily found in the head and neck region, with a predilection for the periorbital area in adult females. These cysts typically present as small, tense, thin-walled structures ranging from 1 to 6 mm in size, occurring either as solitary entities or in multiples. Despite their benign nature, eccrine hidrocystomas pose diagnostic challenges due to their resemblance to malignant lesions both clinically and in imaging studies. This study aims to explore the varied clinical presentations of eccrine hidrocystoma and discuss the complexities associated with its diagnosis. Materials and Methods: Five cases were included in the study along with a comprehensive review of the existing literature. We emphasize the importance of accurate and early diagnosis for appropriate management. The clinical manifestations of eccrine hidrocystoma often overlap with features suggestive of malignancy, underscoring the necessity for meticulous histopathological examination to definitively differentiate between these entities. This differentiation is crucial as it impacts treatment decisions and patient outcomes. Conclusion: In conclusion, our study underscores the diagnostic dilemmas posed by eccrine hidrocystoma, highlights its potential mimicry of malignancy, and emphasizes the significance of histopathological evaluation in achieving accurate diagnosis and guiding management strategies.

Kansal N.K., Singh A., Kumar B.

Abstract Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Cutaneous involvement primarily affects the central face, with findings, such as persistent centrofacial redness, papulopustules, flushing, telangiectasia, and phymatous skin changes (e.g., rhinophyma). Ocular involvement may manifest with lid margin telangiectases, conjunctival injection, ocular irritation, or other signs and symptoms. In this review, we focus on the ophthalmological manifestations of rosacea and its management.

Sood G., Mahajan S.

Abstract We present a challenging case of a 60-year-old female who underwent cataract surgery in the right eye (RE) 10 years back. On presentation, visual acuity in RE with aphakic correction was 6/18, and the patient had a superior corneal scar with iris incarceration. Fundus examination revealed an attached retina and healthy optic nerve head with two dislocated rigid intraocular lenses (IOLs). The patient underwent vitrectomy with temporal scleral tunnel for explanting the IOLs. The same tunnel was used for scleral fixation of IOL whose haptics were buried into two opposite-facing scleral partial thickness scleral tunnels made at 12 and 6 o’clock. Thus, we describe a newer technique of sutureless scleral fixated IOL where scleral pockets are used for fixating three-piece IOL without the use of any suture, glue, or specialized IOL.

Shrinkhal, Garg P., Shukla R., Singh S.P., Banerjee N.

Abstract A 34-year-old male presented with a sudden, painless decrease in vision in both eyes in the past 7 days. He had a history of an episode of fever 7 days before ocular symptoms and had been treated with three doses of injection cefixime (1.5 g) and antipyretics based on a positive Widal test. On detailed fundus examination, both eyes showed creamy white superficial lesions with ill-defined margins, suggestive of retinitis, with a few hemorrhages along the inferior arcade. The diagnosis of both eyes’ post-typhoid fever retinitis was made, and he was investigated for complete blood count, peripheral smear, erythrocyte sedimentation rate, and human immunodeficiency virus Tridot test, which were normal. He was treated with oral cefixime (400 mg) twice daily and oral prednisolone 1 mg/kg body weight for 7 days. The patient showed significant improvement after the treatment.

Garg S., Yadav U., Singh A.

Angrish S., Malik K.B., Mishra S., Ansari A., Singh A.

Abstract Strabismus surgery in a scleral buckle patient is a challenging task that requires precise planning and meticulous surgical skills to accomplish a successful outcome. We report a case of a 32-year-old male who presented with complaints of diminution of vision in the right eye (RE) for 23 years and outward deviation of RE for 5 years after blunt trauma with a ball. The patient was diagnosed with RE total retinal detachment (RD) with traumatic retinal dialysis. He underwent scleral buckling as RD surgery in 2004 followed by silicon oil removal 6 months later elsewhere. On ocular examination of the RE, the best corrected visual acuity was perception of light with accurate projection of rays in all four quadrants, there was grade III relative afferent pupillary defect with an exotropia of 20° on Hirschberg test. The prism bar reflex test revealed an exotropia of 50 prism diopters (PD) [Figure 1]. An anterior segment examination revealed posterior subcapsular and cortical cataracts. After taking a retina clinic opinion, the patient underwent uneventful RE cataract surgery with in-bag implantation of a foldable implant cataract surgery first, followed by strabismus surgery under a guarded visual prognosis. Clinically significant adhesion and the presence of the scleral buckle posed a magnificent challenge during the strabismus surgery. The plan was improvised to 8 mm lateral rectus recession with 4 mm hang loose recession irrespective of a large deviation under local anesthesia. To our surprise, a satisfactory primary position alignment within 10 PD (orthophoria) was achieved, which was maintained on subsequent follow-up visits. We report an interesting and challenging case of restrictive strabismus due to scleral buckle which emphasizes that surgical procedures and their outcomes may not always align with expectations. Therefore, it is necessary to adopt a flexible and customized approach to effectively manage such instances.

Singh A.