(-6.1 ± 3.5) and pattern standard deviation value of (5.3 ± 3.3). Significant differences between glaucoma and normal subjects were found for all tomographic parameters. The best parameters based on Receiver operating characteristic curves and sensitivity at 95% specificity were RNFL-Average (AROC, 0.960; sensitivity, 80%) and 0.912; sensitivity, 80%). Conclusions: Both retinal nerve fibre layer thickness parameters and macular Ganglion cell complex parameters showed good diagnostic abilities in the diagnosis of early glaucoma using the spectral domain Optical Coherence Tomography. Better performance of macular parameters (compared to previous observations using older -Time Domain-Optical Coherence Tomography) were noted in the current study, however they did not outperform RNFL parameters.

Introduction: Various haemodynamic factors have been implicated as pathophysiological mechanisms in Primary Open Angle Glaucoma (POAG) other than raised Intraocular Pressure (IOP). However, the exact relationship still remains unclear. Aim: To examine the circadian pattern of Blood Pressure (BP), IOP and Ocular Perfusion Pressure (OPP) with the aim of understanding their relationships in a cohort of patients with POAG. Materials and Methods: A cross-sectional study was conducted in which 44 cases of newly diagnosed, non-hypertensive patients with POAG were enrolled and categorised based on the severity of glaucoma. Recording of BP and IOP were done every 4th hourly during a 24 hour hospital stay. The Mean OPP (MOPP) was calculated as 2/3×Mean Arterial Pressure (MAP)-IOP. Systolic OPP (SOPP) was calculated as Systolic BP-IOP and Diastolic OPP (DOPP) was calculated as Diastolic BP-IOP. The diurnal, nocturnal and 24 hour fluctuations were derived from the difference between the highest and lowest values within each period. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Univariate and multivariate regression analysis of the variables with age and severity of POAG were performed Results: Significant positive correlation of the nocturnal fluctuations in MAP (r=0.533), SOPP (r=0.835), DOPP (r =0.768), MOPP (r=0.685) and 24 hour fluctuation in MOPP (r=0.636) were noted with severity of glaucoma on multivariate analysis. No significant correlation of these parameters with age was noted on multivariate analyses. Conclusion: Nocturnal dip in OPP was an important observation among patients with POAG, potentially contributing to its pathophysiology.

BACKGROUND Thyroid eye disease is a relatively rare condition, with an incidence of 2.9 to 16.0 cases per 100 000 population per year. Approximately 50 % of patients with Graves’ disease (GD) develop clinically apparent thyroid eye disease. It may cause severe damage to vision and orbital architecture. It is the most frequent cause of unilateral or bilateral proptosis in adults. METHODS A cross sectional study of 80 patients with GD was carried out in association with thyroid clinic of Government Medical college Thiruvananthapuram for a period of 1 year from April 2017 to March 2018. Subjects who have a prior diagnosis of Graves’ disease including those who are on antithyroid drugs were included in the study. Patients who are sick due to other systemic diseases like cardiac failure and end stage renal disease were excluded. RESULTS Eighty patients with mean age of 45.31 years were studied. Out of them, 66% were females and 34% were males. Ophthalmopathy was present in 38.8%.Majority had mild and bilateral disease (61.2 %). Only a small percentage had sight threatening disease (6.4 %).The mean age of patients with ophthalmopathy was 47.93. Major population with ophthalmopathy was females. Majority of patients with ophthalmopathy (64.5 %) retained a good visual acuity better than 6 / 9. Lid retraction was the most common manifestation among patients with Graves’ ophthalmopathy that is 74.2% followed by exophthalmos (64.5 %) and eye movement restriction and soft tissue involvement (58.1 %). Diplopia, optic nerve dysfunction were rare (3.2 %). Only 19.3 % patients had active disease according to clinical activity score. Major clinical sign of activity was redness of conjunctiva. Maximum no. of patients with active disease had a clinical activity score of 4. Smoking showed a significant association with the severity of ophthalmopathy. (p value 0.001) There was a significant association between age and activity of disease. (p value 0.021). No association was found between duration of disease with presence or severity of ophthalmopathy. There was no association between co- morbidities with presence or severity of ophthalmopathy. No association was found between hormone status and presence or severity of ophthalmopathy. CONCLUSIONS Our results indicated that the prevalence of ophthalmopathy in our population with GD evaluated at our tertiary care centre was similar to that reported in the Caucasians of European origin. Clinically active and sight threatening ophthalmopathy was uncommon. KEYWORDS Graves’ Disease, Ophthalmopathy

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