Background: Patients with central scotoma have poor fixation stability and poor visual acuity. Acoustic biofeedback training can be an effective way to train such patients to eccentrically fixate. This study analyses the mean retinal sensitivity, saccadic velocity, and fixation stability after acoustic biofeedback training and shows correlation with age and scotoma size. Methods: Patients with irreversible central scotoma in both the eyes secondary to macular diseases were selected. After undergoing comprehensive low vision assessment, 19 patients who were willing were recruited for the acoustic biofeedback training to the better eye in 10 sessions, using the MP-1 Microperimeter. Mean retinal sensitivity, saccadic velocity, fixation stability before and after the acoustic biofeedback were recorded. Results: There were 17 men and two women. Ages ranged from 19-94 years (mean 54.63 AE 24.66). The scotoma size ranged from four to 20 degrees. Ten patients had agerelated macular degeneration, four had Stargardt disease, three had traumatic macular scar, two had scarred myopic choroidal neovascular membrane, and one had myopic macular degeneration. The vision improved from 1.06 AE 0.36 to 0.86 AE 0.33 logMAR (p < 0.0001). The mean retinal sensitivity improved from 2.1 AE 2.9 dB to 2.7 AE 3.1 dB (p = 0.01), with negative correlation with age (p = 0.01) and scotoma size (p = 0.02). Fixation stability improved with reduction in the bivariate contour ellipse area (p = 0.01). It showed negative correlation with age (p = 0.02) and scotoma size (p = 0.10). The saccadic velocity reduced from 0.34 /second to 0.26 /second but was not significant (p > 0.99). The majority (58 per cent) had their preferred retinal locus superior to the fovea. There was good agreement between bivariate contour ellipse area and MP-1 Microperimeter inbuilt fixation parameters. The effect was maintained at six months with slight reduction in fixation stability. Conclusion: Acoustic biofeedback can improve fixation behaviour, visual acuity and retinal sensitivity in patients with central scotoma. The results are better with younger age and smaller scotoma size.

Purpose:To determine the correlation between fundus perimetry with Micro Perimeter 1 (MP1) and conventional automated static threshold perimetry using the Humphrey Field Analyzer (HFA) in healthy individuals and in subjects with glaucoma.Materials and Methods:In this study, we enrolled 45 eyes with glaucoma and 21 eyes of age-matched, healthy individuals. All subjects underwent complete ophthalmic examination. Differential light sensitivity was measured at 21 corresponding points in a rectangular test grid in both MP1 and HFA. Similar examination settings were used with Goldmann III stimulus, stimulus presentation time of 200 ms, and white background illumination (1.27 cd/m2). Statistical analysis was done with the SPSS 14 using linear regression and independent t-test.Results:The mean light thresholds of 21 matching points in control group with MP1 and HFA were 14.97 ± 2.64 dB and 30.90 ± 2.08 dB, respectively. In subjects with glaucoma, the mean values were MP1: 11.73 ± 4.36 dB and HFA: 27.96 ± 5.41 dB. Mean difference of light thresholds among the two instruments was 15.86 ± 3.25 dB in normal subjects (P < 0.001) and 16.22 ± 2.77 dB in glaucoma subjects (P < 0.001). Pearson correlation analysis of the HFA and MP1 results for each test point location in both cases and control subjects showed significant positive correlation (controls, r = 0.439, P = 0.047; glaucoma subjects, r = 0.812, P < 0.001). There was no difference between nasal and temporal points but a slight vertical asymmetry was observed with MP1.Conclusion:There are significant and reproducible differences in the differential light threshold in MP1 and HFA in both normal and glaucoma subjects. We found a correction factor of 17.271 for comparison of MP1 with HFA. MP1 appeared to be more sensitive in predicting loss in glaucoma.

Intravitreal DEX implant is safe and effective adjunct therapy. It reduces dependence on systemic steroids, immunosuppressives and provides long-term effects.

PURPOSE. To evaluate the inflammatory cytokine, growth factors, extracellular matrix (ECM) remodeling genes, profibrotic and antifibrotic molecules in patients undergoing glaucoma filtration surgery (GFS). Additionally, the effect of preoperative antiglaucoma medications (AGMs) and postoperative bleb status were related to these parameters. METHODS. Tenon's tissue and aqueous humour (AH) were collected from 207 patients undergoing GFS with primary open-angle glaucoma (POAG) (n ¼ 77), primary angle-closure glaucoma (PACG) (n ¼ 62), and cataract controls (n ¼ 68). Monocyte chemoattractant protein-1 (MCP-1), connective tissue growth factor (CTGF), transforming growth factor b1/2 (TGF-b1/2), lysyl oxidase (LOX), lysyl oxidase L2 (LOXL2), elastin (ELN), collagen type 1 a 1 (COL1A1), secreted protein acidic and rich in cysteine (SPARC), a-smooth muscle actin (a-SMA), and decorin (DCN) were determined in tenon's tissue by real-time PCR and in AH using ELISA. RESULTS. A significant increase was observed in the transcripts of MCP-1, TGF-b2, and SPARC in POAG and PACG (P < 0.05); CTGF, TGF-b1, LOX, LOXL2, ELN, COL1A1, and a-SMA in PACG (P < 0.05) compared with control. DCN transcript was significantly decreased in POAG and PACG (P < 0.05) compared with control. The protein levels of CTGF, TGF-b1/b2, ELN, SPARC, and LOXL2 was significantly elevated in POAG and PACG (P < 0.05); DCN was decreased (P < 0.05) compared with control. These parameters showed significant association with duration of preoperative AGMs and postoperative bleb status. CONCLUSIONS. This study demonstrates increased expression of growth factors and ECM molecules, both at protein and transcript levels in GFS patients. A decreased DCN in AH seems striking, and if restored might have a therapeutic role in minimizing postoperative scarring to improve GFS outcome.

Vitreo-retinal (VR) surgeries induce conjunctival changes. However, there are no study reports regarding prevalence and severity of dry eye after these surgeries. This study evaluated dry eye outcome after VR surgery. Patients undergoing VR surgery classified as scleral buckle and microincision vitrectomy surgery (n = 44, mean age: 56.09±10.2 years) were recruited. Dry eye evaluation was done before and 8 weeks after surgery (2 weeks after omitting topical eye drops). Conjunctival imprint cytology for goblet cell count and tear Mucin 5AC (MUC5AC) protein estimation was done. Gene expressions of MUC5AC, MUC4, MUC16, Aquaporin 4 (AQP4) and AQP5 were analyzed in the conjunctival imprint cells by qPCR. None of the patients exhibited clinical signs of dry eye after VR surgery. But the conjunctival goblet cell density (GCD) was significantly lowered post-VR surgery (63% cases, **p = 0.012) with no alterations in the tear MUC5AC protein. Post-VR surgery, the conjunctival cell gene expression of MUC4, MUC16 and AQP4 were significantly increased (*p = 0.025, *p = 0.05 and *p = 0.02 respectively) and AQP5 was significantly lowered (*p = 0.037), with no change in MUC5AC expression. Tear cytokines were significantly increased post-VR surgery (anti-inflammatory: IL1RA, IL4, IL5, IL9, FGF; PDGFbb and pro-inflammatory: IL2, IL6, IL15, GMCSF and IFNg). Though clinical signs of dry eye were not observed after VR surgery, ocular surface changes in the form of reduced GCD, altered MUC5AC, MUC4, MUC16, AQP4, AQP5 and cytokines are suggestive of dry eye outcome at the molecular level especially inpatients aged above 51 years, especially female gender and those who are diabetic.