Abstract
PURPOSE:
To study factors affecting laser energy levels required for neodymium: yttrium aluminium garnet (Nd: YAG) laser capsulotomy and to evaluate whether any correlation exists between applied laser energy levels and complications.
METHODS:
The present study examined 474 consecutive patients for a number of factors including age, type of posterior capsule opacification (PCO), material and fixation of intraocular lens (IOL) and complication rates, versus energy levels used for Nd: YAG laser capsulotomy.
RESULTS:
Mean patient age was 55.6 � 8.7 years and mean follow up period was 22.9 � 4.5 months. IOL biomaterial (KW ANOVA; P = 0.173) and patient's age (P = 0.246) did not significantly influence total laser energy requirement for capsulotomy. However, total laser energy levels were significantly higher (KW ANOVA; P < 0.001) with fibro-membranous and fibrous subtypes of PCO. Complications such as IOL pitting, intraocular pressure (IOP) elevation, uveitis, retinal detachment (RD) and cystoid macular edema (CME) were significantly more common when higher energy levels was used. The mean total energy in patients with RD was 77.7 � 17.7 mJ as compared to 43.4 � 26.9 mJ in the rest of the cohort. RD was more common in patients with higher axial length [n = 7 (63%)] (P < 0.001).
CONCLUSION:
Type of PCO significantly influenced laser energy levels required for capsulotomy, whereas IOL biomaterial and fixation did not. Complications such as IOL pitting, uveitis, IOP elevation, RD and CME was significantly more common when total laser energy was higher. It is recommended that the lowest possible single pulse laser energy be used for capsulotomy to minimize complications.
KEYWORDS:
Intraocular Lens; Laser Capsulotomy; Posterior Capsule Opacification

Abstract
AIM:
To compare surgical peeling and aspiration and neodymium yttrium garnet laser capsulotomy for pearl form of posterior capsule opacification (PCO).
METHODS:
A prospective, randomized, double blind, study was done at Rotary Eye Hospital, Maranda, Palampur, India, Santosh Medical College Hospital, Ghaziabad, India and Laser Eye Clinic, Noida India. Consecutive patients with pearl form of PCO following surgery, phacoemulsification, manual small incision cataract surgery and conventional extracapsular cataract extraction (ECCE) for age related cataract, were randomized to have peeling and aspiration or neodymium yttrium garnet laser capsulotomy. Corrected distance visual acuity (CDVA), intra-operative and post-operative complications were compared.
RESULTS:
A total of 634 patients participated in the study, and 314 (49.5%) patients were randomized to surgical peeling and aspiration group and 320 (50.5%) to the Nd:YAG laser group. The mean pre-procedural logMAR CDVA in peeling and neodymium: yttrium-aluminium-garnet (Nd:YAG) laser group was 0.80�0.25 and 0.86�0.22, respectively. The mean final CDVA in peeling group (0.22�0.23) was comparable to Nd:YAG group (0.24�0.28; t test, P=0.240). There was a significant improvement in vision after both the procedures (P<0.001). A slightly higher percentage of patients in Nd:YAG laser group (283/88.3%) than in peeling group (262/83.4%) had a CDVA of 0.5 (20/63) or better at 9mo (P<0.001). On the contrary, patients having CDVA worse than 1.00 (20/200) was also significantly higher in Nd:YAG laser group as compared to peeling group (25/7.7% vs 15/4.7%, respectively). On application of ANCOVA, there was less than 0.001% risk that PCO thickness and total laser energy had no effect on rate of complications in Nd:YAG laser group and less than 0.001 % risk that PCO thickness had no effect on complications in peeling group respectively. Sum of square analysis suggests that in the Nd:YAG laser group, thick PCO had a stronger impact on complications (Fischer test probability, Pr<0.0001) than thin PCO and total laser energy (Fischer test probability, Pr<0.002), respectively; similarly, in peeling group, thick PCO and preoperative vision had a stronger effect on complications than thin PCO, respectively (Fischer test probability, Pr<0.001).The rate of complications like uveitis (P=0.527) and cystoid macular edema (P=0.068), did not differ significantly between both the groups. However, intraocular pressure spikes (P=0.046) and retinal detachment (P<0.001) were significantly higher in Nd:YAG laser group as compared to peeling group. Retinal detachment was more common in patients having degenerative myopia (7/87.5%, P<0.001). Recurrence of pearls was the most common cause of reduction of vision in the peeling group (24/7.6%, P<0.001).
CONCLUSION:
There is no alternative to Nd:YAG laser capsulotomy for fibrous subtype of PCO. For pearl form of PCO, both techniques are comparable with regard to visual outcomes. Nd:YAG laser capsulotomy has a higher incidence of IOP spikes and retinal detachment whereas recurrence of pearls may occur after successful peeling and aspiration. When posterior capsulotomy is needed in patients with retinal degenerations, retinopathies and pre-existing retinal breaks, the clinician should be cautious about increased risks of possible complications of Nd:YAG laser capsulotomy.
KEYWORDS:
Elschnig pearls; capsulotomy; neodymium: yttrium-aluminium-garnet; posterior capsule

Abstract
AIMS AND OBJECTIVES:
To compare the diagnostic value and accuracy of dry eye scoring system (DESS), conjunctival impression cytology (CIC), tear film breakup time (TBUT), and Schirmer's test in computer users.
METHODS:
A case-control study was done at two referral eye centers. Eyes of 344 computer users were compared to 371 eyes of age and sex matched controls. Dry eye questionnaire (DESS) was administered to both groups and they further underwent measurement of TBUT, Schirmer's, and CIC. Correlation analysis was performed between DESS, CIC, TBUT, and Schirmer's test scores. A Pearson's coefficient of the linear expression (R (2)) of 0.5 or more was statistically significant.
RESULTS:
The mean age in cases (26.05 � 4.06 years) was comparable to controls (25.67 � 3.65 years) (P = 0.465). The mean symptom score in computer users was significantly higher as compared to controls (P < 0.001). Mean TBUT, Schirmer's test values, and goblet cell density were significantly reduced in computer users (P < 0.001). TBUT, Schirmer's, and CIC were abnormal in 48.5%, 29.1%, and 38.4% symptomatic computer users respectively as compared to 8%, 6.7%, and 7.3% symptomatic controls respectively. On correlation analysis, there was a significant (inverse) association of dry eye symptoms (DESS) with TBUT and CIC scores (R (2) > 0.5), in contrast to Schirmer's scores (R(2) < 0.5). Duration of computer usage had a significant effect on dry eye symptoms severity, TBUT, and CIC scores as compared to Schirmer's test.
CONCLUSION:
DESS should be used in combination with TBUT and CIC for dry eye evaluation in computer users.
KEYWORDS:
Computer vision syndrome; conjunctival impression cytology; dry eye scoring system; tear function tests

Abstract
PURPOSE:
The aim of this study was to evaluate the effect of dietary omega-3 fatty acid (O3FA) supplementation on dry eye symptoms, tear film tests, and conjunctival impression cytology in patients with contact lens wear-associated dry eye.
METHODS:
In this randomized, double-blind, multicentric trial, contact lens wearers (n = 496) were randomized to receive either O3FAs or placebo capsules (corn oil) twice daily for 6 months. Subjects underwent examinations at baseline, 3 months, and 6 months. At each visit, a questionnaire of dry eye symptoms and lens wear comfort was administered. Subjects further underwent measurement of tear film break-up time (TBUT) and a Schirmer test. Conjunctival impression cytology was performed by the transfer method. Improvement in symptoms and lens wear comfort were primary outcome measures. Changes from baseline in TBUT, Schirmer, and Nelson grade at 6 months were secondary outcome measures.
RESULTS:
The mean improvement in symptom score in the O3FA group was 4.7 � 2 (2.0) as compared with 0.5 � 2 (0.9) in the placebo group (P < 0.0001). Lens wear comfort levels improved significantly (P < 0.0001) from baseline. There was a significant increase in TBUT [3.3 � 2 (1.5)] and Nelson grade [0.7 � 2 (0.6)] in the O3FA group (P < 0.0001) as compared with 0.3 � 2 (0.6) and 0.1 � 2 (0.4) in the placebo group (P = 0.164 and 0.094, respectively). However, the magnitude of increase in Schirmer score [2.0 � 2 (1.5)] was relatively small (P = 0.08).
CONCLUSIONS:
The results of this study point toward benefits of orally administered O3FAs in alleviating dry eye symptoms, improving lens wear comfort, and cytological changes in contact lens wearers.

Diabetes, often referred to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body's cells do not respond properly to insulin, or both. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia).

Diabetes continues to be a major menace that keeps the medical community on tenterhooks. This is one ailment that affects multiple organs of human body including the kidneys, eyes and heart. Diabetes also wrecks havoc with essential processes like digestion, nervous system functioning and makes life pathetic for the victims. Sadly, diabetes does not spare your sexual prowess either. Both men and women can face fertility problems after becoming diabetic.

People can often have diabetes and be completely unaware. The main reason for this is that the symptoms, when seen on their own, seem harmless. However, the earlier diabetes is diagnosed the greater the chances are that serious complications, which can result from having diabetes, can be avoided. Diabetes is a long-term condition that causes high blood sugar levels.

There are 3 types of diabetes.

Type 1 Diabetes, Type 2 Diabetes and the Gestational Diabetes.

Talk with infertility and fertility experts about the types of diabetes, its implications on infertility and the ways to prevent diabetes at http://www.blossomivfindia.com/meet-the-team

All types of diabetes are treatable. Diabetes type 1 lasts a lifetime, there is no known cure. Type 2 usually lasts a lifetime; however, some people have managed to get rid of their symptoms without medication, through a combination of exercise, diet and body weight control. The majority of gestational diabetes patients can control their diabetes with exercise and diet. Between 10 to 20% of them will need to take some kind of blood-glucose-controlling medications.

Diabetes and Fertility

Infertility, the inability to become pregnant within 12 months of trying to conceive, affects about 10% of the population. In fact, only about 10% of infertility cases go unexplained. In most instances, simple lifestyle changes like weight loss through proper exercise and nutrition can help reverse the affects of infertility. However, diseases like diabetes can cause extra complications for both women and men when it comes to fertility.

If you have been trying with no luck to get pregnant and have not been able to find a reason for your infertility, it may be time to have a simple blood test to determine if your glucose levels are too high. More and more infertility specialists are looking toward this health issue as a main cause of some otherwise unexplained infertility cases they see.

When it comes to diabetes and infertility the answer is clear: there is a connection.

Diabetes in women:

Diabetes in Men:

Should Diabetic Partners Try and Conceive At All?

Read the whole article in detail about the diabetes, its effects on fertility in men and women and the ways to overcome the diabetes at http://www.blossomivfindia.com/pages/diabetes-and-infertility

Infertility specialists encourage their patients with Type 2 diabetes to focus their efforts on eating healthy, exercising, losing weight and closely monitoring blood sugar levels. Taking vitamin supplements is also encouraged. If those efforts alone don't lead to a healthy pregnancy, then medications may be introduced to improve fertility. It can be a challenge to make the lifestyle changes necessary to deal with Type 2 diabetes. The good news is that those efforts are, quite often, rewarded.

Research has shown a strong correlation between PCOS and Type 2 diabetes. Both PCOS and Type 2 diabetes are characterized by unhealthy levels of blood glucose and a resistance to insulin. A variety of medications can be prescribed to help lessen or reverse the effects of PCOS. As with Type 2 diabetes, a healthy lifestyle can also go a long way toward reducing or eliminating PCOS. The key is to bring blood sugar levels into a normal and stable range while combating insulin resistance.
Diabetes doesn't preclude men and women from reproducing. It does, however, require professional guidance, meticulous maintenance of health, and monitoring of blood sugar and hormonal levels. With proper care and attention, the vast majority of diabetics can have healthy offspring.

To help explain diabetes complications in relation to female infertility and male infertility, Specialists at Blossom Fertility and IVF Centre are well-versed in obstetrics, gynaecology and reproductive endocrinology. The Blossom Fertility Centre aims to reduce the stress and hassle associated with infertility investigations and treatment, by offering a one-stop diagnostic and treatment service for infertile couples. While coping up with infertility, it is important that all the test and diagnostic treatment options are considered. The team of specialists at Blossom Centre are in favour of the entire test for blood to be done at the beginning of any diagnosis for the fertility treatment. So if at all any variation in blood sugar levels are there, it is treated initially only. We at Blossom offer to our patient�s clinical excellence, cost-effective treatment options, personalized compassionate care, and exceptional success rate. Our clinic symbolizes excellence, experience, and professionalism in treating all cases of infertility whether it is due to diabetes, PCOS, male infertility, women infertility, hormonal imbalance or egg or sperm production.

You can meet our team of endocrinologist and obstetrician at http://www.blossomivfindia.com/ or you can have their opinion and talk to them at +91 261 2470444