'Late' functionally successful repair of Descemet's membrane detachment following phacoemulsification.
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Aged↗
Biomedical subjects
J Ram
Publications and source records attributed to J Ram.
Type II lepra reaction: an unusual presentation.
Ulcers with maculo-papular rash are an unusual presenting feature of leprosy. They occur as result of neuropathy, type-2 lepra reaction or Lucio's phenomenon. The hall mark of type-2 reaction is erythema nodosum. Very rarely it manifests as ulcerative skin lesions. We describe one such unusual case of a young male who presented with multiple ulcers and maculo-papular rash over the legs, chest and abdomen. In addition to this, he had fever, heart murmur, pulmonary infiltrates, neuropathy, and deranged liver function. A clinical differential diagnosis of infective endocarditis and systemic nectrozing vasculitis was made. Skin biopsy showed dense inflammation with lepra bacilli consistent with type-2 lepra reaction.
Abdomen↗
Modulatory influence of Adhatoda vasica Nees leaf extract against gamma irradiation in Swiss albino mice.
The radiomodulatory influence of ethanolic extract of Adhatoda vasica Nees leaf extract against radiation-induced hematological alterations in peripheral blood of Swiss albino mice was studied at various post-irradiation intervals between 6 h to 30 days. Oral administration of A. vasica leaf extract (800 mg/kg body weight) prior to whole body irradiation showed a significant protection in terms of survival percentage and hematological parameters. Mice exposed to radiation (8.0 Gy) without A. vasica leaf extract pre-treatment exhibited signs of radiation sickness like anorexia, lethargicity, ruffled hairs and diarrhoea and such animals died within 25 days post-irradiation. The dose reduction factor (DRF = 1.6) for A. vasica leaf extract was calculated from LD50/30 values. A significant decline in hematological constituents (RBCs, WBCs, Hb and Hct) was evident till day 15 and no animal could survive beyond day 25. Conversely, animals pre-treated with A. vasica leaf extract showed 81.25% survival till 30 days after exposure and a gradual recovery was noted in the hematological values. However, these hematological values remained significantly below the normal even till day 30. A significant decrease in blood reduced glutathione (GSH) content and increase in lipid peroxidation (LPO) level was observed in control animals (Radiation alone). However, A. vasica leaf extract pretreated irradiated animals exhibited a significant increase in GSH content and decrease in LPO level. A significant increase in the serum alkaline phosphatase activity and decrease in acid phosphatase activity was observed in A. vasica leaf extract pretreated irradiated animals during the entire period of study.
Administration, Oral↗
Molecular theory of elastic constants of liquid crystals. III. Application to smectic phases with tilted orientational order.
Using the density-functional formalism we derive an expression for the distortion free energy of systems with continuous broken symmetry and use it to derive an expression for the elastic constants of smectic phases in which the director is tilted with respect to the smectic layer normal. As in the previous papers of this series [Y. Singh, S. Singh, and K. Rajesh, Phys. Rev. A 45, 974 (1992); Y. Singh, K. Rajesh, V. J. Menon, and S. Singh, Phys. Rev. E 49, 501 (1994)], the expressions for the elastic constants are written in terms of order and structural parameters. The structural parameters involve the generalized spherical harmonic coefficients of the direct pair correlation function of an effective isotropic liquid. The density of this effective isotropic liquid depends on the nature and amount of ordering present in the system and is evaluated self-consistently. We estimate the value of elastic constants using reasonable guesses for the order and structural parameters.
Journal Article↗
Curvularia lunata endophthalmitis with secondary keratitis.
PURPOSE: To report a case of pseudophakic endophthalmitis with secondary keratitis caused by Curvularia lunata. METHODS: A 40-year-old man presented with a fluffy mass in the anterior chamber with low-grade delayed postoperative inflammation in the right eye. RESULTS: The anterior chamber and vitreous aspirate demonstrated C. lunata. A large corneal infiltrate developed after aspiration of the mass. Treatment with systemic, topical, and intraocular antifungal agents cleared the vitreous, but the cornea perforated. CONCLUSION: Delayed low-grade infection with a fluffy mass in the anterior chamber after cataract surgery can rarely be a clinical presentation of dematiaceous fungal infection. Secondary keratitis may result after a diagnostic aspiration.
Adult↗
Fungal endophthalmitis following cataract surgery: clinical presentation, microbiological spectrum, and outcome.
PURPOSE: To determine the clinical presentation, microbiological spectrum, and outcome in cases of fungal endophthalmitis following cataract surgery. DESIGN: Observational case series. METHODS SETTING: Tertiary referral hospital. PATIENTS: Retrospective analysis of 27 cases of smear- and culture-proven fungal endophthalmitis. INTERVENTION: Pars plana vitrectomy in 18 eyes, where the corneal condition did not preclude the same. All eyes received intravitreal amphotericin B and dexamethasone along with systemic antifungal agents. MAIN OUTCOME MEASURES: Functional success: Final visual acuity of 3/60 or better with attached retina. Anatomical success: Final visual acuity of better than light perception with preserved anatomy of globe. RESULTS: The majority of the eyes (22 of the 27) had early onset and diffuse presentation (that is, anterior segment as well as posterior vitreous exudates). Substantial corneal involvement was seen in 14 eyes (51.85%). Aspergillus sp. was the most common isolate. Multivariate analysis using forward stepwise logistic regression showed corneal involvement as the single most important risk factor in determining final visual outcome (P =.0429). CONCLUSIONS: Early onset and diffuse presentation, which mimics bacterial endophthalmitis, stresses the importance of both bacterial and fungal cultures from intraocular fluids to reach a diagnosis apart from the clinical judgment. Corneal involvement was the most important predictor of outcome in cases of fungal endophthalmitis.
Adult↗
Eradication of posterior capsule opacification: documentation of a marked decrease in Nd:YAG laser posterior capsulotomy rates noted in an analysis of 5416 pseudophakic human eyes obtained postmortem.
OBJECTIVE: (1) To report the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy rate (%) of eight rigid and foldable intraocular lens (IOL) designs in a series of 5416 pseudophakic human eyes obtained postmortem, accessioned in our center between January 1988 and January 2000. (2) To identify factors that are instrumental in reducing the incidence of posterior capsule opacification, (PCO, secondary cataract) and hence the need for Nd:YAG laser posterior capsulotomy. DESIGN: Comparative autopsy tissue analysis. PARTICIPANTS: A total of 5416 globes with posterior chamber intraocular lens (PC-IOLs) obtained postmortem received from Lions Eye Banks between 1988 and 2000. METHODS: Miyake-Apple posterior photographic technique. Special reference was given to the presence or absence of Nd:YAG laser posterior capsulotomy orifice on the posterior capsule of each eye. MAIN OUTCOME MEASURES: The Nd:YAG laser posterior capsulotomy rate (%) as of January 2000 was documented. In addition, the Nd:YAG laser posterior capsulotomy rate for each lens was plotted on a monthly basis for the same period, creating a computerized trend or "timeline" for each IOL style. RESULTS: Relatively high Nd:YAG laser posterior capsulotomy rates ranging from 20.3% to 33.4% were noted with four relatively older designs (high incidence of implantation between 1988 and the early 1990s). Four modern foldable IOLs manufactured from silicone and acrylic materials had significantly lower Nd:YAG laser posterior capsulotomy rates ranging from 0.9% (Alcon Acrysof) to 17.1%. The difference in Nd:YAG rates among the eight IOL designs was found to be significant (P < 0.0001, chi-square test). Comparing foldable versus rigid designs, the foldable IOLs were associated with a much lower Nd:YAG laser posterior capsulotomy rate (14.1% vs. 31.1%). CONCLUSIONS: By use of the six factors regarding surgical technique and IOL choice described in this article, we strongly believe that the overall incidence of PCO and hence the incidence of Nd:YAG laser posterior capsulotomy is now rapidly decreasing from rates as high as 50% in the 1980s to early 1990s. Surgical tools and IOLs are now available to bring these rates down to single digits. Careful application and use of these tools by surgeons can genuinely lead in the direction of virtual eradication of secondary cataract, the second most common cause of visual loss worldwide.
Cataract↗
Effect of in-the-bag intraocular lens fixation on the prevention of posterior capsule opacification.
PURPOSE: To compare the incidence of posterior capsule opacification (PCO) after extracapsular cataract extraction (ECCE) and phacoemulsification and to evaluate the role of posterior chamber intraocular lens (PC IOL) haptic fixation and biomaterial/design in reducing the incidence. SETTING: Postgraduate Institute of Medical Education and Research, Chandigarh, India; Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: This study comprised 278 eyes of 263 patients having ECCE and 318 eyes of 297 patients having phacoemulsification with PC IOL implantation. Posterior capsule opacification leading to a decrease in Snellen visual acuity of 2 or more lines was considered visually significant. The presence of PCO and IOL haptic fixation were evaluated postoperatively using slitlamp biomicroscopy. Haptic position was noted as in-the-bag (B-B), 1 haptic in the bag and 1 in the sulcus (bag-sulcus [B-S]), or both haptics out of the bag (sulcus-sulcus [S-S]). In addition, the rate of visually significant PCO was compared among 3 IOL biomaterials: poly(methyl methacrylate), silicone, and hydrophobic acrylic. RESULTS: Visually significant PCO occurred in 42.45% of eyes having ECCE and 19.18% of eyes having phacoemulsification (P <.001, chi-square test) after a mean follow-up of 2.4 years +/- 0.7 (SD). In both groups, visually significant PCO was significantly less in eyes with B-B fixation than in those with B-S or S-S fixation (P <.001). The rate of visually significant PCO in all eyes in the phacoemulsification group with B-B fixation was low (11.90%) and was significantly lower in eyes with a hydrophobic acrylic IOL (2.22%; P <.05, chi-square test). CONCLUSIONS: In-the-bag PC IOL fixation is required to consistently reduce the incidence of PCO. Thorough removal of lens substance, including hydrodissection-assisted cortical cleanup, and in-the-bag PC IOL fixation seem to be the most important factors in reducing PCO, regardless of surgical procedure or IOL type used. Intraocular lens biomaterial and design also help prevent PCO.
Biocompatible Materials↗
Clear tectonic penetrating graft using glycerine-preserved donor cornea.
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Adult↗
Late clouding on an acrylic intraocular lens following routine phacoemulsification.
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Biofilms↗
Intracameral amphotericin B: initial experience in severe keratomycosis.
PURPOSE: Fungal keratitis is a significant cause of ocular morbidity in India. The most commonly implicated fungi are Aspergillus spp. Patients often present with hypopyon, which usually contains fungal elements. The treatment is difficult owing to poor intraocular penetration of most available antifungal agents. This study evaluated the results of intracameral injection of amphotericin B in natamycin resistant cases of severe keratomycosis. METHODS: Three patients of culture proven Aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin B 0.15%, and oral itraconazole were administered intracameral amphotericin B. The first case received 7.5 microg in 0.1 mL followed by two subsequent injections of 10 microg in 0.1 mL each, the second case received two injections of 10 microg in 0.1 mL, and the third patient received a single dose of 10 microg in 0.1 mL. Culture of the aqueous sample also grew A. flavus in all three cases. RESULTS: All three cases responded favorably, with the ulcer and hypopyon clearing completely. There was no clinical evidence of corneal or lenticular toxicity in any patient. CONCLUSIONS: Intracameral amphotericin B may be a useful modality in the treatment of severe keratomycosis not responding to topical natamycin. It ensures adequate drug delivery into the anterior chamber and may be especially useful to avoid surgical intervention in the acute stage of the disease.
Adult↗
Frequency doubled Nd:YAG (532 nm) laser photocoagulation in corneal vascularisation: efficacy and time sequenced changes.
PURPOSE: To evaluate the efficacy of frequency-doubled Nd:YAG (532 nm) laser treatment in quiescent corneal vascularisation, and to record the sequential changes in lasered vessels and complications in eyes with one and two quadrant vascularisation. METHODS: Thirty eyes (30 patients)--15 eyes (15 patients) with one-quadrant and 15 eyes (15 patients) with two-quadrant corneal vascularisation were treated. Frequency-doubled Nd:YAG laser (532 nm) was used at laser setting of 120-480 mw power, 50-150 mm spot size and 0.05 sec pulse duration. The area of corneal vascularisation, status of treated corneal vessels, area of corneal opacity and visual acuity were recorded before treatment, at one week after treatment and thereafter at monthly intervals up to three months. RESULTS: The mean area of corneal vascularisation decreased from 20.09% to 8.31% of the total corneal area in group I (p<0.01) and from 44.34% to 20.67% of the total corneal area in group II (p<0.01) at 3 months' follow-up. The mean reduction in the area of corneal vascularisation was 58.64% in group I and 53.38% in group II (p>0.05). Of 148 corneal vessels treated, 60 (44.6%) were totally occluded, 44 (30%) partially occluded, 37 (28%) recanalized and there was one shunt vessel at one week following laser treatment. At three months' follow-up, 80 (54.15%) vessels were totally occluded, 14 (9%) partially occluded, 52 (35.14%) recanalised and two shunt vessels appeared. Thus, at three months' follow-up, the number of totally occluded vessels increased and partially occluded vessels decreased. Superficial corneal haemorrhage was observed in 4 (14%) patients. CONCLUSION: Frequency-doubled Nd:YAG (532 nm) laser photocoagulation appears a safe and effective means of reducing the area of corneal vascularisation in quiescent eyes with vascularised corneal opacities.
Adult↗
Bacterial adherence to polymethylmethacrylate posterior chamber intra ocular lenses.
PURPOSE: Bacterial adherence to intraocular lenses (IOLs) has been incriminated in the pathogenesis of postoperative endophthalmitis. Staphylococcus epidermidis is the most common organism isolated. We studied the in-vitro adhesion of Staphylococcus epidermidis to Polymethylmethacrylate (PMMA) IOLs and the effect of duration of exposure to adherence. METHODS: Two groups of 10 IOLs each were incubated in Staphylococcus epidermidis suspension for 2 minutes and 20 minutes respectively. Adhesion of bacterial cells was determined by counting the number of viable bacteria attached to IOLs. RESULTS: The mean bacterial adherence with 2 minutes incubation was 12,889 +/- 7,150 bacteria/ IOL and with 20 minutes incubation was 84,226 +/- 35,024 bacteria/IOL (P< 0.01). CONCLUSION: Our results show that Staphylococcus epidermidis adheres to PMMA IOLs in vitro and the degree of adherence is less for shorter duration of exposure. We conclude that viable bacteria irreversibly adherent to IOLs may play a role in the pathogenesis of postoperative endophthalmitis. Shorter duration of operative manipulation and exposure to contaminating sources may decrease the chances of postoperative endophthalmitis.
Bacterial Adhesion↗
Prevention of postoperative infections in ophthalmic surgery.
Postoperative endophthalmitis is a serious, vision-threatening complication of intraocular surgery. Better instrumentation, surgical techniques, prophylactic antibiotics and better understanding of asepsis have significantly reduced the incidence of this complication. Postoperative endophthalmitis may occur as an isolated event or as a cluster infection. Topical antibiotics, preoperative periocular preparation with povidone-iodine combined with a sterile operating room protocol significantly reduce the incidence of isolated postoperative endophthalmitis. The role of antibiotics in the irrigating fluid and subconjunctival antibiotics remains controversial. Cluster infections on the other hand are more likely to occur due to the use of contaminated fluids/viscoelastics or a breach in operating room asepsis. Prevention of postoperative endophthalmitis requires strict adherence to operating room norms, with all involved personnel discharging their assigned roles faithfully.
Administration, Topical↗
Surgical prevention of posterior capsule opacification. Part 1: Progress in eliminating this complication of cataract surgery.
PURPOSE: To evaluate over almost 2 decades the success of a component of cataract surgery that represents a critical step in reducing the incidence of posterior capsule opacification (PCO); namely, the efficacy of cortical cleanup. SETTING: Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: Accessioned from the early 1980s to 1997, 3320 eyes obtained postmortem with posterior chamber intraocular lenses were analyzed with respect to formation of a postoperative Soemmering's ring. This anatomic lesion, the precursor of clinical PCO, represents an important and measurable indication of the quality of cortical cleanup. Its formation was documented using Miyake-Apple posterior photographic analysis. RESULTS: The quality and thoroughness of cortical cleanup and overall effectiveness in eliminating retained and/or regenerating cortical cells, as measured by scoring of Soemmering's rings, showed virtually no net change since the early 1980s. The intensity of Soemmering's ring was higher in the most recent specimens than in those in the early 1980s. CONCLUSION: The results indicate that renewed attention to cortical cleanup in cataract surgery is warranted for significant reduction in incidence or the elimination of PCO. More attention to the hydrodissection (cortical cleaving hydrodissection) step of the procedure is likely a practical, immediately implementable, and inexpensive remedy.
Cadaver↗
Fungal endophthalmitis after a single intravenous administration of presumably contaminated dextrose infusion fluid.
PURPOSE: To report fungal endophthalmitis in nonimmunocompromised patients, each of whom received a single intravenous administration of presumably contaminated dextrose infusion fluid for minor ailments in rural settings. METHODS: This noncomparative case series included 12 nonimmunocompromised patients (12 eyes) with culture-positive fungal endophthalmitis. All eyes underwent initial vitreous tap with injection of intravitreal antibiotics. Eleven eyes required pars plana vitrectomy and oral fluconazole or itraconazole for 4 to 6 weeks. One patient with panophthalmitis was treated with intravenous amphotericin B. To support the hypothesis that contaminated intravenous fluid was the possible risk factor, samples from 72 sealed bottles of 5% dextrose were subjected to fungal culture. RESULTS: Patients presented 1 to 11 weeks (mean, 4.6 weeks) after the intravenous infusion. All eyes had a positive smear and cultures for fungi. Aspergillus specimen was isolated in nine eyes, Candida in two eyes, and Mucor in one eye. Final visual acuity was 20/80 or better in 8 (66.6%) eyes. Eleven of the 72 samples from dextrose bottles were culture-positive for fungi: six for Aspergillus fumigatus, three for Aspergillus niger, and two for Candida albicans. CONCLUSION: A presumed contaminated intravenous infusion administered in a rural setting was found as a new risk factor for development of endogenous fungal endophthalmitis. These patients were successfully treated with pars plana vitrectomy and oral fluconazole and itraconazole therapy.
Adult↗
Visual outcome following cataract surgery in rural punjab.
In a cluster sample survey in rural areas of Punjab visual outcome after cataract surgery was assessed. Three hundred patients (428 cataract operated eyes) were included in the study from 24 sampled villages. The mean age at cataract extraction was 61.70 +/- 9.82 years. The average interval since the cataract surgery was 7.05 +/- 5.86 years (range 0.11-32 years). Of the 428 operated eyes, 72 (16.82%) were blind (VA < 3/60), 162 (37.85%) had low visual acuity (VA 3/60-< 6/18) and 194 (45.33%) eyes gained good visual acuity (VA > or = 6/18). Cataract surgery related complications were the principal causes leading to blindness in 50 of 72 eyes; these included corneal oedema, (17/72;23.3%), retinal detachment (14/72;19.4%), and aphakic glaucoma (13/72;18.05%). This study emphasizes the need to improve the qualitative aspect of cataract surgery including long-term follow up in rural India.
Aged↗