PURPOSE: To determine factors predisposing to the development of choroidal detachment following conventional retinal detachment surgery, to evaluate its clinical course, and to identify possible measures to reduce its occurrence. METHODS: Analysis of 25 consecutive cases of choroidal detachment following retinal detachment surgery out of a total of 510 cases undertaken at a tertiary care referral eye center over a period of 15 months. RESULTS: The incidence of developing choroidal detachment was 4.9%. The mean age was 61 years (range 28 to 76 years) and there was no sex predilection. Hypertension was present in 16% (n=4). A total of 44% (n=11) of patients had myopia and with respect to the lens status, 44% (n=11) were phakic, 36% (n=9) were pseudophakic, and 20% (n=5) were aphakic. Redetachment of the retina was observed in 12% (n=3) of cases. Elevated intraocular pressure developed in 12% (n=3). In one patient with an anterior chamber intraocular lens and "kissing" choroidal detachment, drainage of the choroidals was undertaken to prevent corneo-lenticular touch and corneal decompensation. In two patients with redetachment, anatomic settlement of the retina was achieved only following vitreoretinal surgery. CONCLUSIONS: The following preoperative and intraoperative factors are associated with a significantly increased risk of choroidal detachment following retinal detachment: higher age, myopia, posteriorly placed explants even if its extent is less, anteriorly placed explants whenever its extent is large, drainage of subretinal fluid, and intraoperative hypotony. Choroidal detachment may also occur in patients with only a radial sponge. Designing a notch intraoperatively in the region of the explants overlying the vortex veins may help to reduce the risk of choroidal detachment following conventional retinal detachment surgery.

Adult↗

PubMedDate not supplied

Prospective evaluation of intravitreal triamcinolone acetonide injection in macular edema associated with retinal vascular disorders.

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders. METHODS: This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions. RESULTS: Mean preinjection central macular thickness was 531.84+/-132 microm in Group I, 458.4+/-149 microm in Group II, and 750.81+/-148 microm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7+/-119 microm in Group I, 218.2+/-99 microm in Group II, and 210.5 +/-56 microm in Group III) and 3 months (253.19+/-109 microm in Group I, 187+/-47 microm in Group II, and 182+/-50 microm in Group III) after injection (p < 0.05). Mean follow-up was 22+/-2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2+/-0.4 logMAR units; Group II, 1.24+/-0.5 logMAR units; Group III, 1.1+/-0.4 logMAR units; 1 month postinjection in Group I, 0.88+/-0.3 logMAR units; Group II, 0.67+/-0.3 logMAR units; Group III, 0.86+/-0.4 logMAR units; 3 months postinjection in Group I, 0.84+/-0.4 logMAR units; Group II, 0.59+/-0.3 logMAR units; Group III, 0.82+/-0.5 logMAR units) (p < 0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.

Diabetic Retinopathy↗

PubMedDate not supplied

Aureobasidium pullulans scleritis following keratoplasty: a case report.

Fungal scleritis is a rare entity. A 50-year-old patient with culture proven Aureobasidium pullulans corneal ulcer underwent therapeutic keratoplasty. He developed scleritis 5 days following surgery. Although the patient had symptomatic improvement after antifungal therapy, surgical debridement, and cryotherapy, visual improvement was only marginal. Aureobasidium pullulans should be looked for as a cause for keratomycosis and scleromycosis, especially in tropical countries.

Antifungal Agents↗

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Cytomegalovirus retinitis in a patient with non-Hodgkin's lymphoma: a diagnostic dilemma.

PURPOSE: Patients with lymphoma can rarely develop cytomegalovirus (CMV) retinitis. Clinically it is difficult to distinguish from intraocular lymphoma. Also, in such cases the CD4+ count may be high. The authors report a rare case of bilateral CMV retinitis in a patient with non-Hodgkin's lymphoma with high CD4+ counts. METHODS: Observational case report with review of literature. RESULTS: CMV retinitis was clinically suspected due to the presence of large areas of retinal necrosis and hemorrhages in one eye and a demarcation line with white mottled retina in the other eye. Other differential diagnoses considered were intraocular lymphomatous infiltration and acute retinal necrosis due to herpes group of viruses. The diagnosis of CMV retinitis was confirmed by polymerase chain reaction performed on vitreous sample. CONCLUSIONS: CMV retinitis can develop in cases of lymphoma despite high CD4+ counts. An early diagnosis can be established by performing PCR on vitreous biopsy.

Adult↗

PubMedDate not supplied

Primary carcinoid tumour of trachea.

Tracheal carcinoid is a rare entity. A patient with a primary carcinoid tumour of trachea treated as a case of bronchial asthma for over a decade, is presented.

Adult↗

PubMedDate not supplied

Fibrebronchoscopy in pulmonary sarcoidosis--an Indian experience.

Twenty-four patients suspected to have sarcoidosis were subjected to fibrebronchoscopy. Histopathological support for the diagnosis was ultimately obtained in 20 patients. Fibrebronchoscopy provided the diagnosis in 17 patients, while histopathological confirmation was obtained from extrapulmonary biopsy sites in 3 patients. Transbronchial lung biopsy, attempted without fluoroscopic guidance, revealed non-caseating granulomata in 15 patients. The only complication encountered was a small pneumothorax, not requiring intervention, in one patient. Lack of fluoroscopic guidance did not compromise the diagnostic yield or increase the complication rate of the procedure. Bronchial biopsy confirmed the diagnosis in 2 patients with a non-specific lung biopsy. It was positive in 6 of 8 patients with an abnormal appearing mucosa and in 5 of 12 patients with a normal bronchial tree. Random bronchial biopsy in all patients, irrespective of mucosal changes, made an important contribution to the yield of fibrebronchoscopy. Fibrebronchoscopy confirmed the diagnosis of tuberculosis in 2 patients with an atypical radiological picture, thereby differentiating the two conditions which occasionally mimic each other.

Biopsy↗

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A new approach in evaluation of fertility in surgically treated cryptorchids.

In this study twenty two operated cryptorchids were followed up (average period 12.02 years) and various indices of function like size, semen analysis and histology were assessed. FNAC as an index of spermatogenic potential of testis was added and compared with other investigations. The fertility potential in operated unilateral cryptorchids was 86.7 percent and in bilateral 42.9 percent. As an investigation in cryptorchids, FNAC correlated well with semen analysis and histology in all respects--the two gold standards. When done in a child FNAC would hence give an excellent idea of spermatogenic potential of that testis, regardless of age. We recommend that FNAC being the least traumatic but equally reliable modality should replace biopsy in the intraoperative as well as subsequent follow up evaluation of cryptorchids.

Adolescent↗

PubMedDate not supplied