Biomedical subjects
Publications and source records attributed to S Ghose.
An unusual sibship is described of a spectrum of microphthalmos associated with various degrees of anterior segment mesodermal dysgenesis ranging from partial sclerocornea to congenital anterior staphyloma. The possible embryologic significance of these anomalies manifesting together are discussed, along with the visual benefits which are sometimes surprisingly attainable in these usually hopeless eyes.
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A unique case of bilateral, partial cryptophthalmos is described, with no associated systemic anomalies. There were symmetrical, well-developed palpebral apertures medially with small conjunctival sacs, and symmetrical hemicryptophthalmos laterally. A faint groove extended temporally over the fused lids on both sides. There was a distinct plane of cleavage laterally between the disorganized microphthalmic globes and overlying tissues. The surgical observations are detailed.
A total of 171 isolates of Streptococcus pneumoniae were obtained from eyes of children who had congenital dacryocystitis, congenital cataract and glaucoma, acute bacterial conjunctivitis, corneal ulceration, nasolacrimal duct block, or discharging socket, or who had developed ectropion, endophthalmitis and orbital cellulitis. The highest number of strains was obtained from cases of dacryocystitis (74.4%), followed by conjunctivitis (8.2%) and those having developed nasolacrimal duct block (7.6%). The least overall resistance was to erythromycin (17.6%) and chloramphenicol (31.0%). Erythromycin being unavailable for ocular use in India, chloramphenicol was reported to be one of the best drugs against pneumococcal ocular infections in children, the other being cloxacillin, a 2.5% solution of which is made from injectable cloxacillin and used as an ophthalmic preparation. Their use on patients has met with considerable success. Nineteen out of 20 isolates were typeable--the types being 3, 46, 8, 28, 29, 45, 21 and 18. To the best of our knowledge, this is the first report from a developing country of serotyping ocular strains of pneumococci.
The manifest (dry) and cycloplegic refractions of 50 eyes of 25 patients aged 8 to 28 years were studied on the Nikon Auto Refractometer NR-1000F (AR) and compared with the results of clinical refraction (CR) under homatropine and the final clinical acceptance on postmydriatic testing. Only patients in the younger age groups with low to moderate refractive errors were included in this study; high myopes and hypermetropes and patients with aphakia and mixed astigmatism were excluded. The degree of agreement for spherical equivalents, sphere components, and cylinder components was analysed separately for both cycloplegic and manifest refractions on the AR and CR. The results showed that the fixation target in the NR-1000F induces significant instrument myopia during manifest refraction in the younger patients with lower refractive errors. We recommend that caution should be exercised in interpreting manifest refractions on the AR, especially in younger patients. A cycloplegic automatic refraction would be acceptably accurate.
A procedure is described for the ophthalmoscopic examination of the fundus in children after 1% or 2% oral fluorescein ingestion without sedation or anaesthesia. No major complications or any allergic reactions were observed. In the ophthalmoscopically normal fundi of the five healthy children studied the fluorescence of the nerve head and retinal blood vessels could be visualised at 15 minutes, increasing at 30 minutes, and declining by 60 minutes. The possible problems of the technique are discussed.
Nine eyes of suspected papilloedema, 21 with incipient papilloedema, and 16 with pseudopapilloedema in 23 children aged 1 month to 10 years were examined after oral fluorescein. In pseudopapilloedema the retinal vascular fluorescence and slight disc head fluorescence with sharp margins at 30 minutes markedly declined by 60 minutes. These features were similar to our earlier findings with oral fluorescein in the normal fundi of children. Of the 30 eyes with suspected or incipient papilloedema late disc and peripapillary 'staining', polar or diffuse was observed in 12, the 60 minutes fluorescence being more than at 30 minutes in nine and of equal in intensity in three. In these 12 'positive' eyes, and four more of the 18 'negative' eyes, the retinal vascular fluorescence at 60 minutes was significantly more than at 30 minutes. The problems of interpretation after oral fluorescein in the early diagnosis of papilloedema in children and the possible fallacies are discussed.
The manifest refractions of 37 high myopic and 16 high hypermetropic eyes in a total of 28 patients, aged 5 to 42 years, were determined on the Nikon NR-1000F Auto Refractometer. The data obtained were compared with the final clinical prescriptions for these eyes and analysed for degree of agreement for the spherical equivalents, sphere components, and cylinder powers and axes. The Auto Refractometer recordings for all the different refractive components were observed to skew towards more minus in the high myopic eyes but more plus in the high hypermetropes. The possible significance of these skewing patterns is discussed with reference to our earlier studies.
The echographic profile of the optic nerve was studied in ten eyes with coloboma of the optic nerve head. Optic nerve dimensions measured with A-scan ultrasonography revealed an increase in the overall diameter of the nerve; B-scan echography was performed in six patients and showed excavation of the optic discs with a double-walled lining posteriorly. Additional B-scan features included widening of the anterior angle of the nerve and random perpendicular echoes in the anterior part of the nerve head. The similarities and differences in echographic pictures observed in coloboma of the optic disc and glaucomatous optic atrophy are described, and the genesis of these ultrasonographic features is discussed.
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The manifest (dry) refractions of 165 eyes of 86 patients, aged 6 to 75 years, were studied on the Nikon Auto Refractometer NR-1000F. The results obtained were compared with the clinical refractive data, and they were analysed for degree of agreement of various refractive components in different types and grades of refractive errors in the separate age groups. On the NR-1000F the spherical and cylindrical components and spherical equivalents skewed towards more minus (or less plus), especially so in emmetropes, low hypermetropes, and low myopes. This error declined with increasing age over 40 years and was also significantly lower in aphakia and mixed astigmatism. Determination of cylinder axis was found to be reliable on the NR-1000F. In spite of the obvious utility of the device its inbuilt automatic fogging system does not seem adequately to neutralise the patient's accommodative efforts, as the fixation target probably induces instrument myopia.
A unique case of bilateral aniridia, partial anodontia, bilateral cervical ribs and Marfan's syndrome is presented. This is the first report in the literature of the established association of all these four entities in the same patient. The etiological possibilities and clinical significance are discussed.
An ophthalmic evaluation was undertaken in 250 consecutive cases of mental retardation where no specific etiological diagnosis could be established, ie, "idiopathic" mental retardation. Visual impairment was noted in 59 of these patients, and was mainly due to primary optic atrophy, besides cortical blindness, strabismus, nystagmoid eye movements, refractive errors and various associated congenital ocular anomalies. It was encouraging to find that 191 children had active vision, including 10 patients with definite disc pallor. The importance of useful vision in these retarded children cannot be overemphasized. This is probably the first report in the literature analyzing the ocular changes and their significance in a fairly large series of idiopathic mental retardation.
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An unusual case of bilateral nanophthalmos with pigmentary retinal dystrophy and angle closure glaucoma is presented. This is probably the first published report of the established association of all these three entities in the same patient. The aetiological possibilities and clinical significance are discussed.
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The ocular and systemic features of 11 cases of optic nerve hypoplasia were analysed, with particular reference to visual function and associated anomalies of the central nervous system. Schizencephaly, noted in one of the cases, is reported for the first time in association with optic nerve hypoplasia. The role of ultrasonography in the diagnosis and qualitative evaluation of optic nerve hypoplasia is highlighted.