Surgically induced necrotising scleritis (SINS)--report of two cases.
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Administration, Topical↗
Biomedical subjects
S S Badrinath
Publications and source records attributed to S S Badrinath.
Optic disc in fundus coloboma.
PURPOSE: To categorize and describe the type of optic disc involvement and blood vessel patterns seen in patients with fundus coloboma. METHODS: This is a prospective study involving 67 eyes of 40 patients with choroidal coloboma. The evaluation included documentation of fundus details using fundus drawings or photographs, or both. RESULTS: Six types of disc involvement were identified: (1) normal disc outside fundus coloboma (27.8%); (2) disc outside the fundus coloboma and abnormal (10.4%); (3) disc outside the fundus coloboma and independently colobomatous (8.9%); (4) disc within the fundus coloboma and normal (5.0%); (5) disc within the fundus coloboma and colobomatous (44.3%); and (6) disc shape not identified but blood vessels seen emanating from the superior border of the large fundus coloboma (2.9%). Visual acuity was better in types I, II, and III compared with IV, V, and VI. Microphthalmos was more common with the more severe anomalies. High myopia was more common in the less severe anomalies. CONCLUSION: Optic disc involvement in fundus coloboma is widely variable. Of fundus colobomas, 67.2% are associated with either a frankly colobomatous or an altered disc. Of the discs located outside fundus colobomas, 41% are also abnormal. Visual acuity was better in types I, II, and III.
Adolescent↗
Comparison of ciprofloxacin ophthalmic solution 0.3% to fortified tobramycin-cefazolin in treating bacterial corneal ulcers. Ciprofloxacin Bacterial Keratitis Study Group.
PURPOSE: The purpose of the study is to compare the clinical efficacy and safety of ciprofloxacin ophthalmic solution 0.3% (Ciloxan) with a standard therapy regimen (fortified tobramycin, 1.3%-cefazolin, 5.0%) for treating bacterial corneal ulcers. METHODS: This randomized, parallel group, double-masked, multicenter study was conducted in 324 patients at 28 centers in the United States, Europe, and India. Patients were randomized into 2 treatment groups: 160 to ciprofloxacin and 164 to fortified tobramycin-cefazolin. Positive microbiologic cultures were obtained in 188 (58%) of 324 patients. Of these, 176 patients met protocol criteria and were evaluated for treatment efficacy: 82 in the ciprofloxacin group and 94 in the standard therapy group. The dosing schedule for both treatment groups was 1 to 2 drops of the first study medication (ciprofloxacin or fortified tobramycin) every 30 minutes for 6 hours, then hourly for the remainder of day 1; 1 to 2 drops every hour on days 2 and 3; 1 to 2 drops every 2 hours on days 4 and 5, followed by 1 to 2 drops every 4 hours on days 6 to 14. The second medication (ciprofloxacin or cefazolin) was instilled 5 to 15 minutes after the first drug, following the same dosing frequency. Physician's judgment of clinical success, cure rate, changes in ocular sings, and symptoms and the rate of treatment failures were the primary efficacy criteria. RESULTS: Topical ciprofloxacin monotherapy is equivalent clinically and statistically to the standard therapy regimen of fortified antibiotics. No statistically significant treatment differences were found between ciprofloxacin (91.5%) and standard therapy (86.2%) in terms of overall clinical efficacy (P = 0.34). Similarly, no differences were noted in resolution of the clinical signs and symptoms (P > 0.08) or the time to cure (P = 0.55). The incidence of treatment failures was less in the ciprofloxacin group (8.5%) compared with the standard therapy group (13.8%). Significantly fewer patients treated with ciprofloxacin reported discomfort than did patients treated with the standard therapy regimen (P = 0.01). CONCLUSION: Ciprofloxacin ophthalmic solution 0.3% monotherapy is equivalent clinically and statistically to standard therapy (fortified tobramycin-cefazolin) for the treatment of bacterial corneal ulcers and produces significantly less discomfort.
Adolescent↗
Linkage of blepharophimosis syndrome in a large Indian pedigree to chromosome 7p.
Blepharophimosis syndrome (BPES) is an autosomal dominant disorder involving abnormal eyelid development. Cytogenetic and linkage analyses have previously implicated the chromosome 3q23 region in multiple cases of this syndrome. However, in a few cases cytogenetic analyses have implicated other chromosomal regions in this condition. Here we report linkage of BPES in a large Indian pedigree to chromosome 7p13-p21; affected only two-point and multipoint analyses using D7S488, D7S2551 and D7S2562 both showed peak lod scores of 3.61 coincident with D7S2562. Recombinations in affected individuals placed the critical region between D7S488 and D7S629. When both affected and unaffected individuals were considered, a maximum two-point lod score of 3.38 at theta = 0.08 was obtained with D7S2551 while a peak multipoint lod score of 3.64 was obtained between D7S488 and D7S2551. Segregation analysis revealed two unaffected individuals carrying the affected haplotype accounted for the difference in peak, relative to the affected only analysis. The chromosome 7p candidate genes inhibin beta A and epidermal growth factor receptor map outside this region whereas the HOX1 gene cluster may map inside this region. Although BPES is sometimes associated with female infertility due to premature ovarian failure, in the current family affected females were fertile. The current finding together with the previous evidence implicating chromosome 3q2 provides strong evidence that BPES involves locus heterogeneity; this point should be considered when counselling affected families.
Blepharophimosis↗
Removal of silicone oil and epimacular proliferation from eyes following vitrectomy.
BACKGROUND AND OBJECTIVES: Epimacular proliferation (EMP) represents a localized form of reproliferation at the macula. The significance of EMP in eyes that have undergone vitrectomy is still not clear. This study investigated the redetachment rate following silicone oil removal when combined with removal of EMP. PATIENTS AND METHODS: Twenty-two consecutive eyes underwent removal of silicone oil and EMP These eyes had attached retinas following silicone oil injection used as an adjunct to complex vitreoretinal surgery. RESULTS: The retina remained attached in 19 (86.4%) of the eyes, with functional improvement it vision in 81.8% of the eyes. Visual acuity of 6/60 (20/200) or better was obtained in 12 (54.5%*) of the eyes. The mean follow-up time was 6.3 months. CONCLUSION: These results suggest that removal of EMP and silicone oil does not increase the risk of redetachment.
Adolescent↗
A case control study of senile cataract in a hospital based population.
A case-control study (244 cases and 264 controls) was done during 1986-89 on a hospital based population to evaluate the risk factors associated with the etiology of senile cataract. Patient with age between 40-60 years, visual acuity of 6/9 or less, and presence of lenticular opacity of senile origin were included as cases. Age matched individuals with absence of lenticular opacity made up the controls. Multivariate logistic regression analysis revealed that higher systolic BP and number of meals were significantly (P < or = 0.05) associated with presence of senile cataract; whereas higher weight, education and income, and utilization of cooking water had a significant protective effect against senile cataract. The present study helps the clinician to understand the possible risk factors associated with the development of senile cataract and could be helpful in designing a intervention strategy in future.
Adult↗
Pattern of retinal breaks and retinal detachments in eyes with choroidal coloboma.
PURPOSE: To describe the type of breaks that occur in the diaphanous tissue within the coloboma of the choroid and the types of retinal detachment that are associated with these breaks. METHODS: This is a retrospective study of 36 eyes of 36 patients with retinal detachments that extended into the choroidal coloboma. Preoperative findings were documented using detailed fundus drawings and color photographs. Intraoperative identification of retinal breaks was possible using high magnification of the operating microscope. RESULTS: Based on the identifiable breaks inside the coloboma and the extent of retinal detachment, these patients were divided into five subgroups. Three distinct types of breaks were identified within the coloboma: (1) breaks at the edge of the detachment inside the coloboma; (2) oval atrophic breaks; and (3) breaks in anatomic macula that was involved in the coloboma. Multiple breaks were common. CONCLUSIONS: Retinal detachments that extend into the colobomatous area always are associated with breaks in the diaphanous tissue. Intraoperative identification of these breaks is relatively easy. Commonly, the breaks are seen at the edge of the retinal detachment inside the coloboma or as oval breaks within the detached diaphanous tissue. Macula, if involved in the coloboma, occasionally can harbor a retinal break.
Adolescent↗
Retinal detachment secondary to ocular perforation during retrobulbar anaesthesia.
The clinical characteristics and the retinal breaks associated with rhegmatogenous retinal detachments secondary to accidental globe perforation during local infiltration anaesthesia in five highly myopic eyes are presented. Retinal detachment was total with variable proliferative vitreoretinopathy. The pattern of retinal breaks was rather typical and predictable. Management involved vitreous surgery with internal tamponade by silicone oil in four eyes and perfluoropropane gas in one eye. At the last follow-up, all eyes had attached retina. One eye did not recover useful vision due to possible concurrent optic nerve damage.
Anesthesia, Local↗
Endophthalmitis caused by anaerobic bacteria.
A retrospective analysis of 22 patients who underwent pars plana vitrectomy for endophthalmitis and had culture-proven anaerobic bacteria, was done. Elimination of infection with attached retina and recovery of ambulatory vision > or = 2/60 were considered as anatomic success and functional success, respectively. Mean follow-up period was 12.7 months (range, 2 to 48 months). Anatomic success was attained in 14 (63.6%) eyes and functional success in 12 (54.6%) eyes. A poor preoperative visual acuity was found to be associated with poor functional outcome (p < 0.046). In endophthalmitis, a routine anaerobic culture of intraocular specimen is recommended.
Adolescent↗
Intraocular tuberculosis. Clinicopathologic study of five cases.
BACKGROUND: Intraocular tuberculosis is a rare disease. Only approximately 18 cases of microbiologically or histopathologically proven cases of intraocular tuberculosis have been reported. METHODS: Between 1984 and 1994, five cases of intraocular tuberculosis were confirmed microbiologically and histopathologically from intraocular specimens in the authors' uveitis clinic. Systemic antitubercular treatment was instituted, along with the treatment for the ocular inflammation. RESULTS: Clinical presentation included subretinal abscess (two cases), granulomatous anterior uveitis with scleral perforation, an exudative mass in the anterior chamber, and choroidal mass with panuveitis (one case each). Aqueous aspirate in three patients and eviscerated material in the other two showed presence of acid fast bacilli. One globe that required enucleation revealed granulomatous inflammation with caseation necrosis. Two patients showed a significant response to antitubercular therapy, whereas the other three patients eventually required evisceration or enucleation. CONCLUSIONS: Intraocular tuberculosis can have protean manifestations and variable response to systemic antitubercular therapy.
Abscess↗
Clinical features and virologic studies in viral retinitis.
Viral retinitis is an important infectious disease of the retina which can occur in both healthy and immunocompromized or immunodeficient individuals. The clinical picture and the role of laboratory studies in diagnosis of viral retinitis are still not well-defined. We correlated the clinical picture and virologic study in the serum and vitreous specimens by Enzyme-linked Immunosorbent Assay (ELISA), rapid immunofluorescence technique and culture in five clinically suspected patients of viral retinitis. None of the patients had any evidence of systemic viral infections. In four patients, the virus was detected by immunofluorescence, ELISA or culture from the vitreous sample. Paired serum samples showed elevation of antiviral IgG titre in two cases and high antiviral IgM titre in all cases. Our study evaluated the role of virological investigations of vitreous aspirate and rising antibody titre in the paired serum samples in the diagnosis of active viral retinitis.
Adolescent↗
Ocular lesions in AIDS: a report of first two cases in India.
Although 444 cases of AIDS have been officially registered till July 1993 from various parts of India, ocular lesions in these cases have not been reported. Till May 1994, ELISA test for HIV 1 and HIV 2 had been done in 12 cases of suspicious ocular lesions which include viral retinitis, endogenous endopthalmitis and active chorioretinitis. Two patients had seropositivity for HIV 1. Ocular lesions include subretinal yellow mass in the first case and cytomegalovirus retinitis and cotton-wool spots in the second case. These two patients also had several systemic infections which include tuberculosis in both and nocardia in one. To the best of our knowledge, these two cases are the first report of ocular lesions in AIDS from India.
Acquired Immunodeficiency Syndrome↗
Intraocular Gnathostoma spinigerum. Clinicopathologic study of two cases with review of literature.
BACKGROUND: Live intraocular nematode is a rare occurrence that is mostly reported in Southeast Asian countries. Common nematodes that are seen live in the eye are microfilaria, Gnathostoma, and Angiostrongylus. Approximately 12 cases of intraocular gnathostomiasis have been reported in the literature. METHOD: Two cases of intraocular gnathostoma, removed by vitrectomy in the first case and by paracentesis in the second case, are reported. Morphologic study of the parasites in wet preparation was performed under dissecting microscope and fixed in Karnovosky's fixative. Light microscopic and scanning electron microscopic studies were also performed. RESULTS: The first patient had anterior uveitis, multiple iris holes, and dense vitreous haze with fibrous proliferation over the optic disc. On resolution of the vitreous haze, a live worm was seen in the vitreous cavity. The second patient had anterior uveitis with secondary glaucoma, multiple iris holes, mild vitritis, and focal subretinal haemorrhage with subretinal tracts. Four days later a live worm was seen in the anterior chamber and removed. Microscopic study of the parasites from both patients revealed typical head bulb with four circumferential rows of hooklets, and fine cuticular spines were seen on the surface of the body. CONCLUSIONS: Iris holes, uveitis, and subretinal haemorrhage with subretinal tract can be characteristic features of intraocular gnathostomiasis. Identification of this parasite can be made by typical features, which can be identified on light and scanning electron microscopic study.
Adult↗
Penetrating ocular trauma in children by "broomstick bows and arrows".
Ocular trauma by "broomstick bows and arrows" is a unique penetrating injury among Indian children. Hitting the eye with a great velocity, these highly contaminated missiles may cause severe damage. The results of surgical treatment of 100 children who suffered such trauma are presented. Anatomic success, ie, successful reconstruction of the globe with attached retina, was attained in 85 (85%) of these eyes. Functional success, ie, improvement in visual acuity of two Snellen lines in eyes with measurable preoperative acuity, or improvement to at least 2/60 in the eyes with preoperative acuities of light perception or hand movements, was attained in 62 (62%) of the eyes. Of the functionally successful eyes, an acuity of 6/9 or better was achieved in 28 (45.2%). Factors predictive of poor anatomical success were: injuries involving both anterior and posterior segment (P < .02), endophthalmitis (P < .05), and presence of retinal detachment with or without proliferative vitreoretinopathy (P < .05). Mean follow up was 4.5 +/- 3.59 months (range, 2 to 24 months).
Athletic Injuries↗
Intraoperative measurement of intraocular pressure in vitrectomized aphakic air-filled eyes using the Tono-Pen XL.
The Tono-Pen XL (Bio-Rad, Santa Ana, CA) was compared with manometer readings for intraoperative measurement of intraocular pressure (IOP) in 40 eyes of 40 consecutive patients after vitrectomy, lensectomy, and fluid-air exchange. Tono-Pen readings corresponding to manometer readings of 10, 20, 30, 40, and 50 mmHg were obtained in a masked fashion with a randomized sequence of manometer readings. A correlation was obtained between the manometer and Tono-Pen readings (r = 0.96 in emmetropic eyes and r = 0.93 in myopic eyes). The regression curve that represents the calibration curve of Tono-Pen in terms of the manometer readings for air-filled vitrectomized eyes was obtained. Any Tono-Pen reading can be easily translated into the corresponding manometer reading by referring to the curve. The Tono-Pen can therefore be effectively used to accurately determine intraoperative IOP in eyes undergoing vitrectomy, lensectomy, and fluid-air exchange.
Adolescent↗
Primary nonfamilial amyloidosis of the vitreous. A light microscopic and ultrastructural study.
Nonfamilial amyloidosis, a form of primary amyloidosis accompanied by vitreous opacity, is a rare condition. Here, a 50-year-old man developed strand-like opacities in the vitreous of both eyes. Pars plana vitrectomy was performed to improve the patient's vision. The vitreous specimens showed typical light microscopic and ultrastructural features of amyloidosis.
Amyloidosis↗
Infant scleral depressor.
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Fundus Oculi↗
Peribulbar anesthesia for primary vitreoretinal surgery.
We prospectively studied the efficacy of peribulbar anesthesia in 76 consecutive patients who underwent vitreoretinal surgery. The mean duration of anesthesia was 124.74 +/- 50.17 minutes, and the mean duration of akinesia, 151.5 +/- 54.45 minutes. Adequate anesthesia and akinesia, independent of the duration of surgery, was obtained in 26 of 33 (78.8%) patients who underwent vitrectomy; 9 of 32 (28.1%) who underwent scleral buckling; and 2 of 11 (18.2%) who underwent vitrectomy combined with scleral buckling. In all, topical and systemic supplementation of drugs for inadequate anesthesia or akinesia allowed 32 of the 33 (97%) vitrectomies, 30 of the 32 (94%) scleral buckling procedures, and all 11 of the combined surgeries to be completed as planned. Three (4%) patients vomited, moved, or were restless, resulting in an operative complication or postponement of surgery. Fifty-eight (76%) said they would desire similar anesthesia if subsequent surgery was needed in the same or fellow eye. We conclude that peribulbar anesthesia should be considered primarily for patients requiring vitreous surgery alone, and as an alternative for patients requiring scleral buckling or combined surgery for whom general anesthesia is contraindicated.
Adult↗