ABSTRACT
Purpose@#Mucormycosis is a multisystemic, aggressive, and an opportunistic fungal infection. The most common type is rhino-orbito-cerebral mucormycosis (ROCM) accounting for almost 40% of the cases. In this study, we analyzed the etiopathology, clinical features, treatment outcome, and the factors associated with outcome in ROCM. @*Methods@#Case records of 52 patients of ROCM were analyzed. Clinical parameters, laboratory parameters, imaging findings, treatment regime, and treatment outcome details were retrieved from each case record. The outcome measures were evaluated as treatment success and treatment failure. Univariate and logistic regression analyses were performed to identify factors associated with treatment outcome. @*Results@#On univariate analysis, factors associated with poor treatment outcome were uncontrolled blood sugar, blood urea, diabetic ketoacidosis, duration of ocular symptoms, no perception of light at presentation, ptosis, conjunctival chemosis, relative afferent pupillary defect, two or more sinus involvement, bony erosion of orbital wall, intracranial extension, intraconal invasion, etc. On subsequent logistic regression analysis, factors that maintained significant association with poor treatment outcome were uncontrolled blood sugar (adjusted odds ratio [aOR], 1.17; p = 0.018), no perception of light at presentation (aOR, 10.67; p = .006), ptosis at presentation (aOR, 3.90; p = 0.03), conjunctival chemosis (aOR, 7.11; p = 0.024), relative afferent pupillary defect (aOR, 10.60, p = 0.01), central retinal artery occlusion at presentation (aOR, 3.54; p = 0.021) and two or more sinus involvement (aOR, 4.90; p = 0.009). @*Conclusions@#The current study identified newer factors in the form of presenting ocular and radiological features as predictors for aggressive systemic disease and poor treatment outcome. Future prospective studies are, however, needed to substantiate these associations.
ABSTRACT
Purpose@#To compare the efficacy of 0.1% nepafenac and 1% prednisolone acetate eye drop in postoperative inflammation control in micro-incisional cataract surgery. @*Methods@#We conducted a prospective, randomized, comparative, single-blind study. All the patients underwent temporal 2.2-mm micro-incisional cataract surgery. They were randomized into two groups (group A and B). Group A received 0.1% nepafenac eye drops 4 times/day for 4 weeks and group B received 1% prednisolone acetate eye drops in tapering doses for 4 weeks after surgery. Both the groups received moxifloxacin 0.5% eye drops 4 times/day for 2 weeks. Patients were examined on 1st, 7th, and 30th postoperative days and parameters of postoperative inflammation were evaluated and noted at each visit. @*Results@#A total of 200 patients were enrolled in the study. However, five patients lost to follow up, group A had 97 and group B had 98 patients respectively. Results were statistically insignificant in terms of the difference in lid edema, conjunctival congestion, corneal edema, anterior chamber cells and flare between the two groups with p-values >0.05 for each parameter at each visit. However, the difference in mean central macular thickness between the groups was significant (205.713 ± 17.14 vs. 220.984 ± 32.83 in group A and B, respectively, p ≤ 0.001) at 1 month. Also, the mean pain score was significantly lower (p = 0.018) in the nepafenac group at day 7 of surgery. @*Conclusions@#Nepafenac is equally effective and non-inferior to prednisolone acetate in suppression and prevention of inflammation in postoperative period.
ABSTRACT
Purpose@#The objective of the study was to evaluate the type of conjunctival microbial flora in intensive care unit patients and their antimicrobial sensitivity pattern. @*Methods@#A total of 272 samples (conjunctival swabs) were taken from patients in various intensive care units and sent for culture and sensitivity. An ocular examination was done to look for lagophthalmos, conjunctival discharge, exposure keratitis, and corneal perforation. @*Results@#Majority (82.1%) of the samples showed at least one microbial isolate while 29 (10.7%) samples showed multiple microbial growth. The most common microbes were coagulase negative Staphylococcus spp. (41.5% of isolates), diphtheroids (11.0% of isolates), and Staphylococcus aureus (9.6% of isolates) which are the usual commensals of the ocular surface. Of the other microbes isolated, Pseudomonas aeruginosa (4.0%) was the most common. Eighty-four percent isolates of coagulase negative Staphylococcus sp., 81.8% isolates of diphtheroids and 100% isolates of Staphylococcus aureus were penicillin resistant. All isolates of Enterococcus fecalis were sensitive only to vancomycin. Two hundred and twenty eyes (80.9%) had varying degrees of lagophthalmos. Nineteen (7.0%) had severe corneal exposure changes leading to infectious corneal ulcer and perforation in all of them. @*Conclusions@#The isolates in patients of intensive care units were no different from the normal conjunctival flora though few pathogenic organisms such as Pseudomonas aeruginosa and Acinetobacter sp. were also isolated. Most of the isolates were penicillin resistant. This knowledge will help take appropriate prophylactic measures to contain ocular infections in the intensive care units.
ABSTRACT
Purpose@#To compare the efficacy of 0.1% nepafenac and 1% prednisolone acetate eye drop in postoperative inflammation control in micro-incisional cataract surgery. @*Methods@#We conducted a prospective, randomized, comparative, single-blind study. All the patients underwent temporal 2.2-mm micro-incisional cataract surgery. They were randomized into two groups (group A and B). Group A received 0.1% nepafenac eye drops 4 times/day for 4 weeks and group B received 1% prednisolone acetate eye drops in tapering doses for 4 weeks after surgery. Both the groups received moxifloxacin 0.5% eye drops 4 times/day for 2 weeks. Patients were examined on 1st, 7th, and 30th postoperative days and parameters of postoperative inflammation were evaluated and noted at each visit. @*Results@#A total of 200 patients were enrolled in the study. However, five patients lost to follow up, group A had 97 and group B had 98 patients respectively. Results were statistically insignificant in terms of the difference in lid edema, conjunctival congestion, corneal edema, anterior chamber cells and flare between the two groups with p-values >0.05 for each parameter at each visit. However, the difference in mean central macular thickness between the groups was significant (205.713 ± 17.14 vs. 220.984 ± 32.83 in group A and B, respectively, p ≤ 0.001) at 1 month. Also, the mean pain score was significantly lower (p = 0.018) in the nepafenac group at day 7 of surgery. @*Conclusions@#Nepafenac is equally effective and non-inferior to prednisolone acetate in suppression and prevention of inflammation in postoperative period.
ABSTRACT
Purpose@#The objective of the study was to evaluate the type of conjunctival microbial flora in intensive care unit patients and their antimicrobial sensitivity pattern. @*Methods@#A total of 272 samples (conjunctival swabs) were taken from patients in various intensive care units and sent for culture and sensitivity. An ocular examination was done to look for lagophthalmos, conjunctival discharge, exposure keratitis, and corneal perforation. @*Results@#Majority (82.1%) of the samples showed at least one microbial isolate while 29 (10.7%) samples showed multiple microbial growth. The most common microbes were coagulase negative Staphylococcus spp. (41.5% of isolates), diphtheroids (11.0% of isolates), and Staphylococcus aureus (9.6% of isolates) which are the usual commensals of the ocular surface. Of the other microbes isolated, Pseudomonas aeruginosa (4.0%) was the most common. Eighty-four percent isolates of coagulase negative Staphylococcus sp., 81.8% isolates of diphtheroids and 100% isolates of Staphylococcus aureus were penicillin resistant. All isolates of Enterococcus fecalis were sensitive only to vancomycin. Two hundred and twenty eyes (80.9%) had varying degrees of lagophthalmos. Nineteen (7.0%) had severe corneal exposure changes leading to infectious corneal ulcer and perforation in all of them. @*Conclusions@#The isolates in patients of intensive care units were no different from the normal conjunctival flora though few pathogenic organisms such as Pseudomonas aeruginosa and Acinetobacter sp. were also isolated. Most of the isolates were penicillin resistant. This knowledge will help take appropriate prophylactic measures to contain ocular infections in the intensive care units.