Demographic pattern, risk factors, clinical and microbiological characteristics of fungal keratitis

Purpose: to document the clinico-epidemiological features and laboratory diagnosis of fungal corneal ulcer observed at a tertiary referral center

Design: prospective descriptive study

Setting: department of Ophthalmology Unit III, Eye Hospital, Liaquat University of Medical and Health Sciences Hyderabad, Sindh-Pakistan from April 2007 to March 2010

Material and methods: three hundred and fifteen patients of different ages having provisional diagnosis of suppurative corneal ulceration were registered for the study. Data were collected through history and slit lamp examination. Corneal scraping was performed. A portion of each scraping was examined by direct microscopy. Another portion was inoculated directly on to solid culture media

Result: among corneal scraping from 315 patients, the fungus grew in 116 [36.8%]. The mean age of patients was 42.6 years [ranged between 9 and 82 years]. Majority of patients [80; 68.97%] were between the 3[rd] and 5[th] decade of life. Males [72; 62.1%] were affected more often. Majority of the patients [80; 69%] was from rural areas. A majority of [52; 44.80%] patients was farmer by profession. Corneal trauma [70; 60.4%] was identified as the leading precipitating factor. Forty eight [41.4%] patients had corneal injury with vegetative material. The peak incidence observed in the months of October to December followed by March to June. The clinical features were dry, thick and raised grayish white corneal surface in 76 [65.51%] patients, stromal infiltrates with feathery margins in 64 [55.2%] patients, typical satellite lesions in 19 [16.38%] patients, hypopyon was present in 70 [60.3%] patients. Candida albicans was the most frequent organism which was isolated in eighty [69%] patients

Conclusion: fungi were found to be the frequent cause of suppurative corneal ulcer following agriculture trauma and Candida albicans being the most commonly isolated pathogen. For the diagnosis of fungal infection direct microscopic examination with potassium hydroxide 10% is a rapid, inexpensive, and reliable method

Incidence and visual outcome of acute postoperative endophthalmitis

Objectives: To assess the incidence and visual outcome of acute post operative endophthalmitis treated by intravitreal antibiotics. Methods: This Prospective study was conducted at Department of Ophthalmology, Liaquat University Eye Hospital Hyderabad from November 2002 to October 2010. One hundred and nine patients of acute post operative endophthalmitis were treated with intravitreal antibiotics. The inclusion criteria of the patients was the clinical diagnosis of acute post operative endophthalmitis within 14 days of post operative period and visual acuity better than or equal to hand movement close to face. After enrolment, vitreous tap was carried out followed by intravitreal antibiotics injection. The outcome was measured in terms of clinical resolution of endophthalmitis and post resolution best corrected visual acuity. Results: Of the 109 patients 97 meet the criteria and followed completely were included. Sixty patients [61.9%] had extracapsular cataract extraction [ECCE] with posterior chamber intraocular lens implantation while phacoemulsification done in 37 [38.1%] patients. The visual acuity at presentation was 6/60 or worse in 80 [82.5%] patients. Vitreous tap was done in 86 [88.7%] patients. Vitreous biopsy yields an organism in 32 [33%] patients. Coagulase positive were the most common organism. 75 [77.3%] patients received single dose of intravitreal antibiotic. Forty five [46.4%] patients received single antibiotic, ceftazidime while two antibiotics given in 52 [53.6%] patients. Twenty five [25.8%] patients also had oral steroids. Ninety one [93.8%] patients responded to intravitreal antibiotics. Seventy five [77.32%] patients achieved final visual outcome better than 6/60 in meantime of 54.08 days. Six [6.2%] patients developed no perception of light and another six patients [6.2%] referred for vitrectomy. Conclusion: The final visual outcome of the patients with acute postoperative endophthalmitis is strongly associated with the visual acuity at presentation as well as type of infective organisms

Frequency and types of diabetic retinopathy in type II diabetes; a hospital base study

Objectives: To determine the frequency and type of diabetic retinopathy in different age groups

Study Design: Descriptive Case series study

Place and duration of study: Department of Ophthalmology Liaquat University of Medical and Health Sciences [LUMHS] Hyderabad, from February 2009 to January 2010

Methods: Two hundred and forty four patients of diabetes mellitus [DM] were randomly selected and grouped out into 30-40 years, 41-50 years, 51-60 years, 61-70 years and more than 70 years of age. Each patient was evaluated for diabetic retinopathy [DR] by fundoscopy and Fundus Fluorescence Angiography [FFA]. The retinopathy was graded as 0-3 grade; grade 0= no DR, grade 1= mild DR, grade 2= moderate to severe DR and grade 3= proliferative DR. The different risk factors [age, gender, duration of DM, treatment type and hypertension] were evaluated in relation to diabetic retinopathy

Result: Among 244 patients, 149 were males and 95 were females. Diabetic retinopathy was detected in 100 [40.94%] patients. Mean duration of DM was 13 years in patients with DR and 7.5 years in patients without DR. Most of the DR was found in 40-60 years of age. Out of 244 subjects 25% patients were found with grade 1, 6.96% patients with grade 2 and 9.01% patients were found with grade 3 diabetic retinopathy

Conclusion: Most of the diabetic retinopathy cases were below the age of 60-years, and majority of DR cases presented with type 1 diabetic retinopathy

Treatment of primary pterygium with conjunctival autograft and mitomycin C. A comparative study

Background: Conjunctival autograft and Mitomycin C are two useful adjutants in the prevention of pterygium recurrence

Objective: To compare the recurrence rate of conjunctival autograft and Mitomycin C adjuvant in primary pterygium excision. Design: Quasi-experimental study on patients of primary pterygium from November 2004 to November 2006. Setting: Department of Ophthalmology, Liquat University of Medical and Health Sciences Jamshoro/Hyderabad

Method: One hundred cases of primary pterygium were treated with conjunctival autograft and Mitomycin C 0.02% intra-operatively for 5 minutes at the bare sclera by cotton swab. Anesthesia used was topical proparacaine and local infiltration of lignocaine. Patients were followed postoperatively for 9-12 months to find the recurrence [defined as fibrovascular tissues invading the cornea 1mm or more] of pterygium and complications. All surgeries were performed by one surgeon

Results: Of the hundred cases 17 were lost in follow-up. In remaining eighty-three eyes received conjunctival autograft [CAG n=52] and Mitomycin C [MMC n=31]. There were 4 [7.69%] recurrences in group A [CAG] and 8 [16.13%] recurrences in group B [MMC]. There was statistically significant difference in the recurrence rate between the two groups. The post operative complications in MMC group were two punctate epithelial keratitis, one conjunctival granuloma and one has dellen. No significant complications were encountered in conjunctival autograft group

Conclusion: Simple excision of pterygium followed by conjunctival autograft has the lowest recurrence rate and minimal incidence of complications as compared to intraoperative Mitomycin C

Periocular tuberculosis

Tuberculosis has reemerged as a serious public health problem in recent years. The periorcular manifestations of tuberculosis are uncommon and diverse. We present two cases of periocular tuberculosis. One patient had a history of painless non-healing ulcer in the right periorbital region inferiorly and temporal fossa. Initially, it was on inferior side and, later on same type of lesion occurred in temporal fossa. Both the lesions developed communication in the form of sinus. Other patient was referred with the suspicion of chronic dacryocystitis with history of watering and painless swelling since 9 months and not responding to systemic antibiotics. Both cases had no known history of systemic tuberculosis, only the periorbital findings were presenting manifestations of systemic tuberculosis. In both cases anti-tuberculosis regimen was advised. In conclusion, ocular tuberculosis can have variable clinical manifestations and occasionally appears as a dacryocystitis or non-healing ulcer in periorbital region. A high degree of clinical suspicion is important in cases not responding to antibiotics