ABSTRACT
Irido-Corneal Endothelial (ICE) syndrome is an uncommon clinical entity which includes corneal endothelial damage, obstruction of anterior chamber angle, iris atrophy, and polycoria.ICE syndrome is a spectrum of clinical entities namely Progressive Iris Atrophy (PIA), Cogan Reese Syndrome (CRS), and Chandler Syndrome (CS). It is considered to be sporadic, usually unilateral and diagnosed in young adults, females and occasionally in children. Corneal decompensation and glaucoma are the commonest causes of vision loss in patients with ICE syndrome.Medical management of this condition is usually with topical antiglaucoma medication. In most cases medical therapy fails and requires Glaucoma Filtration surgery. Glaucoma drainage devices are the mainstay of treatment and many patients require keratoplasty. We wanted to study the clinical profile of ICE syndrome patients, its association with glaucoma in Indian population and compare the findings with those of previous studies. METHODSIn this retrospective study, data of 50 consecutive patients having ICE syndrome at a tertiary eye care centre was collected. RESULTSOut of 50 patients, 28 (56%) were females, aged 7 to 65 years (median - 40.72 years). 49 patients (98%) had unilateral presentation, and one had bilateral involvement (2%). Progressive Iris Atrophy (PIA) was seen in 20 (40%), Chandlers Syndrome (CS) in 20 (40%) and 10 eyes (20%) had Cogan-Reese Syndrome (CRS). 46 (92%) eyes had glaucoma. Mean Intra-Ocular Pressure (IOP) was 23.70 ± 11.7 mm of Hg. Mean AGM used was 2.44 ± 1.3. 44 (88%) eyes were diagnosed to have glaucoma at presentation, 1 (2%) eye was diagnosed with glaucoma during follow up. 20 (40%) eyes were managed medically for IOP control. 8 (16%) eyes had undergone previous glaucoma surgery. 20 (40%) eyes underwent glaucoma surgery for IOP control. 15 (30%) eyes had Trabeculectomy with Mitomycin C, 5 (10%) had Ahmed glaucoma valve. 4 (8%) eyes underwent diode cyclophotocoagulation. 6 (12%) eyes required more than 1 surgery for IOP control. 6 (12%) eyes underwent penetrating keratoplasty (PK) for corneal oedema. Mean period of follow up was 8.4 ± 6.4 months. There were no cases of sight threatening complications like suprachoroidal haemorrhage, blindness or endophthalmitis. CONCLUSIONSGlaucoma is strongly associated with ICE syndrome. ICE patients may require more than 1 surgery for IOP control. They are commonly associated with corneal complications which may require penetrating keratoplasty.
ABSTRACT
Endophthalmitis is an inflammatory condition involving the intraocular cavities, including the Uveal tissue and retina. Panophthalmitis includes the sclera and Tenon’s capsule. Endophthalmitis may be classified as Infective and Sterile endophthalmitis. Infective causes can be further subdivided into Exogenous, Endogenous and Secondary infections from surrounding structures. Exogenous forms arise from perforating injuries or postoperatively. Endogenous endophthalmitis may develop as a result of seeding from a distant focus of infection in the body. Depending on the causative organism, it may be bacterial or fungal.Diabetes mellitus may accentuate the condition. Endophthalmitis can lead to serious complications such as visual loss and Phthisis bulbi. Hence if not managed adequately and early, enucleation may be required.
ABSTRACT
Coronary artery disease is an important cause of cardiovascular morbidity and mortality all over the world. Hypertension has been identified as an important risk factor for the development of CAD. Retinal vessel changes can occur in patients with uncontrolled or poorly controlled hypertension and are a predictor of the effect of hypertensive damage in the body. Retina is a place where end artery circulation can be directly visualized and quantifying retinal vessel changes in hypertensive patients presenting with angina can help in determining the risk and identifying those patients who need coronary angiogram especially in a primary care set up as it is an expensive investigation. We wanted to analyse retinal vessel changes in elderly hypertensives presenting with angina and correlate the same with the risk of developing coronary artery disease.METHODS50 elderly hypertensives who presented with acute angina were included in the study and were subjected to a coronary angiogram. They were divided into case and control groups. Those with the disease on angio are taken as cases and those without are considered as controls. The effect of age, sex, BMI, smoking, presence of retinopathy, LVH on ECG, grade of retinopathy were all analysed and correlated with the risk of developing CAD.RESULTSAge, Sex, BMI, smoking, LVH had no relation with development of CAD in our study. Presence of retinopathy had a significant correlation with development of CAD (p = 0.031, p<0.05) with OR of 5.81. Commonest grade of retinopathy in our study was Grade 2 and this also showed a significant correlation with the risk of developing CAD.CONCLUSIONSRetinal vessel changes are a significant predictor of risk of developing CAD in elderly hypertensives presenting with angina. The risk of developing CAD was six fold more in those with retinopathy changes and this can help as a screening tool to determine those who need angiography in a primary setting.