Management of corneal perforations: An update

Corneal perforation is a potentially devastating complication that can result from numerous conditions that precipitate corneal melting. It is associated with significant morbidity and prompt intervention is necessary to prevent further complications. Causes include microbial keratitis, ocular surface disease, and autoimmune disorders and trauma. Various management options have been described in the literature to facilitate visual rehabilitation. This rview discusses the treatment options that range from temporising measures such as corneal gluing through to corneal transplantation, with decision making guided by the location, size, and underlying aetiology of the perforation.

A simple alternative method for rapid detection of slime produced by Staphylococcus epidermidis isolates in bacterial keratitis.

BACKGROUND & OBJECTIVES: Slime is a known virulence factor of Staphylococcus epidermidis. The conventional Christensen's method for detection of slime in the laboratory takes at least 48 h. We, therefore, tried to evaluate the efficacy of the Congo red agar method as a routine procedure for detecting slime among isolates from corneal ulcers. METHODS: A total of 244 isolates from corneal ulcers were identified as S. epidermidis by the standard procedures. Slime was detected both by the conventional Christensen's method as well as by the Congo red agar method. RESULTS: Ninety two (37.7%) isolates were positive and 86 (35.2%) were negative for slime by both the techniques. Fifty four (22.1%) isolates were positive in Congo red agar, but negative by Christensen's method; whereas only 12 (4.9%) were negative by Congo red but positive by Christensen's method. Detection of slime by Congo red agar method was rapid i.e., all the 146 strains were positive within 24 h of incubation. On the other hand, Christensen's method had a delayed response; 42.3 per cent (44/104) strains being negative during the first 24 h of incubation. INTERPRETATION & CONCLUSION: Our results suggested that culture on Congo red agar was a sensitive and rapid test for detecting slime. This might help in the quick identification in a routine laboratory of slime positive isolates in bacterial keratitis.

Phakic-pseudophakic bullous keratopathy following implantation of a posterior chamber IOL in the anterior chamber to correct hypermetropia.

There is an increasing demand for refractive surgery stemming from a heightened awareness among patients wearing spectacles or contact lenses. Cosmetic or occupational reasons prompt patients to seek the alternative option of refractive surgery.

Posterior keratoconus due to iron nail injury--a case report.

A case of post-traumatic keratoconus is presented. This is an unusual variant of an uncommon disorder. Posterior keratoconus is a very rare ectatic dystrophy of the cornea. Since its first description in 1927, only a few cases have been described in the literature. Posttraumatic posterior keratoconus is a much rarer entity. We are reporting a case of posterior keratoconus caused by iron nail injury.

A simple accurate method of cataract classification. Cataract-I.

A simple and accurate system of cataract classification using slit lamp and direct ophthalmoscope is reported. Lens opacities are classified into cortical (anterior and posterior), nuclear and posterior sub-capsular and each sub-type of opacity is graded, extent and density wise, using both slit lamp and direct ophthalmoscope. A circle representing enface view of opacity divided into 100 equal parts is used in calculating the area of each opacity. This classification takes into account both the area and depth of opacity in arriving at the total extent of sub-type of each opacity. For density determination, we do not recommend the use of a resolution target projection ophthalmoscope. Intra-observer and inter-observer variability studies using this classification system indicated that the classification system is fairly reliable.

Methodology for studies on medical therapy of cataracts: cataract-II.

The methodology for testing any possible effect of potential anti-cataract agents is described. This is based on slit lamp and ophthalmoscopic cataract classification and on visual acuity. The difficulties encountered in such studies are highlighted. The presented methodology is suggested to be fairly adequate in assessing usefulness of any possible medical therapy of cataracts.

Topical glutathione therapy in senile cataracts. Cataract-III.

We undertook a prospective study in 66 cataract patients to study if topical glutathione has any effects on the progression of cataracts. The eye with more advanced cataract received topical glutathione drops q.i.d. and contralateral eye served as control. Only 32 patients completed the follow-up of three months or more. Data analysis revealed no beneficial effect of topical glutathione drops on any of the parameters studied. PSC opacity density in eyes treated with topical glutathione showed significant increase as compared to control eyes.

Topical sulindac therapy in diabetic senile cataracts: cataract-IV.

Sulindac, a non-steroidal anti-inflammatory drug has been found to be a potent inhibitor of enzyme aldose reductase. We used sulindac topically in diabetic senile cataract patients to note if it effects the progression of cataracts. More of sulindac treated eyes maintained initial vision and fewer eyes had visual loss of up to two lines or more as compared to control eyes. The extent and density of different opacities showed less progression in sulindac treated eyes but it was not statistically significant except that the ophthalmoscopically observed density of opacity showed statistically very significant lesser mean increase in sulindac treated eyes. We suggest that sulindac is a potential drug which should be further evaluated in large double blind photodocumented studies in diabetic senile cataracts.

Systemic aspirin and systemic vitamin E in senile cataracts: cataract V.

We undertook a prospective study in senile cataract patients using systemic aspirin and systemic vitamin E. Vitamin E treated eyes did show less progression of PSC opacities extent and less new nuclear opacities during the follow-up, but overall vitamin E treated eyes did no better than the control group eyes. More eyes in systemic aspirin treated group maintained the initial vision and loss of vision in the aspirin group was also less marked. Aspirin also caused a significant less mean increase in cortical opacity extent, nuclear/opacity and density and PSC opacity extent and density as well as in ophthalmoscopically graded opacity extent and density. We suggest that aspirin is a potential drug which should be further evaluated in large double blind photodocumentated studies. The present data does not justify the recommendation that aspirin be prescribed for slowing down cataract progression. This must await large studies and confirmation.