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Purpose: We report clinical characteristics, risk factors, treatment outcomes, and prognostic predictors of post?vitrectomy secondary macular holes (MHs). Methods: This was a retrospective observational case series from November 2014 to December 2020. Eyes that developed secondary MH, two weeks and beyond after primary vitrectomy for non?MH indications, were enrolled. Pre? and intraoperative records were screened to exclude pre?existence of MH. Eyes with multiple vitreoretinal surgeries prior to MH detection and tractional myopic maculopathy were excluded. Results: A total of 29 eyes of 29 patients with a mean age of 52 years developed secondary MH post?vitrectomy. The most common indications for primary vitrectomy were rhegmatogenous retinal detachment (RRD, 48.2%) and tractional retinal detachment (TRD, 24.1%). Time to MH detection after primary vitrectomy was 91.5 ± 117.6 days. The mean minimum hole diameter was 530 ± 298 microns. Epi?retinal membrane and cystoid degeneration was noted in 6 (20.7%) and 12 (41.3%) eyes, respectively (p = 0.088). The mean time from MH detection to MH repair was 34 ± 42 days. The surgical intervention included internal limiting membrane peeling with tamponade in 25 eyes. Overall, 80% showed anatomic hole closure, 90.9% versus 57.1% in the RRD and TRD (p = 0.092), respectively. The mean best?corrected visual acuity (BCVA) at the final visit was 0.71 logarithm of the minimum angle of resolution. Thirteen eyes (52%) had a BCVA of 20/100 or better. Minimal hole diameter (p = 0.029) only predicted final visual acuity. The interval between MH diagnosis and repair did not affect hole closure significantly (p = 0.064). Conclusion: Secondary MH post?vitrectomy closed successfully with limited visual improvement and trails behind idiopathic MH.
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Systemic corticosteroids and immunocompromised state following SARS?CoV?2 infection can predispose individuals to endogenous endophthalmitis. A 66?year?old gentleman presented with complaints of diminution of vision and redness one week post discharge after hospitalization for COVID?19 infection. Clinical examination suggested fulminant endogenous endophthalmitis which responded poorly even after aggressive treatment requiring evisceration. Culture and gene sequenced analysis confirmed Aspergillus fumigatus to be the causative organism. A high degree of suspicion is warranted in the presence of recent onset of floaters in COVID?19?infected individuals to facilitate early diagnosis and outcomes.
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Background: Leprosy, a chronic inflammatory granulomatous disease chiefly involving skin and peripheral nerves and occasionally other organ systems, caused by Mycobacterium leprae. It has tormented the human civilization through time immemorial. Leprosy remains a significant public health problem worldwide, especially in developing countries like India. The diagnosis of leprosy is not always easy because of long incubation period, over dependence of clinical expertise and a lack of rapid and simple diagnostic tool, patients remain undiagnosed for longer time. Fine needle aspiration (FNAC) technique is an inexpensive, rapid and accurate procedure for diagnosis of leprosy. We conducted a prospective study evaluating the ability of fine needle aspiration cytology in diagnosing and classifying leprosy lesions on Ridley-Jopling scale (R-J scale). The aim of this prospective study was to assess the usefulness of fine needle aspiration cytology in early diagnosis of leprosy, to identify specific cytological characteristics of diagnosis and to correlate the cytological smear findings with histopathology and to evaluate merits of relatively non-invasive procedure of FNAC over more invasive procedure - biopsy. Methods: The study is a hospital based prospective study carried out in the Department of Pathology and Department of Skin, Venereal Diseases, Leprosy, N.S.C.B. Medical College & Hospital, Jabalpur (M.P.) September 2010 to September 2013. Patients with new skin lesions were selected for the study. FNAC was performed and aspirates were evaluated for cytology using Hematoxylin and Eosin staining (H&E staining), Ziehl-Neelsen staining (ZN staining) and punch biopsy was collected. Results: Out of 50 cases, clinical and cytological correlation was seen in 88% tuberculoid leprosy, 93.7% of borderline tuberculoid, 33% of borderline lepromatous leprosy and 66% of lepromatous leprosy. While clinical with histopathological correlation revealed 100% specificity in tuberculoid leprosy, 100% in borderline tuberculoid, 66.6% in borderline lepromatous, 83.3% in lepromatous leprosy and 80% in indeterminate leprosy and 100% in histoid leprosy in our study. The overall cytodiagnostic accuracy has been 92% in present study. Conclusion: Our study demonstrates that the combination of FNAC and ZN staining for Acid Fast Bacilli (AFB) can provide a rapid diagnosis in majority of leprosy suspected cases. FNAC is a safe, simple, rapid, less-invasive, OPD procedure for early diagnosis and classification of leprosy cases.