Hyaluronidase hypersensitivity: A rare complication of peribulbar block.

Peribulbar block, though safe, can cause serious complications such as globe perforation and peribulbar hemorrhage. Hyaluronidase is an enzyme that is used as an adjuvant in peribulbar anesthesia, and it helps in rapid penetration of the anesthetic agent. Hypersensitivity to hyaluronidase is a rare but potentially sight‑threatening complication. We report a case of hyaluronidase hypersensitivity following peribulbar injection for cataract surgery mimicking as peribulbar hematoma in the immediate postinjection phase and as orbital cellulitis 48 h later.

Visual outcome of central serous retinopathy.

Background: Central serous chorioretinopathy (CSCR) is a sporadic disorder of the outer blood retinal barrier. Increasing evidence implicates an abnormal choroidal circulation as the cause of CSCR. The study aimed at the visual outcome of central serous retinopathy for a duration of 6 months from the primary attack. Methods: Study conducted at Department of Ophthalmology in Out Patient Department of Mediciti Medical College Hospital, from June 2013 to December 2014. Total 30 patients’ eyes were treated with placebo treatment with antioxidants for a period of 6 months. Results: Highest prevalence of central serous retinopathy was seen in age group of 20-40 years in 26 eyes (85%), males are predominant i.e. out of 30 patients 27 (90%), risk factors of central serous retinopathy like Type A personality are observed in 3. Associated visual abnormalities like micropsia, central scotomas in 20% of patients, fluorescein angiography showed 60% inkblot pattern. After observation for 6 months visual acuity was spontaneously improved within 4-6 months in 70% of patients, recurrences was seen in 6 patients i.e. 20% is observed. Conclusions: Central serous retinopathy is most commonly seen among 20-40 years age group, with male predominance, unilateral in which Spontaneous resolution of central serous retinopathy is seen in 4-6 months so for which aggressive treatment is not necessary.

Spontaneous expulsive suprachoroidal hemorrhage caused by decompensated liver disease.

Expulsive suprachoroidal hemorrhage can be surgical or spontaneous. Spontaneous expulsive suprachoroidal hemorrhage (SESCH) is a rare entity. Most of the reported cases of SESCH were caused by a combination of corneal pathology and glaucoma. We are reporting a rare presentation of SESCH with no pre-existing glaucoma or corneal pathology and caused by massive intra- and peri-ocular hemorrhage due to decompensated liver disease.

Spontaneous globe luxation associated with chronic obstructive pulmonary disease.

Spontaneous globe luxation is a rarely reported condition which can lead to complications like optic neuropathy. Common causes are thyroid eye disease, shallow orbit and floppy eyelid syndrome. We report a case of spontaneous globe luxation with the onset and severity associated with chronic obstructive pulmonary disease (COPD). To our knowledge, this is the first case of spontaneous globe luxation associated with COPD.

Keratomycosis caused by Exserohilum rostratum.

We report a case of keratomycosis caused by Exserohilum rostratum. A 46-year-old farmer presented with history of pain, watery discharge and redness of the right eye for the past 2 weeks following trauma with vegetable matter. On ocular examination, a central corneal ulcer of about 8 mm with a greyish-white slough, feathery edges and diffuse corneal edema was seen in the right eye. KOH examination of corneal scrapings revealed thick, brown, branched, septate hyphae. Culture of corneal scrapings on Sabouraud dextrose agar showed velvety greenish-black colony with a black pigment on the reverse. The culture was identified as E. rostratum on the basis of microscopic morphology. The patient responded well to treatment with topical natamycin and oral itraconazole.

Comparison of different techniques of cataract surgery in bacterial contamination of the anterior chamber in diabetic and non-diabetic population.

Aim: To compare the bacterial contamination of the anterior chamber (AC) between manual small incision cataract surgery (SICS) and phacoemulsification (Phaco). To study the conjunctival flora and bacterial contamination of AC between well-controlled diabetics and non-diabetics. Materials and Methods: Three hundred and sixty-eight patients were randomized to manual SICS and Phaco. Sixty-eight patients were excluded for not completing follow-up or for intraoperative complications like posterior capsule rupture. One hundred and fifty patients in each group were finally analyzed. Conjunctival swabs were taken on admission, after one day of topical ofloxacin and 15 min after 5% Povidone Iodine (PI) instillation. AC aspirate at the end of the surgery was also cultured. Results: Fifty-six (18.66%) patients had positive conjunctival swab on admission which was reduced to 19 (6.33%) with topical ofloxacin and to five (1.66%) with instillation of 5% PI. AC contamination in both manual SICS and Phaco was 0.66%. The conjunctival flora in diabetics was similar to non-diabetics. None of the diabetics had AC contamination. Statistical analysis was performed by Chi-Square test (with Yates’ correction). Conclusion: Statistically significant reduction in conjunctival flora was achieved with topical ofloxacin and 5% PI instillation and AC contamination in both manual SICS and Phaco was minimal (0.66%). Well-controlled diabetics who underwent cataract surgery in this study had similar conjunctival flora and AC contamination as non-diabetics.