Global variation and pattern changes in epidemiology of uveitis.

Uveitis, a complex intraocular inflammatory disease results from several etiological entities. Causes of uveitis are known to vary in different populations depending upon the ecological, racial and socioeconomic variations of the population studied. Tropical countries are unique in their climate, prevailing pathogens and in the existing diseases, which further influence the epidemiological and geographical distribution of specific entities. We provide an overview of the pattern of uveitis of 15221 cases in 24 case series reported from several countries over 35 years (1972-2007) and we integrate it with our experience of an additional 8759 cases seen over six years (1996-2001) at a large community-based eye hospital. Uveitis accounted for 0.8% of our hospital-based outpatient visits. The uveitis was idiopathic in 44.6%, the most commonly identified entities in the cohort included leptospiral uveitis (9.7%), tuberculous uveitis (5.6%) and herpetic uveitis (4.9%). The most common uveitis in children below 16 years (616 patients; 7.0% of the total cohort) was pediatric parasitic anterior uveitis, (182 children, 29.5% of the pediatric cohort), whereas the most common uveitis in patients above 60 years (642 patients; 7.3% of the total cohort) was herpetic anterior uveitis, (78 patients, 12.1% of the elderly cohort). Etiologies varied with the age group of the patients. As in other tropical countries, a high prevalence of infectious uveitis was seen in this population.

Double prepapillary arterial loops associated with superior branch macular artery occlusion.

Prepapillary arterial loops are congenital vascular anomalies that have been noted to cause arterial occlusions. We report a case of superior branch macular artery occlusion in an eye with two independent prepapillary arterial loops, following a Valsalva-like mechanism.

Management of age-related macular degeneration.

With the increase in life expectancy across the world, the magnitude of blindness due to age-related macular degeneration (AMD) is expected to rise. Exudative form is the major cause of visual loss from AMD. Several treatment options are available for this form of the disease. However, all treatment strategies aim at preservation of residual vision rather than regaining the lost vision. Two well-proven strategies are laser photocoagulation and photodynamic therapy. Other viable options are submacular surgery, transpupillary thermotherapy and pharmacological modalities like angiostatic-steroids. Oral anti-oxidants and zinc appear to be beneficial in preventing disease progression in early cases. Further research is on to explore more efficient treatments and to prove the safety and efficacy of large number of emerging newer treatment options.

Congenital retinal arterial loops and spontaneous vitreous haemorrhage: a case report.

This report describes a case of unilateral spontaneous vitreous haemorrhage associated with congenital retinal arterial loops.

Malignant melanoma of choroid.

Four cases of malignant melanoma of the choroid are reported due to rarity of the condition in India. One of the cases presented with Naevus of Ota. All the cases had typical clinical and investigative features. All cases were enucleated. Histopathologically three of them were of mixed type and one was of the epithelioid type. Two of the cases were seen in patients below 40 years of age.

Scleral buckling with hydrogel implant.

The hydrogel implant for scleral buckling, first developed in 1980, is said to combine the advantages of both solid silicone rubber and silicone sponges. But it is still not widely used. Our clinical experience with the hydrogel implant used in 23 cases of rhegmatogenous retinal detachment is described. It was used both as exoplant and implant. Anatomical success was achieved in 91% of the cases. There was no infection, erosion, migration of extrusion of the buckle. The advantages are that it is soft, elastic, nontoxic, and nonpyogenic; it is devoid of infection and postoperatively it swells up, for additional heightening of the buckle. This new material appears to combine the advantages of both silicone sponge and solid silicon rubber thereby providing an ideal buckling material.

Groenblad Strandberg syndrome--a case report.

A rare case of Groenblad Strandberg syndrome in which angioid streaks are associated with pseudoxanthoma elasticum is being reported. The pathology, clinical features, complications and treatment of angioid streaks are discussed in detail.

Immunological status of patients of Eales' disease.

To test the hypothesis that altered immune reactivity to an extraneous agent might lead to primary retinal perivasculitis, a study was undertaken to determine the serum immunoglobulin levels, T lymphocyte subsets, antibody responses to BCG and 'S' antigen, and lymphoproliferative response to mitogens. No difference was observed in these parameters between patients and controls. Both Mantoux positive and negative conditions existed in patients with Eales' disease. Mantoux positive patients showed a higher level of lymphoproliferative response in vitro to PPD than Mantoux positive controls, indicating the presence of two populations among Eales' patients.

Wedge scleral buckling in prevention of fish mouth phenomenon in retinal detachment surgery.

Wedge scleral buckling done in 45 eyes of 43 patients with ballooning detachment and large horseshoe tears where fish-mouth phenomenon was anticipated pre-operatively is analysed. In all of the cases, the retinal break settled on the wedge buckle after drainage of sub-retinal fluid and there was no radial retinal folds over the buckle nor was there fish-mouthing of the tears. The final success rate was 89%. There were no significant operative or post-operative complications and in none of the cases was there extrusion of implant or infection.

Combined photocoagulation and cryotherapy in treatment of Eales' retinopathy. Preliminary report.

This is a preliminary report of Eales' disease study (EDS). Compilation of two years data shows that combined xenon are photocoagulation and peripheral cryotherapy has beneficial effects in treatment of Eales' disease with grade II and grade III retinopathy. In very advanced stage of the disease (grade IV retinopathy) the treatment has no beneficial effects and untreated also it leads to vitreous haemorrhage and traction retinal detachment. The Eales' disease study (EDS) is still an on-going project and recruitment of the patients is continuing. Over another year we hope to have a larger number of patients, accumulate enough data and cover a longer follow-up period to substantiate these preliminary findings.