Post penetrating keratoplasty glaucoma: Cumulative effect of quantifiable risk factors.

Purpose: To ascertain the incidence, identify risk factors and calculate cumulative eff ect of risk factors in patients developing glaucoma following optical penetrating keratoplasty. Materials and Methods: We carried out retrospective analysis of 445 patients, those underwent optical PK and had a minimum follow up of 6 m. Data on post-operative intra-ocular pressure (IOP) recorded at 3, 6, 9, 12 and 18 m or more was analyzed. Various risk factors including age, sex, indications for penetrating keratoplasty, pre-existing glaucoma and type of surgical procedures performed were analyzed by using univariate analysis and logistic regression technique. Results: Ninety (21%) of eyes developed post-PK glaucoma. On applying logistic regression, age, sex, indication of surgery, pre-existing glaucoma were found to be signifi cant risk factors for the development of post-PK glaucoma (P < 0.05). Using logistic regression equation the cumulative risk of developing post-PK glaucoma in an individual patient can be calculated. Conclusions: Male patients, aged more than 40 years, having opaque grafts as an indication and with pre-existing glaucoma were found to be higher risk of developing post-PK glaucoma. Patients at higher cumulative risk for development of post-PK glaucoma may be closely monitored during follow-up.

Outcome of in-the-bag implanted square-edge polymethyl methacrylate intraocular lenses with and without primary posterior capsulotomy in pediatric traumatic cataract.

Purpose: To study the outcome of in-the-bag implanted square-edge polymethyl methacrylate (PMMA) intraocular lenses (IOL) with and without primary posterior capsulotomy in pediatric traumatic cataract. Materials and Methods: The study was undertaken in a tertiary care center. Thirty eyes of 30 children ranging in age from 4 to 16 years with traumatic cataract which underwent cataract extraction with capsular bag implantation of IOL were prospectively evaluated. Group A included 15 eyes of 15 children where primary posterior capsulotomy (PPC) and anterior vitrectomy with capsular bag implantation of square-edge PMMA IOL (Aurolab SQ3602, Madurai, Tamil Nadu, India) was performed. Group B comprised 15 eyes of 15 children in which the posterior capsule was left intact. Postoperative visual acuity, visual axis opacification (VAO) and possible complications were analyzed. Results: Best corrected visual acuity (BCVA) of 20/40 or better was achieved in 12 of 15 eyes in both groups. Amblyopia was the cause of no improvement in visual acuity in the remaining eyes. Visual axis opacification was significantly high in Group B as compared to Group A (P=0.001). Postoperative fibrinous uveitis occurred in most of the eyes in both groups. Pupillary capture was observed in one eye in each group. Conclusion: Primary posterior capsulotomy and anterior vitrectomy with capsular bag implantation of square-edge PMMA significantly helps to maintain a clear visual axis in children with traumatic cataract.

Profile of angle closure in a tertiary care center in north India.

Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC) were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434) were diagnosed to have various subtypes of angle closure. Mean (±SD) age at presentation was significantly higher for males (57.57 ± 11.62 years) as compared to females (53.64 ± 10.67 years) (P < 0001). Primary angle closure glaucoma (PACG) was most frequently diagnosed subtype (49.38%) followed by Primary angle closure (PAC) (39.68%) and Primary angle closure suspect (PACS) (10.93%) respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction). Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical) done.

Posterior scleritis associated with systemic tuberculosis.

Infective isolated posterior scleritis is rare. We report a case of isolated posterior scleritis associated with histopathologically documented systemic tuberculosis, a hitherto unreported association. The patient responded well to a combination of oral corticosteroids with antituberculosis therapy.

Spectrum and clinical profile of post cataract surgery endophthalmitis in north India.

PURPOSE: To determine the spectrum, clinical profile and risk factors for poor visual outcome in patients of post cataract surgery endophthalmitis. METHODS: Data from 124 eyes were analysed. Various clinical and microbiological parameters were evaluated and risk factors for unfavourable outcome identified. RESULTS: The mean age of the patients was 59.50 +/- 13.75 years; 60.5% were males. The median surgery-symptom interval was 7 days (mean 15.81 +/- 24.01) and the medium symptom-presentation interval 7.5 days (mean 14.19 +/- 19.13). Corneal infiltrates were seen in 29%, hypopyon in 62 (50%). Smear positivity was 52.5% and culture positivity 38%. Equivocal microbiological positivity was seen in 22 (18%), bacterial 12 (10%), fungal 27 (21.5%), polymicrobial 8 (6.5%) and negative 55 (44%). 20% eyes had total loss of vision at last follow-up. Poor visual acuity at presentation, presence of intraocular lens, shorter surgery-symptom interval, corneal and surgical wound infiltrates, loss of red reflex, microbiological positivity of the vitreous tap and systemic diabetes mellitus were significant risk factors for unfavourable outcome. CONCLUSION: Our data highlights a low culture positivity and a predominance of fungal pathogens as a cause of post cataract surgery endophthalmitis. The visual outcome in these patients is still dismal and better treatment strategies should be evolved keeping in mind the microbiological spectrum. The risk factors identified may be helpful in prognosticating the outcome in such patients.

Papillary carcinoma thyroid presenting as a choroidal metastasis. Report of a case and brief review of literature.

A patient of papillary thyroid carcinoma, who initially presented with a choroidal metastasis and secondary intractable glaucoma is reported. The orange-coloured tumour posed a diagnostic difficulty, until histopathology of the enucleated eye confirmed the metastasis from the thyroid. The initial presentation of distant metastasis in patients with thyroid cancer is rare.

Role of prophylactic intravitreal antibiotics in open globe injuries.

PURPOSE: To determine the efficacy of prophylactic intravitreal antibiotics in reducing the incidence of endophthalmitis after trauma. METHODS: This was a prospective, randomised, case control study of 70 consecutive patients with open globe injury. The patients were prospectively randomised into group I (32 eyes) and group II (38 eyes). Group I patients were given prophylactic intravitreal injection of vancomycin 1 mg and ceftazidime 2.25 mg at the conclusion of primary repair. Group II patients were not given prophylactic intravitreal antibiotics. All the patients received intravenous ciprofloxacin. RESULTS: The incidence of endophthalmitis was higher in group II (7 of 38 eyes; 18.42%) compared to group I (2 of 32 eyes; 6.25%). Both the patients who developed endophthalmitis despite prophylactic intravitreal antibiotics in group I had an initially undetected intraocular foreign body (eyelash) in the vitreous cavity. CONCLUSIONS: Prophylactic intravitreal broad spectrum antibiotic injection decreases the risk of post-traumatic endophthalmitis.