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Background: Ophthalmic dirofilariasis is an uncommon zoonotic parasitic infection caused by species of Dirofilaria, a dog tapeworm that is transmitted to human by mosquitoes. Man is a dead?end host for the parasite. Ophthalmic involvement is rare and includes periorbital, subconjunctival, subtenon, and intra?ocular involvement. We report the removal of a subconjunctival worm and identification by light microscopy (LM) and scanning electron microscopy (SEM). Purpose: A 62?year?old female presented with complaints of redness, discharge, and foreign body sensation with difficulty in opening eyes in the left eye for the last 3 days. The patient is a non?vegetarian. On examination, her best corrected visual acuity in both eyes was 20/20. On slit lamp examination, there was a long, thin, round, coiled white subconjunctival live worm in the left eye superiorly. The rest of anterior segment evaluation, intra?ocular pressure, and fundus was normal in both eyes. The parasite was removed under local anesthesia from subconjunctival space [Video]. External surface morphology under LM revealed fine transverse cuticular striations with tapered cephalic and caudal ends. Uterus was long and coiled with indistinguishable masses inside. The finding was also confirmed by SEM. Synopsis: A subconjuctival parasite was removed and identified as Dirofilaria repens by characteristic LM and SEM findings. Highlight: Dirofilaria species may lodge in many tissues of human bodies including eye and adnexa. Dirofilaria is a natural parasite of carnivorous animals, mostly dogs, cats, and foxes.[1] The most common mode of transmission to human is usually by bite of mosquitoes like Culex and Aedes, which are considered as vectors, and it is often thought that parasitemia is because of accidental conduction.[1] Simple surgical removal of the worm is curative. After removal, the worm should be visualized directly under LM. All the internal structures of the transparent worm could be seen and compared with those under SEM.
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Purpose: To describe a novel approach of subconjunctival injection of mitomycin C (MMC) at the end of trabeculectomy and compare it with intraTenon MMC injection. Methods: This pilot study included 40 eyes of 40 patients with uncontrolled primary and secondary glaucoma. Patients below18 years and failed trabeculectomy were excluded. Patients were randomly allocated into groups A and B (20 patients each). Group A patients received subconjunctival MMC injection in the superonasal quadrant at the end of standard trabeculectomy. Group B received an intraTenon MMC injection before the initial conjunctival incision. Outcome measures included intra?ocular pressure (IOP) reduction, bleb morphology, and complication rates. The complete success was defined as an IOP of ?21 mmHg without antiglaucoma drugs. Results: The mean preoperative IOP of 46.00 ± 11.2 mmHg in group A and 43.05 ± 10.3 mmHg in group B reduced to 12.00 ± 2.41 mmHg (P ? 0.001) in group A and 13.65 ± 2.76 mmHg in group B (P ? 0.001) at last follow?up. Complete success was 95% and 75% in groups A and B, respectively, 19 months after surgery. Avascular microcystic blebs (70% of group A and 45% of group B) were more common than avascular white blebs (15% in group A and 35% in group B). No intraoperative complications were seen. Postoperative wound leak, hypotony, choroidal detachment, or endophthalmitis were not encountered in any group. Conclusion: A novel approach of subconjunctival MMC application during trabeculectomy is reported. Both approaches appear to be highly effective in reducing IOP in primary and secondary glaucoma with similar safety profiles and bleb morphology. Subconjunctival MMC yielded a greater success rate (95%) compared to the intraTenon MMC group (75%)
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The purpose was to assess the profile of subconjunctival oblique limbus incision (SCOLI) design by using anterior-segment optical coherence tomography (AS-OCT) and try to emphasize the proper technique of wound construction. The structural dimensions and integrity of the wound were acquired from the patients, who had undergone manual small-incision cataract surgery with SCOLI techniques, using a Canon OCT anterior-segment imaging system on the first postoperative day. The use of AS-OCT allowed for an in vivo evaluation of SCOLI in high definition. The radial OCT scan image showed three staggered incisions, including conjunctiva incision, scleral entrance, and inner corneal lip. A tangential scan demonstrated that the internal lip is parallel to the curvature of the peripheral cornea. The en face image showed an asymmetric 4 arc-shaped configuration rather than a symmetrical one. In conclusion, AS-OCT could be used to analyze SCOLI to determine optimal wound construction and geometry. The results of this study indicated that an asymmetric 4 arc-shaped limbus tunnel incision was superior to the conventional linear equivalent in stability and nucleus delivery.
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Ever-evolving modern day cataract extraction techniques have been accompanied by the use of smaller quantities and less invasive methods of anesthesia. Topical anesthesia is routinely used for phacoemulsification. However, peribulbar block or some modification of it is used for anesthesia in manual small-incision cataract surgery (MSICS) by most practitioners. The authors describe a technique using a combination of 1.5�milliliters of anesthetic mixture given subconjunctivally and supplemented with commercially available intracameral anesthetic and mydriatic for MSICS. It is possible to get high level of anesthetic effect and ease of surgery with this technique though there is a small learning curve. Several modifications from topical phacoemulsification like two side ports six o抍lock hours apart make this surgery easy to adapt to. No special instrumentation is required. It gives adequate analgesia and anesthesia to complete the surgery. a minimalistic anesthetic approach in MSICS can be used with enhanced safety and by avoiding usual complications of traditional peribulbar and retrobulbar anesthesia.
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@#AIM: To evaluate the clinical effects of subconjunctival injection of vitamin C in the treatment of corneal ulcer by using Meta-analysis.<p>METHODS: Using “vitamin C” and “corneal ulcer” as keywords, the randomized controlled trials(RCT)of subconjunctival injection of vitamin C in Embase, Cochrane library, Pubmed, CNKI and Wanfang database in the treatment of corneal ulcer was searched. Relevant reference published before February 2021. The risk bias tool provided by the Cochrane cooperation scale was used to assess the risk bias of included studies of RCTs. The publication bias of the included studies were assessed by the Egger's test with Stata software. Meta-analysis was performed with RevMan 5.3.<p>RESULTS: A total of 32 eligible articles were included, all of which were Chinese literatures, with a total of 4 514 patients. The control group was treated with routine treatment, and the experimental group was treated with subconjunctival injection of vitamin C combined with routine treatment. The Meta-analysis showed that the experimental group was better than control group(<i>OR</i>=4.61, 95%<i>CI</i>:3.70, 5.74). The recurrence rate was lower than control group(<i>OR</i>=0.24, 95%<i>CI</i>: 0.18, 0.31). The cure time in experimental group was shorter than control group(<i>MD</i>= -6.29, 95%<i>CI</i>: -7.08, -5.51), 32 studies do not adequately report adverse drug reactions(ADR). Egger's test was performed on the total effective rate, recurrence rate and cure time. The results showed that there was publication bias in the total effective rate and cure time. Trim and fill method showed that the publication bias did not affect the results.<p>CONCLUSION: Subconjunctival injection of vitamin C is feasible in the treatment of corneal ulcer. The clinical effect, cure time and recurrence rate were better than routine treatment. However, due to the low intensity of the included research evidence, more multicenter, randomized double-blind clinical trials are needed to improve the evidence intensity of vitamin C in the treatment of corneal ulcer.
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Introduction: Pterygium progression and recurrence is acommon complication. In various studies conducted on role ofsubconjunctival depot injection of bevacizumab, nothing hasbeen standardized with regards to dosage and its frequency.The study was done with aim to assess role and clinicalefficacy of subconjunctival injection of bevacizumab as a nonsurgical treatment modality for pterygium.Material and Methods: 80 cases of pterygium were includedin this study. Study was done over a period of 12 months fromDecember 2018 to November 2019 at a tertiary care ophthalmiccentre of Northern India. In this study, three doses of 2.5 mgof bevacizumab were administered sub-conjunctivally atmonthly interval under topical anaesthesia on Outdoor PatientDepartment basis. Standard aseptic measures were observed.Results: Cases were followed up next day after each injectionand thereafter on monthly basis for three months and finallyafter 06 months of first injection. Progression of pterygiumwas noted in 8 cases. Subconjunctival haemorrhage was notedin 41 cases. Conjunctival cyst was seen in three cases whichwere punctured in OPD, however recurrence was noted afterone month in one case. No rise in Intra Ocular Pressure (IOP)was noted.Conclusions: Subconjunctival injection of bevacizumab isuseful in treatment of patients with pterygium without local orsystemic adverse effects.
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We report a rare case of deep anterior lamellar keratoplasty (DALK) neovascularization managed with combination of subconjunctival bevacizumab and argon laser photocoagulation. A 24 year old male underwent Deep anterior lamellar keratoplasty for corneal stromal opacity following presumed viral keratitis. Deep corneal neovascularization was observed postoperatively which was successfully managed using a combination of subconjunctival bevacizumab and argon laser photocoagulation within one week of DALK. The neovascularization resolved by 3 months and at 2 years follow up, patient maintained good visual acuity of 6/12 Snellen's without recurrence of vascularization. A combination of bevacizumab and argon laser may be an effective approach to manage neovascularisation in the immediate postoperative phase (Post DALK) and improve graft survival.
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Background: Blindness due to cataract presents an enormous problem in terms of human morbidity, economical loss, andsocial burden. Retrobulbar anesthesia was commonly used for cataract surgery. Rare but serious complications led manyophthalmologists to replace retrobulbar with peribulbar anesthesia. However, even peribulbar anesthesia does not eliminatethe serious complications totally. These concerns have led to increased use of blunt needle sub-Tenon’s block over the sharpneedle blocks.Materials and Methods: 200 cases were selected, of which 100 were in the sub-Tenon’s group and the remaining 100 werein the peribulbar group. The efficacy of anesthesia between the two groups was compared in terms of analgesia at variousintervals, akinesia of the globe and eyelids attained after the block. They were graded on a subjective scale and recorded.Minor complications such as chemosis, sub-conjunctival hemorrhage, and rise in increased intraocular pressure (IOP) werealso compared and analyzed.Results: Sub-Tenon’s anesthesia provided better analgesia than peribulbar anesthesia although the akinesia was poorer thanthe latter. Minor complications such as sub-conjunctival hemorrhage were more in sub-Tenon’s group while instantaneous risein IOP was more in peribulbar group. The incidence of chemosis was almost comparable in both the groups.Interpretation and Conclusion: Sub-Tenon’s anesthesia is recommended as a safe and effective alternative to peribulbaranesthesia for small-incision cataract surgery as it provides good analgesia, adequate akinesia, and rare minor complications.
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Congenital lamellar ichthyosis is an autosomal recessive, heterogeneous disorder presenting at birth with generalized skin involvement. The most common ophthalmic manifestation noted is bilateral ectropion of the lower eyelids. A 1-month-old female neonate, the second born of a nonconsanguineous marriage, presented with 4 days' history of redness, discharge, and swelling in the right eye. There was severe right upper eyelid ectropion, conjunctival injection, chemosis, a subconjunctival mass on the temporal bulbar conjunctiva spontaneously draining pus and corneal haze. The anterior chamber, iris, lens and fundus appeared normal. Congenital lamellar ichthyosis was suspected because of scaling and excessive dryness of the entire body. The occurrence of a spontaneous subconjunctival abscess is not known in lamellar ichthyosis. We thus report the management of a rare case of unilateral upper eyelid ectropion, subconjunctival abscess with orbital cellulitis in congenital lamellar ichthyosis.
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@#Glaucoma surgery is divided into two major categories: reducing the formation of aqueous humor and increasing the flow of aqueous humor. The former one is represented by the laser ablation of the ciliary processes, and the latter one is represented by trabeculectomy. From traditional glaucoma filtering surgery to newer glaucoma procedures, which target different aqueous outflow pathways, the use of glaucoma drainage implants has improved the safety profile of glaucoma surgery and decreased the complications during the operation and post operation, also the surgical techniques have been getting easier than ever. This article systematically reviews the clinical progress of new glaucoma drainage implants including the implants targeting the trabecular network and schlemm’s canal (iStent, Hydrus Micro-stent)，the implants targeting the superachoridial space (CyPass Micro-Stent, iStent Supra) and the implants targeting the subconjunctival space (XEN gel stent，InnFocus MicroShunt).
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Objective To evaluate the ocular pharmacokinetics of a novel antibody, MIL60, tar-geting vascular endothelial growth factor ( VEGF) after subconjunctival injection. Methods After subcon-junctival injection of MIL60 in rabbits, aqueous humour, vitreous from both eyes and peripheral blood were collected of each rabbit to analyze the concentration of MIL60 with ELISA. Results After subconjunctival administration, MIL60 could penetrate into the injected eye′s anterior chamber and vitreous, and maintained at an effective concentration in the aqueous or vitreous for about 10. 7 or 6. 8 days. Moreover, MIL60 could be found in the uninjected eye. Conclusion After subconjunctival injection, MIL60 could maintain at a therapeutic concentration in injected eyes. The pharmacokinetics analysis of MIL60 might provide some basis and guidance for its application in humans in the near future.
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AIM:To verify the safety application of MIL60 in the treatment of corneal neovascularization both in vivo and in vitro.METHODS:We observed the biological characteristics of human corneal epithelial cells.The cell proliferation was analyzed using CCK-8 assay,which also used to test the toxicity of MIL60 and the solvent on cultured human corneal epithelial (HCE).FACs was used to analyze the apoptosis of HCE after treated with MIL60.Also we evaluated the effect of subconjunctival injection of MIL60 on corneal epithelial healing model in normal rat and rats with epithelium defect through slit lamp-microscopy,Draize scores and histopathology way.RESULTS:The proliferation speed of HCE in three groups was the same.MIL60 did no harm on the proliferation of HCE and the apoptosis of HCE,and has no effect on corneal epithelial healing and other parts of the ocular in rats without inflammation cells infiltration.CONCLUSION:When given subconjunctival injection,Mil60 does no harm to the proliferation and apoptosis of HCE,and is safe with ocular application.
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El trauma ocular es una causa importante de morbilidad oftalmológica en el mundo con implicaciones socioeconómicas importantes para el paciente y sus familiares. Ocurre generalmente en adultos jóvenes, con una buena agudeza visual al inicio del evento traumático, la cual se verá comprometida según la severidad del trauma, las estructuras oculares que afecte y las complicaciones que puedan aparecer. Presentamos dos pacientes con rotura escleral posterior secundario a trauma ocular a globo abierto contuso. Se describe el manejo personalizado el seguimiento en cada caso y sus resultados visuales(AU)
The ocular trauma is an important cause of ophthalmological morbidity in the world with significant socio-economic implications for the patient and its relatives. It generally occurs in young adults, with good visual acuity at the beginning of the traumatic event, which may be affected by the trauma severity, the ocular structures that it affects and the possible complications. This is the report on two patients with posterior scleral rupture secondary to blunt open-globe ocular trauma. The customized management, the follow-up of each case and the visual results achieved were all described(AU)
Sujets)
Humains , Mâle , Adolescent , Adulte , Lésions traumatiques de l'oeil/diagnostic , Lésions traumatiques de l'oeil/thérapie , Ophtalmoscopes/statistiques et données numériques , Vitrectomie/méthodes , Hémorragie du vitré/diagnostic , Chambre antérieure du bulbe oculaire/traumatismes , Lésions traumatiques de l'oeil/complications , Acuité visuelleRésumé
AIM: To evaluate the clinical efficacy of surgery for spontaneous subconjunctival orbital fat prolapse via bulbar conjunctiva under topical anesthesia. ●METHODS: A total of 22 eyes of 11 patients received surgery for spontaneous subconjunctival orbital fat prolapse via bulbar conjunctiva under topical anesthesia were included. Objective and subjective duration of the operation, degree of cooperation during surgery, postoperative recovery, recurrence and complications were observed. ●RESULTS: In the process of surgery, patients without pain and being-cooperated were recorded in 17 eyes. The patients who occasionally felt slight pain, but within endurance after adding topical anesthesia once and the operation was completed successfully were recorded in 5 eyes ( the second eye surgery ) . The operation was successfully completed in all the patients. Compared the coordination degree during surgery of Gradel with GradeⅡ, the difference was statistically significant ( t=-3. 123, P ● CONCLUSION: The surgery for spontaneous subconjunctival orbital fat prolapse via bulbar conjunctiva under topical anesthesia can ensure satisfactory anesthetic effect and get better quality of operation. It′s a simple, safe and effective anesthesia method for spontaneous subconjunctival orbital fat prolapse.
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Cysticercus cellulosae occurs worldwide, mainly in poor regions with insufficient sanitary conditions. Ocular cysticercosis develops from Taenia solium larvae in ocular structures. The eye could be the prime location for such parasitic infection because of its rich vascularization and almost all structures such as orbit, extraocular muscles, conjunctiva, anterior segment, and posterior segment can be involved. Diagnosis is usually made on history, clinical examination, radiological findings, and histopathology. We report a case of a 13-year-old girl who presented with a subconjunctival cyst. It was diagnosed as implantation cyst based on history and clinical findings. Complete surgical excision was done. On histopathological examination, ocular cysticercosis was confirmed. The patient was given oral albendazole and prednisolone, post-operatively. The ocular cysticercosis is an oft-reported problem in North India. Surgical excision is the treatment of choice. Inaccessible cysts are best treated with oral albendazole along with prednisolone.
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Human dirofi lariasis is a rare infection caused by fi larial worms of genus Dirofi laria. Subconjunctival dirofi lariasis has been reported from Asia, Europe, Italy and Africa. In India majority cases are from Kerala, Karnataka and very few from Maharashtra. We report the rare case of subconjunctival dirofi lariasis caused by Dirofi laria repens from Maharashtra, western India.
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Dislocation of intraocular lens (IOL) is a serious complication of blunt ocular trauma in pseudophakic eyes. Here, a 72‑year‑old male patient with subconjunctival dislocation of an IOL (pseudophacocele) secondary to bull horn injury was reported. In this case report, a new sign named as “golden half ring sign” was described for easy identification and localization of subconjunctival dislocation of IOL in patient with open globe injury (surgical wound dehiscence) associated dense subconjunctival hemorrhage.
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Cysticercosis: is a systemic parasitic disease caused by the larval form of cestode Taenia solium. It has a worldwide distribution and is potentially harmful with variable clinical manifestations. The most commonly involved sites include eye, brain, bladder wall and heart. Ocular cysticercosis can be extraocular or intraocular and may present with varied clinical symptoms. We report the condition in a 10-year old female child who presented with redness and painful diminution of vision in right eye for 5 days, where in cysticercosis cellulosae cyst was found intraocular within the vitreous body. Multiple sites of involvement were noted including Central Nervous System, lungs and spleen. This case is reported to highlight the prime importance of systemic evaluation of a patient of ocular cysticercosis, relative rarity of this condition these days and young age of the patient.
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There are cases in which the presence of a foreign body (FB) is difficult to diagnose based on history taking or clinical examination. We report a case of subconjunctival FB confused with uveal prolapse. A 68‑year‑old man, who had the history of pterygium excision in his right eye, complained of irritation and congestion in that same eye. He also had the history of growing vegetables in a plastic greenhouse. It seemed to be a suspected uveal mass bulging through a focal scleral thinning site. On the basis of slit‑lamp magnification, the lesion was presumed to be a hard and black keratinized mass embedded under the conjunctiva. Histopathologically, the removed mass was revealed to be a seed of the dicotyledones. Patients who show signs of prolapsed uvea or scleral thinning, possibility of a subconjunctival FB should be considered as differential diagnosis. In addition, a removed unknown FB should be examined histopathologically.
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A 60 year old nonsmoker, non-diabetic, normotensive farmer presented with 4 days history of fever, myalgia & headache. He had relative bradycardia, eye congestion, diffuse muscle tenderness and tender hepatomegaly at presentation. He developed subconjunctival hemorrhage on 3rd in-hospital day. His investigations showed thrombocytopenia, hepatic and renal dysfunctions. His leptospira serology was positive. He was treated with injection crystalline penicillin and supportive therapy. While on treatment, even though he did not have any known cardiac risk factors, except for his age & gender, he developed 3 paroxysms of atrial fibrillation on 5th - 7th in-hospital days, without hemodynamic instability. His cardiac markers and echocardiogram during the paroxysms were otherwise normal. He had uneventful recovery, remained in sinus rhythm and stable at follow-up. This paroxysmal atrial fibrillation may be a coincidence or attributed as unusual association of leptospirosis.