Corneal honey bee sting: endoilluminator-assisted removal of retained stinger.

To report the clinical findings and a novel method of removal of bee sting using an endoillumination light source the following methods were used: clinical presentation, slit-lamp photographs, serial endothelial images and surgical management of a case of retained bee sting in the cornea. The bee sting was surgically removed by forceps under focal illumination with an endoillumination light source. Topical steroids and cycloplegics were given postoperatively to control the inflammation. The patient had complete visual recovery and partial resolution of endothelial changes after 1 year of treatment. The clinical picture of a corneal honey bee sting resembles keratouveitis. Focal corneal infiltrate and associated low-grade uveitis tend to persist if treated with topical steroids only. Early recognition and prompt removal of the stinger may help in the early resolution of anterior segment inflammation and prevent irreversible damage to endothelial cells.

Natural history of macular status in recent-onset branch retinal vein occlusion: an optical coherence tomography study.

PURPOSE: To evaluate serially the course of structural changes in the macula in recent onset branch retinal vein occlusion (BRVO), using optical coherence tomography (OCT). METHODS: Twenty eyes of patients at an institutional practice with recent onset BRVO were examined by OCT at presentation and at 3 and 6 months of onset of the occlusion. The macular thickness (MT) and the visual acuity were correlated with the macular perfusion status and analyzed statistically. RESULTS: The mean MT at presentation, 3 and 6 months was 398.9 +/- 98.6 mm, 346.8 +/- 84.8 mm and 341.3 +/- 95.3 mm, respectively. Three distinct anatomical patterns of structural changes were appreciated on OCT-serous retinal detachment (SRD) only in 15%, cystoid macular edema (CME) only in 40%, and a combined form with both SRD and CME in 45%. At 6 months while the non-ischemic group showed an average percentage decline of 26.8% in thickness, the ischemic group showed an increase of 19.2% (P < 0.01). CME resolved in 10 of 13 perfused (non-ischemic) maculae, but persisted in all seven ischemic cases. CONCLUSION: OCT delineates macular changes at a stage when fundus biomicroscopy and fluorescein angiography are not very informative. The anatomical cause for the increase in MT i.e., SRD and/or CME is also well delineated. Non-ischemic maculae show an early and more rapid decline in MT compared with ischemic occlusions. An increase in MT at 3 months on OCT in BRVO patients could be an indication of a possible ischemic course.

Bilateral periorbital necrotizing fasciitis following exposure to Holi colors: a case report.

Holi festival is celebrated in India traditionally by applying colors on one another. Various ocular adverse effects of these colors have been reported including conjunctivitis and corneal abrasion. We report a case of bilateral periorbital necrotizing fasciitis, following exposure to Holi colors. General physicians might encounter more such cases after exposure to Holi colors. In India, these colors are prepared on a small scale and lack any quality checks. Use of such toxic colors should be discouraged, and all doctors should caution people against using synthetic dyes. This case report highlights the need to put manufacturing of Holi colors under guidelines of the Food and Drug Cosmetic Act and the Bureau of Indian Standards.

In vivo microscopy of Best's Vitelliform Macular Dystrophy: optical coherence tomography study of combined stage III and IV lesions.

A 35-year-old man presented with decreased vision in both eyes. Fundus biomicroscopy of the right eye revealed a pseudohypopyon along with an area of hyperpigmentation and scarring at the macula (combined stage III and IVb Best's Vitelliform Macular Dystrophy [BVMD]). The left eye showed the presence of a pseudohypopyon along with macular atrophy (combined stage III and IVa). On optical coherence tomography both eyes had a neurosensory retinal detachment with an optically clear subretinal zone, an accumulation of material between neurosensory retina and the retinal pigment epithelium corresponding to the pseudohypopyon and subfoveal photoreceptor atrophy. We document on optical coherence tomography the transition of BVMD from stage III to IV (in the form of the combined stage). These new findings may be considered unique for this stage of BVMD, and would help in a further understanding of the disease as it passes through its various stages.

Familial calcific band-shaped keratopathy: report of two new cases with early recurrence.

We report two siblings with the rare entity of familial calcific band-shaped keratopathy (BSK). Detailed ophthalmic and systemic investigations failed to reveal any underlying causative pathology. Topical disodium ethylenediamine-tetraacetate (EDTA) was applied for 30 min to all four eyes. In addition the right eye of the younger sibling required a superficial keratectomy. An improvement in corneal clarity was seen in the immediate postoperative period in both siblings. Histopathology of the keratectomy specimen revealed linear extracellular sub-epithelial granular calcium deposits. However, an early recurrence was noted in all four eyes at four weeks postoperatively. We report the second instance in the English literature of this entity. Band-shaped keratopathy presenting without an obvious etiology merits a complete systemic and ophthalmic workup. Patients with familial idiopathic BSK could be cases with poor prognosis for treatment with EDTA due to an early recurrence of the disease.

Chemo-paralysis for the removal of a live intraocular worm in ocular angiostrongyliasis.

Angiostrongylus cantonensis is also called the rodent lung worm. It was first discovered in 1935 by Chen in Rattus rattus, in Canton, China. The rodent is the definitive host while infected mollusks, snails and crabs act as the intermediate hosts. Humans are infected by the 3rd stage larvae, either by eating undercooked intermediate hosts or by consuming vegetables.(1) It is a delicate nematode reported in Asia Pacific region most commonly in South-east Asia and has been reported from Taiwan, Thailand, Indonesia, Vietnam and Sri Lanka.(2) Anterior chamber angiostrogyliasis is extremely rare, and no previous case of ocular angiostrogyliasis from India could be found on Medline search. We report a new technique in the removal of the actively motile thread-like worm by paralysing it with intracameral preservative free lidocaine, which aids in the easy removal of the intact worm.

Inverse hypopyon as the presenting feature of infectious scleritis in a case of tropical pyomyositis.

CASE REPORT: A 25-year-old man presented with inverse hypopyon due to dense inflammatory exudation in the left eye. He was an ascetic with a history of long pilgrimages barefoot. Drainage of the pyogenic material with superficial exploration revealed localized scleral thinning at 2'o clock. Two days later, a thigh abscess was noted, which on ultrasonography showed hypoechoic areas with increased muscle mass suggestive of tropical pyomyositis. The culture from anterior chamber aspirate grew Staphylococcus aureus, as did 200 mL of pus drained from the thigh. His ocular condition improved significantly with high-dose systemic antibiotics. COMMENTS: To our knowledge, this unusual presentation of infectious scleritis and coexistent pyomyositis has not been previously reported in the literature.

Clinical evaluation of refractive changes following brow suspension surgery in pediatric patients with congenital blepharoptosis.

BACKGROUND AND OBJECTIVE: To evaluate the postoperative visual acuity and refractive changes occurring after bilateral frontalis brow suspension surgery in pediatric patients with congenital blepharoptosis. PATIENTS AND METHODS: Twenty-three patients between 4 and 12 years old with severe congenital blepharoptosis (unilateral in 21 cases and bilateral in 2 cases; total of 25 eyes) and poor levator function underwent bilateral frontalis brow suspension surgery by Crawford's double triangle method with 4:0 expanded polytetrafluoroethylene sutures. The non-ptotic eyes (21 eyes) undergoing frontalis brow suspension surgery served as the control group. All patients had best-corrected spectacle visual acuity (BCSVA) of more than 6/9 preoperatively in both eyes. Changes in the postoperative BCSVA, binocularity, relevant refractive parameters, lid position, lagophthalmos, lid lag, and tear break-up time were evaluated in both groups for 12 weeks and appropriate statistical tests were applied. RESULTS: Significant differences were found in the baseline characteristics and the postoperative changes in the eyes with and without ptosis. However, these were found to be transient and did not result in any new cases of amblyopia postoperatively. No complications requiring revision of surgery were seen. CONCLUSIONS: The changes in the BCSVA after frontalis brow suspension surgery are transient. Retinoscopy, manual keratometry, and corneal videokeratoscopy are simple and effective methods to evaluate the sequential refractive changes occurring in these eyes.

Viscoexpression of anterior chamber cysticercus cellulosae.

We report a case of anterior chamber Cysticercus cellulosae that was removed by viscoexpression.

Combined extracapsular cataract extraction with ahmed glaucoma valve implantation in phacomorphic glaucoma.

PURPOSE: To report a retrospective analysis of a combined procedure of extracapsular cataract extraction (ECCE) with heparin surface modified (HSM) posterior chamber intraocular lens (PCIOL) implantation along with primary Ahmed glaucoma valve (AGV) implantation in an attempt to optimize visual acuity gains and intraocular pressure (IOP) control in patients with phacomorphic glaucoma. METHODS: ECCE with HSM PC IOL and AGV implantation was performed through two separate incisions in 15 patients diagnosed with phacomorphic glaucoma. Postoperative improvement in visual acuity and IOP control were monitored. RESULTS: A steady control of IOP was maintained in all patients with minimum anti-glaucoma medications. The average visual acuity was approximately 6/24 at 3 months. CONCLUSION: Superior preoperative IOP control and a shorter phacomorphic attack resulted in better postoperative vision. The successful maintenance of IOP within the desired range in this study suggests that the procedure should be performed under similar conditions.