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1.
Int Ophthalmol ; 39(8): 1665-1667, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30022332

ABSTRACT

PURPOSE: To report patterns of uveitis in patients with systemic tuberculosis. METHODS: Records of patients presenting at uvea clinic of a tertiary eye care centre were evaluated retrospectively, and 47 cases with proven systemic tuberculosis were analyzed for patterns of uveitis. Tuberculosis had been proven with a combination of radio imaging and detection of acid fast bacilli in body fluids. All patients had been reviewed by a specialist as applicable before diagnosing tuberculosis. These patients had undergone a thorough ocular workup. Pattern of uveitis was the primary outcome measure. RESULTS: Mean age was 35.34 ± 15.56 years. Lung was the commonest systemic focus, seen in nearly 75% of the cases. Anterior uveitis was the most common presentation (48.9%), followed by posterior (25.5%), panuveitis (10.6%) and intermediate uveitis (10.6%). Multifocal serpiginoid choroidopathy (MSC) was seen in only one patient, while granulomatous choroiditis was the commonest type of posterior uveitis. CONCLUSIONS: Anterior uveitis is the most frequent type of uveitis seen in patients with proven systemic tuberculosis. Rarity of MSC in such patients indicates possibility of etiologies other than tuberculosis in causing MSC.


Subject(s)
Eye Infections, Bacterial/complications , Tuberculosis, Ocular/complications , Tuberculosis, Pulmonary/complications , Uveitis/etiology , Adult , Eye Infections, Bacterial/diagnosis , Female , Humans , Incidence , India , Male , Tuberculosis, Ocular/diagnosis , Tuberculosis, Pulmonary/diagnosis , Uveitis/diagnosis , Uveitis/epidemiology
2.
Int Ophthalmol ; 38(5): 2061-2068, 2018 Oct.
Article in English | MEDLINE | ID: mdl-28861733

ABSTRACT

AIM: To study patterns of uveitis in Indian children and compare with data sets published earlier in the literature. METHODS: Consecutive patients below 16 years of age presenting to the uvea clinic of a tertiary eye care center were included prospectively through the period of July 2009-August 2013. Children with retinal vasculitis, exogenous endophthalmitis and masquerade syndromes were excluded from analysis. Uveitis was classified as per the nomenclature system adopted by the International Uveitis Study Group. Hemogram, Mantoux test and chest X-ray were done for each patient, along with tailored investigations and pediatric review as per clinical profile. Clinical pattern and etiology were the main outcome measures. RESULTS: One hundred and thirty-four children were analyzed. Anterior uveitis (40%) was the commonest pattern followed by intermediate uveitis (25%), panuveitis (18%) and posterior uveitis (17%). Bilateral disease was present in 54%, 15% had infectious uveitis, 10% had granulomatous uveitis and 54% had idiopathic uveitis. Complications were present in half of the patients. Juvenile idiopathic arthritis (22), followed by toxoplasmosis (10) and tuberculosis (5), was the commonest etiology. Intermediate uveitis, non-granulomatous inflammation and older onset of disease had the high odds ratio of having idiopathic disease. CONCLUSION: Patterns of pediatric uveitis can vary between regions from even within the same geopolitical region. Anterior uveitis is commonest, and juvenile idiopathic arthritis and toxoplasmosis are the most frequent etiologies. Diagnosis of pediatric ocular tuberculosis is more difficult than in adults and needs better and well-defined criteria.


Subject(s)
Tertiary Care Centers , Uveitis/epidemiology , Child , Humans , Incidence , India/epidemiology
3.
Digit J Ophthalmol ; 23(1): 33-35, 2017.
Article in English | MEDLINE | ID: mdl-28924419

ABSTRACT

We describe 3 cases with unusual events during and after intravitreal injection of dexamethasone intravitreal implants and bevacizumab. In case 1, delayed release of the safety stop of a dexamethasone intravitreal implant injector led to impaction and retinal break formation. Timely recognition and laser treatment prevented further retinal complications. In case 2, reinjection of a second dexamethasone intravitreal implant from the same site as the first injection was noted to dislodge the remnant of the previous implant from the vitreous base. In case 3, translucent floating particles were noted in the vitreous after intravitreal injection of bevacizumab from ampules procured from our dispensing pharmacy.


Subject(s)
Bevacizumab/administration & dosage , Dexamethasone/administration & dosage , Macula Lutea/pathology , Macular Edema/drug therapy , Retinal Perforations/etiology , Visual Acuity , Angiogenesis Inhibitors/administration & dosage , Drug Implants/adverse effects , Female , Glucocorticoids/administration & dosage , Humans , Intravitreal Injections/adverse effects , Macular Edema/diagnosis , Male , Middle Aged , Retinal Perforations/diagnosis , Tomography, Optical Coherence
5.
Int Ophthalmol ; 34(6): 1221-6, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25301079

ABSTRACT

The purpose of this article is to study the clinical and demographic profile of uveitis-related ocular hypertension (OHT) and evaluate risk factors predisposing to development of OHT in uveitis. Two hundred patients (200 eyes) with uveitis were evaluated for type of uveitis and the presence of OHT [IOP > 21 mmHg]. All patients underwent a complete ophthalmic examination and appropriate systemic evaluation. Patients with OHT were started on appropriate antiglaucoma medication and were followed up for minimum of 6 months. Forty-two eyes (21 %) were found to have OHT. Anterior uveitis alone was seen in 22 (52.4 %), granulomatous uveitis was seen in 8 (19.1 %) eyes, while 13 eyes (30.9 %) had active uveitis. On multiple logistic regression, age greater than 60 years (p = 0.025), peripheral anterior synechiae (PAS) > 180° (p = 0.029), and steroid use (p < 0.001) were found to have significant association with OHT. Mean IOP at baseline was 24.6 ± 10.1 mmHg which decreased to 17.3 ± 4.5 mmHg at 6 months (p < 0.001). At 6 months, 30 eyes were medically controlled (71.4 %), 5 eyes underwent trabeculectomy with MMC (11.9 %), and in 7 eyes, antiglaucoma medication could be discontinued. One-fifth of eyes with uveitis had OHT. Risk factors for IOP elevation included increased age, PAS > 180°, and corticosteroid use.


Subject(s)
Ocular Hypertension/etiology , Uveitis/complications , Adolescent , Adult , Age Factors , Aged , Analysis of Variance , Antihypertensive Agents/therapeutic use , Child , Female , Humans , Intraocular Pressure , Logistic Models , Male , Middle Aged , Ocular Hypertension/diagnosis , Risk Factors , Uveitis/drug therapy , Young Adult
6.
Indian J Ophthalmol ; 60(4): 311-3, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22824601

ABSTRACT

The outcome of four cases of sterile endophthalmitis that developed after intravitreal injections of bevacizumab has been reported here. All four eyes received 1.25 mg/0.05 ml intravitreal bevacizumab from 0.2-ml aliquots for different etiologies. The inflammation predominantly involved the anterior chamber with mild vitreous reaction. All patients were culture negative and regained preinjection visual acuity and were culture negative following intravitreal antibiotic administration. This report highlights that intravitreal bevacizumab can cause sterile endophthalmitis and this has to be kept in mind, and clinical judgment should be used to differentiate it from infective endophthalmitis.


Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Endophthalmitis/drug therapy , Adult , Angiogenesis Inhibitors/administration & dosage , Bevacizumab , Endophthalmitis/diagnosis , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Intravitreal Injections , Microscopy, Acoustic , Ophthalmoscopy , Retinal Pigment Epithelium/pathology , Time Factors , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors
7.
Ophthalmologica ; 224(3): 183-7, 2010.
Article in English | MEDLINE | ID: mdl-19864928

ABSTRACT

OBJECTIVE: To evaluate intravitreal triamcinolone acetonide (IVTA) in unilateral serpiginous choroiditis with macular involvement with special reference to effectiveness of treatment and its side effects. METHODS: In this prospective nonrandomized, consecutive, interventional case series, IVTA was given in 8 eyes of 8 patients of unilateral active serpiginous choroiditis. Treatment was evaluated on both subjective and objective parameters: any improvement or stabilization of visual acuity, fundus and fluorescein angiography (FA) and central macular thickness on optical coherence tomography (OCT). RESULT: The treatment induced rapid remission clinically and vision improved or stabilized. Mean visual acuity improved from 0.93 +/- 0.21 LogMAR units at baseline to 0.36 +/- 0.24 (p = 0.00) LogMAR units at 6 months. A 33.73% reduction in mean central macular thickness was observed at the 6-month follow-up from 294.63 +/- 17.84 to 195.25 +/- 5.49 mum (p = 0.00). Lesions healed rapidly with FA and OCT proving the clinical observation. CONCLUSION: Intravitreal triamcinolone may prove to be a promising therapeutic approach as a rescue therapy in this recurrent sight-threatening disorder by inducing rapid remission without the systemic side effects seen with systemic immunosuppression.


Subject(s)
Choroiditis/drug therapy , Glucocorticoids/administration & dosage , Triamcinolone Acetonide/administration & dosage , Adult , Choroiditis/diagnosis , Choroiditis/physiopathology , Female , Fluorescein Angiography , Follow-Up Studies , Glucocorticoids/adverse effects , Humans , Injections , Male , Prospective Studies , Tomography, Optical Coherence , Treatment Outcome , Triamcinolone Acetonide/adverse effects , Visual Acuity/physiology , Vitreous Body
8.
Int Ophthalmol ; 28(5): 359-62, 2008 Oct.
Article in English | MEDLINE | ID: mdl-17898938

ABSTRACT

PURPOSE: To describe the natural course of subretinal triamcinolone acetonide (TA) deposition after a TA-assisted vitrectomy for retinal detachment. METHODS: Observational case series. RESULTS: TA deposition was observed between the neurosensory retina and retinal pigment epithelium in the macular area at the conclusion of vitreoretinal surgery in three patients with retinal detachment. On follow up, TA granules gradually decreased over the next 2 weeks and resolved completely by 3 weeks. Two months after the operation, the retina was observed to be successfully attached and no ophthalmoscopic or functional damage was observed. CONCLUSION: As no apparent clinically detectable adverse effect was found in the three cases that demonstrated subretinal deposition of TA we opine that active surgical maneuvers to remove the same are not warranted during surgery.


Subject(s)
Glucocorticoids/adverse effects , Granuloma, Foreign-Body/etiology , Retinal Diseases/etiology , Triamcinolone Acetonide/adverse effects , Vitrectomy , Adolescent , Adult , Child, Preschool , Follow-Up Studies , Humans , Male , Pigment Epithelium of Eye/surgery , Retinal Detachment/surgery
9.
Invest Ophthalmol Vis Sci ; 47(8): 3474-8, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16877418

ABSTRACT

PURPOSE: This case-control study was conducted to evaluate autonomic function activity and reactivity in patients with central serous chorioretinopathy (CSCR), because stress and type A personality, known risk factors, are also related to autonomic nervous system activity. METHODS: Patients with CSCR were selected from the outpatient department and medical retina services in one center. Control subjects were chosen from the healthy subjects of similar age group. The autonomic activity (both sympathetic and parasympathetic) in 45 patients with CSCR was evaluated and compared with that in 28 healthy control subjects, by using HRV (heart rate variability) analysis according to the guidelines laid down by the Task Force of European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996). Autonomic reactivity (both sympathetic and parasympathetic) was also evaluated in 32 patients with CSCR and compared with that in 28 healthy control subjects, by using standard autonomic function tests: HRV, as a measure of the resting sympathetic and parasympathetic activity (tone), and changes in blood pressure response and heart rate changes during various stressor stimuli in the tests as a measure of sympathetic and parasympathetic reactivity. RESULTS: Patients with CSCR showed significantly decreased parasympathetic activity (P = 0.002), significantly increased sympathetic activity (P = 0.005), and significantly increased sympathetic-parasympathetic balance (P = 0.004) as measured from different measures of beat-to-beat heart rate variability. The patients also showed significantly decreased parasympathetic reactivity (P = 0.03). Sympathetic reactivity showed a trend toward lessening. CONCLUSIONS: Autonomic function, both activity and reactivity components of sympathetic and parasympathetic system, is impaired in patients with CSCR. Because autonomic supply modulates the choroidal blood flow, there may be a correlation between measures of autonomic function and the presence of CSCR.


Subject(s)
Choroid Diseases/physiopathology , Choroid/blood supply , Parasympathetic Nervous System/physiopathology , Retinal Diseases/physiopathology , Sympathetic Nervous System/physiopathology , Adult , Blood , Blood Pressure/physiology , Cardiac Output/physiology , Case-Control Studies , Electrophysiology , Female , Heart Rate/physiology , Humans , Male
10.
Clin Exp Ophthalmol ; 34(6): 621-3, 2006 Aug.
Article in English | MEDLINE | ID: mdl-16925718

ABSTRACT

A 16-year-old boy presented with diminished visual acuity of 6/60 following blunt trauma to his right eye with a cricket ball. Fundus examination showed commotio retinae. Optical coherence tomography (OCT) demonstrated increased reflectivity with small optically clear spaces in the area corresponding to the photoreceptor outer segment. At 2-month follow up the visual acuity improved to 6/6. A small area of retinal opacification persisted nasally, and OCT of the corresponding area continued to show increased reflectivity in the area of photoreceptor outer segment. Increased reflectivity on OCT in eyes with commotio retinae probably denotes photoreceptor outer segment disruption and seems to be reversible to a variable extent.


Subject(s)
Athletic Injuries/complications , Eye Injuries/diagnosis , Retina/injuries , Retinal Diseases/diagnosis , Tomography, Optical Coherence/methods , Wounds, Nonpenetrating/diagnosis , Adolescent , Edema/diagnosis , Edema/etiology , Edema/physiopathology , Eye Injuries/etiology , Female , Humans , Remission, Spontaneous , Retina/physiopathology , Retinal Diseases/etiology , Retinal Diseases/physiopathology , Vision Disorders/diagnosis , Vision Disorders/etiology , Vision Disorders/physiopathology , Wounds, Nonpenetrating/etiology , Wounds, Nonpenetrating/physiopathology
11.
Graefes Arch Clin Exp Ophthalmol ; 244(7): 885-7, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16331482

ABSTRACT

BACKGROUND: Surgically induced scleral necrosis (SINS) is a rare consequence of ocular surgery. Various graft materials have been recommended for the repair of scleral necrosis. We report use of fresh cadaveric limbal graft for the same purpose. METHOD: A 42-year-old female presented with severe pain and buckle extrusion following external segmental buckling surgery for inferior retinal detachment. Buckle removal performed under general anesthesia revealed an area of scleral necrosis with uveal prolapse. Due to non-availability of other donor material a fresh cadaveric limbal graft remnant after keratoplasty was used for the repair after obtaining informed consent. RESULTS: Successful uptake of graft was observed and the globe integrity was restored. CONCLUSION: The case suggests that a fresh limbal graft may provide adequate tectonic support in eyes with SINS and can serve as an option for donor graft tissue in emergency situations.


Subject(s)
Limbus Corneae , Sclera/surgery , Sclera/transplantation , Scleral Buckling/adverse effects , Female , Humans , Middle Aged , Necrosis/etiology , Necrosis/surgery , Retinal Detachment/surgery , Sclera/pathology , Suture Techniques
14.
Clin Exp Ophthalmol ; 33(1): 78-80, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15670086

ABSTRACT

A 28-year-old man presented with bilateral acute loss of vision following a high-voltage injury. The visual acuity was 6/36 in the right eye and 6/24 in the left eye. Fundus examination revealed a well-defined round lesion simulating a full thickness macular hole in the right eye and yellow deposits in the macular area in the left eye. Optical coherence tomography (OCT) showed bilateral macular cysts, with intact outer and inner retinal layers. At 1 month follow up, OCT showed a persistent macular cyst in the right eye with spontaneous resolution of the macular cyst along with visual improvement in the left eye.


Subject(s)
Burns, Electric/complications , Cysts/etiology , Eye Burns/complications , Retina/injuries , Retinal Diseases/etiology , Adult , Burns, Electric/diagnosis , Cysts/diagnosis , Cysts/physiopathology , Eye Burns/diagnosis , Fluorescein Angiography , Humans , Male , Retinal Diseases/diagnosis , Retinal Diseases/physiopathology , Retinal Perforations/diagnosis , Retinal Perforations/etiology , Retinal Perforations/physiopathology , Tomography, Optical Coherence , Vision Disorders/etiology , Vision Disorders/physiopathology , Visual Acuity
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