Meeting the Unmet Need in the Management of MDR Gram-Positive Infections with Oral Bactericidal Agent Levonadifloxacin.

Levonadifloxacin (intravenous) and its oral prodrug alalevonadifloxacin are broad-spectrum antibacterial agents developed for the treatment of difficult-to-treat infections caused by multidrug-resistant Gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus, atypical bacteria, anaerobic bacteria, and biodefence pathogens as well as Gram-negative bacteria. Levonadifloxacin has a well-defined mechanism of action involving a strong affinity for DNA gyrase as well as topoisomerase IV. Alalevonadifloxacin with widely differing solubility and oral bioavailability has pharmacokinetic profile identical to levonadifloxacin. Unlike existing MRSA drugs such as vancomycin and linezolid, which cause unfavorable side effects like nephrotoxicity, bone-marrow toxicity, and muscle toxicity, levonadifloxacin/alalevonadifloxacin has demonstrated superior safety and tolerability features with no serious adverse events. Levonadifloxacin/alalevonadifloxacin could be a useful weapon in the battle against infections caused by resistant microorganisms and could be a preferred antibiotic of choice for empirical therapy in the future.

Recurrent unintentional filtering blebs after vitrectomy: A case report.

A lady who underwent lensectomy for microspherophakia and pars plana vitrectomy for retinal detachment in her left eye developed recurrent filtering blebs at the site of sclerotomies. Filtering blebs were managed by suturing the sclerotomies. Targeted gene sequencing identified a variant of ASPH gene (p.Arg688Gln) which is not known to be associated with Traboulsi syndrome. But considering the paucity of cases with genetic analysis, it would be possible that p.Arg688Gln is a pathogenic variant. This is the first case report of Traboulsi syndrome due to an ASPH variant not reported earlier that can lead to recurrent filtering blebs.

Optical coherence tomography angiography-based analysis of intrinsic vasculature in juxtapapillary melanoma after ruthenium-106 plaque brachytherapy.

In this case report, we demonstrate the use of optical coherence tomography angiography (OCTA) as a tool to evaluate intrinsic vasculature in a case of juxtapapillary melanoma which underwent ruthinium.106 plaque brachytherapy. In this case, OCTA could demonstrate a decrease in caliber and density of the intrinsic vasculature of the tumor post brachytherapy.

Optical coherence tomography angiography in assessment of response to therapy in retinal capillary hemangioblastoma and diffuse choroidal hemangioma.

In this series, we discuss the role of optical coherence tomography angiography (OCTA) in assessing response to treatment in intraocular vascular tumors. This is a series of two cases: Multiple retinal capillary hemangioblastoma (RCH) treated with laser photocoagulation and diffuse choroidal hemangioma (DCH) with radiotherapy. In large RCH and DCH, optical coherence tomography (OCT) showed significant reduction of subretinal and intraretinal fluid. But post-treatment mean tumor vascular density (MTVD) was slightly reduced. In one small RCH, vascular loop was seen suggesting minimal residual disease. So, OCTA helps in identifying treatment inadequacy and understanding alternate mechanism involved in treatment response in vascular tumors.

Ocular coherence tomography angiography features of congenital hypertrophy of retinal pigment epithelium.

Congenital hypertrophy of retinal pigment epithelium (CHRPE) is a benign, pigmented, flat lesion arising from the retinal pigment epithelium (RPE). In this study, we describe optical coherence tomography angiography (OCTA) features of two eyes with solitary CHRPE. We found that the retinal vasculature over CHRPE was normal in both cases. We observed that in solitary CHRPE, segmentation artifacts can interfere in the interpretation of retinal vasculature due to thinning of the outer retina. Visualization of the underlying choroidal vasculature was obscured to some extent by masking effect of the hyperpigmented RPE. The choroidal vasculature was better appreciated on en face OCTA. On OCTA, the retinal and choroidal vasculature associated with CHRPE was found to be normal in our study.

Optical coherence tomography angiography features of retinitis post-rickettsial fever.

The intraocular manifestations of rickettisial retinitis include retinal vasculitis, maculopathy, optic neuritis, and neurosensory detachment. Extensive leakage of dye on the fundus fluorescein angiography may obscure visualization in eyes with retinitis. We report the vascular changes in eyes with rickettsial retinitis and its response to treatment using optical coherence tomography angiography. The microvascular abnormalities we noted were, capillary drop out areas corresponding to retinitis patches, vascular loops, and pruning of vessels. The choriocapillary slabs showed signal void areas. Post-treatment there was vascular remodeling with decrease in non-perfused area, appearance of new vascular lateral branching, and appearance of collaterals.

Optical coherence tomography angiography of fleeting macroaneurysm in retinal racemose angioma.

We present a rare case of retinal racemose angioma complicated with fleeting macroaneurysm (MA). A 50-year-old female presented with diminution of vision in her right eye for 6 years. Fundus examination showed a racemose angioma with hemorrhagic MA temporal to the fovea in the right eye. On subsequent follow-ups, spontaneous thrombosis of MA was noted with the development of new MA inferior to the fovea, with intraretinal hemorrhage extending into the fovea. Focal laser to MA resulted in resolution of MA with improvement in vision. We report optical coherence tomography angiographic features of the fleeting MA in a case of racemose angioma.

Novel techniques in scleral buckling.

Scleral buckling is a surgical technique that is employed successfully to treat rhegmatogenous retinal detachments (RRD) for more than 60 years. With the introduction of pars plana vitrectomy (PPV), there is a growing trend towards the use of PPV for treatment of retinal detachment. There is a reluctance to perform scleral buckling (SB) in RRD due to the perceived steep learning curve, declining mastery over indirect ophthalmoscopy, and poor ergonomics associated with SB. In this article, we discuss the surgical challenges and tips to overcome these in four headings: localization of the break, retinopexy, SB, and subretinal fluid (SRF) drainage. Localization of the break can be performed by the use of forceps or illuminated scleral depressor. It can be facilitated by prior drainage of SRF in cases with bullous RRD. Chandelier with wide-angle viewing system can be used for easier localization of break and cryopexy. Sutureless buckling and suprachoroidal buckling are easier and faster alternatives to the conventional technique. Reshaping the silicone segment helps in accommodating the wider circumferential band. Modified needle drainage, laser choroidotomy, and infusion-assisted drainage can make SRF drainage easier and safer. The above techniques and other practical tips have been explained in detail with the illustrations to make the process of learning the art of SB easier.

Optical coherence tomography angiography features of choroidal hemangioma.

This is an observational case series of four cases of choroidal hemangioma. All cases underwent OCT angiography with swept source OCTA (Topcon DRI OCT Triton plus) 6 mm * 6 mm protocol. OCTA at the level of large choroidal vessels demonstrated peculiar vascular pattern in all four eyes. Patterns observed were bag of worms, spaghetti like and vessels with terminal bulbs. In eye with diffuse choroidal hemangioma comparison of choroidal vascular pattern with the contralateral eyes showed significant difference in the vascular architecture. OCTA is an excellent non invasive tool in assessing the choroidal vascular pattern in eyes with choroidal hemangioma.

Retropupillary fixation of iris-claw lens in visual rehabilitation of aphakic eyes.

CONTEXT: Surgical outcome of retropupillary fixation of iris claw lens. AIMS: To evaluate the various indications, intra and post-operative complications, and visual outcome of retropupillary fixation of iris claw lens in aphakic eyes. SETTINGS AND DESIGN: The study design is a retrospective study at a tertiary eye care center. METHODS: Review of medical records of 61 aphakic eyes of 61 patients, who were rehabilitated with retropupillary fixation of an iris claw lens, with a follow-up duration of at least 1 year. STATISTICAL ANALYSIS USED: Data analysis was performed using paired t-test and Chi-square test. RESULTS: Mean preoperative uncorrected visual acuity was 1.66 ± 0.3 LogMAR and postoperative acuity at 1 year was 0.53 ± 0.5 LogMAR (P = 0.00001). Preoperative distant best-corrected visual acuity was 0.30 ± 0.48 LogMAR and postoperative acuity at 1 year was 0.27 ± 0.46 LogMAR (P = 0.07). Mean preoperative astigmatism was 1.43 ± 1.94 D and postoperatively was 1.85 ± 2.16 D (P = 0.0127). Mean endothelial cell count was 2353.52 ± 614 cells/mm2 preoperatively which decreased to 2200 ± 728 cells/mm2 at 1 year follow-up (P = 0.006). There was no significant difference in central macular thickness and intraocular pressure pre and post-surgery. Complications included ovalization of pupil in 9.83%, hypotony in 1.63%, toxic anterior segment syndrome in 1.63%, cystoid macular edema in 11.47%, epiretinal membrane in 3.27%, and iris atrophy in 6.55%. CONCLUSION: Iris claw is a safe and an effective method of rehabilitating aphakic eyes.

Fundus imaging with a nasal endoscope.

Wide field fundus imaging is needed to diagnose, treat, and follow-up patients with retinal pathology. This is more applicable for pediatric patients as repeated evaluation is a challenge. The presently available imaging machines though provide high definition images, but carry the obvious disadvantages of either being costly or bulky or sometimes both, which limits its usage only to large centers. We hereby report a technique of fundus imaging using a nasal endoscope coupled with viscoelastic. A regular nasal endoscope with viscoelastic coupling was placed on the cornea to image the fundus of infants under general anesthesia. Wide angle fundus images of various fundus pathologies in infants could be obtained easily with readily available instruments and without the much financial investment for the institutes.

Comparative Efficacy and Safety of Various Anti-Microbials in Patients of Acute Rhinosinusitis at Tertiary-Care Hospital in Uttarakhand (UK).

To compare the efficacy of gatifloxacin, azithromycin with amoxicillin as positive control for the treatment of Acute rhinosinusitis (ARS). To monitor adverse drug reaction profile of amoxicillin, azithromycin and gatifloxacin in patient of ARS. An open randomized trial of comparative efficacy and safety of amoxicillin, azithromycin and gatifloxacin in patients with ARS. Patients were randomized into three groups as under: group 1: patients on oral amoxicillin 500 mg TDS for 10 days; group 2: patients on oral azithromycin 500 mg OD for 5 days; group 3: patients on oral gatifloxacin 400 mg OD for 10 days. Patients were evaluated for signs and symptoms at day 1, day 7 (for group 2), on day 12 (for group 1, 3) as primary end points and 28 days after post therapy as secondary end point. All the three antimicrobial drugs i.e., amoxicillin, azithromycin and gatifloxacin were effective in reducing symptoms of acute sinusitis on visual analogue scale scoring. Azithromycin showed significant improvement radiographically on day 7 (P < 0.01) and on day 35 (P < 0.01). Gatifloxacin elicited very highly significant improvement radiographically on day 40 (P < 0.001) and significant improvement on day 12 (P < 0.01) when compared with amoxicillin. Azithromycin, the ketolide was associated with lesser adverse effects as compared to amoxicillin. All the three antimicrobial drugs i.e., amoxicillin, azithromycin and gatifloxacin were effective in reducing symptoms of acute sinusitis on visual analogue scale scoring. Gatifloxacin was found to be most effective drug both in terms of improvement in signs and symptoms on visual analogue scale and radiographic scoring and was associated with least adverse events in comparison to rest of two drugs under study.

Background noise in healthy volunteers--a consideration in adverse drug reaction studies.

In adverse drug reaction studies proper control over 'Back ground noise' is to be maintained to avoid erroneous conclusions to be drawn for adverse drug effects. Healthy volunteers, not taking any medication, were surveyed by a questionnaire to obtain data on the occurrence of any symptoms, often ascribed to side effects of drugs. Only 62 subjects out of a total of 236 (26.27%) stated experiencing none of these symptoms during the previous 3 days. The remaining subjects reported some symptoms, with an median number of symptoms experienced per person being 2; the most common being fatigue; headache, inability to concentrate and excessive sleepiness.