ABSTRACT
PURPOSE: To describe clinical, ultrasonographic, radiological and histopathological features of orbital aspergillosis in immunocompetent patients. METHODS: Medical records of immunocompetant individuals with orbital aspergillosis between November 1995 and November 2010 were reviewed. RESULTS: Thirty-five cases (27 males, 8 females) were reviewed. Mean age at presentation was 37.63 (8-73) years and mean duration of symptoms was 12.03 (0.5-84) months. Proptosis (22.63%) and mass lesion (13.37%) were the commonest presenting complaints. Presenting visual acuity was better than 6/9 in 21 (60%) and no perception of light in 3 (8%). Ocular motility restriction was noted in 25 (71%). The commonest clinical differential diagnosis was non-specific orbital inflammatory disease (NSOID) (10.29%) followed by malignancy (7.20%). CT showed infiltrative lesions with bone destruction in 22 (63%), contiguous paranasal sinus involvement in 22 (63%) and intracranial extension in 10 (29%). Diagnosis was by histopathology and microbiological evaluation. Fungal cultures revealed Aspergillus flavus in 30 (86%) and Aspergillus fumigatus in 5 (14%). Treatment included conservative medical management in 18 (51%) and surgical debulking in 17 (49%). Average follow-up was 37.6 (3-183) months, and patient survival was 33/35 (94%). CONCLUSIONS: Though orbital aspergillosis is commonly seen in immunocompromised patients, it should be suspected in young immunocompetent individuals presenting with proptosis of insidious onset and infiltrating lesions involving the paranasal sinuses. Definitive diagnosis is achieved by histopathological and microbiological evaluation. Systemic steroids should be avoided prior to definitive diagnosis. Prolonged systemic antifungal therapy with an option of additional debulking of lesions provides good disease control with improved survival.
Subject(s)
Aspergillosis/microbiology , Aspergillus flavus/isolation & purification , Aspergillus fumigatus/isolation & purification , Eye Infections, Fungal/microbiology , Immunocompetence , Orbital Diseases/microbiology , Adolescent , Adult , Aged , Antifungal Agents/therapeutic use , Aspergillosis/diagnosis , Aspergillosis/therapy , Child , Combined Modality Therapy , Diagnosis, Differential , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/therapy , Female , Humans , Male , Middle Aged , Ocular Motility Disorders/diagnosis , Ocular Motility Disorders/microbiology , Ocular Motility Disorders/therapy , Ophthalmologic Surgical Procedures , Orbital Diseases/diagnosis , Orbital Diseases/therapy , Retrospective Studies , Tomography, X-Ray Computed , Vision Disorders/diagnosis , Vision Disorders/microbiology , Vision Disorders/therapy , Visual Acuity/physiology , Young AdultABSTRACT
AIMS: To create a normative data for lea grating (LG) in the Indian population and to compare LG with Cardiff Acuity Card (CAC). SETTINGS AND DESIGN: Normative Data was acquired from normal children between 6 months-3 years coming to the 'Immunisation Clinic' and 'Well-Baby Clinic' at a Civil Hospital. To compare LG with CAC, normal and amblyopic children between 6 months-3 years were evaluated, MATERIALS AND METHODS: Monocular and binocular visual acuity (VA) was measured using LG and then CAC. VA and time taken to perform the test were compared. STATISTICAL ANALYSIS USED: Pearson's Correlation Coefficient to compare VA and Student paired t-test (significance P<0.005) to compare time. RESULTS: Two standard deviations of VA of 100 normal children overlapped with that published by Lea. Of the 30 amblyopic children aged 18.32 ± 10.5 months (2-36), 18 were females. VA was 0.95 ± 0.3 logMAR (0.7-1.2) and 1.0 ± 0.6 logMAR (0.5-2.1) binocularly and 1.32 ± 0.08 logMAR (0.2-0.6) and 1.15 ± 0.15 logMAR (0.88-1.48) monocularly on CAC and LG respectively. Pearson's correlation coefficient was 0.98 and 0.63 for binocular and monocular assessment respectively. Time taken to perform LG monocularly and binocularly was significantly less (P<0.001) than CAC. CONCLUSION: Normative data acquired in Indian pre-verbal children is similar to that published by Lea. Though VA by CAC is better than LG, the two tests are comparable.
