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2.
Indian J Ophthalmol ; 2024 May 20.
Article in English | MEDLINE | ID: mdl-38770604

ABSTRACT

PURPOSE: To study the morphological and histological characteristics of the fibrous capsule formed around a novel biodegradable glaucoma drainage device (GDD) implant made of oxidized regenerated cellulose (ORC) after 1 and 3 months of its implantation. METHODS: It was a prospective, interventional, preclinical experimental study using New Zealand white rabbits. All animals underwent GDD implantation with a novel biodegradable device. The device's body was made of ORC and attached to a silicone tube, connecting the body to the anterior chamber. Histopathology (hematoxylin and eosin/Masson's trichrome staining) and immunohistochemistry (Alpha-Smooth Muscle Actin expression) characteristics of the bleb formed around the novel device were noted at 1 and 3 months. RESULTS: One month post implantation, the biodegradable material produced a significant foreign body type of reaction evidenced by the exuberant infiltration by macrophages, lymphocytes, and multinucleated giant cells. The granulomatous response subsided by 3 months with disorganized collagen deposition on Masson's trichrome staining. The silicone tube was an internal control, and histopathology demonstrated well-organized collagen deposition around it at 3 months. Immunohistochemistry for α-smooth muscle actin also demonstrated more myofibroblast transformation at the site of the tube than the biodegradable implant. CONCLUSIONS: Our results indicate that the tissue response around a biodegradable GDD was different from the response to conventional devices. A diffuse, loose vascularized mesh was observed to develop, which may be more compatible with sustained IOP control over a longer period, in contrast to the usual thick and dense capsule formed around the non-biodegradable devices.

3.
JAMA Ophthalmol ; 142(4): e234861, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38634922

ABSTRACT

This case report discusses the accumulation of endothelial exudates in a boy aged 15 years after lensectomy for endophthalmitis.

4.
Oman J Ophthalmol ; 17(1): 124-126, 2024.
Article in English | MEDLINE | ID: mdl-38524338

ABSTRACT

A 48-year-old male with oculocutaneous albinism (OCA) presented with bilateral diminution of vision. Ocular examination revealed bilateral central corneal thinning, scarring with ectasia, depigmented irides, transillumination defects, and pseudophakia. Examination of the right eye also revealed a hyperoleon, emulsified silicon oil in the vitreous cavity, and an attached retina, while the left eye had a total rhegmatogenous retinal detachment (RRD). This case describes a unique set of challenges (the presence of an ectatic scarred cornea and a hypopigmented fundus) and sodium fluorescein dye as an adjunct in the surgical management of a complex RRD. A review of literature highlighting the association of keratoconus and RRD in OCA is also presented in this report.

5.
Am J Ophthalmol Case Rep ; 33: 101962, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38192606

ABSTRACT

Purpose: To describe a novel technique for repair of rhegmatogenous retinal detachment in an eye with a previous non-valved glaucoma drainage device, the Aurolab Aqueous Drainage Implant (AADI). Observations: A 5-year-old child with bilateral primary congenital glaucoma presented with an inferior retinal detachment (RD) in the left eye. The left eye had a history of multiple surgical interventions including combined trabeculotomy and trabeculectomy done twice, AADI implantation and subsequently phacoaspiration with IOL implantation, 18 months prior to presentation. The left eye retinal detachment was managed by scleral buckling technique using the plate of the AADI as a buckling element without its explantation. Conclusions: AND IMPORTANCE: Management of retinal detachment in eyes with a pre-existing glaucoma drainage device (GDD) is uniquely challenging. Explantation of the GDD would likely result in intractable glaucoma post-operatively, requiring another surgery. Use of the trimmed plate of the GDD itself as the buckling element helped in settling the RD and preserving intraocular pressure control.

6.
Eye (Lond) ; 37(14): 2915-2920, 2023 10.
Article in English | MEDLINE | ID: mdl-36754984

ABSTRACT

INTRODUCTION: The incidence of post vitrectomy endophthalmitis (PVE) is reported to be between 0.02 and 0.84%. Resterilization of single use instruments is a common practice amidst developing countries to make it more affordable to the patients by reducing the cost of the surgery and also reduce the environmental hazard. The aim of our study is to evaluate the incidence of PVE amidst existing sterilization practices of reused instruments in multiple vitreoretinal centres in India. METHODOLOGY: Centres with an endophthalmitis tracking system were invited to participate in a survey. Twenty-five centres were sent a questionnaire via email. The questionnaire included details about the institution, number of vitrectomies performed in a year, sterilization practices followed pre-operatively, intraoperatively and postoperatively, incidence of endophthalmitis and instrument reuse policies. RESULTS: A total of 29 cases of endophthalmitis were reported out of the 47,612 vitrectomies performed across various centres. The mean incidence of endophthalmitis was 0.06%. There was no difference in the rates of endophthalmitis based on various pre-operative, intraoperative or postoperative prophylactic measures. Nearly 80% of the centres change most of the instruments after every case, while the rest reused. The mean number of times a cutter was being reused until discarded was 4.7. Nearly 76% followed a performance-based protocol, and the remaining 24% had a fixed protocol for the number of times an instrument can be reused before discarding it. CONCLUSION: PVE rates are not significantly different in India despite the multiuse of single use instruments. The purpose of this paper is not to suggest an alternate protocol but to creating one in the future with these results in mind, to rationalise the use of single use instruments, make VR surgery more affordable and also have a positive impact on the carbon footprint of consumables in surgery.


Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Humans , Vitrectomy/adverse effects , Vitrectomy/methods , Postoperative Complications/etiology , Incidence , Eye Infections, Bacterial/etiology , Retrospective Studies , Endophthalmitis/epidemiology , Endophthalmitis/etiology , Endophthalmitis/prevention & control , India/epidemiology
7.
Eur J Ophthalmol ; 33(3): NP118-NP121, 2023 May.
Article in English | MEDLINE | ID: mdl-35306917

ABSTRACT

PURPOSE: To report recurrence of tubercular choroiditis following anti-SARS-CoV-2 vaccination in two patients with quiescent disease activity for more than a year. METHODS: Retrospective observational case reports. RESULTS: Two patients (one female and one male) under follow-up for posterior uveitis having stable course with absence of ocular inflammation for more than a year presented with recurrence of choroiditis lesions 2-6 weeks following anti-SARS-CoV-2 vaccination. Both the patients were managed with intravitreal dexamethasone implant (Ozurdex®, Allergan, Inc., Irvine, CA, USA) and showed resolution of choroiditis lesions upon follow-up. CONCLUSIONS: Acute onset recurrence of inflammation, in absence of any change in health status or treatment suggests the potential role of vaccination being the trigger of this reactivation. Given large-scale vaccination against novel coronavirus- SARS-CoV-2, careful vigilance is warranted to pick up the disease recurrence in patients with posterior uveitis.


Subject(s)
COVID-19 , Choroiditis , Uveitis, Posterior , Humans , Male , Female , Retrospective Studies , SARS-CoV-2 , Choroiditis/diagnosis , Choroiditis/drug therapy , Dexamethasone , Uveitis, Posterior/diagnosis , Uveitis, Posterior/drug therapy , Inflammation
8.
Indian J Ophthalmol ; 70(6): 2084-2089, 2022 06.
Article in English | MEDLINE | ID: mdl-35647987

ABSTRACT

Purpose: To report clinical features, antibiotic susceptibility profile, management, and outcomes of a cluster outbreak of post-cataract surgery Pseudomonas stutzeri endophthalmitis. Methods: This was a hospital-based case series in which 14 patients with acute postoperative endophthalmitis who underwent cataract surgery on the same day were included. Based on severity of presentation, they either underwent pars plana vitrectomy (PPV) with intraocular antibiotics (IOAB) or vitreous tap with IOAB. Vitreous aspirates and environmental surveillance samples were inoculated on culture media and further processed by MALDI-TOF MS for identification and Vitek3 for susceptibility profile. Results: There were 8 females and 6 males with a mean age of 62.14 ± 8.08 years. Presenting signs included corneal folds (100%), hypopyon (57.1%) and fibrin (50%). Ten patients with mild presentation underwent vitreous tap with IOAB. Four patients with severe presentation underwent PPV with IOAB. Pseudomonas stutzeri was isolated from the vitreous samples and was pan-sensitive. Six eyes required multiple interventions. Favorable outcome was obtained in 12 eyes, one eye developed phthisis, and one patient was lost to follow-up. Conclusion: We report the first ever cluster outbreak of Pseudomonas stutzeri endophthalmitis following phacoemulsification with IOL implantation in a single surgeon setting. Majority of the patients had a mild presentation and responded well to targeted anti-microbial treatment.


Subject(s)
Endophthalmitis , Eye Infections, Bacterial , Phacoemulsification , Pseudomonas Infections , Pseudomonas stutzeri , Acute Disease , Aged , Anti-Bacterial Agents/therapeutic use , Cataract/epidemiology , Disease Outbreaks , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Endophthalmitis/epidemiology , Eye Infections, Bacterial/diagnosis , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/epidemiology , Female , Humans , Male , Middle Aged , Phacoemulsification/adverse effects , Pseudomonas Infections/epidemiology
9.
Indian J Ophthalmol ; 70(5): 1787-1793, 2022 05.
Article in English | MEDLINE | ID: mdl-35502073

ABSTRACT

Purpose: The COVID-19 pandemic has brought medical and surgical training to a standstill across the medical sub-specialties. Closure of outpatient services and postponement of elective surgical procedures have dried up opportunities for training vitreoretinal trainees across the country. This "loss" has adversely impacted trainees' morale and mental health, leading to feelings of uncertainty and anxiety. Therefore, there is an urgent need to redraw the surgical training program. We aimed to describe a systematic stepwise approach to vitreoretinal surgical training. Methods: We introduced a three-pronged approach to vitreoretinal surgical training comprising learn from home, wet lab and simulator training, and hands-on transfer of surgical skills in the operating room in our institute. Results: Encouraging results were obtained as evaluated by feedback from the trainees about the usefulness of this three-pronged approach in developing surgical skills and building their confidence. Conclusion: The disruption caused by the COVID-19 global pandemic should be used as an opportunity to evolve and reformulate surgical training programs to produce competent vitreoretinal surgeons of the future.


Subject(s)
COVID-19 , Internship and Residency , Surgeons , COVID-19/epidemiology , Humans , Pandemics , Tertiary Healthcare
10.
BMJ Case Rep ; 15(2)2022 Feb 25.
Article in English | MEDLINE | ID: mdl-35217551

ABSTRACT

Haemorrhagic choroidal detachment (HCD) is a dreaded intraoperative complication of ophthalmic surgery, despite being rare. Multiple systemic and ocular risk factors of HCD have been reported. Acute hypotony during surgery is considered one of the most important precipitating factors. We herein describe a series of events during pars plana vitrectomy surgery for management of rhegmatogeneous retinal detachment which lead to localised HCD. We believe that the pathogenesis of localised HCD is related to compressive decompressive forces during the final tie of the encircling element after fluid air exchange.


Subject(s)
Choroidal Effusions , Retinal Detachment , Humans , Intraoperative Complications/etiology , Intraoperative Complications/surgery , Retinal Detachment/etiology , Retrospective Studies , Visual Acuity , Vitrectomy/adverse effects
11.
J AAPOS ; 26(1): 34-35, 2022 02.
Article in English | MEDLINE | ID: mdl-35101627

ABSTRACT

Over 21 genes have been associated with the inherited retinal dystrophy, Leber congenital amaurosis (LCA). A comprehensive genotype-phenotype correlation in such heterogenous cases helps guide further genetic studies and therapies. We report 2 children (10-month-old girl and an 8-month-old boy) who presented with low vision in the first year of life. Both patients manifested nystagmus, sluggish pupillary reactions, hyperopia, and normal fundus. Focussed exome sequencing was performed because LCA was suspected. A novel c.1937T>C (p.Leu646Pro) missense mutation was found in exon 9 of the tyrosine kinase domain of the GUCY2D gene in both patients.


Subject(s)
Leber Congenital Amaurosis , Retinal Dystrophies , DNA Mutational Analysis , Humans , Leber Congenital Amaurosis/diagnosis , Leber Congenital Amaurosis/genetics , Mutation , Mutation, Missense , Pedigree
12.
Cytopathology ; 33(3): 402-405, 2022 05.
Article in English | MEDLINE | ID: mdl-35158406

ABSTRACT

Coats disease is an exudative retinal vasculopathy characterised by presence of yellow-golden deposits in the retina and retinal detachment. Subretinal fluid drainage performed as a part of therapeutic management makes the fluid amenable to cytological examination. Infection by Toxoplasma may closely simulate the ocular symptoms seen in Coats disease. Awareness of the cytological findings in Coats disease helps to clinch accurate diagnosis. We herein present a case of Coats disease with many histiocyte-like cells with plentiful intracytoplasmic melanin pigment in cytology smears from subretinal fluid, where cytological diagnosis was challenging and a correct diagnosis was made with the aid of ancillary techniques.


Subject(s)
Retinal Detachment , Retinal Telangiectasis , Histiocytes , Humans , Melanins , Retina , Retinal Telangiectasis/diagnosis , Retinal Telangiectasis/drug therapy
14.
Ocul Immunol Inflamm ; 30(1): 29-33, 2022 Jan 02.
Article in English | MEDLINE | ID: mdl-32783681

ABSTRACT

PURPOSE: To describe the presentation and management of atypical subretinal lesions following initiation of antitubercular therapy for a tubercular choroidal granuloma. CASE REPORT: An 18-year-old female was diagnosed with choroidal granuloma and shallow exudative retinal detachment in the left eye. Biopsy from a cervical lymph node was positive for tuberculosis. She was treated with antitubercular therapy (ATT) and oral steroids. After one week of therapy exudative detachment increased markedly and discrete yellowish-white subretinal lesions appeared first in the inferior periphery, then temporally and later involved the macula leading to a drop in visual acuity. A diagnosis of paradoxical worsening was considered and she was managed with a higher dose of oral corticosteroids, intravitreal methotrexate and intravitreal ranibizumab. The granuloma healed and the subretinal lesions as well as exudative detachment gradually resolved with improvement in visual acuity. CONCLUSION: Subretinal yellow-white lesions may develop as a paradoxical response to ATT.


Subject(s)
Choroid , Retinal Detachment , Adolescent , Antitubercular Agents/adverse effects , Female , Granuloma/diagnosis , Granuloma/drug therapy , Humans , Ranibizumab/therapeutic use , Retinal Detachment/diagnosis
15.
Retina ; 42(12): 2419-2424, 2022 12 01.
Article in English | MEDLINE | ID: mdl-31929416

ABSTRACT

PURPOSE: To evaluate the feasibility and utility of microscope-integrated optical coherence tomography in patients undergoing full-thickness neurosensory retinal autograft for refractory macular hole (MH)-associated retinal detachment. METHODS: We analyzed two eyes of two patients who had undergone a neurosensory retinal autograft for large MH associated retinal detachment. Both cases had microscope-integrated optical coherence tomography-guided placement and sizing of the retinal autograft. Time taken for obtaining microscope-integrated optical coherence tomography images, morphology of the retinal autograft (intraoperative and postoperative), and anatomic and functional outcomes were noted. RESULTS: The first case had optic disc pit-related maculopathy with a large MH and total retinal detachment. She had undergone a vitrectomy with internal limiting membrane peeling elsewhere. The second patient had a treatment-naive large MH with total retinal detachment. Both patients underwent vitrectomy with microscope-integrated optical coherence tomography-guided autologous neurosensory retinal autograft placement and silicone oil tamponade. At 6 months and 3 months follow-up, respectively, both patients had closed MHs, attached retinas, and improvement in visual acuity. CONCLUSION: Microscope-integrated optical coherence tomography provides intraoperative visualization of MHs and provides real-time feedback regarding dimensions of the retinal autograft, thus aiding in accurate sizing of the graft. This ensures that the autograft fits snugly in the MH, thereby restoring macular structure and improving visual acuity.


Subject(s)
Retinal Detachment , Retinal Perforations , Female , Humans , Retinal Perforations/diagnosis , Retinal Perforations/surgery , Retinal Detachment/diagnosis , Retinal Detachment/surgery , Tomography, Optical Coherence , Endotamponade/methods , Autografts , Retrospective Studies , Vitrectomy/methods
17.
Ocul Immunol Inflamm ; 30(5): 1172-1175, 2022 Jul.
Article in English | MEDLINE | ID: mdl-34424118

ABSTRACT

BACKGROUND: Bilateral diffuse uveal melanocytic proliferation (B-DUMP) is a paraneoplastic disorder that may be seen in patients with a known malignancy but more commonly is seen in those without any history of cancer. It leads to multiple uveal tumors with exudative retinal detachment along with thickening of the choroid and generally carries a poor prognosis. Its etio-pathogenesis is poorly understood but is said to involve factors secreted by the systemic malignancy that lead to proliferation of melanocytes in the uvea. METHODS: We report the presentation and management of a female with history of treated frontal lobe meningioma who presented with neovascular glaucoma along with B-DUMP and was found to have recurrence of the meningioma on neuro-imaging. CONCLUSIONS: Central nervous system meningiomas can cause B-DUMP and management of the malignancy may lead to partial resolution of posterior segment manifestations of B-DUMP.


Subject(s)
Meningeal Neoplasms , Meningioma , Retinal Neoplasms , Cell Proliferation , Female , Frontal Lobe , Humans , Melanocytes/pathology , Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/pathology , Meningeal Neoplasms/surgery , Meningioma/diagnosis , Meningioma/pathology , Meningioma/surgery , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/pathology
20.
J AAPOS ; 25(5): 271.e1-271.e6, 2021 10.
Article in English | MEDLINE | ID: mdl-34582950

ABSTRACT

PURPOSE: To determine ocular biometric and refractive profiles of premature children at risk of retinopathy of prematurity (ROP), comparing those who did and did not require laser treatment. METHODS: In this prospective study, premature infants underwent biometry and refraction with their first ROP examination. Study parameters were assessed again at 3 months, 6 months, and 1 year. The main outcome measures were spherical equivalent, axial length, and keratometry. RESULTS: A total of 122 infants (243 eyes) were included. At baseline, infants without ROP, those with ROP who never needed treatment, and those who later needed treatment had overall comparable axial length (P = 0.53) and myopia (P = 0.05); the highest severity group had higher corneal steepness and more myopia at baseline. At 1 year, children with laser-treated ROP had the shortest axial lengths, with the least decrease in keratometry, and the greatest increase in myopia (-2.0 D; P = 0.001). Anisometropia, if present initially, persisted through the 1-year examination. Mean refractive error was more myopic in zone 1 disease (P = 0.3) and in aggressive posterior ROP (P = 0.15). CONCLUSIONS: Severe ROP is associated with disruption of emmetropization, and steeper corneas and more myopia at the first ROP examination, before any intervention. In our study cohort, these differences became more marked over the course of 1 year after laser therapy. The myopia in these cases was not axial. Laser therapy did not induce new anisometropia.


Subject(s)
Retinopathy of Prematurity , Biometry , Child , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Prospective Studies , Refraction, Ocular , Retinopathy of Prematurity/diagnosis
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