Multicolor imaging: Current clinical applications.

Multicolor (MC) imaging is an innovative pseudocolor fundus imaging modality based on confocal scanning laser ophthalmoscopy. It effectively scans the retina at different depths to create a composite image. The green reflectance image depicts the middle retinal while blue reflectance image provides images of the retinal surface. The infrared reflectance image depicts retinal structures at the level of outer retina and choroid. We systematically analyze published case reports, case series, and original articles on MC imaging where it has helped in discovering additional clinical features of retinal diseases not readily apparent on conventional color fundus photography and played a role in monitoring the response to treatment.

Multimodal imaging in a case of bilateral astrocytic hamartoma with retinitis pigmentosa.

Astrocytic hamartoma is a benign glial tumor. It may be associated with tuberous sclerosis and can also be found incidentally on retinal examination as an isolated presentation. Here, we describe multimodal imaging characteristics of astrocytic hamartoma in a patient with retinitis pigmentosa. Spectral domain optical coherence tomography of both eyes showed moth-eaten optically empty spaces and hyperreflective dots along with foveal thinning. Multicolor image highlighted mulberry appearance of the lesion with green shift signifying elevated lesion. In infrared reflectance, lesion was hyporeflective with its margins well delineated. Green reflectance and blue reflectance highlighted calcification as multiple hyperreflective dots. Autofluorescence showed typical hyperautofluorescence.

Multimodal imaging in choroidal osteomas.

Choroidal osteoma is a rare benign tumor which is found in the posterior pole of the eye. We herein describe multimodal imaging in two cases of choroidal osteoma. Fundus of our first case showed a yellowish-orange colored subretinal lesion at the posterior pole. Multicolor imaging highlighted the lesion with greenish hue. Infrared reflectance showed hyporeflectance. A dense echogenic plaque persisting in lower gain was noted on B-scan. FFA showed hyperfluorescence with corresponding hypocyanescence on ICG. EDI OCT showed an increase in choroidal thickness with elevated retinal pigment epithelium. The second case showed choroidal osteoma with active choroidal neovascular membrane that responded to intravitreal injection of Ranibizumab.

Quantum heat engine based on level degeneracy.

We study a quantum Stirling cycle which extracts work using quantized energy levels of a potential well. The work and the efficiency of the engine depend on the length of the potential well, and the Carnot efficiency is approached in a low temperature limiting case. We show that the lack of information about the position of the particle inside the potential well can be converted into useful work without resorting to any measurement. In the low temperature limit, we calculate the amount of work extractable from distinguishable particles, fermions, and bosons.

A rare case of bilateral tractional retinal detachment following snakebite.

A 13-year-old female presented with diminution of vision in both eyes for 3 months following snakebite. Best-corrected visual acuities were hand movement in both eyes. Fundoscopy showed vitreous hemorrhage, and B-scan ultrasonography revealed an underlying tractional retinal detachment (TRD) involving the macula in both eyes. Patient underwent 25-gauge pars plana vitrectomy in conjunction with belt buckling, endolaser, and silicone oil tamponade in the left eye. At 6 weeks postoperatively, best-corrected visual acuity of the left eye was noted to be 20/200 with settled TRD and attached retina. Bilateral proliferative retinopathy with TRD is a hitherto unreported complication of snake bite.

Effect of human placental extract in the management of biofilm mediated drug resistance - A focus on wound management.

Management of infectious wounds, particularly chronic wounds and burn injuries, is a matter of global concern. Worldwide estimates reveal that, billions of dollars are being spent annually for the management of such chronic ailments. Evidently, bacterial biofilms pose a greater problem in the effective management of infection in chronic wounds, since most of the currently available antibiotics are unable to act on the microorganisms residing inside the protected environment of the biofilms. Accordingly, in the present study, we have attempted to evaluate the anti-biofilm properties of human placental extract (PLX) and also other virulence factors that are mediated via the quorum sensing (QS) signalling system. PLX is well known for its anti inflammatory action and it has been shown earlier some anti microbial and enzymatic activity also. PLX was found to produce significant inhibition of biofilm formation and also decreased the levels of pyoverdin and pyocyanin. The microscopic analysis (both light microscopy and atomic force microscopy) of biofilms was also used for substantiating the findings from spectrophotometric (crystal violet estimation) and fluorescence analysis (resazurin uptake). PLX pre-treatment decreased the hydrophobicity of gram-positive and gram negative cells, indicating the effect of placental extract on adherence property of planktonic cell, serving as an indicator for its antibiofilm effect on microorganisms. The reduced extracellular DNA (eDNA) content in biofilm matrix following treatment with PLX also indicates the effectiveness of placenta extract on bacterial adherence, which in turn serves as evidence substantiating the antibiofilm effects of the PLX. Furthermore, PLX was also found to be significantly effective in the in vitro wound biofilm model. Thus the present study, the first of its kind with PLX, establishes the therapeutic benefit of the same particularly in infected wounds, opening up newer avenue for further exploration.

Variation in Visual Outcome to Anti-Vascular Endothelial Growth Factors in Choroidal Neovascular Membrane Developing in Eyes with Previously Untreated Versus Focal Laser-Treated Central Serous Chorioretinopathy.

PURPOSE: To report the visual outcome in choroidal neovascular membrane developing (CNVM) in eyes with central serous chorioretinopathy (CSCR) with our without prior focal laser. METHODS: A retrospective case series of eyes with CNVM secondary to CSCR treated with intravitreal anti-VEGF. RESULTS: Ten eyes of nine patients of CNVM with CSCR who underwent intravitreal anti-VEGF injections were analyzed. Five eyes had CNVM without prior laser photocoagulation, and five eyes developed CNVM after laser photocoagulation for CSCR. Intravitreal injection bevacizumab was given in five eyes and ranibizumab in five eyes. The lasered group had significantly shorter duration of the disease, fewer injections given, and better visual acuity at final follow-up (P <0.05). None had any recurrences of either CSCR or CNVM until the last follow-up. CONCLUSION: CNVM in CSCR with prior history of focal laser had better outcome than that developed de novo, without prior history of laser.

Bilateral retinitis pigmentosa with unilateral choroidal nevus: A hitherto unreported association.

Retinitis Pigmentosa (RP) has been reported to be associated with retinal hemangioma, retinal angiomatous proliferation, polypoidal choroidal vasculopathy and vasoproliferative tumours. However there is no previous report of choroidal nevus in an eye with RP. We describe such a case in which the eye with RP had a choroidal nevus at the macula. The coexistence of these two entities in the same eye emphasizes the need of careful examination of patients with RP. The presence of choroidal nevus warrants additional investigations such as B scan ultrasonography and a close follow-up to pick up changes in the nevus size and morphology.

Endogenous Endophthalmitis: A 10-Year Retrospective Study at a Tertiary Hospital in South India.

PURPOSE: The aim of this study was to review the clinical profile including predisposing systemic conditions, microorganisms responsible, clinical presentation, and outcomes of endogenous endophthalmitis (EE) in South India. DESIGN: This study is a retrospective, noncomparative case series. METHODS: This study presents a retrospective analysis of records of patients with EE in a 10-year period. RESULTS: A total of 61 eyes of 58 patients were included in the study. Preceding systemic illness or surgery was noted in 31 patients (53.4%). No predisposing condition was found in 27 patients (46.5%). All eyes had severe diffuse EE. Culture positivity was seen in 34 of 58 patients (58.6%). Gram-positive organisms were isolated in 9 cases (15.5%), and Gram-negative organisms were isolated in 20 cases (34.5%). Pseudomonas aeruginosa (13.8%) was the most common isolate. Eleven eyes (18%) were managed medically with intravenous and intravitreal antibiotics, and 38 eyes (62.3%) also underwent vitrectomy. Eight eyes (13.1%) required repeat vitrectomy, and 12 eyes (19.7%) were eviscerated. The mean follow-up was 16.2 ± 13.9 months. Final visual acuity of 20/200 or better was seen in 29.5% eyes. A favorable outcome was noted in culture-positive patients (P = 0.03) and in patients with no predisposing causes. CONCLUSIONS: This study provides information about the clinical and microbiologic profile of EE. Aggressive medical and surgical treatment can result in favorable outcomes.

Postcataract surgery endophthalmitis caused by acinetobacter lwoffii.

Acinetobacter lwoffii is a rare cause of endophthalmitis. We report a case of acute postoperative endophthalmitis in a female, who was treated successfully with pars plana vitrectomy and intravitreal antibiotics.

Acute retinal necrosis: clinical features, management and outcomes--a 10 year consecutive case series.

PURPOSE: To determine the viral diagnosis and clinical outcome of eyes with acute retinal necrosis (ARN). METHOD: A retrospective analysis was done of 62 eyes of 53 patients presenting to a tertiary care ophthalmic institute between 1997 and 2007 with features of ARN. All patients with active disease were started immediately on intravenous acyclovir followed by oral antivirals along with systemic steroids. A prophylactic laser retinopexy was performed in patients with a clear media to areas posterior to the necrotic retina. RESULTS: The aqueous and the vitreous sample revealed herpes simplex virus in 19 (30.60%) and varicella zoster virus in 28 patients (45.16%). Forty-one (66.12%) eyes had retinal detachment. Prophylactic laser photocoagulation was given in 19 (30.64%) eyes. Surgical intervention was required in 32 (51.61%) eyes. Favorable functional outcome was seen in 28 (45.1%) eyes. CONCLUSION: ARN is a fulminant disorder, which if treated early and aggressively gives good results.

The eyes have it! Tamoxifen maculopathy revisited: a case report.

PURPOSE: To report on tamoxifen crystalline maculopathy in an 80-year-old patient and to review the ocular side effects of oral tamoxifen. METHODS: We report a case of an 80-year-old female patient who presented to our ophthalmic institute with painless gradual progressive diminution of vision in both eyes. She had a history of surgery for breast cancer after which she had been treated with oral tamoxifen citrate for 2 years before presentation. RESULTS: Our patient had profound visual impairment in both eyes. The anterior segments were found to be normal; in particular, the corneas were clear; the intraocular pressures in both eyes were 12 mm Hg. The perimacular region in both eyes showed deposits of multiple, fine crystalline material. Color vision was found to be impaired in both eyes and optical coherence tomography (OCT) confirmed the diagnosis of tamoxifen-induced maculopathy. CONCLUSION: Tamoxifen is a selective estrogen receptor modulator widely used in the treatment of hormone-responsive breast cancer. Ocular complications are rare with tamoxifen therapy and include cataract, vortex keratopathy, optic neuritis, and retinopathy. Crystalline maculopathy is one of the rare side effects of long-term tamoxifen use, which can be detected by noninvasive diagnostic tools such as OCT. Our patient is the oldest such patient reported in literature. Patients receiving tamoxifen therapy must be informed about the potential side-effects, and the need for serial ophthalmic examination to detect early signs of toxicity.