Comparison of Cataract Surgery Alone Versus Cataract Surgery Combined With Trabeculectomy in the Management of Phacomorphic Glaucoma.

PURPOSE: To compare the outcomes of cataract surgery alone versus combined cataract surgery with trabeculectomy in eyes with phacomorphic glaucoma. MATERIALS AND METHODS: In a retrospective comparative case series, 126 eyes of phacomorphic glaucoma presenting within 4 weeks of onset between 1993 and 2012, with at least 6 months of postoperative follow-up were included. Group 1 included 63 eyes with cataract surgery only and group 2 included 63 eyes with combined cataract surgery and trabeculectomy. Primary outcome measure was intraocular pressure (IOP) ≤21 mm Hg (without antiglaucoma medication) 6 months after surgery. RESULTS: The median (interquartile range) preoperative IOP in group 1 was 36 mm Hg (30 to 50 mm Hg) and group 2 was 40 mm Hg (32 to 48 mm Hg) (P=0.34). The median duration of phacomorphic attack was 7 days (3 to 12 d) in group 1 and 7 days (3 to 15 d) in group 2 (P=0.39). The median duration of postoperative follow-up was 23 months in group 1 and 30 months in group 2 (P=0.89). Six months after surgery, 97% of the eyes in group 1 and 100% in group 2 achieved IOP≤21 mm Hg without antiglaucoma medications with a median postoperative IOP of 12 mm Hg in both the groups (P=0.09). The median Log MAR visual acuity was significantly better in group 1 compared with group 2 (0.2 vs. 0.3, P<0.001). The percentage of eyes that achieved visual acuity better than 20/40 at 3 months was 62% in group 1 versus 19% in group 2 and at 6 months it was 75% in group 1 versus 38% in group 2 (P<0.001). CONCLUSIONS: In our cohort of phacomorphic glaucoma presenting within 4 weeks of onset, cataract surgery and combined surgery resulted in similar IOP control at 6 months. However, cataract surgery alone resulted in better and faster visual recovery.

Etiology and clinical profile of childhood optic nerve atrophy at a tertiary eye care center in South India.

BACKGROUND: Optic nerve atrophy is an important ophthalmological sign that may be associated with serious systemic conditions having a significant bearing on the overall morbidity of the child. Studies specific to etiology of childhood optic atrophy are scarce, this being the first such study from India to the best of our knowledge. AIM: The aim was to analyze the clinical features and etiology of diagnosed cases of optic nerve atrophy in children <16 years of age. MATERIALS AND METHODS: Retrospective review of records of children diagnosed with optic nerve atrophy between the ages of 0 and 16 years from 2006 to 2011. RESULTS: A total of 324 children (583 eyes) were identified. Among these 160 (49%) presented with defective vision, 71 (22%) with strabismus, 18 (6%) with only nystagmus. Rest had a combination of two or three of the above symptoms. Sixty-five patients (20%) had a unilateral affection. Hypoxic ischemic encephalopathy seen in 133 patients (41%) was the most frequent cause of childhood optic atrophy, followed by idiopathic in 98 (30%), hydrocephalus in 24 (7%), compressive etiology in 18 (5%), infective in 19 (6%), congenital in 6 (2%), inflammatory in 5 (2%) patients, respectively. CONCLUSION: Hypoxic ischemic encephalopathy appears to be the most common cause of optic atrophy in children in this series. The most common presenting complaint was defective vision.

Endothelial Keratoplasty: A Review of Indications at a Tertiary Eye Care Centre in South India.

PURPOSE: The objective of this study was to review the indications for endothelial keratoplasty (EK) performed at a tertiary eye care center in South India between January 2007 and December 2011. DESIGN: This was a hospital-based, cross-sectional study. METHODS: A retrospective analysis of the indications of EK surgeries between January 2007 and December 2011 was done using the Corneal Tissue Utilization Register available with the Ramayamma International Eye Bank, L. V. Prasad Eye Institute, Hyderabad, India. Additional data such as age, sex, and socioeconomic status of the transplant recipients were obtained from the Medical Records Department, L. V. Prasad Eye Institute. RESULTS: Data were available for 1048 EK surgeries performed on 978 patients. The number of EK surgeries increased from 40 in 2007 to 232 in 2011. The median age of the patients was 58 years (range, 5 months to 92 years) with a male-female ratio of 1.5:1. The clinical indications for EK were pseudophakic corneal edema (47.9%), failed prior penetrating keratoplasty (20.0%), Fuchs endothelial corneal dystrophy (10.8%), aphakic corneal edema (6.0%), failed prior EK (4.3%), congenital hereditary endothelial dystrophy (1.8%), Descemet membrane detachment/tear (1.6%), iridocorneal endothelial syndrome (1.4%), and corneal edema due to other reasons (6.2%). CONCLUSIONS: The most common indication for EK was pseudophakic corneal edema, followed by post-penetrating keratoplasty graft failure and Fuchs endothelial corneal dystrophy.

Bilateral exudative retinal detachment as a presenting sign of acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) can present with various ocular complications but exudative retinal detachment is a rare complication. A 36-year-old healthy young adult male presented with gradual decrease in the vision in both eyes over nearly 2 weeks. His best-corrected visual acuities were 20/50 and 20/25 at distance and N12 and N10 at near in the right and left eyes, respectively. Fluorescein angiography and optical coherence topography indicated bilateral exudative retinal detachment. Systemic workup revealed a marked increase in the number of white blood cells with 30% blast cells and immunophenotyping revealed common acute lymphoblastic leukemia-associated antigen (CALLA) positive precursor B-cell lymphoblastic leukemia. Cerebrospinal fluid (CSF) tap was negative. The patient started systemic chemotherapy and steroids. Bilateral exudative retinal detachment may be a presenting sign of acute lymphoblastic leukemiaALL in an otherwise healthy young adult. Clinicians should be aware of the possibility of leukemia in such patients. A simple blood investigation such as complete blood profile confirms the diagnosis.

Persistent pupillary membrane, strabismus, and optic nerve hypoplasia in Donnai-Barrow syndrome.

We report a case of Donnai-Barrow syndrome in a 2-year-old boy who presented with exotropia and prominent eyes since birth. Ocular findings included high myopia, persistent pupillary membrane, and optic nerve hypoplasia. Facial manifestations included broad nasal bridge, hypertelorism, and downward-slanting of palpebral fissures. The patient had associated omphalocele, sensorineural hearing loss, and developmental delay. Magnetic resonance imaging revealed agenesis of the corpus callosum. To our knowledge, this is the first reported association of persistent pupillary membrane, strabismus, and optic nerve hypoplasia in a patient with Donnai-Barrow syndrome.