Progression pattern of non-amblyopic Anisomyopic eyes compared to Isomyopic eyes.

This study aimed to determine the progression pattern of non-amblyopic anisomyopic children from ages 6 to 16 years. This retrospective study analyzed the electronic medical records of 8680 myopic children who visited Sankara Nethralaya, Chennai, India over eight years (2009 to 2017). A total of 711 records were retrieved based on inclusion criteria. In addition, 423 records out of 711 had consecutive follow-up for three years (baseline plus three follow-up visits) and were considered to determine the progression pattern. The cycloplegic sphero-cylindrical refraction was taken for analysis and converted to vector notation of M (SE), J0, and J45. Anisomyopia referred to the interocular difference of myopic SE of ≥ 1 D whereas isomyopia referred to the interocular difference of myopic SE of < 1 D. Based on the refraction of the less ametropic eye, anisomyopes were further categorized into bilateral anisometropic myopia (BAM) and unilateral anisometropic myopia (UAM). The isomyopic cohort showed a mean annual progression of -0.49 ± 0.54 D (median [IQR] -0.38 D [{-0.75}-0.00]). In BAM, the mean annual progression of the more myopic eye was -0.45 ± 0.55 D (median [IQR] -0.38 D [{-0.75}-0.00]), and the less myopic eye was -0.37 ± 0.55 D (median [IQR] -0.25 D [{-0.63}-0.00]). This difference was significant (t (212) = -2.14, p < 0.05). In UAM, the myopic eyes (-0.39 ± 0.51 D; median [IQR] -0.25 D [{-0.75}-0.00]) showed a statistically significant higher mean annual progression compared to emmetropic eyes (-0.22 ± 0.36 D; median [IQR] 0.00 D [{-0.44}-0.00]; t (96) = -3.30, p < 0.001). In terms of progression trend, in the BAM group, the rate of change of mean SE between the more myopic and the less myopic eyes were similar (-1.12 ± 1.20 D; median [IQR] -1.13 D [{-2.00}-{-0.38}] vs. -1.05 ± 1.25 D; median [IQR] -0.88 D [{-1.75}-{-0.13}]; t (138) = -0.64, p > 0.05). However, the more myopic eyes of UAM showed a higher myopic trend compared to the emmetropic eyes (-1.37 ± 1.06 D; median [IQR] -1.32 D [{-2.13}-{-0.50}] vs. -0.96 ± 1.11 D; median [IQR] -0.75 D [{-1.56}-{-0.25}]; t (61) = -2.74, p < 0.05).   Conclusion: Children with BAM and UAM eyes exhibit different progression patterns from each other. While the rate of the refractive shift in myopic eyes of UAM is similar to isomyopic eyes, BAM eyes present a slower rate of progression than isomyopic eyes. What is Known: • The rate of change of refraction in anisomyopes is higher compared to isomyopic children. • Less myopic eyes tend to shift towards more myopia while more myopic eyes show stable refraction. What is New: • The progression pattern of bilateral anisometropic myopia and unilateral anisometropic myopia differ from one another. • While the rate of the refractive shift in myopic eyes of unilateral anisometropic myopia is similar to isomyopic eyes, bilateral anisometropic myopia eyes present a slower rate of progression than isomyopic eyes. • The pattern of change in the interocular difference of anisometropia depends on the laterality (bilateral or unilateral ametropia), and degree of spherical equivalent in the more ametropic eye.

Effectiveness of 0.01% atropine in anisomyopic children.

Purpose: To investigate the change in ocular parameters of anisomyopic children treated with 0.01% atropine. Methods: This retrospective study analyzed the data of anisomyopic children who underwent comprehensive examination at a tertiary eye center in India. Anisomyopic subjects (difference of ≥1.00 D) of age 6-12 years who were treated with 0.01% atropine or prescribed regular single vision spectacle and had follow-ups of more than 1 year were included. Results: Data from 52 subjects were included. No difference was observed in the mean rate of change of spherical equivalent (SE) of more myopic eyes between 0.01% atropine (-0.56 D; 95% confidence interval [CI]: -0.82, -0.30) and single vision lens wearers (-0.59 D; 95% CI: -0.80, -0.37; P = 0.88). Similarly, insignificant change in the mean SE of less myopic eyes was noted between the groups (0.01% atropine group, -0.62 D; 95% CI: -0.88, -0.36 vs. single vision spectacle wearer group, -0.76 D; 95% CI: -1.00, -0.52; P = 0.43). None of the ocular biometric parameters showed any difference between the two groups. Though anisomyopic cohort treated with 0.01% atropine revealed a significant correlation between the rate of change of mean SE and axial length in both eyes (more myopic eyes, r = -0.58; P = 0.001 and less myopic eyes, r = -0.82; P < 0.001) compared to single vision spectacle wearer group, the change was not significant. Conclusion: Administration of 0.01% atropine had minimal effect on reducing the rate of myopia progression in anisomyopic eyes.

Long-standing undiagnosed foreign body aspiration with concomitant pulmonary tuberculosis in an Immunocompetent man.

Foreign body aspiration is a rare clinical finding in adults, among which very few are reported, probably due to absence of classical clinical features in adults when compared to children and due to lack of awareness. We present a 57-year-old with chronic productive cough who was diagnosed to have pulmonary tuberculosis (TB), complicated by long-standing foreign body in the tracheobronchial tree. There are many cases reported in literature where there have been misdiagnosis with respect to pulmonary TB as foreign body or foreign bodies as pulmonary TB. However, this is the first case where retained foreign body and pulmonary TB coexisted in a patient.

Tracheobronchopathia osteochondroplastica: A rare case of misdiagnosis and difficult intubation.

Tracheobronchopathia osteochondro-plastica (TPO) is a rare disorder of yet unknown etiology. The common clinical features include cough with expectoration, breathing difficulty, hemoptysis, and recurrent airway infections, which can lead to a misdiagnosis as another chronic respiratory illness in a large number of cases due to the rare nature of TPO. Here we present a 25-year-old lady who was misdiagnosed as bronchial asthma for many years, and was found to have TPO after difficulty in intubation for administering general anesthesia prior to a surgical procedure.

Case Report: Chronic Cavitatory Pulmonary Aspergillosis after COVID-19.

Chronic pulmonary aspergillosis can present in four distinct clinical syndromes, one of which is chronic cavitary pulmonary aspergillosis (CCPA). CCPA is generally associated with a mildly immunosuppressed state or, in immunocompetent patients, with structural lung damage. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with reactivation of previous quiescent infections such as tuberculosis and invasive fungal infections, but CCPA in a patient with COVID-19 is rarely reported. Here we present the case of a 57-year-old man with CCPA associated with COVID-19 infection in whom latent aspergilloma was most likely activated after SARS-CoV-2 infection. The patient presented with severe COVID and, after initial response to treatment, started to deteriorate due to reactivation of latent aspergilloma to a more aggressive CCPA form. After confirmation of the diagnosis, the patient was initiated on treatment with voriconazole. He showed a good response to treatment with clinicoradiological response. This case also depicts one of the common causes of clinical deterioration in otherwise recovering COVID-19 patients.