Recommendations for an expert team investigating a case of cluster endophthalmitis.

Occurrence of postoperative cluster endophthalmitis is a nightmare for the operating surgeon, the involved hospital, and the patients. Due to its multifactorial etiology, surveillance of such an event is extremely important to identify the causative factor and to prevent recurrences in future. For surveillance, a team of ophthalmologists and microbiologists is often appointed by the local health department, and it is imperative that this team investigates thoroughly, reports appropriately safeguarding the interests of all, and also suggests remedial measures for future. Much literature is available on postoperative endophthalmitis and sterilization and disinfection protocols, but to the best of our knowledge, there is none to guide the surveillance team regarding the conduct of the entire process of investigation in the case of such unfortunate incidents. Through this article, we have made an attempt to formulate recommendations for expert teams investigating cases of postoperative cluster endophthalmitis.

Modified transscleral external drainage of subretinal fluid in high bullous exudative retinal detachment due to Coats' disease.

Surgical management of advanced coats' disease has always been a challenge to a surgeon. Various different techniques have been tried. With the advancement in surgical instruments and machines, surgeons are now modifying older surgical techniques. We have tried a novel minimally invasive surgical technique for the management of advanced coats' disease patient having high bullous exudative retinal detachment. Intravitreal injection of Bevacizumab at the end of the surgery has a role in such cases.

Combined CRVO with CRAO in a patient with protein C deficiency.

PURPOSE: To study the underlying factors in a young patient having central retinal venous obstruction with central retinal arterial obstruction and its effects on visual outcome. METHODS: A 33-year-old man presented with a complaint of sudden loss of vision in his right eye. A complete ophthalmic evaluation with fundus angiography showed combined central retinal venous obstruction with central retinal arterial obstruction. Detailed investigations revealed reduced (20%) functional assay of protein C suggestive of the diagnosis of severe Type II protein C deficiency with Factor V Leiden mutation. This ocular event was the first sign of the underlying disorder. RESULTS: The ophthalmic event rapidly progressed to no perception of light. Anticoagulant therapy was started to prevent life-threatening systemic complications. Despite antiglaucoma medications, intraocular pressure was high and cyclocryotherapy was advised. CONCLUSION: Retinal vascular disorders in the younger population have different underlying risk factors than in the older age group. Clinical presentation, severity, and management also depend on causative factors. Combined retinal artery and vein occlusion is very uncommon. Combined cases have mostly been attributed to rheological causes like thrombophilia, vessel wall inflammation, and mechanical compression. Protein C deficiency has mainly been linked to vein occlusions and there is no reference to protein C deficiency as a cause of combined central retinal venous obstruction and central retinal arterial obstruction. Combined cases usually present with severe visual loss and have rapid progression. Young patients having such presentation should be thoroughly evaluated to diagnose underlying factors and initiate appropriate management at the earliest.

Aditya Jyot-Diabetic Retinopathy in Urban Mumbai Slums Study (AJ-DRUMSS): study design and methodology - report 1.

PURPOSE: To describe the methodology of Aditya Jyot-Diabetic Retinopathy in Urban Mumbai Slums Study (AJ-DRUMSS), which was designed (i) to estimate the prevalence of diabetic retinopathy (DR) in a general population, (ii) to study the risk factors associated with DR in those with type 2 diabetes mellitus (DM), and (iii) to create awareness for early detection and develop timely interventional management for DR. METHODS: AJ-DRUMSS is an ongoing population-based cross sectional study conducted in seven wards of slums in Mumbai, India, wherein eligible subjects from the general population were screened for DR and profiled for their demographic, social and biochemical parameters to study the associations of these factors. RESULTS: To date, nearly 54,000 households have been enumerated for both awareness and DR prevalence in five study areas (out of seven) during 17 awareness campaigns and 78 DR screening camps. Of these, 4295 households were included in AJ-DRUMSS. Nearly 15,000 camp subjects (including subjects from awareness-focused areas who also turned up for the screening camps) were screened from the total enumerated households, of which 16.1% were diagnosed with type 2 DM. A total of 14.5% of these had evidence of DR and 3.5% had sight-threatening DR. CONCLUSIONS: A detailed study design of AJ-DRUMSS is described. In the screening camps nearly 3.5% of the diabetic population had sight-threatening DR, which needed an active interventional strategy. This study will help in formulating efficient eye care policies, making optimum use of available resources, reorienting healthcare providers and the ignorant within the population regarding the need for periodic ophthalmic surveillance and timely intervention.

Application of amniotic membrane transplantation in cases of symblepharon.

Injuries to the eye causing ocular surface damage may develop symblepharon as a complication in which palpebral conjunctiva got adhered to the bulbar conjunctiva or cornea. Removal of adhesions is must for ocular surface reconstruction but chances of recurrence are more in simple removal. A study was done among 10 eyes of 10 patients to see the efficacy, safety and outcome of symblepharon excision with amniotic membrane transplantation. All the patients were operated by a single surgeon with standard technique and all of them were followed up for 6 months. All eyes exhibit a stable, intact corneal epithelial surface and healthy conjunctival growth without developing recurrent erosion or persistent epithelial defect. Visual improvement was seen in 60% of cases. Eighty per cent patients showed symptomatic relief. All eyes exhibited decreased vascularisation and inflammation at final follow-up. Thus, amniotic membrane transplantation is very effective in ocular surface reconstruction in cases of symblepharon and limbal stem cell deficiency.