Premature Expression of Pseudoexfoliation Syndrome With Presenile Cataract in a 28-Year-Old Lady.

PURPOSE: We report a case of premature expression of pseudoexfoliation syndrome with presenile cataract in a 28-year-old lady with primary developmental glaucoma who had undergone glaucoma filtration surgery 26 years ago. METHODS/RESULTS: We report a case of a 28-year-old Indian lady with progressive diminution of vision associated with photophobia in the left eye for 5 years and loss of vision in the right eye since childhood. She underwent glaucoma filtration surgery in the left eye at the age of 2 and was on 2 topical glaucoma medications when she presented to us. Refractive error was -17.00 D with -3.50 D @ 90-degree cylinder in the left eye. The right eye was phthisical. Left eye showed superior diffuse bleb, enlarged but clear cornea with superior Haab's striae, deep and quiet anterior chamber and patent surgical iridectomy at 1 o'clock position. There was diffuse iris atrophy with pseudoexfoliation at the pupillary ruff and over the anterior lens capsule. Lens showed grade 2 nuclear cataract. Intraocular pressure in the left eye was 23 mm Hg. Fundus examination showed 0.9 cupping with an inferior notch and diffuse pallor of the optic disc. Axial length of left eye was 31.44 mm. On the basis of these findings, she was diagnosed with primary developmental glaucoma and high myopia, status after glaucoma filtration surgery with presenile cataract and pseudoexfoliation in the left eye. The topical antiglaucoma medications were augmented. After 1 month, intraocular pressure in the left eye was reduced to 14 mm Hg. She was advised to continue topical glaucoma medications and regular follow-up. CONCLUSIONS: The present case is the first to describe the unusual presentation of pseudoexfoliation in a young individual along with presenile cataract. Simultaneous occurrence of pseudoexfoliation with cataract could be due to previous intraocular surgery, iris trauma, possible low-grade inflammation, and high myopia in a predisposed eye. The clinician should be aware that although a rare condition, pseudoexfoliation can occur in the young and may be associated with presenile cataract.

Effect of chronic alcohol and tobacco use on retinal nerve fibre layer thickness: a case-control study.

OBJECTIVE: To identify the effects of chronic alcohol and/or tobacco use on retinal nerve fibre layer (RNFL) thickness and to find the association between severity of addiction with RNFL thinning. METHODOLOGY: A case-control study was performed in 200 eyes of cases and 200 healthy control eyes. Cases were recruited from deaddiction clinic having history of alcohol and/or tobacco use for at least 5 years. Severity of alcohol and tobacco was graded by Alcohol Use Disorders Identification Test (AUDIT) and Fagerstorm Nicotine Dependence (FTND) scale, respectively. Age-matched and gender-matched individuals attending ophthalmology outpatient department without addiction were recruited as controls. RNFL thickness was measured using Stratus optical coherence tomography (OCT). RESULTS: Statistically significant RNFL thinning was noted in all quadrants except nasal quadrant in the cases. Statistically significant thinning was seen in all quadrants except nasal with increased FTND scale. Thinning was noted in all quadrants with higher AUDIT scale, but this was statistically not significant. CONCLUSION: Chronic alcohol and tobacco use are likely to cause RNFL thinning. OCT can be used as a screening tool to suspect visual morbidities in chronic tobacco and alcohol users.

Promising Role of Exfoliative Cytology in the Evaluation of Glycaemic Status of Type II Diabetics: A Pilot Study.

BACKGROUND: The degree of metabolic control in diabetes mellitus influences the susceptibility of patients to oral diseases. It is mandatory to regularly monitor glycaemic status, however invasive methods may be contraindicated or intolerable to diabetic individuals. Thus, cytology, being a simple, non-invasive and rapid procedure, is a promising protocol for assessing diabetic status and assisting in management. AIM: To assess the number of PAS positive glycogen containing cells and associated cellular changes in buccal smears of type II diabetics and correlate the findings with their serum glucose levels. SETTINGS AND DESIGN: The study was conducted at the out patient Department of Oral and Maxillofacial Pathology, KLES Institute of Dental Sciences, Belgaum. MATERIALS AND METHODS: Fifty known cases of type II diabetes mellitus and 50 healthy individuals were included in the study. Fasting blood glucose levels were estimated and buccal smears stained with Periodic Acid Schiff stain. The observed cellular changes were correlated with the glycaemic status of each patient. STATISTICAL ANALYSIS: Statistical evaluations such as Student's t test (P < 0.01-very significant; P < 0.001-highly significant), correlation-coefficient and probability values were computed. RESULTS: Smears of diabetic patients depicted an increase in the number of PAS positive cells in significant correlation to their glycaemic status. Cellular and nuclear morphological alterations were also found in squames of diabetic individuals. CONCLUSION: Cytological findings and clinical observations, suggest a correlation between the extent of these changes and clinical parameters like glycaemic control. Further studies in this aspect can help in improving the reliability of oral cytology as a diagnostic tool in diabetes.

Clinico-radiological correlation in a cohort of cervical myelopathy patients.

OBJECTIVE: Though both clinical evaluation and MRI are complimentary in detection and precise localization of the level of lesion in patients with cervical myelopathy, there is paucity of data comparing segment specific clinical features with the MRI abnormalities in cervical myelopathy. MATERIALS AND METHODS: Thirty one patients with cervical myelopathy and abnormal MRI of the cervical spine (signal changes in the cord) admitted to the neurology and neurosurgery wards during the study period were included in the study. The patients were prospectively evaluated by a detailed neurological examination. Clinically, the site of lesion was determined by highest of the pyramidal, sensory or segmental features of involvement. The MRI lesions were categorized based on the vertebral level at which the abnormalities were seen. The patients were divided into three groups according to the site of lesion on MRI: (1) cervico-medullary (foramen magnum to C1) lesions (2) upper cervical (C2-C4) lesions and (3) lower cervical (C5-T1) lesions. Comparisons of clinical symptoms, signs and level of lesion with MRI abnormalities were done and the level of significance was set at p < 0.05. RESULTS: Clinical evaluation showed limb weakness in all, sensory loss in 90%, sphincter disturbances in 67.7%, scissoring gait in 32.2%, diaphragmatic weakness in 12.9% of patients. Based on clinical examination the site of lesion was cervico-medullary in 9, upper cervical region in 4 and lower cervical region of involvement in five patients. The maximal antero-posterior extent of the lesion and neurological deficits were concordant (p-0.05). As compared to pyramidal signs or sensory abnormalities, segmental features - segmental sensory loss, weakness, wasting or 'reflex' loss - were most concordant with the MRI level of lesion (p - 0.03). Among 'motor', 'sensory' and 'reflex' levels, the 'reflex (DTR)' levels were most concordant with the MRI level of lesion (p - 0.04). CONCLUSION: Segmental features form the foundation for clinical localization of the level of lesion. Though the clinical level of lesion and MRI level of lesion were discordant in 14 patients, clinical evaluation may still provide useful information.

Bilateral acute anterior uveitis and optic disc edema following a snake bite.

The authors wish to report a case of bilateral acute anterior uveitis and optic disc edema following a hemotoxic snake bite, in order to highlight the concomitant occurrence of these conditions and the potential adverse effects of anti-snake venom (ASV). A 35-year-old male was bitten by a viper at seventeen thirty hours, and was started on ASV. Two days following treatment he experienced sudden onset redness and painful diminution of vision in both eyes (OU). On examination, the patient's visual acuity (VA) in OU was 20/200. Examination revealed fresh keratic precipitates, cells, and flare in the anterior chamber (AC), posterior synechiae, sluggish and ill-sustained pupillary reaction, and hyperemic, edematous disc with blurred margins in OU. He was started on topical steroids, cycloplegics and intravenous methylprednisolone. Following treatment, the patient showed improvement and was continued on topical medications and oral prednisolone tapered over 3 weeks, after which VA OU improved, the AC showed no cells and flare and disc edema resolved. Uveitis and optic disc edema in snake bite can either be due to the direct toxic effects of the venom or the effect of ASV. Steroids have a beneficial role in the management of these symptoms.