A case of non-Hodgkin lymphoma diagnosed after 35-month of initial presentation as recurrent vitritis with multiple negative biopsies.

To report a case of non-Hodgkin lymphoma (NHL) that was diagnosed 35-month of initial ocular manifestation. Retrospective chart review. A 53-year-old male presented with painless diminution of vision in both eyes. He subsequently underwent extensive laboratory investigations including multiple vitreous biopsies with a suspicion of intraocular lymphoma. Cytology from the vitreous aspirate failed to diagnose any relevant pathology. After 35-month from the onset of his ocular symptom, a brain biopsy revealed a round cell tumor suggestive of NHL. Even with high index of suspicion, consultation with ocular oncologist, imaging, and diagnostic vitrectomy, the diagnosis of lymphoma remains challenging.

Isolated intraocular histiocytosis-A rarely reported entity masquerading clinically as uveitis.

An immunocompetent, 25-year-old gentleman with bilateral chronic uveitis presented to various uveitis clinics at different points of time with documented typical clinical features of Toxoplasma Chorioretinitis (Headlight in fog appearance), Behcet's Disease (Hypopyon with peripheral retinal vasculitis), and Presumed Ocular Tuberculosis (Granulomatous Intermediate Uveitis with positive Interferon-gamma release assay) and had been treated with anti-toxoplasma drugs, oral prednisolone, and immunomodulation with oral Mycophenolate/oral Azathioprine to no avail. After cytological examination of vitreous aspirate, he was found to have non-Langerhans cell Histiocytosis which responded to chemotherapy with Vinblastine and Cyclophosphamide.

Polymicrobial endophthalmitis: prevalence, causative organisms, and visual outcomes.

BACKGROUND: The purpose of the present study is to evaluate the prevalence, causative organisms, and visual acuity outcome in patients with culture-proven polymicrobial endophthalmitis. The method used in this study is the non-comparative, consecutive case series using a retrospective analysis of patients diagnosed with polymicrobial endophthalmitis for the period 2000 to 2010. RESULTS: Polymicrobial endophthalmitis was identified in 43/1,107 (3.88%) patients. Forty-two patients had two isolates, and one patient had grown three isolates, yielding a total of 87 isolates. Gram-positive cocci were the most common isolate (n = 53; 60.9%) including Staphylococcus epidermidis (n = 14/53; 16.1%) and Streptococcus pneumoniae (n = 13/53; 13.8%). The etiologies included posttraumatic (n = 31/43; 72.1%) and postoperative (n = 9/43; 20.9%) endophthalmitis. Antibiotic susceptibilities among Gram-positive bacteria were vancomycin (100%) and chloramphenicol (96%). Susceptibilities among Gram-negative bacteria were ciprofloxacin (86.4%) and ofloxacin (81.2%). A maximum number of secondary interventions were done in traumatic cases (38.7%) and cases having coinfection with Gram-negative bacteria and fungus (66.7%). Visual acuity (VA) < 20/200 was more frequently observed in posttraumatic cases (n = 27/31; 87.1%) as compared with postoperative cases (n = 4/9; 44.4%). Of the 43 patients, only 9 patients (20.9%) achieved a VA ≥ 20/200 on final follow-up. Four out of twelve patients (33.3%), with fungus as one of the isolates, had a VA ≥ 20/200. CONCLUSIONS: Although polymicrobial infection in endophthalmitis is uncommon, it is generally associated with poor visual acuity outcomes especially in eyes with open-globe injuries. Coinfection with Gram-negative bacteria or fungi was associated with most unfavorable visual outcome.

Clinical and microbiologic review of culture-proven endophthalmitis caused by multidrug-resistant bacteria in patients seen at a tertiary eye care center in southern India.

PURPOSE: To determine the type of bacteria and the visual outcome of culture-proven multidrug-resistant bacterial endophthalmitis in patients at a tertiary eye care center in southern India. METHODS: This is a retrospective case series in which clinical and microbiologic records of culture-proven bacterial endophthalmitis between January 2000 and December 2007 were reviewed. Multidrug resistance was defined as resistance to two or more different groups of typically susceptible classes of antibiotics. RESULTS: Of 807 patients, vitreous from 42 patients (5.2%) yielded multidrug-resistant bacteria in culture. Thirty-two (71%) of these patients had a poor visual outcome (31.6% in non-multidrug-resistant group). Multidrug resistance was more common in gram-negative bacteria (33; 78.6%) compared with gram-positive bacteria (9; 21.4%). Pseudomonas spp. (24 isolates) were the most common isolated bacteria. Fifteen (45%) of the 33 gram-negative isolates were resistant to ceftazidime, 18 (54.5%) were resistant to amikacin, and 11 (33.3%) were resistant to both amikacin and ceftazidime. Five (55.56%) of the 9 gram-positive isolates were resistant to vancomycin. CONCLUSION: Gram-negative bacteria, chiefly Pseudomonas, are the most common multidrug-resistant organisms, and the outcome is usually poor. Emergence of multidrug-resistant bacteria is a matter of concern. A new alternative group of drugs may be considered for the management of these isolated cases.

Exaggerated subepithelial fibrosis after anterior stromal puncture presenting as a membrane.

PURPOSE: The aim of the study was to describe the clinical features, histopathological findings, and management of eyes presenting with a thick membrane after anterior stromal puncture (ASP) for bullous keratopathy. STUDY DESIGN: Retrospective interventional case series. METHODS: Retrospective chart analysis of 3 eyes presenting with a thick membrane between 12-30 months after ASP was done. Patients presented with complaints of recurrent symptoms of pain, watering, and irritation. The membrane was peeled off from the corneal surface in the operation room and sent for histopathological evaluation. A cryopreserved amniotic membrane was secured on the corneal surface using 10-0 nylon interrupted sutures. RESULTS: Patients reported alleviation of symptoms after the procedure and remained asymptomatic at the final follow-up (range 6-12 months). Histopathological evaluation of the excised membrane revealed the presence of a hyperplastic epithelium with loose fibrocollagenous tissue suggestive of subepithelial fibrosis. CONCLUSIONS: Subepithelial fibrosis after ASP, although a known entity, may rarely present as a thick membrane because of exaggerated response resulting in the recurrence of symptoms. This can be successfully managed by superficial keratectomy and amniotic membrane transplant.

Aniridia associated with congenital aphakia and secondary glaucoma.

We report a case of aniridia associated with congenital aphakia and secondary glaucoma. A 35-year-old male presented with aniridia, congenital aphakia and secondary glaucoma in both eyes. After an unsuccessful medical management, he underwent trabeculectomy with mitomycin C and anterior vitrectomy under local anesthesia in his left eye. Postoperatively, at the end of six months, intraocular pressure (IOP) in his left eye was controlled without medications. This case highlights the rare association of aniridia with congenital aphakia and secondary glaucoma.

The spectrum of Vogt-Koyanagi-Harada disease in South India.

PURPOSE: To report the clinical spectrum of Vogt-Koyanagi-Harada (VKH) disease in a tertiary care center in South India. METHODS: Medical records of patients diagnosed with VKH disease who presented between January 1995 and December 2003, with a minimum follow-up of one year were reviewed. RESULTS: Of the 45 patients, 38 (84.44%) were female. The median age was 37 years (SD +/- 14.23) and median duration of symptoms was 30 days (range 1 day to 1 year). 75.5% (34/45) presented with bilateral anterior uveitis. Posterior segment presentation included disc edema (31/45), bilateral serous retinal detachments (26/45), vitritis (17/45) and sunset glow (8/45). Extra ocular manifestations were seen in only 4/45 (tinnitus: 2, meningismus: 1, poliosis: 1). 97.7% (44/45) received oral Prednisolone (1 mg/kg body weight) for a median duration of 14 months. 69% (31/45) received additional three pulses of intravenous methylprednisolone and 22% (10/45) received a single infusion of intravenous Cyclophosphamide. One patient received intravitreal triamcinolone injection 53.33% (24/45) were treated with additional immunosuppressants. At the first visit, best corrected visual acuity (BCVA) was > or =20/40 in 23 eyes (25.55%) and < or =20/400 in 37 eyes (41.11%). At one year, 61 eyes (67.77%) achieved BCVA of > or =20/40 while 12 eyes (13.33%) had BCVA < or =20/400. Complicated cataract, glaucoma and macular scar were the major complications encountered. CONCLUSIONS: Majority of patients with ocular VKH presented with anterior uveitis and serous retinal detachments and disc edema. Extra-ocular signs are rare in our patients. Visual prognosis is good with treatment with adequate long-term corticosteroids and immunosuppressive agents.