Akshay Bhandari

Lens-Induced Glaucoma: The Need to Spread Awareness about Early Management of Cataract among Rural Population.

Purpose. To determine the clinical profile of lens-induced glaucoma (LIG), reasons for late presentation, and outcome of current management. Methods. Retrospective analysis of 50 eyes with LIG over a 6-year period between 2005 and 2011 at a tertiary care centre in rural India. Visual acuity and intraocular pressure (IOP) were assessed preoperatively and postoperatively along with postoperative complications. Results. Fifty (2.4%) of 12,004 senile cataracts operated at Pravara Rural Hospital, Loni, presented with LIG. There were 39 (78%) phacomorphic cases and 11 (22%) phacolytic glaucoma. Following cataract surgery, 21 of 50 operated eyes (42%) had visual acuity 6/60 or worse. Conclusion. The results highlight the importance of early diagnosis and treatment of visually disabling cataract. There is a need to educate both the patient and the cataract surgeon about the dangers of lens-induced glaucoma and of about poor outcome if treatment is delayed.

Gyrate atrophy of choroid and retina with myopia, cataract and systemic proximal myopathy: A rare case report from rural India

Gyrate atrophy is a rare metabolic disease with autosomal recessive inheritance pattern characterised by hyperornithinemia and typical ocular findings. This report presents a 17-year-old intellectually challenged girl consulting for a progressive fall of visual acuity with night blindness. Fundus examination showed patches of chorioretinal atrophy with typical scalloped borders and peri vascular pigmentation in the equatorial region. Fundus fluroscein angiography revealed characteristic staining pattern. Other ocular associations included myopia and posterior sub capsular cataract. Progressive systemic proximal myopathy was one of the associated features. Dietary supplementation of vitamin B6 was advised.

Ocular fundus changes in pre-eclampsia and eclampsia in a rural set-up

Context: Pregnancy-induced hypertension (PIH) is one of the common complications met with pregnancy and contributes significantly to maternal and fetal mortality and morbidity. Aims: To grade the ocular fundus changes in patients of pre-eclampsia and eclampsia. Settings and Design: Hospital-based prospective observational study. Materials and Methods: Hospital-based prospective observational study conducted over a period of 2 years. One hundred patients of pregnancy having pre-eclampsia and eclampsia were included. Statistical analysis used: Chi-square test. Results: Out of 100 cases, 32 (32%) had mild pre-eclampsia while 50 (50%) had severe pre-eclampsia. Eighteen (18%) patients had eclampsia. Out of 100 cases examined in this study, 54 presented with ocular symptoms and 46 were asymptomatic. Arteriolar attenuation was the most common retinal change observed and it was seen in 44 (44%) cases. Exudative retinal detachment was seen in 7 (7%) cases and macular edema was present in 12 (12%) cases of PIH. Conclusions: Cases of severe pre-eclampsia and of eclampsia showed higher grades of retinal changes. Visual disturbances and symptoms like headache were commonly associated with retinal changes. It is essential to examine each and every patient of pre-eclampsia and eclampsia for ocular manifestations, which should be helpful for obstetrician in the management of patient.

A case of conjunctival malignant melanoma with local recurrence

Malignant melanoma of the conjunctiva is a rare tumour of middle and old age. It is seen predominantly in whites, and is rare in those of pigmented ethnicity. Its clinical presentation varies, and making a clinical diagnosis may be difficult. The tumour is potentially fatal and displays a high rate of recurrence, which can be attributed to delay in diagnosis, as well as inadequate surgical approach. The literature on this melanoma is scanty, even in the West, particularly regarding the precise surgical technique. We report a case of malignant melanoma of the conjunctiva which showed a local recurrence one year after the primary surgery. However, there was no evidence of distant metastasis on either occasion. This case highlights the need for care in making a diagnosis, meticulous attention to the surgical technique, and careful follow-up to detect further disease activity.

Neonatal orbital abscess.

Orbital abscess generally occurs in older children but it can rarely affect infants and neonates too. We report a case of community acquired methicillin resistant staphylococcus aureus (CA-MRSA) neonatal orbital abscess in a 12-day-old term female neonate with no significant past medical history or risk factor for developing the infection. The case highlights the importance of consideration of CA-MRSA as a causative agent of neonatal orbital cellulitis even in a neonate without any obvious predisposing condition. Prompt initiation of appropriate medical therapy against MRSA and surgical drainage of the abscess prevents life threatening complications of orbital cellulitis which more often tend to be fatal in neonates.

Ophthalmic Manifestations of HIV Patients in a Rural Area of Western Maharashtra, India

Introduction. HIV/AIDS is one of twenty first centurys biggest global challenges to mankind with protean manifestations affecting all organs of our body, not even sparing the eyes. The purpose of this study was to determine the pattern of ocular manifestations of HIV/AIDS and their correlation with CD4-count in a rural area of India. Methods. A hospital based observational cross-sectional study was done on 40 HIV-positive patients presenting to ART center with ocular complaints. Data were collected using face-to-face interview, clinical examination, slit lamp examination, fundus examination, and laboratory investigations. Results. Out of 40 patients, 21 were males and 19 were females with mean age of 38.75 ± 13.9 years. HIV retinopathy was the most common HIV-associated ophthalmic lesion while anterior uveitis was the most common anterior segment finding. Posterior segment lesions showed significant association (P < 0.05) with low CD4-count of the patient. CMV retinitis, retinal detachment, tubercular chorioretinitis, and acute retinal necrosis were all seen in patients with CD4-count less than 100 cells/mm3. Conclusions. HIV retinopathy, CMV retinitis, herpes zoster ophthalmicus, and anterior uveitis are common ocular manifestations associated with HIV infection. Low CD4-count is a risk as well as predictor for ocular manifestations. There needs to be awareness of ocular involvement among HIV infected individuals and an increased emphasis on regular ophthalmic examination.

Recurrent neurofibroma of the orbit

A 55-year-old male patient presented with gradual progressive outward and downward deviation of right eye since last two years, with history of a similar complaint 10 years ago when he was diagnosed as having neurofibroma of the orbit. Computed Tomography imaging revealed a large, multilobulated, heterogeneous, soft tissue density mass lesion in the retro bulbar region on the medial side of right orbit suggestive of a neurofibroma. Excision and histopathology confirmed it to be a recurrence of neurofibroma of the orbit.

Pleomorphic adenoma of a deep orbital ectopic lacrimal gland

ABSTRACT Ectopic lacrimal gland, being one of the choristomas, is comprised of lacrimal gland tissue outside the lacrimal gland fossa in the fronto-lateral part of the orbital roof. Ectopic lacrimal gland is a rare condition where the gland may be found in the orbit, eyelids, ocular adnexa or within the globe. Neoplastic transformation of such tissue may occur. A sixty-two-year old male patient presented with right eye proptosis and slight nasal displacement of the globe. Computerized tomography scan revealed a well-defined hypodense lesion of size 19 x 18 x 20 mm supero-lateral to lateral rectus muscle, with mild proptosis and thinning of the right lateral orbital wall. Excisional biopsy was performed through a lateral orbitotomy approach. A well circumscribed globular mass was removed from the right orbit, well behind the fossa for the lacrimal gland in the retrobulbar space. Histopathology was suggestive of pleomorphic adenoma of lacrimal gland. Pleomorphic adenoma is an epithelial tumor of the lacrimal gland which is extremely rare from an ectopic lacrimal gland and only few cases have been reported in literature till date.

Pattern of Ocular Pathologies Diagnosed with B-scan Ultrasonography in a Hospital in Rural India

Context: B-scan ultrasonography (USG) plays a key role as a valuable diagnostic imaging device in the field of ophthalmology. Aim: To study the pattern of ocular pathologies defined by B-scan USG in rural hospital. Settings and Design: Hospital-based prospective observational study. Materials and Methods: Hospital-based prospective observational study conducted over a period of 2 years. A total of 100 patients were included. Statistical Analysis Used: Chi-square test. Results: In this study of 100 cases, majority of the cases (57%) were above 40 years of age. There were 54 (54%) male patients and 46 (46%) female patients. The most commonly observed indication for ophthalmic B-scan USG was ocular trauma leading to cataract formation in 45 cases. Conclusion: B-scan USG stands as an excellent, reliable, and cost-effective noninvasive radiological diagnostic modality for proper evaluation of a variety of ocular disorders in both clear and opaque media.

Outcome after cataract surgery in patients with traumatic cataract

Purpose The aim of the study was to investigate visual outcome in patients with traumatic cataract after cataract surgery and to study the various etiological factors. Patients and methods A prospective study was carried out on all patients with traumatic cataract who underwent cataract extraction with primary intraocular lens implantation at a tertiary eye hospital between January 2012 and December 2014. Data were collected on age, sex, preoperative vision, postoperative vision at 3–6 months, and postoperative complications responsible for decreased visual acuity. Results Fifty eyes in 50 patients were studied. The study population comprised 36 male and 14 female patients. The preoperative visual acuity was less than 6/60 in all 50 eyes. The postoperative visual acuity in 28 eyes was 6/6–6/12, whereas 20 eyes had visual acuity of 6/18–6/36 and two eyes had visual acuity less than 6/60. The cause of poor visual acuity was mainly corneal opacity and posterior capsular opacity. Conclusion Our study shows that good visual results can be achieved with traumatic cataract surgery if the posterior segment is not involved and the corneal scar does not block the optical axis.