Alka Rani

Atypical presentations of retinoblastoma

PURPOSE To study the atypical presentations of retinoblastoma in our institution. METHOD Retrospective, clinical study. RESULTS A total of 392 cases of retinoblastoma were reviewed; 72.2% of the patients had leukocoria, 13% had proptosis, 10% had strabismus, 1.5% were asymptomatic (detected on screening), and 3.3% had atypical presentations. Fourteen different atypical findings were observed including endophthalmitis (0.76%), secondary glaucoma (0.76%), uveitis (0.5%), corneal edema (0.5%), phthisis bulbi (0.5%), orbital cellulitis (0.5%), cataract (0.25%), pseudohypopyon (0.25%), iris nodules (0.25%), hyphema (0.25%), iris neovascularization (0.25%), microphthalmos (0.25%), exposure keratopathy (0.25%), and corneal blood staining (0.25%). All of the patients had Reese-Ellsworth grade V disease. On histopathology, invasion of neighboring structures was seen in 10 patients. All patients underwent enucleation with adjuvant radiotherapy, chemotherapy, or both. CONCLUSIONS Retinoblastoma can mimic any orbital or ocular pathology. Atypical presentations of retinoblastomas are usually associated with advanced disease. The possibility of ocular tumor should be entertained whenever there is an unusual presentation that is unresponsive to the usual therapy. Ultrasonography and computed tomography should be performed in all such patients, especially if the posterior segment is not visible.

Posterior corneal topographic changes after retreatment LASIK

PURPOSE To evaluate posterior corneal topographic changes after retreatment after myopic laser in situ keratomileusis (repeat LASIK). DESIGN Retrospective nonrandomized comparative self-controlled trial. PARTICIPANTS Thirty-three eyes of 23 patients who underwent repeat LASIK for residual myopia. INTERVENTION Retreatments were performed. Slit-scanning corneal topography was performed before and at 1, 3, and 6 months after repeat LASIK. MAIN OUTCOME MEASURES Posterior corneal topographic changes before and after repeat LASIK were correlated with central corneal pachymetry (preoperatively, before repeat LASIK, after repeat LASIK), residual bed thickness (RBT) and ablation depth (after primary laser in situ keratomileusis (LASIK) and repeat LASIK). On the basis of the amount of posterior corneal elevation after repeat LASIK, the eyes were divided into two groups: group 1 (>66 micro m) and group 2 (< or =66 micro m). Students t test/Mann-Whitney rank-sum test was used to determine the significant difference of mean level of each variable between the two groups. RESULTS After primary LASIK, an increase in posterior corneal elevation had significant positive correlation with attempted correction (P = 0.02), ablation depth (P = 0.008), and significant negative correlation with preoperative central pachymetry (P = 0.0003), RBT (P = 0.0003), and postoperative central pachymetry (P = 0.00008). After repeat LASIK, the mean increase in posterior corneal elevation had significant negative correlation with preoperative central pachymetry (P = 0.03). However, its correlation with the ablation depth (P = 0.43) during repeat LASIK and RBT after repeat LASIK (P = 0.11) was statistically insignificant. On multiple linear regression analysis, the attempted correction (P < 0.01) and RBT after primary LASIK (P < 0.001) were two independent significant determinants of an increase in posterior corneal elevation after primary LASIK. However, for increase in posterior corneal elevation after repeat LASIK, preoperative central pachymetry (P < 0.01) and posterior corneal elevation increase after primary LASIK (P < 0.05) were the two significant determinants. Compared with group 2, group 1 had significantly high values of posterior corneal elevation both after primary LASIK (P = 0.0037) and after repeat LASIK (P = 0.0000). This group also had significantly low values of central pachymetry preoperatively (P = 0.0003) and after primary LASIK (P = 0.0001) and repeat LASIK (P = 0.0001) surgeries. The mean RBT after primary LASIK (P = 0.0006) and after repeat LASIK (P = 0.001) was also lower in group 1. CONCLUSIONS Posterior corneal elevation increases after repeat LASIK. Eyes with an increase in posterior corneal elevation after primary LASIK and with thinner cornea are more predisposed.

Outcomes after laser in situ keratomileusis retreatment in high myopes.

PURPOSE: To evaluate the refractive and visual performance after laser in situ keratomileusis (LASIK) retreatment. METHODS: A retrospective study was performed on 33 eyes of 23 patients who underwent LASIK (Bausch & Lomb Technolas 217C) retreatment for residual myopia with or without astigmatism. Parameters evaluated were uncorrected and best spectacle-corrected visual acuity, spherical equivalent refraction, contrast sensitivity, glare acuity, and pachymetry, preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: The mean spherical equivalent refraction before primary LASIK was -9.89 ± 4.00 D and before retreatment was -2.85 ± 2.17 D. Although contrast sensitivity and glare acuity decreased significantly after primary LASIK (P<.05), no significant change in these parameters was observed after retreatment. Smaller ablation zones were associated with decreased contrast sensitivity and glare acuity after primary LASIK as well as following retreatment. Contrast sensitivity and glare acuity following primary LASIK were significantly better in eyes with ablation zones ≥5 mm than those with <5 mm (P<.05). Eyes in which the ablation zone was the same as that for primary LASIK had significantly better contrast sensitivity than those with different ablation zones (increased or decreased) during retreatment. Attempted refractive correction during primary LASIK and retreatment had a significant negative correlation with contrast sensitivity and glare acuity following primary LASIK as well as retreatment. CONCLUSION: The ablation zones following primary LASIK and retreatment should be ≥5.00 mm and remain unchanged to improve visual performance.

Visual performance after interface haemorrhage during laser in situ keratomileusis

Aim: To study the visual performance in eyes with interface haemorrhage during laser assisted in situ keratomileusis (LASIK). Methods: Case records of 20 patients, who had bleeding from the limbal vessels in one eye during LASIK (group 1) and uncomplicated surgery in the fellow eye (group 2) were studied. The parameters evaluated were uncorrected visual acuity (UCVA) best corrected visual acuity (BCVA), spherical equivalent of refraction (SEQ), contrast sensitivity, and glare acuity preoperatively and at 1, 3, and 6 months postoperatively. Results: The mean preoperative SEQ in group 1 and 2 eyes was −5.79 (2.3) D and −5.27 (1.68) D, respectively. The mean decimal UCVA at 6 months after LASIK in group 1 and 2 eyes were 0.6 (0.2) and 1.0 respectively (p<0.001). The mean decimal BCVA at 1 week after LASIK in group 1 and 2 eyes were 0.89 (0.04) and 1.0 respectively (p<0.05). However, all eyes had a BCVA of 6/6 at 1, 3, and 6 months after LASIK. The mean contrast sensitivity values preoperatively in group 1 and 2 eyes were 161.3 (8.7) and 172 (68.2) respectively. There was a significant decrease in group 1 at 6 months (102 (60.5) (p<0.01)) compared to group 2. The decimal glare acuity preoperatively in group 1 and 2 eyes was 0.95 (0.11) and 0.89 (0.12), respectively. It decreased significantly in group 1 (0.7) (0.1 (p<0.01)) compared to group 2 at the 6 month follow up. Conclusion: Occurrence of intraoperative interface haemorrhage may affect the visual performance following LASIK surgery.

Posterior corneal topographic changes after partial flap during laser in situ keratomileusis.

Aim: To study the posterior corneal topographic changes in eyes with partial flaps during laser assisted in situ keratomileusis (LASIK). Methods: Case records of 16 patients, who had partial flap in one eye during LASIK (group 1) and uncomplicated surgery in the other eye (group 2), were studied. Following occurrence of partial flap intraoperatively, laser ablation was abandoned in all the eyes. A 160/180 μm flap was attempted during the initial procedure using the Hansatome microkeratome (Bausch & Lomb Surgicals, Munich, Germany). LASIK surgery in all cases was performed using a 180 μm plate, at the mean interval of 4.16 (SD 1.5) months following the initial procedure. None of the eyes had intraoperative complication during LASIK. Relative posterior corneal surface elevation above the best fit sphere (BFS) before the initial procedure, before, and after LASIK were compared using the Orbscan slit scanning corneal topography/pachymetry system. Results: Posterior corneal elevation was comparable in the two groups, both preoperatively (group 1; 16.4 (4.8) μm, group 2; 16.1 (4.8) μm) and after final surgery (group 1; 57.2 (15.6) μm, group 2; 54.3 (13.1) μm). In group 1 after occurrence of partial flap, the posterior corneal elevation was 16.9 (4.4) μm, and this increase was not significant statistically (p=0.4). On multiple linear regression analysis, residual bed thickness (p<0.001) was independently the significant determinant of final posterior corneal elevation in both groups. Conclusion: The inadvertent occurrence of partial flap during LASIK procedure does not contribute to the increase in posterior corneal elevation.

Visual Outcome in Macular Retinoblastoma Treated with Primary Chemotherapy

In this prospective clinical study, we treated 8 patients (8 eyes, 11 tumors) of macular retinoblastoma with chemotherapy alone, with the aim of avoiding visual loss because of retinal damage by radiation or adjuvant therapy and to assess their final visual outcome. The mean basal dimension of the tumor was 5.0 ± 2.6 mm and the mean height was 2.9 ± 1.3 mm. The fovea was involved in 4 patients (50%) and foveal detachment was present in 3 patients (37.5%). All the patients required less than 6 cycles for tumor control. Four patients (50%) obtained visual acuities ranging from 20/25 to 20/200. Two patients (25%) could gain visual acuity of 20/20. The mean follow-up of patients was 3.24 ± 0.9 years (range 2–5). No patient developed recurrence or metastatic disease. In conclusion, recent trends for ocular salvage have favored chemoreduction followed by focal therapy for the treatment of retinoblastoma. This study supports the consideration of chemotherapy alone as the primary treatment in eyes with macular retinoblastomas, under close supervision, with satisfactory visual outcome.

Simultaneous ocular and systemic cysticercosis and tuberculosis.

Human cysticercosis and tuberculosis are endemic diseases in developing countries. Both these diseases have certain common factors of origin. We would like to present the co-existence of these infections in a 20-year-old female. She was a known case of pulmonary and ocular tuberculosis and she acquired cysticercosis of the eye and brain.

Tractional retinal detachment in Usher syndrome type II

Retinal detachment is a rare complication in patients with retinitis pigmentosa. A case is reported of tractional retinal detachment in a patient with retinitis pigmentosa and sensorineural hearing loss, which was diagnosed as Usher syndrome type II. Because of the poor visual prognosis, the patient refused surgery in that eye. Tractional retinal detachment should be added to the differential diagnoses of visual loss in patients with retinitis pigmentosa.