Debmalya Das

Acute Retinal Necrosis: Clinical Features, Management and Outcomes – a 10 Year Consecutive Case Series

Abstract Purpose: To determine the viral diagnosis and clinical outcome of eyes with acute retinal necrosis (ARN). Method: A retrospective analysis was done of 62 eyes of 53 patients presenting to a tertiary care ophthalmic institute between 1997 and 2007 with features of ARN. All patients with active disease were started immediately on intravenous acyclovir followed by oral antivirals along with systemic steroids. A prophylactic laser retinopexy was performed in patients with a clear media to areas posterior to the necrotic retina. Results: The aqueous and the vitreous sample revealed herpes simplex virus in 19 (30.60%) and varicella zoster virus in 28 patients (45.16%). Forty-one (66.12%) eyes had retinal detachment. Prophylactic laser photocoagulation was given in 19 (30.64%) eyes. Surgical intervention was required in 32 (51.61%) eyes. Favorable functional outcome was seen in 28 (45.1%) eyes. Conclusion: ARN is a fulminant disorder, which if treated early and aggressively gives good results.

Endogenous Endophthalmitis: A 10-Year Retrospective Study at a Tertiary Hospital in South India.

Purpose The aim of this study was to review the clinical profile including predisposing systemic conditions, microorganisms responsible, clinical presentation, and outcomes of endogenous endophthalmitis (EE) in South India. Design This study is a retrospective, noncomparative case series. Methods This study presents a retrospective analysis of records of patients with EE in a 10-year period. Results A total of 61 eyes of 58 patients were included in the study. Preceding systemic illness or surgery was noted in 31 patients (53.4%). No predisposing condition was found in 27 patients (46.5%). All eyes had severe diffuse EE. Culture positivity was seen in 34 of 58 patients (58.6%). Gram-positive organisms were isolated in 9 cases (15.5%), and Gram-negative organisms were isolated in 20 cases (34.5%). Pseudomonas aeruginosa (13.8%) was the most common isolate. Eleven eyes (18%) were managed medically with intravenous and intravitreal antibiotics, and 38 eyes (62.3%) also underwent vitrectomy. Eight eyes (13.1%) required repeat vitrectomy, and 12 eyes (19.7%) were eviscerated. The mean follow-up was 16.2 ± 13.9 months. Final visual acuity of 20/200 or better was seen in 29.5% eyes. A favorable outcome was noted in culture-positive patients (P = 0.03) and in patients with no predisposing causes. Conclusions This study provides information about the clinical and microbiologic profile of EE. Aggressive medical and surgical treatment can result in favorable outcomes.

Bilateral Ocular Myiasis Interna Caused by Botfly (Oestrus ovis): A Case Report

The sheep nasal botfly Oestrus ovis is the commonest of several species of dipteran fly whose larvae are obligatory parasites in the nasal cavities and frontal sinuses of sheep but may cause infestation (myiasis) in man, commonly as external infestations and rarely, involves inner coat of the eye (Ocular myiasis interna). We report an imported case of Bilateral Ocular myiasis interna in an Indian boy.

Postcataract Surgery Endophthalmitis Caused by Acinetobacter Lwoffii

Acinetobacter lwoffii is a rare cause of endophthalmitis. We report a case of acute postoperative endophthalmitis in a female, who was treated successfully with pars plana vitrectomy and intravitreal antibiotics.

Polymicrobial chronic endophthalmitis diagnosed by culture and molecular technique

Accurate etiological diagnosis is the key to prevention of ocular morbidity in endophthalmitis cases. A 66 year old male was suffering from chronic endophthalmitis post-cataract surgery. Polymerase chain reaction examination on anterior chamber fluid was positive for Propionibacterium acnes but negative for the panfungal genome. He was advised vitrectomy with intravitreal injections. Polymerase chain reaction of vitreous aspirate was positive for P.acnes as well as panfungal genome. The vitreous sample also grew yeast in culture which was identified as Candida pseudotropicalis. Patient was treated on an alternate day regimen of intravitreal Vancomycin and Amphotericin B in the post-operative period. There was improvement in vision at final follow up. Chronic endophthalmitis can have polymicrobial etiology which will require appropriate diagnostic and therapeutic strategies. The role of molecular testing is vital in these cases as growth in culture is often negative.

Central serous chorioretinopathy following oral tadalafil intake.

A 45-year-old healthy man presented to us with the complaints of sudden painless loss of vision in his right eye of 10 days duration. Visual acuity was 6/60, N24 in the right eye and 6/6, N6 in the left eye. Anterior segment examination was within normal limits. Fundus examination showed a large neurosensory retinal detachment at the macula. The left macula had no visible changes. Optical coherence tomography confirmed a large sensory detachment in the right eye and no abnormalities in the left eye (Figure 1). There was no abnormality at the level of the retinal pigment epithelium in either eye. The left eye was within normal limits. The patient gave a history of taking oral tadalafil for erectile dysfunction five days prior to his visual problems. There was no history of corticosteroid use in any form and he did not have any specific personality trait. Our diagnosis was central serous chorioretinopathy associated with tadalafil use. The patient was advised to stop tadalafil and to return after one month. On review, the patient’s visual acuity had returned to 6/6 and N6. Optical coherence tomographic scans confirmed a significant flattening of the detachment and reduction of subretinal fluid to a minimal level (Figure 2).

Variation in Visual Outcome to Anti-Vascular Endothelial Growth Factors in Choroidal Neovascular Membrane Developing in Eyes with Previously Untreated Versus Focal Laser-Treated Central Serous Chorioretinopathy.

ABSTRACT Purpose: To report the visual outcome in choroidal neovascular membrane developing (CNVM) in eyes with central serous chorioretinopathy (CSCR) with our without prior focal laser. Methods: A retrospective case series of eyes with CNVM secondary to CSCR treated with intravitreal anti-VEGF. Results: Ten eyes of nine patients of CNVM with CSCR who underwent intravitreal anti-VEGF injections were analyzed. Five eyes had CNVM without prior laser photocoagulation, and five eyes developed CNVM after laser photocoagulation for CSCR. Intravitreal injection bevacizumab was given in five eyes and ranibizumab in five eyes. The lasered group had significantly shorter duration of the disease, fewer injections given, and better visual acuity at final follow-up (P <0.05). None had any recurrences of either CSCR or CNVM until the last follow-up. Conclusion: CNVM in CSCR with prior history of focal laser had better outcome than that developed de novo, without prior history of laser.

A rare case of bilateral tractional retinal detachment following snakebite

A 13-year-old female presented with diminution of vision in both eyes for 3 months following snakebite. Best-corrected visual acuities were hand movement in both eyes. Fundoscopy showed vitreous hemorrhage, and B-scan ultrasonography revealed an underlying tractional retinal detachment (TRD) involving the macula in both eyes. Patient underwent 25-gauge pars plana vitrectomy in conjunction with belt buckling, endolaser, and silicone oil tamponade in the left eye. At 6 weeks postoperatively, best-corrected visual acuity of the left eye was noted to be 20/200 with settled TRD and attached retina. Bilateral proliferative retinopathy with TRD is a hitherto unreported complication of snake bite.

Bilateral retinitis pigmentosa with unilateral choroidal nevus: A hitherto unreported association

Retinitis Pigmentosa (RP) has been reported to be associated with retinal hemangioma, retinal angiomatous proliferation, polypoidal choroidal vasculopathy and vasoproliferative tumours. However there is no previous report of choroidal nevus in an eye with RP. We describe such a case in which the eye with RP had a choroidal nevus at the macula. The coexistence of these two entities in the same eye emphasizes the need of careful examination of patients with RP. The presence of choroidal nevus warrants additional investigations such as B scan ultrasonography and a close follow-up to pick up changes in the nevus size and morphology.

Eyelid excoriation and erythema with nepafenac eye drop

Sir, Periocular contact dermatitis has been known to occur after usage of topical ocular anti-inflammatory medications, mydriatics, antiglaucoma, and even antiallergic medications.[1] Among anti-inflammatory drugs, diclofenac sodium and ketorolac tromethamine have been reported to cause eyelid eczema in the past.[2,3] However, no such adverse reaction has been found in the literature following the use of nepafenac. Nepafenac is primarily used for macular edema postcataract surgery as well as due to other retinal diseases. We report the first case of contact dermatitis with use of topical nepafenac. A 55-year-old female presented to us with branch retinal vein occlusion with macular edema in her right eye. Optical coherence tomography showed cystoid macular edema in her right eye. She was advised to undergo intravitreal Anti-Vascular Endothelial Growth Factor injection in her right eye; however, she was unwilling for intravitreal injection and wanted only topical medication. After explaining the pros and cons of her decision, she was prescribed nepafenac 0.1% (NevanacTM; Alcon Labs, Fort Worth, TX, USA) eye drops three times a day for one month. The patient reported in the emergency department three days later with pain and redness over her right eye. She had developed the symptoms on the same day of starting the eye drop. She had excoriation and erythema in her right eyelid. The left eye was normal [Figure 1]. There was no history of insect bite or similar ailment in family members. She was suspected to have developed contact dermatitis due to nepafenac eye drops and was asked to discontinue the medicine. She was advised to use petroleum jelly over the right eyelid. A skin patch test was planned but the patient did not give consent for the same.