Gaurav Y. Shah

Illuminated curved 25-gauge vitrectomy probe for removal of subsclerotomy vitreous in vitreoretinal surgery

Incarceration of vitreous in sclerotomy sites during pars plana vitrectomy can lead to wound-related complications similar to vitreous incarceration in cataract surgery. We describe an illuminated curved 25-gauge vitrectomy probe for removing vitreous from sclerotomy sites. Polyester tubing is used to secure a fiber optic endoilluminator (0.5 mm) with the curved 25-gauge vitrector (0.5 mm). The resultant illuminated curved vitrector (20 G) has a diameter of 1.0 mm. It facilitates complete removal of vitreous around the internal sclerotomies under direct visualization in both phakic and pseudophakic eyes. The same was confirmed with ultrasound biomicroscopy of the sclerotomy sites. Curved vitrector reduces postoperative complications related to incarcerated vitreous in phakic and pseudophakic eyes and other sclerotomy-related wound complications.

Lowering serum uric acid to prevent acute kidney injury

Epidemiological, experimental and clinical studies support a role for uric acid in acute kidney injury (AKI). We discuss how the conventional role of uric acid in AKI has now evolved from intratubular crystal deposition to pro-inflammatory, anti-angiogenic and immunological function. Data from recent studies are presented to support the hypothesis that uric acid may have a role in AKI via a crystal-independent process in addition to its traditionally accepted role to induce injury via crystal-dependent pathways.

Vancomycin-resistant coagulase negative Staphylococcus endophthalmitis following cataract surgery

Endophthalmitis is an uncommon but potentially devastating complication of intraocular surgery. Coagulase-negative Staphylococcus (CNS) is the most common bacterium isolated from patients with acute postoperative endophthalmitis. Vancomycin is considered the drug of choice for coverage of gram-positive organisms in endophthalmitis. There are a few reports of vancomycin-resistant Enterococcus endophthalmitis, but there are no reports of vancomycin resistance to CNS following endophthalmitis. We report a case of acute postoperative endophthalmitis caused by vancomycin-resistant CNS treated at our institute.

Successful management of melanocytoma-associated choroidal neovascularization with photodynamic therapy.

Purpose To report the efficacy of photodynamic therapy in treatment of choroidal neovascular membrane (CNV) associated with melanocytoma of the optic disc. Methods A middle-aged man with visual acuity of 20/200 in right eye was treated with photodynamic therapy for juxtafoveal classic CNV overlying the papillomacular bundle. CNV was secondary to ocular melanocytoma, a rare event. Results At the 6-month follow-up, a scarred CNV with final visual acuity of 20/30 was noted clinically and angiographically Tomography revealed high reflective scar tissue with flat macula and microperimetry showed restoration of retinal sensitivity over the papillomacular bundle. Conclusions Photodynamic therapy effectively resolved CNV that involved papillomacular bundle (secondary to melanocytoma) and restored retinal function in papillomacular bundle.

Evaluation of web-based annotation of ophthalmic images for multicentric clinical trials

An Internet browser-based annotation system can be used to identify and describe features in digitalized retinal images, in multicentric clinical trials, in real time. In this web-based annotation system, the user employs a mouse to draw and create annotations on a transparent layer, that encapsulates the observations and interpretations of a specific image. Multiple annotation layers may be overlaid on a single image. These layers may correspond to annotations by different users on the same image or annotations of a temporal sequence of images of a disease process, over a period of time. In addition, geometrical properties of annotated figures may be computed and measured. The annotations are stored in a central repository database on a server, which can be retrieved by multiple users in real time. This system facilitates objective evaluation of digital images and comparison of double-blind readings of digital photographs, with an identifiable audit trail. Annotation of ophthalmic images allowed clinically feasible and useful interpretation to track properties of an area of fundus pathology. This provided an objective method to monitor properties of pathologies over time, an essential component of multicentric clinical trials. The annotation system also allowed users to view stereoscopic images that are stereo pairs. This web-based annotation system is useful and valuable in monitoring patient care, in multicentric clinical trials, telemedicine, teaching and routine clinical settings.

Role of famciclovir in the management of acute retinal necrosis in developing countries.

PURPOSE To evaluate clinical presentations, management strategies, and results in patients with acute retinal necrosis (ARN) who received famciclovir. METHODS In a retrospective, noncomparative, interventional case series, we reviewed case records of patients with ARN from the computerized database between January 2007 and December 2009. Data collected included demographic details of the patient, relevant history, examination findings, drugs administered, clinical response, and final visual acuity. The main outcome measures were visual acuity and clinical response. RESULTS Famciclovir was administered in three cases of ARN. In these three immunocompetent patients, there was complete resolution of ARN with improvement in visual acuity and absence of other eye involvement or recurrence in the primary eye. CONCLUSION One may consider treating ARN with oral famciclovir in immunocompetent patients in developing countries when intravenous acyclovir treatment is not affordable to the patient or when there is clinical resistance to acyclovir.