Gauri Bhushan

Spectral-domain optical coherence tomography of astrocytic hamartomas in tuberous sclerosis

Retinal astrocytic hamartomas are benign tumors of the retinal nerve fiber layer (NFL) that may be found in association with tuberous sclerosis (TS). We describe the spectral-domain optical coherence tomography (SD-OCT) features of type 1 astrocytic hamartomas in a child with TS that may aid in the diagnosis and follow-up of these lesions. Gradual, dome-shaped hyper-reflective elevations of the retinal NFL were seen on SD-OCT with subtle shadowing of the underlying tissues. In addition, the vitreous cortex showed focal adhesions to the surface of the tumor.

Comparison of Transcorneal and Pars Plana Routes in Pediatric Cataract Surgery in Infants Using a 25-Gauge Vitrectomy System.

PURPOSE To demonstrate and compare the performance of the 25-gauge transconjunctival sutureless vitrectomy system via anterior (transcorneal) and posterior (pars plana) routes in congenital cataracts in infants. METHODS In this prospective interventional study, 12 pediatric patients younger than 1 year with bilateral congenital cataract were included to undergo cataract surgery with posterior vitreorhexis and limited anterior vitrectomy using a 25-gauge vitrectomy system. One eye of each patient was operated on by the anterior (transcorneal) route and the other by the posterior (pars plana) route. All eyes were left aphakic. Intraoperative and postoperative (12 months after surgery) results were compared between the two routes, including visual axis opacification and astigmatism. All eyes were rehabilitated with contact lenses or spectacles. RESULTS The 25-gauge vitrectomy system allowed excellent intraoperative control in both groups. Postoperatively, there was minimal conjunctival congestion, corneal edema, and inflammatory reaction. No intra-operative or postoperative complications were noted in any eye. All eyes had a clear visual axis 12 months after surgery. Mean spherical equivalent was 15.50 ± 2.28 diopters (D) and mean astigmatism was 0.25 ± 0.45 D in the transcorneal group, whereas in the pars plana group it was 15.46 ± 2.45 D and 0.16 ± 0.39 D, respectively, at 12 months, the difference being statistically insignificant (P > .05). CONCLUSIONS The 25-gauge vitrectomy system allows sutureless surgery with excellent intraoperative control and minimal postoperative inflammation and astigmatism with clear visual axis by both the transcorneal and pars plana routes.

The Optical Performance of Spherical and Aspheric Intraocular Lenses in Pediatric Eyes: A Comparative Study.

PURPOSE To compare the optical performance of aspheric intraocular lenses (IOLs) designed to correct the corneal spherical aberration versus spherical IOLs in pediatric eyes after cataract surgery. METHODS In this prospective study, 40 eyes of patients 6 to 16 years old with developmental cataract were randomly assigned to receive a spherical IOL or an aspheric IOL after pediatric cataract surgery. At 3 months postoperatively, the outcomes compared between the two groups were best-corrected visual acuity, contrast sensitivity, and wavefront aberrometry. RESULTS The mean best-corrected visual acuity was 0.32 ± 0.19 logMAR in the spherical IOL group and 0.28 ± 0.16 logMAR in the aspheric IOL group (P = .179). The aspheric IOL group showed better contrast sensitivity at 1.5, 3, and 6 cycles per degree than the spherical IOL group (P < .05). Total ocular aberrations, higher-order aberrations, and spherical aberrations were significantly lower in the aspheric IOL group (P < .05). CONCLUSIONS The results suggest that aspheric IOLs compensate for the spherical aberration of pediatric eyes. In comparison to spherical IOLs, eyes with aspheric IOLs had decreased ocular aberrations, particularly spherical aberration, which contributed to better contrast sensitivity in these eyes. Further studies are required to evaluate the role of aspheric IOLs in children.

EXUDATIVE RETINAL DETACHMENT AS THE PRESENTING FEATURE OF TUBEROUS SCLEROSIS COMPLEX.

PURPOSE To report a case of exudative retinal detachment as the presenting feature of tuberous sclerosis complex. METHODS A 14-year-old girl presented with loss of vision in the right eye for 1 month. Visual acuity was no perception of light in the right eye and 20/20 in the left eye. Clinical examination, fundus fluorescein angiography, spectral domain optical coherence tomography, and ultrasound B-scan was performed along with complete systemic evaluation. RESULTS On examination, the right eye had an exudative retinal detachment and the left eye had multiple lesions suggestive of retinal astrocytic hamartomas. Ultrasonography of the right eye revealed a total retinal detachment with subretinal exudates and an acoustically solid mass lesion in the inferonasal quadrant, whereas that of the left eye detected a small mass in inferonasal quadrant. Fundus fluorescein angiography of the left eye revealed staining in the late phase in the lesions. Spectral domain optical coherence tomography taken through the lesion demonstrated an elevated lesion with high reflectivity arising from inner retinal layers and causing backshadowing. On systemic examination, she had multiple skin colored bumps on cheeks and nose and multiple hypomelanotic macules on lower legs. Contrast-enhanced magnetic resonance imaging brain revealed features suggestive of multiple cortical tubers. Contrast-enhanced magnetic resonance imaging orbits showed a T2-hypointense nodule in the right globe medially with intense postcontrast enhancement, and contrast-enhanced magnetic resonance imaging abdomen detected multiple renal cysts suggestive of angiomyolipoma. CONCLUSION Retinal astrocytic hamartomas in association with tuberous sclerosis complex is considered to be a relatively stationary lesion that has little potential for aggressive behavior. In rare instances, however, a retinal astrocytic hamartomas can show progressive growth and cause exudative retinal detachment.

A rare case of delayed onset capsular block syndrome managed using 25-gauge vitrector.

We report a case of delayed onset capsular block syndrome in a patient 6 years after undergoing cataract surgery. Ocular examination revealed marked diminution of vision accompanied with a collection of milky fluid between the intraocular lens and posterior capsule. To treat and to understand the pathology of the condition, aspiration of fluid using 25-gauge vitrector through pars plana was done, and contents sent for microbiological analysis which did not reveal any growth. Postoperative period was uneventful with the absence of intraocular inflammation and excellent visual recovery.

Central Retinal Artery Occlusion as an Iatrogenic Complication of Treatment of Central Giant Cell Granuloma of the Mandible

Although intralesional steroid injection as a management option for central giant cell granuloma (CGCG) of the mandible is considered safe, central retinal artery occlusion (CRAO) is a dreaded and previously unreported complication of this treatment modality. The present report discusses an iatrogenic case of CRAO that occurred during treatment of CGCG of the mandible. This complication occurred because of high injection pressure, which led to the opening of an anastomosis between the external and internal carotid arteries, leading to retrograde migration of steroid particles. This report also highlights the importance of being aware of such communications.

Inverted mucoepidermoid papilloma of conjunctiva in a child

Inverted papillomas are benign epithelial tumors usually arising from the mucous membrane of the sinonasal cavity and the urinary tract. Similar tumors of the conjunctiva are much rarer. We describe a case of juxtalimbal inverted papilloma in an 11-year-old boy who presented with a pigmented lesion that simulated a conjunctival nevus. Excisional biopsy established the diagnosis of inverted papilloma. The patient was carefully followed for 2 years, because the tumors behavior in the conjunctiva is unknown. There was no recurrence of the lesion.

Bilateral optic neuritis following Mycoplasma pneumoniae infection

Dear Editor, We read with interest, the article on bilateral optic neuritis following Mycoplasma pneumoniae infection by Chiang and Huang.[1] Management of the case by authors was solely based on the hypothesis that optic neuritis developed secondary to an immune reaction. After going through the literature, we would like to highlight few important facts regarding the role of M. pneumoniae in cases with neurological damage. Extrapulmonary manifestations of M. pneumoniae infection especially nervous system involvement have been widely reported in the literature. Neurological injury falls into two patterns: Direct invasion by organism and secondary to an immune response. Cases when neurological involvement has been attributed to an immune complex mediated reaction, the duration of prodromal respiratory symptoms has usually been >7 days.[2] An auto-immune response causes neurological damage secondary to cytokine production, autoimmunity, and vascular occlusion. In a large case series published by Bitnun et al. the authors claim that in patients with neurological involvement they could detect M. pneumoniae antigen by polymerase chain reaction in cerebrospinal fluid/throat of patients who had at least 5–7 days of respiratory prodromal symptoms.[3] They proposed that respiratory infection can have a cytotoxic effect on respiratory epithelium, and this can facilitate blood stream invasion by M. pneumoniae. In the current case, coexistence of respiratory symptoms and visual symptoms along with raised Mycoplasma immunoglobulin (Ig) M titres (+, >75 BU/mL) raises the possibility of acute M. pneumoniae infection for the treatment of which intravenous Ig should be administered under a 2 week macrolide cover.[4] Although the response to Ig suggests an immune mechanism is involved along with acute infection, administration of high dose steroids can cause transient leucopenia which can suppress micro-organism. Holistic approach in such a case requires management of systemic status along with visual complaints. A chest X-ray at the time of presentation and a repeat serology to look for change in IgM and IgG levels would have supplemented the management. We agree with authors that in cases of optic neuritis in children with respiratory symptoms M. pneumoniae should not be overlooked as a probable cause and should be investigated for.