Harsh Kumar

Bilateral nanophthalmos, pigmentary retinal dystrophy, and angle closure glaucoma--a new syndrome?

An unusual case of bilateral nanophthalmos with pigmentary retinal dystrophy and angle closure glaucoma is presented. This is probably the first published report of the established association of all these three entities in the same patient. The aetiological possibilities and clinical significance are discussed.

Changing profile of retinopathy of prematurity.

The aim of this study was to determine the evolving trends of retinopathy of prematurity (ROP) at a tertiary neonatal intensive care unit. In an ongoing screening programme for ROP, we estimated the incidence of ROP among at-risk neonates in a tertiary care unit. We compared our data over the last 12 months (1999-2000; period II) to the previously published data (1993-94; period I) to study changes in the spectrum of the disease. The overall incidence of ROP in period II was not significantly different from the incidence in period I (32 vs. 20 per cent, p > 0.05). However, a decreasing trend in the proportion of severe ROP (stage III) from 46 to 21 per cent in the later period was noted. The need for cryotherapy also dropped significantly compared with the earlier period (8 vs. 46 per cent respectively, p < 0.05). On multivariate analysis, apnea (p < 0.001; RR = 12.5; 95 per cent CI, 3.03-50.9; clinical sepsis (p < 0.001; RR = 5.7; 95 per cent CI, 1.6-20.7); and male sex (p < 0.001; RR = 6.3; 95 per cent CI 1.6-25.5) emerged as significant risk factors. Although the incidence of ROP is static, the more severe form of the disease (stage III) is showing a decline. Our data suggests that efficient management of apnea and sepsis may be crucial in further minimizing the risk of ROP.

Retinopathy of prematurity: Mutations in the Norrie disease gene and the risk of progression to advanced stages

Abstract Background : Retinopathy of prematurity (ROP) is a retinal vascular disease that occurs in infants with short gestational age and low birth weight and may lead to retinal detachment and blindness. Missense mutations in the Norrie disease (ND) gene have been associated with the risk of progression to advanced stages in cases of ROP from the US and also in clinically similar ND and familial exudative vitreoretinopathy.

Hyperplastic Pupillary Membrane and Laser Therapy

The eyes in two cases of extensive hyperplastic pupillary membranes with significant reduction of visual acuity and clarity were subjected to sectioning of the membranes in the superior 270 degrees of the pupil using a Q-switched Nd:YAG laser. The complications of microhemorrhages, pigment dispersal, and elevation of intraocular pressure were insignificant, while the objective and subjective improvement in vision was remarkable.

Prospective randomized evaluation of diode-laser and cryotherapy in prethreshold retinopathy of prematurity.

Purpose: To study the efficacy of indirect diode laser photocoagulation and cryotherapy in prethreshold retinopathy of prematurity (ROP).

Diagnostic Intraocular Fine-Needle Aspiration Biopsy—An Experience in Three Cases of Retinoblastoma

Ophthalmoscopically guided intraocular fine‐needle aspiration biopsy (FNAB) under general anesthesia was performed in three suspected cases of retinoblastoma (Rb). The first case presented with uveitis and the second with unusual radiological features. The third case had classical clinical features of bilateral Rb but the parents refused enucleation. After a cytologic diagnosis of retinoblastoma, two cases were subjected to enucleation and a histologic confirmation was obtained. The present article discusses the technique of guided intraocular FNAB and its limitations as well as utility in the preoperative diagnosis of retinoblastoma (Rb). The authors are of the opinion that FNAB should be considered a viable diagnostic option in selected cases of leucocoria when conventional investigative modalities prove inconclusive or for tissue diagnosis when a patient of suspected Rb refuses enucleation. Diagn. Cytopathol. 1999;21:331–334.

Treatment of Overhanging Blebs With Frequency-Doubled Nd:YAG Laser

Large overhanging blebs can be associated with various complications (eg, overfiltration, endophthalmitis, and dellen formation). Argon laser treatment of such blebs has already been described. The authors used frequency-doubled Nd:YAG laser in 3 eyes of 3 patients with large filtering blebs. Gentian violet was used to stain the bleb surface and enhance the laser absorption. Laser spots were applied over the bleb surface. Bleb shrinkage and remodeling was observed in all 3 eyes. Intraocular pressure remained normal, suggesting that the filtering capability of the blebs was maintained.

Laser conjunctivoplasty: a new technique for correction of mild medial ectropion.

Thirty patients with mild medial ectropion of the lower lid were treated by Argon green laser.A diamond-shaped area (6 × 4mm in size) on the medial part of the tarsal conjunctiva of the lower lid was burnt with overlapping spots until white blanching and visible contraction of tissue were seen. The apex of the diamond was kept 4mm below the punctal opening. After an average follow-up of 6 months, functional success was achieved in 22/30 eyes. Anatomical success in terms of repositioning of the punctum was attained in 24/30 eyes. The only side effect noted was a mild burning sensation of the eyes lasting for two hours after the procedure. This is the authors’ initial experience with a somewhat new and easy procedure to treat mild medial ectropion of the lower lid that can be performed on an outpatient basis.

Management outcome in prethreshold retinopathy of prematurity.

PURPOSE To evaluate the success of and timing for intervention in retinopathy of prematurity (ROP). PATIENTS AND METHODS Eighty-two eyes of 50 children with stage 3 ROP were divided into two groups based on severity. Cryotherapy or laser therapy was performed soon after the detection of threshold stage in the first group of 40 eyes and at a prethreshold stage in the second group of 42 eyes. The patients were observed from 4 months to 2 years and regression or progression was noted. Unfavorable outcomes including macular and disc drag and the progression of ROP to stages 4 and 5 were correlated with birth weight, gestational age, age at threshold, and age at intervention. RESULTS Regression of ROP occurred in 75 (91.46%) of the eyes. An overall unfavorable outcome occurred in 14 (17.07%) of the eyes, 11 of which reached threshold during the critical period of 37 to 39 postconceptional weeks of age. Of the cases (n = 14) with an unfavorable outcome, 9 eyes (22.5%) were in the group treated in the threshold stage (n = 40) and 5 eyes (11.9%) were in the group treated at a prethreshold stage (n = 42). The mean birth weight, gestational age, age at threshold, and age at intervention in the favorable and unfavorable outcome groups were 953.2 +/- 2.19 g and 1,059.57 +/- 2.62 g, 28.63 +/- 2.03 weeks and 28.36 +/- 1.98 weeks, 38.04 +/- 2.13 weeks and 37.71 +/- 1.13 weeks, and 38.32 +/- 2.34 weeks and 38.25 +/- 1.05 weeks, respectively. CONCLUSION Early intervention at a prethreshold stage of ROP or at a younger postconceptional age (ie, younger than 37 weeks) may decrease the incidence of an unfavorable outcome.

Inverse Uhthoff's symptom

Two cases of optic neuritis are presented in whom an inverse Uhthoffs symptom was elicited, i.e., an improvement in visual acuity instead of expected deterioration following exercise. The probable mechanisms for the genesis of inverse Uhthoffs symptom are discussed.