Jayanthi Peter

Ocular manifestations of Takayasu arteritis: a cross-sectional study.

Purpose: To detail the spectrum of eye manifestations in Takayasu arteritis and factors predisposing to its development. Methods: In this cross-sectional study, 61 patients with proven Takayasu arteritis who were identified during a 16-month period were evaluated for disease- and treatment-related eye manifestations. A fundus fluorescein angiography examination was performed where indicated and with the patients consent. Results: The mean (±standard deviation) duration of illness before ophthalmic evaluation was 55 ± 69 months. Decreased vision was the most common ocular symptom (30%). Thirty-five patients underwent fundus fluorescein angiography examination. Takayasu retinopathy was seen in 9 (15%), ocular ischemic syndrome in 4 (7%), and hypertensive retinopathy in 10 (16%) patients. The most common treatment-related ocular complication was steroid-induced cataract (23%). Other manifestations included iris neovascularization (n = 3), anterior ischemic optic neuropathy (n = 2), steroid-induced glaucoma (n = 1), neovascular glaucoma (n = 1), and uveitis (n = 1). Those manifesting Takayasu retinopathy and ocular ischemic syndrome had significantly (P < 0.05) lower blood pressure in both upper limbs compared with patients not manifesting ischemic retinopathy. A significant (P < 0.03) proportion of patients with Takayasu retinopathy and ocular ischemic syndrome had a nonrecordable right upper limb blood pressure. Conclusion: Disease- and treatment-related ocular complications are not infrequent in Takayasu arteritis. Arteritis involving the aortic arch and its branches favors the development of ischemic ocular complications.

Incidence and risk factor evaluation of exposure keratopathy in critically ill patients: A cohort study

PURPOSE Recent emphasis on eye care in intensive care unit (ICU) patients has translated to eye assessment being part of routine care. In this setting, we determined the incidence, risk factors, and resolution time of exposure keratopathy. METHODS In this prospective cohort study, 301 patients were examined within 24 hours of ICU admission and subsequently daily by an ophthalmologist till death or discharge. Eyelid position, conjunctival and corneal changes, treatment, and outcome data were collected. RESULTS Admission diagnoses included febrile illnesses (35.2%) and respiratory failure (32.6%); 84.1% were ventilated. Forty-nine patients had exposure keratopathy (bilateral = 35, unilateral = 14) at admission; 35 patients developed new onset keratopathy (incidence 13.2%) 4.6 ± 2.6 days after ICU admission. In 67 patients, keratopathy was mild (punctate epithelial erosions). Macroepithelial defects (n = 9), stromal whitening with epithelial defect (n = 3), and stromal scar (n = 3) were infrequent. None developed microbial keratitis. On multivariate logistic regression analysis, eyelid position (odds ratio, 2.93; 95% confidence interval, 1.37-6.25), and ventilation duration (odds ratio, 1.11; 95% confidence interval, 1.04-1.19) were strongly associated with the development of keratopathy after ICU admission. Keratopathy resolved in 3.6 ± 4.5 days. CONCLUSIONS Severe exposure keratopathy is infrequent in a protocolized ICU setting. Eyelid position and duration of ventilation are associated with exposure keratopathy.

Hypoperfusive and hypertensive ocular manifestations in Takayasu arteritis

Takayasu arteritis is a relatively rare inflammatory arteritis that can be associated with ocular manifestations. We report four patients with proven Takayasu arteritis; two patients manifested hypoperfusive ocular manifestations of ocular ischemic syndrome and anterior ischemic optic neuropathy whilst two others had exudative retinal detachment and papilledema as a result of severe hypertension. The ischemic ocular manifestations were a result of hypoperfusion of the ocular structures due to occlusive arteritis of the aortic arch and its branches. The exudative retinal detachment and papilledema were manifestations of severe hypertension due to renal arterial involvement. Patients with Takayasu arteritis should be referred for ophthalmic assessment and screening for hypoperfusive and hypertensive manifestations.

Oculocutaneous anthrax: detection and treatment

Anthrax, a zoonotic disease that primarily affects herbivores, has received recent attention as a potential agent of bioterrorism. We report a patient who presented with a 4-day history of pain, watering and difficulty in opening the left upper and lower eyelids, and fever. Clinical examination revealed brawny nonpitting edema with serosanguinous discharge. The history of the death of his sheep 1 week prior to the illness provided the clue to the diagnosis. Although standard cultures of the blood and the serous fluid from the lesion were negative, probably as a result of prior treatment, the diagnosis of cutaneous anthrax was made by a polymerase chain reaction (PCR) test of the serous fluid. Serial photographs demonstrating resolution of the lesion with appropriate antibiotic therapy are presented.

Visual loss in Takayasu Arteritis – Look Beyond the Eye

Patients with Takayasu arteritis often present with reduced vision related either to the disease per se or due to complications of therapy. We report a patient with Takayasu arteritis who developed acute onset bilateral visual loss 6wks following percutaneous revascularization of occluded aortic arch branches. No ocular cause for the visual loss was evident. The reason for visual loss in this patient was an extraocular cause. Ocular and extraocular causes of visual loss in Takayasu arteritis are discussed.

Risk of pandemic (H1N1) 2009 virus infection among healthcare workers caring for critically ill patients with pandemic (H1N1) 2009 virus infection

laparoscopygrouphadpreoperative chemotherapy. Data onpreoperative albumin, smoking history and diabetes were not collected. All patients but one were followed up at 30 days (one patient lost to follow-up because of a change in general practitioner). Surveillance was performed on one patient who remained an inpatient at 30 days, by reviewing the case notes and drug charts and scrutinising for evidence of SSI. PDS was performed at 4–6 weeks; an outpatient appointment with a consultant surgeonwas made by checking the clinic entry for documented evidence of infection. The two patients readmitted within the 30 day period had case notes and drug charts scrutinised for evidence of infection. When three patients were discharged home prior to 30 days post surgery and had not had an outpatient appointment, PDS was performed by contacting their general practitioners by telephone and asking whether they had prescribed antibiotics for SSI. Our case–control audit demonstrates that the SSI rates in our department are not significantly different for robotic, laparoscopic surgery (3.8%) compared with conventional laparoscopic abdominal surgery (8.7%), although too few patients were assessed to confirm any real difference and the surveillance is ongoing. We conclude that it is important to collate the PDS data on SSI when a new procedure is introduced to an institution to ensure that quality indicators such as SSI are kept under review.

Rare retinal manifestations in Takayasu arteritis.

Two patients diagnosed with Takayasu arteritis (TA) using the American College of Rheumatology classification1 had uncommon retinal findings. A 54-year-old woman with stable Type I TA for 10 years presented with reduced vision of the right eye for 4 days. Fundus examination showed retinal edema along the inferotemporal arcade (Figure 1) with a corresponding field defect consistent with …

Orbital Metastasis of Cervical Carcinoma – Case Report and Review of Literature

The orbit is a frequent site of metastasis, particularly from the breast, prostate gland and the lung. Carcinoma of the cervix metastasizing to the orbit is rare. We report a 27-year-old woman with Stage II B cervical cancer who presented with progressive painless protrusion of the left eye of one month duration associated with diplopia. Histology of the orbital mass was similar to that of the cervical cancer and reported as squamous cell carcinoma. She received palliative radiation to the left orbit 30 Gy in 10 fractions along with chemotherapy (Paclitaxel and Carboplatin). This resulted in regression of the proptosis. We review published literature of cases of carcinoma of the uterine cervix with metastasis to the orbit.