Jitendra Jethani

Helicobacter pylori IgG antibodies in aqueous humor and serum of subjects with primary open angle and pseudo-exfoliation glaucoma in a South Indian population.

PurposeA prospective, nonrandomized, comparative study was carried out to investigate levels of anti–Helicobacter pylori-specific IgG antibodies in the aqueous humor and serum of patients with primary open angle glaucoma (POAG), exfoliation syndrome [pseudo-exfoliation glaucoma (PXFG)], and with normotensive cataract patients, who served as controls. MethodsAqueous humor was aspirated at the beginning of glaucoma surgery from 50 eyes of 50 patients with POAG, with PXFG and at the beginning of phacoemulsification cataract surgery from controls. Serum samples were obtained. Anti-H. pylori IgG concentration in the aqueous humor and serum was measured by means of enzyme linked immunosorbent assay. ResultsSerum analysis of anti-H. pylori IgG antibodies revealed statistically significant difference between POAG and PXFG (52.26±52.51 vs. 25.22±35.27, P=0.01). Also, the difference between POAG and controls was statistically significant (54.05±55.04 vs. 33.83±41.73, P=0.04). However, on comparing PXFG with the control group, the difference was statistically insignificant (P=0.12). The mean concentration of anti-H. pylori IgG antibodies in aqueous humor of patients in POAG and controls were not statistically different (3.93±5.14 vs. 2.65±2.87, respectively, P=0.73). The mean concentration of anti-H. pylori IgG antibodies in aqueous humor of patients in PXFG and controls were not statistically different (8.87±30.25 vs. 2.65±2.87, respectively, P=0.83). There was also no statistical difference of IgG levels between POAG and PXFG (3.93±5.14 vs. 8.87±30.25, respectively, P=0.87). ConclusionsThe levels of anti-H. pylori IgG titers in sera of individuals with POAG were significantly higher compared with PXFG and control groups. We support the hypothesis of the role of anti-H. pylori antibodies in causative mechanism for POAG. We could not find a significant link between the anti–H. pylori IgG antibodies and the PXFG.

Measuring normal ocular torsion and its variation by fundus photography in children between 5-15 years of age

Cycloposition has been measured by various methods; however, fundus photography is the most reliable method to evaluate the torsion objectively. We did a prospective study to find out the disc foveal angle (DFA) and its variation in children without squint. We included 210 eyes of 105 children between the ages of 5-15 years. DFA was calculated using standard technique after taking a fundus photograph. The cycloplegic refraction was done and compared. The mean age was 10.6 ± 2.5 years. Mean DFA in right eye (RE) was 6.49 ± 3.25° (0-13°) and in left eye (LE) was 5.80 ± 3.29° (0-12°). The difference between the RE and LE was statistically not significant (P=0.131) (mean 1.15 ±1.39°). Mean DFA in emmetropic children was 6.1° ± 3.4° (n=112 eyes). DFA varies widely in children. The difference observed in DFA measurement for eyes with various refractive errors were compared with DFA measurements for emmetropic eyes.

Bilateral persistent fetal vasculature: A study of 11 cases

PURPOSE To describe the clinical and radiologic features of patients with bilateral persistent fetal vasculature (PFV). METHODS All patients diagnosed with symmetric, bilateral PFV over a 3.5-year period were included in this representative, observational case series. Only patients with more or less symmetrical disease in both eyes were included. Examination under anesthesia was performed in all but 1 case. B-scan ultrasonography of the eye was performed in all cases. A computed tomographic or magnetic resonance imaging scan was done if the ocular ultrasonography was inconclusive. A systemic workup was performed to rule out associated systemic anomalies. RESULTS The study group included 11 patients. Of the 22 eyes studied, 20 (91%) showed features of both the anterior and the posterior forms of PFV. Two children tested positive for IgM rubella antibodies. Ten eyes (45.5%) had a horizontal corneal diameter of less than 10 mm. Fifteen eyes (68.2%) had cataract at presentation. Intraocular pressure was >21 mm Hg in 17 eyes (77.3%). CONCLUSIONS Microcornea and cataract were common findings. Bilateral PFV cases were more commonly associated with combined anterior and posterior PFV. Bilateral PFV, although infrequent, should be considered in the differential diagnosis of bilateral leukocoria.

Congenital unilateral ocular fibrosis syndrome secondary to benign congenital tumor.

Congenital unilateral fibrosis, blepharoptosis and enophthalmos syndrome is one of the rare forms of congenital fibrosis of extraocular muscles. The nature and cause of such unilateral inflammation leading to fibrosis is unknown. Prenatal orbital penetration has been proposed as a cause of this syndrome. We report a case of this rare syndrome associated with an adjacent sinus tumor.

Synergistic convergence and split pons in horizontal gaze palsy and progressive scoliosis in two sisters.

Synergistic convergence is an ocular motor anomaly where on attempted abduction or on attempted horizontal gaze, both the eyes converge. It has been related to peripheral causes such as congenital fibrosis of extraocular muscles (CFEOM), congenital cranial dysinnervation syndrome, ocular misinnervation or rarely central causes like horizontal gaze palsy with progressive scoliosis, brain stem dysplasia. We hereby report the occurrence of synergistic convergence in two sisters. Both of them also had kyphoscoliosis. Magnetic resonance imaging (MRI) brain and spine in both the patients showed signs of brain stem dysplasia (split pons sign) differing in degree (younger sister had more marked changes).

Bilateral spontaneous hyphaema in juvenile xanthogranuloma

This report describes a rare occurrence of bilateral, spontaneous, nontraumatic hyphema in a 6 weeks old infant, associated with a small, multiple skin lesions. The diagnosis of juvenile xanthogranuloma was confirmed by histopathological examination of the cutaneous lesions. The hyphaema cleared gradually in 2 weeks time with conservative management.

A technique for standardizing disk foveal angle measurement

Ocular torsion can been measured by perimetry, double Maddox rod, Bagolini glasses, indirect ophthalmoscopy lens, slit-lamp biomicroscopy, synoptophore, and fundus photography. Wide variations have been reported in the measurement of the disk foveal angle (DFA) using fundus photography. We describe a technique for measuring the DFA, formed by a horizontal line extending from the center of the optic disk and a line from the center of disk to the fovea, using Microsoft PowerPoint and ImageJ software.

Anterior plagiocephaly with contralateral superior oblique overaction

Anterior plagiocephaly is a craniofacial anomaly related to premature unilateral synostosis. We present three cases of anterior plagiocephaly with contralateral superior oblique dysfunction. A detailed ophthalmic examination, including orthoptic assessment for the extraocular muscle misalignment, with appropriate radio- imaging was done in all the three cases. All of them showed a right-sided plagiocephaly, with overaction of the left superior oblique muscle, alternating exotropia and a dissociated vertical deviation. Two underwent surgical correction of squint. Both were well aligned after squint surgery. Plagiocephaly has been reported to simulate superior oblique muscle paresis. We report a rare occurrence of contralateral superior oblique muscle overaction in three children with anterior plagiocephaly.

Atypical association of Duane retraction syndrome and Bardet Biedl syndrome.

Duanes retraction syndrome (DRS) includes changes in palpebral fissure width along with restriction of ocular motility. Bardet Biedl syndrome (BBS) includes presence of retinitis pigmentosa (RP) with obesity, mental retardation, polydactyly and renal abnormalities. We report a case of rare association of DRS with BBS in a seven-year-old child. The ocular motility examination revealed left DRS with esotropia. Fundus examination revealed findings characteristic of an atypical retinitis pigmentosa. The electro-retinogram waveforms were extinguished both for rods and cones. He was diagnosed as a case of BBS on the basis of the ophthalmological findings plus association with the systemic features of obesity, polydactyly, hypogonadism, mental retardation and renal abnormalities. This case gives further evidence of the fact that BBS may be associated with abnormalities of eye movements.

Asymmetry of Retinal Nerve Fiber Layer and Posterior Pole Asymmetry Analysis Parameters of Spectral Domain Optical Coherence Tomography in Children

ABSTRACT Purpose: To determine inter- and intraocular differences in the retinal nerve fiber (RNFL) and posterior pole asymmetry analysis (PPAA) macular thickness parameters in children using spectral domain optical coherence tomography. Method: A prospective, cross-sectional study involving 126 subjects between the age group of 5–15 years received a standardized eye examination including spectral domain optical coherence tomography for retinal nerve fiber layer and macular thickness measurements. Asymmetry was calculated as the difference between the right and left eyes as well as the superior and inferior area of one randomly selected eye for each subject. Normal ranges were established as the 2.5 and the 97.5 percentiles. Correlation between the right and left eyes were assessed by intraclass correlation coefficients. Results: The difference in the average and superior RNFL between the right and the left eye was not statistically significant. The interocular 2.5 and 97.5 percentile limits for RNFL thickness and total PPAA macular thickness were –7.75 to 12.5 microns and –9 to 21 microns, respectively. The 2.5 and 97.5 percentile limits of the intraocular superior-inferior area difference for the RNFL thickness and PPAA macular thickness were –40 to 37 microns and –32 to 38 microns, respectively. A strong correlation for all parameters between the right and the left eye was seen. Conclusion: The normal interocular RNFL and PPAA macular thickness asymmetry should not exceed 12.5 microns and 21 microns, respectively. Similar intraocular limits for superior-inferior asymmetry should not exceed 40 and 38 microns, respectively.