Jks Parihar

Medical and Surgical Management of Keratomycosis.

BACKGROUND Fungal keratitis is a diagnostic and therapeutic challenge to the ophthalmologist. If not treated energetically it results in marked ocular morbidity and permanent visual loss. METHODS Twenty five patients of fungal keratitis were studied for their response to management and final visual outcome. RESULT Males outnumbered females. Medical treatment was successful in 72% cases, while 28% required surgical intervention. Keratoplasty was done in five patients out of which graft was clear in four after one year of follow up. Three of these underwent optical keratoplasty since therapeutic grafts became opaque. CONCLUSION Early recognition of the disease and institution of prompt therapy is the key to successful management in fungal keratitis. Occasionally surgical management is required to preserve anatomical integrity of the globe and to salvage useful vision.

Conventional B-mode Ultrasonography for Evaluation of Retinal Disorders

Sonographic study of 164 patients (328 eyes) in the present series highlights the advantages of ocular ultra sonography (B-mode) in the evaluation of retinal disorders especially in patients with opaque ocular media. B-mode sonography of the eye is a rapid, cheap, safe and reliable investigation for the eye. The sensitivity and specificity of this modality in detecting ocular pathologies has been recorded as extremely high and is of great value to the eye surgeon for a preoperative assessment of the posterior segment when fundoscopy is not possible due to opaque ocular media from various causes.

Comparison of Phaconit Rollable IOL with Acrylic Foldable IOL

BACKGROUND Phaconit or ultra micro incision phacoemulsification cataract surgery involves phacoemulsification through a 0.9 millimetre sleeveless phaco tip and irrigating chopper followed by implantation of a rollable intraocular lens. The procedure leads to negligible astigmatism and faster visual recovery as compared to phacoemulsification with a foldable intraocular lens. METHODS This prospective study analysed 80 cases of sub millimetre phaconit surgery with implantation of rollable intraocular lenses(IOL) in 40 cases and acrylic foldable IOL in the remaining 40 cases. Evaluation of efficacy and adaptability of procedure, equipment settings, operative constraints, postoperative complications, keratometric and topographic evaluation of induced astigmatism with visual outcome and patients rehabilitation were studied. RESULTS The intraoperative complications were surge/ chamber collapse in 16 (20%), iris chaffing in one and corneal burns in two cases. All cases had an induced astigmatism of less than or equal to ± 0.25 D in four to six weeks after rollable IOL and ± 0.5 D to ± 0.75 D after acrylic IOL implantation. All patients had best-corrected visual acuity of 6/6 by third post operative day. CONCLUSION Phaconit with rollable IOL is a perfect blend of surgical skill, application of technology and ultra thin IOL.

Corneal ulcer? Think beyond only a bacterial etiology

Though globally, an estimated 4.0 billion people are infected with the herpes virus, however even after several years of intensive research into herpes simplex virus keratitis (HSK) and substantial progress in understanding its virology, the management of this condition continues to be challenging.1 In addition, in an under developed country like ours where bacterial and fungal keratitis are far more common, a viral etiology for keratitis is generally not thought of initially, which delays the initiation of timely appropriate treatment often resulting in permanent damage.

An interesting case of rubeosis iridis with neovascular glaucoma in a young patient.

Rubeosis iridis is defined as neovascularization of the iris characterized by numerous coarse and irregular vessels on the surface and stroma of the iris. These new blood vessels may cover the trabecular meshwork, cause peripheral anterior synechia and give rise to secondary glaucoma. Its most frequent causes are diabetes mellitus and central retinal vein occlusion (CRVO). CRVO is one of the most common retinal vascular disorders that may lead to blindness. It usually affects older patients, with over 90% cases being over the age of 65 years.1 Hypertension, diabetes, atherosclerosis and hypercoagulable states are all considered as its predisposing factors, in addition to the various local ophthalmic conditions such as open angle glaucoma, ocular trauma and orbital infections.1 Here we report an interesting case of unilateral rubeosis iridis leading to severe neovascular glaucoma following CRVO in a young patient with no major predisposing factors whatsoever.

Simple laceration wound of the eyelids? Always remember to look under the lids!

Lacerated wounds of the eyelids are common features of ocular trauma and often occur in isolation without any associated intraocular injuries. Their management too is quite straightforward with simple primary lid repair. However sometimes these injuries may obscure a much more severe accompanying intraocular injury, which if not detected in time may lead to a total blindness. The aim of this article is to highlight the importance of a complete ophthalmological evaluation in each and every case of even a supposedly mild ocular injury.

Macular Hole Surgery : Maiden Experience

Macular holes (MHLs) first described over a century ago by Noyes [1], have seen a renewed interest in their pathophysiology and management in the last two decades. They occur following trauma, laser treatment, cystoid macular edema, retinal vascular disorders, retinal detachment (RD) or may not have any detectable cause. Most MHLs occur as age-related primary idiopathic entities. Full thickness MHLs were once considered untreatable and were treated only when there was an accompanying extensive RD. Initially MHLs were treated with achieving strong vitreo-retinal (VR) adhesions around the MHL but with refinement of VR techniques and emphasis on tangential traction being responsible for the MHL, retinal surgeons are attempting treatment with vitrectomy, membrane peeling and intra-ocular gas tamponade.

Role of Transpupillary Thermotherapy in Central Serous Chorio-Retinopathy

BACKGROUND To assess the efficacy of transpupillary thermo therapy (TTT) in cases of chronic central serous chorio- retinopathy (CSCR). METHODS A prospective evaluation was carried out on 25 cases of chronic CSCR who were subjected to TTT. Resolution of CSCR and improvement in visual acuity was noted after six weeks of therapy. RESULT Out of 25 patients, 13 (52%) had complete success (resolution of CSCR and improvement in visual acuity > 2 lines on Snellens chart), 10 (42%) had qualified success (resolution of CSCR but no improvement in visual acuity) and two (8%) had failure to therapy (no resolution of CSCR or improvement in visual acuity). CONCLUSION TTT maybe a good modality in aiding resolution of subretinal fluid in cases of chronic CSCR. However, improvement in visual function is dependent upon integrity of photo receptor layer of retina which is not influenced by this modality. A controlled study could be undertaken to compare outcome of TTT with conservative management in cases of early CSCR such that deleterious effects of chronic CSCR on the retinal photoreceptor layer are avoided.

Best's Vitelliform Macular Dystrophy

Macular dystrophies are arbitrarily classified on the basis of their tissue of origin into those originating from nerve fibre layer, photoreceptors and retinal pigment epithelium (RPE), RPE alone, Bruchs membrane and choroid. Vitelliform dystrophy of the fovea is a separate entity among the inherited macular dystrophies. It was first reported by Adam [1] and the first pedigree was described by Best. It results in typical vitelliform lesions that are bilateral though asymmetrical and cause only moderate diminution of vision for a long time.

AC/PC Intraocular Lens Exchange with Penetrating Keratoplasty in Pseudophakic Bullous Keratopathy

BACKGROUND Evaluation of penetrating keratoplasty in cases of pseudophakic bullous keratopathy with AC/PC IOL exchange. METHODS This retrospective study included 120 cases of pseudophakic bullous keratopathy managed over 9 years at three tertiary care eye centres followed up for 4 years. Cases were taken up for penetrating keratoplasty along within adjuvant procedures like IOL explantation and Secondary Posterior Chamber IOL implantation over the frill of posterior capsule. RESULTS Lens exchange with Penetrating Keratoplasty (PK) was done in 93 and PK without lens exchange in 27 cases. 25% required systemic steroids for 2-3 weeks. Re-grafting was performed in 5% and 85% attained moderate visual acuity. CONCLUSION Intra ocular lens exchange and Posterior chamber IOL are suitable for penetrating keratoplasty in terms of optical clarity, graft survival and visual outcome.