Jolly Rohatgi

Retinopathy of Prematurity- Risk Factors

Objective: Improved survival of low birth weight, premature babies have increased the incidence of retinopathy of prematurity. This hospital-based, prospective, study was undertaken to determine its incidence and risk factors in our neonatal unit.Methods: Neonates with gestational age ≤ 35 weeks and/or birth weight ≤ 1500 gm born over a one-year period were examined by indirect ophthalmoscopy between 2 to 4 weeks after birth, and followed up till retinal vascularisation was complete. Maternal and neonatal risk factors were noted and data analyzed by statistical package SPSS-10.0.Results: Sixty babies were thus examined. The incidence of retinopathy was 21.7% in the cohort, 33.3% in babies ≤32 weeks gestation and 36.4% in babies weighing ≤1250 gm. Oxygen (p=0.01), sepsis (p=0.04) and apnoea (p=0.02) were independent risk factors. Retinopathy was significantly more severe in babies with hyaline membrane disease (p=0.02) and lower birth weight (p=0.02). Severe disease was never seen before 6.5 weeks of age.Conclusion: Indirect ophthalmoscopy should be performed at 4 weeks of post natal age in all preterm babies with birth weight ≤ 1500 gm, and intensified in the presence of risk factors like oxygen administration, apnoea and septicemia.

Phlyctenular Eye Disease : A Reappraisal

PURPOSE Phlyctenular keratoconjunctivitis is a nonspecific allergic response in the cornea and/or conjunctiva to a variety of distinct conditions. Tuberculosis as an etiological association is being supplanted by staphylococcal infection and worm infestation in developed countries. Our aim was to determine the relative frequency of the various known etiological factors of phlyctenular keratoconjunctivitis, and the clinical profile of the disease as it exists today in India, a country where tuberculosis is still highly prevalent. CASES This is a prospective study of 112 consecutive patients with phlyctenular eye disease seen over a 2-year period. OBSERVATIONS In 86 patients (76.7%), phlyctenular eye disease was associated with tuberculosis. Worm infestation was found in 14 patients (12.4%), whereas 7 (6.2%) had staphylococcal blepharitis. Thirteen patients had evidence of multiple etiology, of which one causative factor was always tuberculosis. When tuberculosis was the only association, 37% patients had severe lesions, whereas only 11. 5% patients without tuberculosis had such lesions. When tuberculosis along with another etiological factor was present, the incidence of severe lesions increased to 84.6%. Recurrence on follow-up was seen in three patients who were already on multidrug therapy for tuberculosis, and two who had tubercular allergy. CONCLUSIONS Our study shows that tuberculosis is still a major cause of phlyctenular eye disease in India. Severe lesions are more common in patients with tuberculosis, especially when another etiological factor is associated. Recurrences are more common in patients with tuberculosis. Corneal lesions are less extensive than described in the literature and are no longer a significant cause of blindness.

Cutaneous tuberculosis and phlyctenular keratoconjunctivitis: A forgotten association

Cutaneous tuberculosis may be associated with concurrent systemic foci in the body such as lung, lymph node, bone or CNS. Phlyctenular keratoconjunctivitis (PKC) is a manifestation of immunological response to a variety of antigens in the eye, tubercular focus (evident or occult) being the commonest in India. Reports in the existing literature have shown lungs and lymph nodes to be the predominant underlying focus associated with PKC, whereas cutaneous tuberculosis has seldom been found in this situation. We report this forgotten association in two children with cutaneous tuberculosis, one each with lupus vulgaris and scrofuloderma, who also had PKC. Interestingly, one of the cases also had simultaneous lichen scrofulosorum, which is also an immunological response to tubercular antigen and manifests in the skin, thus showing immunological manifestation in two different organ systems along with cutaneous focus of tuberculosis.

Onset and Pattern of Tear Secretions in Full-Term Neonates

Purpose: Serial evaluations of total, basal and emotional tear secretion in full-term normal neonates to determine the time after birth when these parameters attain normal adult values. Method: Both eyes of 102 full-term normal neonates were prospectively evaluated for tear secretions in the Department of Ophthalmology, over a period of one year. Serial recording of the Schirmer I test (total tear secretions), Basal Secretion Test, and Schirmer II test (emotional tears) was done, the first one being within 6 hours of birth. All the tests were repeated in each infant until normal adult values for each test were obtained. Results: The average values of the Schirmer I test, Basal Secretion Test and Schirmer II test at birth were 23.2 (± 3.96) mm, 6.2 (±2.15) mm and 19.2 (±4.94) mm, respectively. A statistically significant correlation of birth weight but not of gestational age was found with basal secretions (p = 0.004) as well as with emotional tears (Schirmer II test, p = 0.010). At birth, 98% of infants had total tear secretion, 3.9% had basal tear secretion and 2.9% had emotional tear secretion comparable to normal adult values. All the parameters of tear secretions increased with time, so that 100% of infants had total tear secretion comparable to normal adult values within 12 hours of birth. The basal secretions took three weeks and emotional tears took four weeks to attain normal adult values in all the neonates. Conclusion: Total tear secretions were the earliest to reach normal adult values, followed by basal secretions and, lastly, emotional tears. Reduced basal tears at birth may predispose neonates to corneal drying during prolonged ocular examinations such as indirect ophthalmoscopy and procedures under general anesthesia.

Complex Ocular Choristomas in Linear Nevus Sebaceus Syndrome: A Report of Two Cases

Two cases of linear nevus sebaceus syndrome (LNSS) are described in which ipsilateral facial nevus of Jadassohn was associated with complex ocular choristoma. One patient also had scleral osteomas, a rare occurrence in LNSS.

Behcet's disease in India: A dermatological perspective

BACKGROUND Behcets disease (BD) is a chronic, recurrent, multi-system inflammatory disorder involving mucocutaneous (MC), ocular, intestinal, articular, vascular, urogenital and neurologic systems. BD occurs with a high prevalence in the Mediterranean population. There is scarcity of clinical data on BD from India with only three case series in the last two decades. AIMS To study demographic profile, clinical manifestations and treatment outcome of patients with BD presenting to the dermatologic clinic in a tertiary hospital in north India. METHODS Prospective analysis of all patients diagnosed to have BD between 1997 to 2011. RESULT Twenty nine patients were diagnosed to have BD. The disease had a female preponderance (M:F = 1:3.8) with a mean age of disease onset of 27.4 (range 16-61) years. The prevalence of various MC and systemic manifestations are as follows: oral aphthae (100%), genital aphthae (93.1%), erythema nodosum (62%), papulopustular and acneiform lesions (31%), articular involvement (68.9%), ocular involvement (31%) and gastrointestinal (GI) involvement (3.4%) . Pathergy test positivity was observed in 31%. The treatment comprised of colchicine (16/29 patients), dapsone (7/29), dapsone with pentoxiphylline (3/29), systemic steroid (2/29), systemic steroid with methotrexate (1/29). Colchicine was effective and well tolerated in all patients. CONCLUSION The disease occurs in a much milder form in India and is primarily mucocutaneous and arthritic. A high index of suspicion in patients with MC lesions may result in early diagnosis, management and prevention of complications of BD. We suggest colchicine as an effective and safe therapeutic option for MC and joint involvement.

Epidermal nevus syndrome associated with unusual neurological, ocular, and skeletal features

Epidermal nevus syndrome (ENS) is a rare disease, the pathogenesis of which is largely elusive. We, hereby, report an exclusive case of a 20-year-old man with verrucous ENS presented with dark colored papules and plaques along the Blaschkos lines present over the head and neck area along with fleshy growth in both eyes since birth. Limb length discrepancy and kyphoscoliosis were remarkable. Skin biopsy was compatible with verrucous epidermal nevus while the biopsy of the ocular lesion confirmed complex choristoma. MRI brain revealed calcification in the right temporal lobe. Bilateral arachnoid cyst in the middle cranial fossa, scleral osteoma in the posterior part of the right eyeball, and deformed calvarium were evident on CECT skull and orbit. The present illustration emphasizes the importance of a punctilious work up of the case.

Burden and depression in primary caregivers of persons with visual impairment

Context: Caregivers who assist persons with visual impairment often neglect their needs, resulting in burden and depression. Rehabilitation efforts, directed to the disabled, seldom target the caregiver. Aim: To assess burden and depression in persons caring for blind individuals. Settings and Design: This was a cross-sectional study carried out in the outpatient department of a tertiary-level teaching hospital in New Delhi. Materials and Methods : Institutional Ethical Board approval was obtained and written informed consent too was obtained from the participants involved in this study. Persons with best-corrected vision <20/200 in the better eye, and their primary caregivers, were recruited. We recorded demography, other illness/disability, household income, relationship with disabled person, and caregiver burden (Caregiver Burden Scale) and depression (Centre for Epidemiologic Studies Depression Scale). Statistical Analysis: Statistical analysis was carried out using SPSS version 20 (Released 2011. Armonk, NY: IBM Corp.); range, average, and standard deviation were determined for age, burden, and depression. The association between burden and depression was determined using Pearson′s correlation; the relationship between degree of disability and caregiver burden and depression was determined using unpaired t-test; using multiple linear regression, factors were found to be statistically significant; significance was taken at P < 0.05. Results: Twenty-seven (53.0%) men and 24 (47.0%) women had visual impairment. Most caregivers (n = 40; 81.6%) were first-degree relatives or a spouse; 32 (65%) had schooling <5 years; and 29 (59%) were unemployed. Depression ranged from 21 to 52 (average 43.2 ± 5.71); it correlated with degree of disability (P = 0.012), household income (r = −0.320; P = 0.025), and burden (r = 0.616; P < 0.001). Burden ranged from 30 to 73 (average 54.5 ± 6.73) and correlated with degree of disability (P = 0.006). On multiple linear regression, burden predicted depression (r = 0.557; P < 0.001). Conclusions: Caregivers merit community support, financial benefit, interventions to diagnose and treat depression, and training in coping. Centers that provide disability certification could offer counseling.

Tuberous sclerosis complex: Diagnostic role of magnetic resonance imaging

Tuberous sclerosis complex (TSC) is a well-known clinical entity, characterized by facial angio-fibroma, shagreen patch, and hypo-melanotic, and confetti-like skin lesions. An exquisite fresh case is being narrated, emphasizing its microscopic pathology. The role of magnetic resonance imaging of the brain, in particular, is highlighted to define the large variety of neurological abrasions for determining its future progression.

A Prospective Study of Anterior Segment Ocular Parameters in Anisometropia

Purpose The aim of this study was to investigate the differences in anterior segment ocular parameters in anisometropia >1 D. Methods This study included 202 eyes of 101 subjects ranging from 10 to 40 years of age with anisometropia of 1 D or more. The subjects were divided into groups according to anisomyopia, anisoastigmatism, and anisohypermetropia. After providing informed consent, each patient underwent a detailed ophthalmological examination including cycloplegic refraction, best-corrected visual acuity, cover test, axial length (AL) measurement using A-scan ultrasound biometer, keratometry, anterior chamber depth, and central corneal thickness measurement. For each participant, the eye with greater refractive error was compared to the fellow eye via paired t-tests. Correlations between parameters were studied using the Pearson correlation coefficient. Results The average age of subjects was 21.7 ± 9.3 years. Of 101 subjects, 31 had anisomyopia; 42 had anisohypermetropia; and 28 had anisoastigmatism. A predisposition toward greater myopia in right eyes was noted in anisomyopia (24 of 31 subjects, 77%). The inter-ocular acuity difference was significant in all three groups (p < 0.01). As the degree of anisometropia increased, there was significant positive correlation in the difference in AL in myopes (r = 0.863, p < 0.01) and hypermetropes (r = 0.669, p < 0.01) and the difference in corneal curvature in anisoastigmatism (r = 0.564, p = 0.002) and hypermetropes (r = 0.376, p = 0.014). A significant positive correlation was also present between the anterior chamber depth difference and refractive difference in hypermetropes (r = 0.359, p = 0.020). Conclusions This study showed that anisomyopia is correlated only with anterior chamber differences. Anisohypermetropia is correlated with AL differences as well as corneal curvature difference and anterior chamber depth difference. The amount of anisoastigmatism correlates only with corneal curvature difference.