Kalpana Narendran

Intravitreal bevacizumab (Avastin) for post laser anterior segment ischemia in aggressive posterior retinopathy of prematurity

Aggressive posterior retinopathy of prematurity (formerly known as fulminate/type II/rush disease) occurs in zone 1 or posterior zone 2. Treatment involves extensive near confluent laser ablation of a large area of avascular retina. Anterior segment ischemia is a rare complication that can occur due to injury to the long posterior ciliary arteries in the horizontal meridians during aggressive posterior laser treatment. The outcome of this rare complication is very poor. This case describes a favorable outcome of intravitreal injection of bevacizumab (Avastin) in a case of anterior segment ischemia.

Rubella serosurveys at three Aravind Eye Hospitals in Tamil Nadu, India

OBJECTIVE To determine the susceptibility of female eye hospital staff to rubella infection and the potential risk for hospital-based rubella outbreaks. METHODS A prospective cohort study on the seroprevalence of rubella IgG antibodies was conducted at three large eye hospitals in Coimbatore, Madurai and Tirunelveli, Tamil Nadu, India, where young children with eye abnormalities attributable to congenital rubella are treated. A total of 1000 female hospital employees aged 18-40 years agreed to participate and gave written informed consent. FINDINGS The proportions of rubella-seronegative women were: 11.7% at Coimbatore, with a 95% confidence interval (CI) of 8.1-16.5; 15% at Madurai (95% CI = 12.3-18.1), and 20.8 at Tirunelveli (95% CI = 14.7-28.6). For the entire cohort the proportion seronegative was significantly higher among married women (21.5%) than among single women (14.0%) (P = 0.02). Rates of seronegativity were highest among physicians and lowest among housekeepers. All 150 seronegative women in the study sample accepted a dose of rubella vaccine. CONCLUSION These are the first rubella serosurveys to have been reported from eye hospitals in any country. The relatively high rate of susceptibility indicated a risk of a rubella outbreak, and this was reduced by vaccinating all seronegative women. A policy has been established at all three hospitals for the provision of rubella vaccine to new employees. Other hospitals, especially eye hospitals and hospitals in countries without routine rubella immunization, should consider the rubella susceptibility of staff and the risk of hospital-based rubella outbreaks.

Speciation of Coagulase Negative Staphylococcus causing Bacterial Keratitis

Thirty-five coagulase negative Staphylococcus (CoNS) cultured from corneal ulcer were speciated and antibiotic sensitivity tested. S epidermidis was the commonest isolate and it was sensitive to ampicillin and vancomycin.

Prevalence of eye signs in congenital rubella syndrome in South India: A role for population screening

Purpose: Congenital rubella syndrome (CRS) resulting from maternal rubella infection, especially in the first trimester, affects an estimated 100 000 infants each year worldwide. Immunisation has reduced its occurrence in the developed world, though it remains a problem in countries with poor immunisation coverage. This population-based study was aimed at screening children below 5 years of age for ocular signs suspicious of CRS. Methods: Suspected CRS cases were recruited from hospital and outreach services of the Aravind Eye Care System over a 24-month period. Clinical confirmation was based on the fulfilment of the World Health Organization (WHO) definition, and laboratory confirmation was based on a positive test for IgM antibody. Results: Children under 5 years of age (n = 51 548) with ocular complaints were screened for eye signs suspicious of CRS; CRS compatible signs were detected in 1.92% (1090) children. Of these suspects (299), 27.42% were subsequently confirmed clinically according to WHO definition, and (46) 4.2% were serologically (Laboratory) confirmed. Of all the eye signs evaluated for screening, cataracts were the most sensitive (80.43%). Conclusions: Cataracts among children have a high sensitivity for detecting CRS in India. It is the only clinical eye finding that has a high enough sensitivity and specificity to be useful as a screening tool for CRS.

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).

Traumatic superior oblique tendon rupture.

Traumatic rupture of an extraocular muscle is rare, and most commonly affects the horizontal and vertical rectus muscles. We report a case of a 45-year-old man injured by a metal hook, with rupture of the superior oblique tendon. The resulting deficit was less severe than expected, raising the question of whether a few superior oblique fibers remained intact.

The key informant strategy to determine the prevalence and causes of functional low vision among children in South India

ABSTRACT Purpose: To report the prevalence and causes of functional low vision (FLV) in school-age children in Coimbatore District, Tamil Nadu, India and to report our experience using the key informant (KI) method in this setting. Methods: Children suspected of having low vision were identified by KIs or Aravind Eye Hospital personnel in Coimbatore District. All identified children underwent a cycloplegic refraction and full eye exam. A primary cause of decreased vision was determined for each child. The prevalence of FLV was calculated for children 6–14 years old. Spectacles and low vision devices were provided free of charge. Results: 345 children aged 6–14 years were referred and 231 had FLV. The positive-predictive value of KI referrals was 64.5%. The prevalence of FLV was 0.071% (7.1 per 10,000; 95% CI 0.062–0.080%) and ranged from 0.026% to 0.141% across the district’s blocks. Older children (age 11–14 years; OR 1.41; 95% CI 1.09–1.82) and males (OR 1.52; 95% CI 1.16–1.98) had greater odds of being diagnosed with FLV. The most common causes of FLV were retinal disorders (30.0%) and amblyopia (25.5%). Low vision devices were provided to 169 children who had a mean near and distance visual acuity improvement of 0.31 and 0.63 logMAR, respectively (p < 0.001). Conclusions: This study reports a moderate prevalence of FLV and demonstrates the ability of KIs to identify school-age children with FLV in South India. The provision of basic low vision services can improve visual outcomes in this population.

Heavy eye syndrome with cataract

A 58-year-old female with high myopia, progressive esotropia, hypotropia, abduction limitation diagnosed with heavy eye syndrome and defective vision due to age-related cataract underwent loop myopexy and phacoemulsification with intraocular lens implantation. Postoperatively, the patient had improved ocular motility, better cosmesis, and considerable visual outcome.

Surgical Outcome of Graded Y Split in Patients With Duane’s Retraction Syndrome

To the Editors: Y splitting for the treatment of up or down shoots in Duane’s syndrome was first described by Jampolsky in 1980.1 Apart from Y splitting of the lateral rectus muscle, the other surgical options for patients with Duane’s retraction syndrome (DRS) with up and down shoots described previously include simple lateral rectus recession combined with medial and lateral rectus muscle recessions,2,3 lateral rectus posterior fixation sutures,4,5 and more. In a recent study, we described and analyzed the surgical outcome of graded recession and Y splitting of the lateral rectus muscle with and without recession of medial rectus muscle in patients with significant up shoot, down shoot, or both in DRS. The study was conducted in the Department of Pediatric Ophthalmology and Strabismus (September 2012 to May 2013) in a tertiary eye care institute after obtaining approval from the institutional review board. Patients with significant up shoot, down shoot, and globe retraction and who were cooperative for detailed evaluation and measurements were included in this study. The surgical procedure consisted of identifying the lateral rectus muscle and splitting it posteriorly as far back as possible. Locking bites were taken separately from the two halves of the muscle prior to cutting it from its insertion and then it was recessed by approximately 1 mm for every 2 prism diopters (PD) of tropia measured preoperatively in forced primary position. In patients with mild, moderate, and severe up shoot, the split ends were positioned 6, 8, and 10 mm apart, respectively, from the center of the line from the original insertion. Thus, the amount of recession of the lateral rectus muscle and the separation of the two halves of the muscle at the new insertion were titrated according to the preoperative deviation in primary position and the severity of up and down shoot. Medial rectus recession was performed in patients with esotropic DRS or in patients with severe globe retraction. Eight patients (mean age: 17.75 years) met the inclusion criteria for this study. Forced duction test was positive in all of the cases. The mean preoperative near deviation was 28.75 ± 16.44 PD, which reduced to 14.14 ± 13.74 PD postoperatively (P = .0277). For distance, it was 24.38 ± 16.9 PD preoperatively, which reduced to 14 ± 11.85 PD (P = .074) postoperatively. All 6 patients with down shoot demonstrated no down shoot postoperatively (P = .002). Of 5 patients with preoperative up shoot, only 1 continued to have mild up shoot postoperatively (P = .039). Of 2 patients who had severe globe retraction preoperatively, 1 had mild globe retraction postoperatively, whereas the other patient did not have any (P = .522). The coefficient of correlation between lateral rectus recession and change in the prism cover test for distance and near was 0.66 and 0.75, respectively. None of the patients had any new vertical deviation in the postoperative period. Graded recession of the lateral rectus muscle along with Y splitting and graded position of scleral attachment of the halves to the “Y” has shown good results in terms of reducing the up shoot, down shoot, and globe retraction postoperatively.

Optical coherence tomography findings in delayed subretinal fluid absorption after scleral buckling surgery.

The occurrence of loculated bleb-like delayed subretinal fluid absorption has been reported following scleral buckling surgery and more commonly following pneumatic retinopexy among adults and seldom in children. The authors report the occurrence of delayed subretinal fluid absorption following scleral buckling surgery for rhegmatogenous retinal detachment in a 15-year-old girl, indicating the need for routine optical coherence tomography evaluation in the non-amblyogenic age group of children who have good anatomical but poor functional outcome following retinal reattachment surgery.