Kasturi Bhattacharjee

Effect of mitomycin C on ostium in dacryocystorhinostomy.

Background:  To observe the effect of intraoperative mitomycin C of varying concentration on postoperative ostium size after external dacryocystorhinostomy (DCR).

Visual performance: Comparison of foldable intraocular lenses

PURPOSE: To compare best distance visual acuity, color perception, and contrast sensitivity between eyes with an AcrySof Natural intraocular lens (IOL) (Alcon Laboratories Inc.) and fellow eye with an AcrySof IOL and to compare results in the IOL groups to those in normal, similarly aged patients with clear phakic eyes. SETTING: Sri Sankaradeva Nethralaya, Guwahati, India. METHODS: This prospective randomized parallel group single‐center patient‐masked examiner‐masked study comprised 26 eyes of 13 healthy patients with bilateral age‐related cataract. All patients had cataract surgery by phacoemulsification in both eyes; 1 eye received an AcrySof Natural IOL (SN60AT) and the fellow eye, an AcrySof (SA60AT) IOL. Final postoperative examination was performed at the end of 18 months. In addition to other findings, visual acuity, color perception, and contrast sensitivity were recorded. A group of normal, similarly aged phakic individuals with clear lenses was examined for contrast sensitivity. The records thus obtained were analyzed statistically. RESULTS: The AcrySof and AcrySof Natural IOL groups had a statistically significant improvement in visual acuity and color perception in comparison to preoperative status, and this was maintained until the last postoperative follow‐up at 18 months. There was no statistically significant difference in the findings between the 2 IOL groups. The AcrySof and the AcrySof Natural IOL groups showed significant improvement in contrast sensitivity from the preoperative to the postoperative period (both P<.001). However, the AcrySof Natural IOL group was better than the AcrySof IOL group when each group was compared separately to similarly aged phakic individuals with clear lenses. CONCLUSIONS: Pseudophakia following AcrySof Natural SN60AT and AcrySof SA60AT IOL implantation led to equivalent visual acuity and color perception. But the contrast sensitivity in the AcrySof Natural group was better and near normal in reference to a healthy, age‐matched control group.

Capsulorhexis in intumescent cataract

This technique of anterior capsulorhexis is for use in eyes with high intralenticular pressure and absence of red reflex as encountered in intumescent cataract. The initial steps of fashioning the anterior capsular flap and lens decompression are done under the microscopes high magnification and noncoaxial oblique illumination. Intralenticular pressure is controlled by filling the anterior chamber with a viscoelastic agent. Once the lens is decompressed, the capsulorhexis is completed with a capsule forceps and an endoilluminator is used as an oblique source of illumination. This technique allows controlled capsulorhexis in eyes with intumescent cataract.

Clinical spectrum of spontaneous carotid-cavernous fistula

A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF is divided into two categories, direct and indirect. Direct fistulas usually account for 70 to 90% of all CCF. Spontaneous, low-flow fistulas are usually associated with atherosclerosis, hypertension and collagen vascular disease or may develop in females during peripartum period. The elderly age group, especially women are at increased risk. We report three cases of spontaneous CCF presenting with ocular manifestations and hypertension, without any collagen vascular disease. One case was a direct variety and the other two were of indirect variety.

Indirect optic nerve injury in two-wheeler riders in northeast India.

Purpose: To investigate the association of posterior indirect traumatic optic neuropathy and superior temporal orbital rim injury in two-wheeler riders and documentation of the clinical profile of such cases. Design: Retrospective observational study. Materials and Methods: Records of all patients reporting with cranio-orbital injury and vision loss following road traffic accidents between October 1994 and April 2006 were reviewed and from them cases with vision loss solely from indirect optic nerve injury were taken up for study. The prognostic significance of different presenting features, role of intravenous methyl prednisolone (IVMP) and relative risk of superior orbital rim injury to posterior indirect traumatic optic neuropathy (at 95% confidence interval) was calculated. Results: Out of 129 consecutive cases of cranio-orbital injury, 35 had posterior indirect traumatic optic neuropathy with minor ipsilateral superior temporal orbital rim trauma and none used any protective headwear. Presenting clinical features like relative afferent pupillary defect (P= 0.365), optic disc status (P= 0.518) and visual evoked potential (VEP) (P= 0.366) were disproportionate to visual loss. Only VEP had prognostic significance. The IVMP did not provide any added therapeutic benefit. The remaining 94 cases sustained direct blinding ocular trauma and 28 of them had associated intracranial pathology. The relative risk of superior temporal orbital rim injury to posterior indirect optic nerve trauma was 2.25. Conclusion: Superior temporal orbital rim injury, even when minor, carries a potential risk for development of blindness from indirect posterior indirect traumatic optic neuropathy in two-wheeler drivers. Presenting signs do not correlate with visual status. Only VEP has prognostic significance and the condition is untreatable.

Chloroma of the orbit in a non-leukemic adult: A case report

Granulocytic sarcoma has been reported as an isolated lesion in non-leukemic patients. However, the majority of these subjects develop acute leukemia within a mean interval of 10.5 months from the time of diagnosis. We present a case of granulocytic sarcoma of the orbit in a non-leukemic patient who was treated with chemotherapy and is doing well after a 2-year period. Patients who do not develop leukemia have a better prognosis. Appropriate treatment is delayed in most cases because of a high rate of misdiagnosis.

A rare case of adult onset retinoblastoma

Retinoblastoma usually manifests before five years of age. Retinoblastoma in an adult is extremely rare. Twenty-three cases of retinoblastoma in adults 20 years or older have been reported in world literature. We report a case of adult onset retinoblastoma in a 29-year-old female. Our patient had unilateral endophytic retinoblastoma with vitreous seeds and calcification on ultrasonography. She underwent enucleation with silicone ball implantation and the diagnosis was confirmed histopathologically. The diagnosis of retinoblastoma should be kept in mind in cases presenting with a white mass lesion of unknown etiology, in the fundus of an adult.

Descemet's membrane detachment caused by inadvertent vancomycin injection

Descemet′s membrane detachment is a condition with a wide range of etiologies. The most common cause is a localized detachment occurring after cataract surgery. We report a case of vancomycin injection-induced Descemet′s membrane detachment as a complication following a routine cataract surgery and its management.

Clear lens extraction and intraocular lens implantation in a case of microspherophakia with secondary angle closure glaucoma.

Phacoemulsification with implantation of single-piece acrylic foldable intraocular lens (IOL) in a 19-year-old boy with microspherophakia, high myopia and angle closure glaucoma is described. The associated myopia and angle closure glaucoma was severely compromising the quality of life. Post-surgical visual recovery was 20/20 with sustained normal intraocular pressure. Management of such cases at times calls for innovations in current surgical technique.

Acute progressive multiple cavernous hemangiomas of orbit in a child--a case report.

Orbital cavernous hemangioma, a slowly progressive tumor of middle aged women is usually unilateral and solitary. We report a case of rapidly progressive multiple cavernous hemangiomas of the orbit in a young male patient.