Krishan Pal Singh Malik

Pterygium surgery: conjunctival rotation autograft versus conjunctival autograft.

BACKGROUND AND OBJECTIVES To compare the safety and efficacy of conjunctival rotation autograft to conjunctival autograft in primary pterygium surgery. PATIENTS AND METHODS A prospective randomized study was performed of 39 eyes in 31 patients who had undergone pterygium surgery. Nineteen eyes were treated by conjunctival rotation autograft (Group A). Twenty eyes were treated by conjunctival autograft (Group B). Follow up ranged from 8 to 12 months (mean 11 months). Recurrence was defined as postoperative regrowth of 2 mm fibrovascular tissue onto clear cornea in the area of previous pterygium excision. Four eyes were excluded from the study. Delayed wound healing occurred in 11.76% of eyes, and 5.88% of eyes had persistent congestion in Group A. A loose graft was present in 5.55% of eyes, and 5.55% of eyes had dellen formation in Group B. CONCLUSION We conclude that conjunctival rotation autograft and conjunctival autograft are both equally effective methods to reduce the recurrence rate after pterygium surgery. Conjunctival rotation autograft can be tried as an alternative attractive procedure for pterygium surgery to reduce the chances of recurrence. However, a larger, randomized, prospective double masked study with more patients and a longer follow up will eventually demonstrate the superiority of one procedure over the other.

Levodopa/Carbidopa in the Treatment of Amblyopia

PURPOSE To evaluate the role of levodopa/carbidopa in the treatment of amblyopia. METHODS Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-blind, randomized study. Patients were divided into two groups. Group A received 0.50 mg + 1.25 mg of levodopa/carbidopa per kilogram body weight three times daily after meals, with a protein rich drink, whereas Group B received placebo. Both groups received full-time conventional occlusion until a visual acuity of 6/6 was achieved or for a maximum of 3 months. RESULTS The authors observed more than two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the placebo group (9 of 15) (P < .005). Furthermore, improvement in visual acuity of more than two lines was greater in patients younger than 8 years (100%) than in patients older than 8 years of age (60%) (P = .0026). There was also no significant reversal of the improved visual acuity in up to 6 months of follow-up. CONCLUSION Levodopa/carbidopa improves visual acuity in patients with amblyopia and maintains improved visual acuity, especially in patients younger than 8 years.

Bilateral cysticercosis of the optic nerve.

Bilateral cysticercosis of the optic nerves affected a man who presented with features suggestive of optic neuritis. Ultrasonography revealed bilateral sonolucent cystic lesions with central echo-dense, highly reflective structures behind the optic nerve heads. A subretinal cyst was present in one eye. Magnetic resonance imaging of the brain and orbit revealed multiple cysticerci in the brain, orbit, and eye. The subretinal cyst was removed by pars plana vitrectomy, and the other cysts resolved on treatment with albendazole.

Bilateral Actinomycotic Blepharokeratoconjunctivitis

Actinomycotic conjunctivitis is usually unilateral and secondary to canaliculitis. We report an unusual case of bilateral actinomycotic blepharokeratoconjunctivitis in the absence of canaliculitis. Keratitis ocurred without any preceding ocular trauma. Both eyes had remissions and relapses in response to the antibiotic-steroid drops. Diagnosis of A. israelii infection was made on the basis of Gram staining, culture and biochemical characteristics. Complete excision of the conjunctival ulcer along with penicillin therapy resulted in cure. This case highlights that microorganisms of the order Actinomycetales should be considered in the differential diagnosis if conjunctivitis or keratitis shows a waxing and waning course.

Acute Lymphocytic Leukemia Presenting as Masquerade Syndrome

An 11-year-old child presented with plastic iridocyclitis and hypopyon. Subsequent paracentesis revealed leukemic infiltrates. A bone marrow biopsy confirmed the diagnosis of acute lymphocytic leukemia. Because of this unusual case of leukemic hypopyon, we advocate anterior chamber paracentesis and pediatrician referral in all cases of refractory uveitis.

Manual small incision cataract surgery for subluxated cataract with lens coloboma

INTRODUCTION The lens coloboma results from a segmental defective or absent development of the zonules. It is usually unilateral and bilateral cases are rare. These eyes are at greater risk of complications during cataract surgery due to ocular malformations. In addition the capsular bag requires stabilization using modified capsule tension ring, capsular tension segment or capsular anchor. METHODS Lens extraction is indicated for cataract or subluxation if visual function is sufficiently compromised. We report our surgical experience in a patient with bilateral isolated lens coloboma by performing manual small incision cataract surgery (MSICS) in left eye and phacoemulsification in right eye. RESULTS The nuclear rotation was hampered because of the lack of zonules and presence of lens coloboma. MSICS was converted to the intracapsular technique in left eye, though breaking the nucleus into pieces during phacoemulsification in right eye enabled its mobilization and successful completion with implantation of modified capsule tension ring. CONCLUSIONS A patient with lens subluxation and lens coloboma is better managed by phacoemulsification as compared to the MSICS.

Feasibility and Complications between Phacoemulsification and Manual Small Incision Surgery in Subluxated Cataract.

Purpose. To compare the feasibility of cataract surgery with implantation of endocapsular supporting devices and intraocular lens (IOL) in subluxated cataract in phacoemulsification and manual small incision cataract surgery (MSICS). Design. Prospective randomized intervention case series consisting of 60 eyes with visually significant subluxated cataract. Method. The patients were randomly distributed between the two groups equally. The main outcome measure was implantation of in-the-bag IOL, requirement of additional procedure and complications, if any. Results. Capsular bag retention in subluxated lenses is possible in 90% cases in phacoemulsification versus 76.67% cases in MSICS (P = 0.16). Both groups, achieved similar best corrected visual acuity (P = 0.73), although additional procedures, intraoperative, and postoperative complications were more common in MSICS. Conclusions. Achieving intact capsulorhexis and nuclear rotation in MSICS may be difficult in cases with large nucleus size and severe subluxation, but subluxated cataracts can be effectively managed by both phacoemuslification and MSICS.

Pattern of intraocular pressure in epidemic dropsy in India.

This study was conducted to report on the intraocular pressure (IOP) pattern in patients with epidemic dropsy. Two hundred and thirty proven cases of epidemic dropsy were sent for ocular examination. We measured IOP by applanation tonometry at different intervals. Patients were followed up until 24 weeks. Intraocular pressure of more than 22 mm of Hg was detected in 10.86% patients at the start of the study. However, at 12 weeks only 0.43% patients needed medication for control of IOP. None required medication for IOP control after 20 weeks. The rise of IOP in this case series of epidemic dropsy appeared to be a transient phenomenon and drugs needed to be titrated on a weekly basis.

Mobile orbital Cysticercus cyst--an unusual presentation.

Introduction Cysticercus commonly affects the central nervous system, skin and skeletal muscles. Eyes are involved in 5–46% of the cases and there, the most common site of infection is subretinal and intravitreal. Cysticercosis is the most common intra-orbital parasitic infestation. In extraocular cysticercosis, the involvement includes extraocular muscles or subconjunctival regions in most cases. Other uncommon sites involved by orbital Cysticercus include the lacrimal gland, the eyelids, the anterior lacrimal crest and the deep orbit. In Cysticercus infection of the orbit, the site of lodgement of a Cysticercus cyst is usually near its rim and only very rarely in the depths of the orbit. The classical presentation of an orbital cyst is that of an anterior orbital mass with a severe inflammatory reaction while the patient also can have ptosis, optic neuritis and restriction of ocular movements. Here we report the case of a young girl who presented to us with a solitary, freely mobile, left orbital wall Cysticercus cyst unattached to any other structure in the orbit.

Two cases of orbital tuberculosis in children with unique presentations

A 3-year-old boy and a 2-year-old girl were diagnosed with orbital tuberculosis. In our first patient the primary focus of tuberculosis was the cervico-thoracic spine, but could not be detected in the second. These are the youngest ever reported cases of orbital tuberculosis. Where tuberculosis is endemic, orbital tuberculosis should be considered as a differential diagnosis for orbital swellings in pediatric patients.