Krishna R. Murthy

Utility of QuantiFERON TB gold test in a south Indian patient population of ocular inflammation

Aim: To study the utility of interferon-γ release assays (QuantiFERON TB gold test) in a south Indian patient population of intraocular inflammation. Design: Evaluation of a diagnostic test- a pilot study from January 2007 to October 2008. Materials and Methods: QuantiFERON TB gold test was performed on the following groups of patients following an informed consent. Group A included healthy volunteers without any exposure to tuberculosis (TB) or past history of TB (n=22). Group B included patients with active systemic TB diagnosed by the demonstration of acid-fast bacilli or by the histopathology finding of caseation with granuloma formation from the sputum, lymph node, skin or intestinal biopsies (n=26). Group C included patients with uveitis of known etiologies other than intraocular TB without any history of exposure to active TB (n=21). Group D included patients with a diagnosis of presumed intraocular TB, who responded to antitubercular therapy by decreased or no recurrences following treatment and with a minimum of nine months follow-up following initiation of antitubercular therapy (n=39). Results: The sensitivity and specificity of the QuantiFERON TB gold test to pick up active systemic TB was 58% and 77% respectively. The sensitivity and specificity of the QuantiFERON TB gold test to pickup intraocular TB was 82% and 76% respectively. Conclusions: QuantiFERON TB gold test alone may not be specific for intraocular TB. The significance of this test in a case scenario needs to be interpreted with clinical presentation and other evidences for intraocular TB.

A study of the efficacy of endoscopic cyclophotocoagulation for the treatment of refractory glaucomas.

BACKGROUND Endoscopic cyclophotocoagulation (ECP) is a relatively new method of cyclodestruction which can be used in the management of refractory glaucomas. AIM To evaluate the safety and efficacy of ECP in the management of refractory glaucomas. SETTINGS AND DESIGN Prospective interventional non-comparative study. MATERIALS AND METHODS Fifty eyes of 50 patients with refractory glaucoma, whose intraocular pressures (IOP) were not under control with maximal medical therapy underwent ECP, by the anterior, or pars plana route. IOP, best corrected visual acuity (BCVA), and the number of anti-glaucoma medications, were compared postoperatively to preoperative values. Success was defined as IOP pound 22 mmhg, with or without use of medications. STATISTICAL ANALYSIS USED Students t test and repeated measures ANOVA were used to evaluate change in IOP and Students t test, for comparison of BCVA. Kaplan Meier survival curve was plotted. Wilcoxon signed rank test was used to evaluate reduction in medications. RESULTS Patients were followed for an average of 12.27 months (3-21months). IOP decreased significantly from 32.58 +/- 9.16 mmHg to 13.96 +/- 7.71 mmHg at last follow-up ( P < 0.001, students t test). BCVA was significantly improved in the postoperative period ( P < 0.001, students t test). The average number of antiglaucoma medications decreased from 2.51 +/- 0.97 to 1.09 +/- 1.16 ( P < 0.001, Wilcoxon signed rank test). ECP had a success rate of 82.2%. CONCLUSION Endoscopic cyclophotocoagulation is an effective procedure in this subset of refractory glaucomas.

Bilateral retinitis following chikun- gunya fever.

A 35-year-old male with a history of chikungunya fever, presented with diminution of vision in the right eye of one-week duration. His best corrected visual acuity (BCVA) was counting fingers 2 meters and 20/20 (Snellens) in the right and left eyes respectively. A diagnosis of neuroretinitis was made in the right eye while left eye showed features of retinitis. ELISA (serum) and polymerase chain reaction (aqueous) were positive for herpes simplex virus. The lesions did not show any response to antiviral or steroid treatment and appeared to be self-limiting. At five months follow-up, lesions had resolved well with BCVA of 20/120 and 20/20 in the right and left eyes respectively.

Mobile diabetes eye care: experience in developing countries

The prevalence of diabetes in developing countries is on the increase and along with it the need to provide structured care to avoid the feared long term complications among them loss of vision and blindness due to diabetic retinopathy (DR). The biggest hurdle facing most developing countries is the lack of resources and trained manpower to both screen and treat the large number of people with DR. Countries also face the additional problem of unequal distribution of resources between the urban and rural areas. To overcome these challenges models of mobile diabetic retinopathy screening and treatment aided by the use of telemedicine have been introduced and demonstrated to be popular and effective. The aim of this review article is to describe different mobile diabetic retinopathy screening and treatment models developed in India, which can be readily replicated in developing countries presented with similar difficulties.

In vivo confocal microscopy in different types of posterior polymorphous dystrophy.

Posterior polymorphous dystrophy is a rare corneal dystrophy, usually detected by chance. This case series describes the morphologic features in the three different types of posterior polymorphous dystrophy using confocal microscopy.

Predictors for tubercular uveitis: a comparison between biopsy-proven cases of tubercular and sarcoid uveitis.

Aim: To look for clinical parameters that will assist in making a diagnosis of tubercular or sarcoid uveitis in a South Indian patient population Methods: Retrospective, nonrandomized, comparative study of 51 patients with a diagnosis of biopsy-proven tuberculosis and sarcoidosis. These patients had a minimum of 1-year follow-up after initiating treatment for either disease. Multivariate logistic regression analysis was used to determine clinical predictors of tubercular uveitis. Results: The mean age group was 47.08 ± 11.19 years. There were 39 women and 12 men in the study. Multivariate logistic regression analysis shows likelihood of uveitis being tubercular in etiology using 3 variables: Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and a positive Mantoux test 76.6%. Conclusion: A combination of Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and positive Mantoux test may be used clinically to differentiate tubercular from sarcoid uveitis in our patient population.

Two Successive Ocular Malignancies in the Same Eye of a HIV-positive Patient: A Case Report

Purpose: To report 2 successive ocular malignancies in the same eye of a HIV-positive patient at different CD4 counts. Materials and methods: A 36-year-old retrovirus-positive male presented with no perception of light in the left eye of 1 month duration. CD4 counts were 44 cells/mm3. Ultrasonography showed an exudative retinal detachment. Retinal biopsy suggested an intraocular B-cell lymphoma for which he received radiotherapy and chemotherapy. He presented 3 years later with a growth in the left eye with CD4 counts of 360 cells/mm3. Results: Histopathology of enucleated eye showed a low-grade conjunctival squamous cell carcinoma. At 1-year follow-up, there is no mass in the anophthalmic socket. Conclusions: This case highlights the development of 2 ocular malignancies in the same eye of an HIV-positive patient, at different CD4 counts, allowing the authors to speculate on additional factors involved in the development of the second malignancy.

Associations of Fuchs heterochromic iridocyclitis in a South Indian patient population

BackgroundThe purpose of this study is to look for any possible associations in 58 consecutive cases of Fuchs heterochromic iridocyclitis (FHI) in a South Indian patient population. Fifty-eight consecutive cases (59 eyes) of FHI underwent a detailed ocular and systemic evaluation. Routine laboratory investigations for uveitis including serum angiotensin-converting enzyme and enzyme-linked immunosorbent assay (ELISA) for toxoplasmosis (IgG and IgM) were done in all the cases. Syndrome Evaluation System comprising of multiplex nucleic acid amplification and signature specific hybridization on the aqueous fluid was done in all 59 eyes for herpes simplex virus (HSV), varicella zoster virus, cytomegalovirus (CMV), rubella virus, chikungunya virus, Toxoplasma, and Mycobacterium tuberculosis. The results were statistically assessed using the SPSS (version 15) package.ResultsThirty-three males and 25 females with FHI were included in the study. Systemic sarcoidosis was seen in two cases. Serological tests failed to confirm an association with toxoplasmosis in all the cases. Aqueous fluid analysis showed positivity only to HSV (one case), CMV (one case), and chikungunya virus (one case).ConclusionsWe do see associations of sarcoidosis, HSV, and CMV in FHI in our patient populations as well. The detection of chikungunya virus in a patient with FHI in our series adds to the list of associations with FHI.

Vision recovery in human immunodeficiency virus-infected patients with optic neuropathy treated with highly active antiretroviral therapy: A case series

We describe three patients with bilateral, presumed human immunodeficiency virus (HIV)-induced optic neuropathy. The above diagnosis was made by exclusion of infectious agents and neoplasms by detailed clinical and laboratory investigations. All patients had decreased visual acuity, pale optic discs and constriction of visual fields. Improvement was documented in all three patients for visual acuity and in one patient for visual fields following treatment with highly active antiretroviral therapy (HAART). Optic neuropathy in HIV-positive patients does not necessarily carry a poor prognosis even when a treatable cause is not found. This article emphasizes the effectiveness of HAART in presumed HIV-induced optic neuropathy.

Triple A syndrome with ophthalmic manifestations in two siblings

Triple A syndrome (Allgrove syndrome) is a rare, autosomal recessive disorder characterized by adrenocorticotropic hormone resistant adrenal insufficiency, alacrima, achalasia of the esophageal cardia, progressive neurological degeneration and occasionally autonomic instability. We report the ophthalmic manifestations in 2 siblings from a consanguineous family with this syndrome. A routine ophthalmic examination showed absence of palpebral portion of lacrimal gland, dry eyes and sluggish pupillary reflexes in both eyes of these patients. Both of these patients had achalasia cardia while the boy additionally had increased serum cortisol levels. Topical ocular lubricants were prescribed for both of them and Hellers cardiomyotomy with fundus plication was done for achalasia. These cases would create an awareness of this rare condition in ophthalmology in addition to suggesting its management.