Lavanya G Rao

Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries.

A prospective observational study was done to assess ocular survival, visual outcome and prognostic factors of open globe injury. Eighty eyes of penetrating trauma between 2004 and 2006 were categorized according to the ocular trauma classification system. Primary repair was done and outcomes were assessed at one, three and six months. The final vision was categorized as per World Health Organization classification of visual impairment. Factors at presentation were evaluated for prognostic value towards visual outcome. Sixty-nine eyes with minimum one month follow-up were included for analysis. Statistical analysis was done using Univariate and Multivariate analysis. We found Grade IV visual acuity (<5/200) at presentation (64%) as the most important factor contributing to poor visual outcome. Statistically insignificant factors were time since injury, cataract, and presence of intraocular foreign body. Ocular survival was 97%. We concluded that initial visual acuity, hyphema, zone and length of injury, retinal detachment and vitreous hemorrhage are statistically significant factors affecting outcome in open globe injuries.

Eye donation - Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia

Aim: Corneal blindness accounts for 3.42% of blindness in Malaysia; the rate of eye donation is low. The aim of the study was to assess the awareness about eye donation and willingness to donate eyes among attendants of patients at various clinics in Melaka, Malaysia. Materials and Methods: This observational study was conducted on attendants who accompanied patients (n = 400) visiting various outpatient departments of the General Hospital and two peripheral clinics in Melaka between August and October 2007. The participants answered a questionnaire (Malay and English versions) which included demographic profile, awareness of eye donation, knowledge regarding facts of eye donation, and willingness to donate eyes. Univariate and multivariate logistic regression was performed at 5% level of significance. Results: Awareness of eye donation was observed in 276 (69%) participants. Multivariate analysis showed that awareness was more among females when compared to males (P = 0.009). Of the 276 participants who were aware of eye donation, only 34.42% were willing to donate eyes. Willingness was more among the Indian race (P = 0.02) and males (P = 0.02). Educational status did not influence the willingness to donate eyes. Conclusions: Although majority of participants were aware of eye donation, willingness to donate eyes was poor.

Bilateral macular hole secondary to remote lightning strike

We report a case of a 16-year-old girl, who was struck by lightning, and experienced blurred vision in the right eye (RE) immediately following the episode. She reported for ophthalmic evaluation two months later. Examination revealed relative afferent pupillary defect in the RE. Posterior subcapsular cataract was noted in both eyes. Fundus examination revealed macular holes and multiple areas of RPE hyperpigmentation in the periphery in both eyes. Fundus fluorescein angiography showed increased choroidal transmission with early fluorescence and late fading in the foveal region and retinal pigment epithelium (RPE) stippling in the periphery in both eyes. This is the first case report of such nature in India to the best of our knowledge.

Diabetic retinopathy in patients with diabetic foot syndrome in South India

Purpose: The purpose was to study the retinopathy status in diabetic patients with a risk of diabetic foot (DF) syndrome visiting a tertiary care hospital in South India. Methods: In this cross sectional study all patients with diabetes mellitus (DM) with a risk of DF syndrome, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status. Results: One hundred and eighty-two patients diagnosed to have a risk profile for DF syndrome were included in the study. Their mean age was 59.28 years and 75.27% were males. The mean duration of Type 1 and Type 2 variants of DM was 14.9 years and 10.9 years, respectively. Of the 182 patients, 67.58% had retinopathy changes. Proliferative diabetic retinopathy (DR) constituted 17.88% of the total patients with retinopathy. An increased presence of retinopathy in patients with an increased risk grade of DF was found significant by the Chi-square test (P < 0.001). Conclusion: Our study found an increased presence of DR in a South Indian cohort with DF syndrome. The severity of retinopathy was greater in patients with higher grades of risk for DF. The establishment of an association between DR and DF syndrome will help in developing an integrated management strategy for these two debilitating consequences of diabetes.

Orbital cellulitis with periorbital abscess secondary to methicillin-resistant Staphylococcus aureus (MRSA) sepsis in an immunocompetent neonate.

This article advocates the need for early incision and drainage of periorbital abscesses. We report a case of a 1.5-month-old neonate with orbital cellulitis and periorbital abscess, which had rapidly developed over a period of 3 days. Treatment history revealed methicillin-resistant Staphylococcus aureus sepsis treated with intravenous vancomycin, and incision and drainage of abscesses at multiple sites (left parotid region, upper and lower limbs). A small swelling noted on the left temporal region on discharge from the hospital was treated with oral cotrimoxazole. However, it spread rapidly to involve the periorbital tissue and the bones of the orbital walls to form a periorbital abscess and orbital cellulitis.

Cunninghamella spinosum fungal corneal ulcer- first case report.

Sir, Cunninghamella species are mainly soil fungi of the Mediterranean and subtropical zones, and less commonly found in temperate regions. The genus contains seven species. However, C.bertholletiae is the only species known to cause disease in man and animals.Cunninghamella is an opportunistic fungus seen to affect diabetics and immunocompromised individuals. It can present as rhinocerebral, pulmonary, cutaneoarticular or disseminated forms.[1,2,3] Literature review did not reveal any case report of Cunninghamella spinosum causing ocular involvement till date. We report a rare case of corneal ulcer caused by Cunninghamella spinosum. A 54-year-old male presented with history of injury to the left eye with a stick 11 days ago. He complained of diminution of vision, pain, redness, watering and discharge from the left eye, five days after the injury. He was not a diabetic and there was no history suggestive of immunocompromised state. His visual acuity in left eye at presentation was hand movements. Anterior segment examination revealed a corneal ulcer with infiltrate measuring 7 × 8 mm involving central and paracentral zone of the cornea. [Figs. ​[Figs.11 and ​and2]2] There was no hypopyon, satellite lesions or endothelial plaque. Anterior chamber showed grade 3 reaction. Figure 1 Central corneal infiltrate, no hypopyon not a typical fungal ulcer on clinical appearance Figure 2 Slit beam showing the corneal infiltrate Corneal scrapings were done from the active edges of the ulcer and smears were sent for Gram stain, Giemsa stain and potassium hydroxide (KOH) mount. Material was also inoculated onto culture plates for bacterial, fungal and Acanthamoeba culture. Gram stain revealed the fungal hyphae [Fig. 3]. Sample sent for mycological processing and direct microscopy revealed broad hyaline, aseptate, branching, and filamentous fungi suggestive of zygomycete [Fig. 4]. Culture grew Cunninghamella spinosum. Figure 3 Gram stain showing hyphae (on direct smear) Figure 4 Microscopic morphology of C. spinosum (lacto phenol cotton blue ×40) The patient was started on G. Ciprofloxacin, Natamycin 5%, Fluconazole 0.3%, Atropine 1%and oral Ketoconazole 200 mg B.D. ×2 weeks. He was put on topical and systemic antiglaucoma medication for the management of secondary glaucoma. Patient was on regular follow-up and the ulcer healed well. His final best corrected visual acuity after 2 months was 6/36 in the left eye with macular grade corneal opacity [Fig. 5]. Figure 5 Healed ulcer The genus Cunninghamella is characterized by white to gray, rapidly growing colonies, producing erect, straight, branching sporangiophores ending in globose or pyriform-shaped vesicles from which several one-celled, globose to ovoid, echinulate or smooth-walled swollen sporangiola attached by denticles develop.[3] C.bertholletiae causes infections in immunocompromised patients leading to devastating results and it is known to cause infection in the bone marrow transplant patients, pneumonia and mucormycosis.[3,4] We report this rare case of fungal corneal ulcer by this opportunistic fungus C. spinosum in a patient who was not immunocompromised. It is important to note that the species C.spinosum is not known to affect human race. Although most of the systemic conditions caused by this cunninghamella species are known to cause devastating results, our patient responded well to Natamycin and Azole antifungal agents.

Primary orbital chronic granulomatous reaction to deep staphylococcal infection due to trauma in immunocompetent

A 53-year-old man presented with a slow-growing mass in the right orbit and temporal area of 1 year duration following a road traffic accident. Examination revealed a nodular fungating mass involving the orbit, right temporal area with multiple discharging sinuses causing proptosis and restricted ocular motility. The patient denied light perception in the right eye. There was exposure keratopathy and optic atrophy. Imaging showed mass lesion of the orbit extending intracranially. Tissue biopsy and culture revealed a chronic granulomatous reaction due to deep infection with coagulase-positive staphylococci. The patient showed remarkable improvement to systemic antibiotics and anticonvulsants. Mortality is high in such cases due to intracranial extension if there is a delay in treatment. This case report summarises a rare aetiology and successful treatment of a case of chronic granulomatous reaction due to deep bacterial infection following trauma and is deemed rare as cases of primary orbital infection in immunocompetent have not been reported so far.

Morphometric Analysis of Peripapillary Thickness in Hypertensives and Normotensives using Optical Coherence Tomography (OCT).

INTRODUCTION Hypotension following antihypertensive treatment is associated with retinal nerve fibre loss. There are studies that have reported the changes in RNFL in hypertensives. AIM To compare the Retinal Nerve Fibre Layer (RNFL) thickness using Optical Coherence Tomography (OCT) in hypertensive and normotensive individuals. MATERIALS AND METHODS The cross-sectional study was conducted from October 2012 to September 2014 to compare the RNFL thickness using SD OCT in hypertensive {no other ocular or systemic co-morbidity, vision better or equal to 6/9 (n=30)} and normotensive (n=30) individuals. RESULTS Statistically significant RNFL loss was detected in hypertensives (98.31 ± 7.01) when compared to the normotensives (102.51 ± 8.72) p=0.001. CONCLUSION Significant loss of RNFL in hypertensives point towards the altered autoregulation and warrants larger studies to assess the clinical relevance.