Mahipal S Sachdev

Topical silver sulphadiazine--a new drug for ocular keratomycosis.

The efficacy of silver sulphadiazine in human keratomycosis has not been evaluated so far. Encouraged by the success of an earlier experimental trial, a prospective, controlled, randomised double masked clinical study was designed to evaluate the efficacy of 1% silver sulphadiazine ophthalmic ointment in 20 eyes of mycotic keratitis. Miconazole 1% was used for comparative evaluation in another 20 eyes. Silver sulphadiazine had a higher success rate (80% vs 55%) than miconazole. It had broad antifungal activity and was found to be effective in fusarium keratitis. Absence of side effects, economy, and its efficacy in deeper and extensive lesions were additional advantages. It is concluded from this study that silver sulphadiazine is a safe and effective broad spectrum antifungal agent which can be used for the treatment of human keratomycosis.

Epidemic dropsy following transcutaneous absorption of Argemone mexicana oil

Four cases manifesting features characteristic of epidemic dropsy following body massage with contaminated mustard oil are reported. A transcutaneous route of absorption for the toxin (sanguinarine) resulting in epidemic dropsy has not been documented previously in man. Oil used for body massage was found to be adulterated with Argemone mexicana oil, while hydrogenated vegetable fat used for cooking did not reveal any contamination. Diagnosis of the disease was confirmed by establishing the presence of sanguinarine in the urine and serum of all four cases.

Bilateral nanophthalmos, pigmentary retinal dystrophy, and angle closure glaucoma--a new syndrome?

An unusual case of bilateral nanophthalmos with pigmentary retinal dystrophy and angle closure glaucoma is presented. This is probably the first published report of the established association of all these three entities in the same patient. The aetiological possibilities and clinical significance are discussed.

Postoperative Intraocular Pressure Changes With Use of Different Viscoelastics

Sixty eyes with age-related cataract underwent extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PC-IOL) implantation under similar conditions using hydroxypropyl methylcellulose (HPMC) (Oculose) (n = 20), sodium hyaluronate (Healon) (n = 20), or hyaluronic acid (IAL) (n = 20) as the viscoelastic (VE). Postoperative evaluation was performed for intraocular pressure (IOP), corneal thickness, and anterior chamber reaction at 6, 24, 48, 72 hours, and 10 days. Statistically-significant rises in IOP with IAL and Healon were observed at 6 and 24 hours; no such rises were observed with Oculose (P < .05). Seven eyes in the IAL group and six in the Healon group had IOPs greater than 22 mm Hg at 6 hours (range: 22 to 38 mm Hg and 22 to 28 mm Hg, respectively). A significant increase in average corneal thickness was observed in all of the 60 patients at 6 hours (18.5%). The average thickness decreased to 6.8% by day 10, with no intergroup variations. There were significantly fewer anterior chamber cells at 6 hours in the Healon group. We conclude that all three viscoelastics are equally useful for routine ECCE with PC-IOL implantation. However, IAL and Healon do cause an early postoperative IOP increase, which, though transient, should be treated.

Comparative Efficacy of Diclofenac and Flurbiprofen for Maintenance of Pupillary Dilatation During Cataract Surgery

A double-blind, prospective, randomized clinical study was undertaken to evaluate the relative efficacy of flurbiprofen 0.03% and diclofenac 0.1% eye drops, in combination with routinely used mydriatics, in maintaining pupillary dilatation during extracapsular cataract surgery with intraocular lens implantation. The effectiveness of administering systemic flurbiprofen along with the topical drugs in enhancing maintenance of pupillary dilatation also was assessed. Pupillary diameter, as measured at various surgical stages, was significantly greater in the patients receiving diclofenac or flurbiprofen eye drops as compared with those in a control group who did not (P < .001). While the maintenance of pupillary dilatation was consistently better with diclofenac than with flurbiprofen, the difference was not statistically significant. Furthermore, though maintenance of pupillary dilatation was better in cases in which systemic flurbiprofen was added to the preoperative drug regime, again, the difference was not significant.

Hyperplastic Pupillary Membrane and Laser Therapy

The eyes in two cases of extensive hyperplastic pupillary membranes with significant reduction of visual acuity and clarity were subjected to sectioning of the membranes in the superior 270 degrees of the pupil using a Q-switched Nd:YAG laser. The complications of microhemorrhages, pigment dispersal, and elevation of intraocular pressure were insignificant, while the objective and subjective improvement in vision was remarkable.

Pupillary Dilatation During Cataract Surgery-Relative Efficacy of Indomethacin and Flurbiprofen

In a prospective, randomized, double-blind trial, we evaluated the relative efficacy of indomethacin and flurbiprofen when used as adjuvants to routinely used mydriatics for maintenance of pupillary dilatation in patients with heavily pigmented iris undergoing extracapsular cataract extraction. The drugs were administered orally as well as topically according to a fixed regimen. The pupillary diameters, measured with calipers at various surgical steps, were significantly larger at every step in the study groups in which either of the adjuvants had been used than they were in the control group (P less than .001). Flurbiprofen tended to help maintain a larger pupillary diameter in the later stages of surgery than indomethacin, but this difference was not statistically significant. We conclude that it is important to use prostaglandin synthetase inhibitors as adjuvants to routine mydriatics, and that flurbiprofen may be somewhat more effective than indomethacin in this capacity.

Choroidal detachment with topical latanoprost after glaucoma filtration surgery

were immediately discontinued and substituted with valproic acid 1 g/day and amlodipine 10 mg/day. After 20 days, the patient was oriented, without hallucinatory phenomenon and delirium, and the serum sodium and chlorium returned to normal values. An EEG disclosed mild, generalized, background alpha activity mixed with theta activity of medium amplitude bilaterally on the temporal-occipital derivation (Figure 1B). During follow-up, performed 6 months later, we recorded complete remission of neurologic manifestations and a normalization of her baseline EEG, as well as sodium and chloride values. Use of the Naranjo probability scale indicated a probable relationship between neurologic manifestations and concomitant use of oxcarbazepine plus furosemide.3 Discussion. The mechanism responsible for hyponatremia in treatment with oxcarbazepine is complex and unclear. It is known, however, to include direct and/or indirect action on kidney osmoceptors.1,4 One study indicated that hyponatremia induced by oxcarbazepine is more likely attributable to a direct effect on kidney-collecting tubules or enhancement of their responsiveness to circulating antidiuretic hormone rather than inappropriate secretion of antidiuretic hormone syndrome.4 Indeed, older patients and patients in concomitant treatment with natriuretic drugs showed a higher risk of hyponatremia induced by oxcarbazepine.1,2 Different clinical studies showed that most cases of hyponatremia had no clinical relevance.1 On the contrary, Nielsen et al.5 demonstrated that high doses of oxcarbazepine induced hyponatremia with clinical symptoms. Based on our experience, we believe that careful monitoring of electrolytes is required when furosemide is administered to older patients with epilepsy treated with oxcarbazepine.

Comprehensive visual and cosmetic rehabilitation of cornea plana.

A case of bilateral cornea plana with high hypermetropia is reported in a 20-year-old woman. Neither routine spectacles nor polymethylmethacrylate (PMMA) contact lenses could achieve satisfactory visual and cosmetic results. Comprehensive visual and cosmetic rehabilitation was accomplished with a high-plus, low-water-content, lenticular soft lens. This new concept of management of cornea plana appears promising in cases not amenable to routine spectacles or hard contact lenses.

Intraocular medullo-epithelioma: Pitfalls in the cytological diagnosis

A case of intraocular malignant medullo-epithelioma in a four-year-old male child is reported. A diagnosis of retinoblastoma was made based on the clinical picture and the cytologic findings of the aqueous aspirate. the histopathology of the enucleated eyeball specimen, however, confirmed the diagnosis of medullo-epithelioma. Difficulties experienced in arriving at an accurate cytological diagnosis of the tumour are highlighted.