Mohit Dogra

Fungal endophthalmitis following cataract surgery: clinical presentation, microbiological spectrum, and outcome.

PURPOSE To determine the clinical presentation, microbiological spectrum, and outcome in cases of fungal endophthalmitis following cataract surgery. DESIGN Observational case series. METHODS SETTING Tertiary referral hospital. PATIENTS Retrospective analysis of 27 cases of smear- and culture-proven fungal endophthalmitis. INTERVENTION Pars plana vitrectomy in 18 eyes, where the corneal condition did not preclude the same. All eyes received intravitreal amphotericin B and dexamethasone along with systemic antifungal agents. MAIN OUTCOME MEASURES Functional success: Final visual acuity of 3/60 or better with attached retina. Anatomical success: Final visual acuity of better than light perception with preserved anatomy of globe. RESULTS The majority of the eyes (22 of the 27) had early onset and diffuse presentation (that is, anterior segment as well as posterior vitreous exudates). Substantial corneal involvement was seen in 14 eyes (51.85%). Aspergillus sp. was the most common isolate. Multivariate analysis using forward stepwise logistic regression showed corneal involvement as the single most important risk factor in determining final visual outcome (P =.0429). CONCLUSIONS Early onset and diffuse presentation, which mimics bacterial endophthalmitis, stresses the importance of both bacterial and fungal cultures from intraocular fluids to reach a diagnosis apart from the clinical judgment. Corneal involvement was the most important predictor of outcome in cases of fungal endophthalmitis.

Morphological changes in the retinal pigment epithelium on spectral-domain OCT in the unaffected eyes with idiopathic central serous chorioretinopathy

Purpose To report the changes seen in the retinal pigment epithelium (RPE) morphology in the asymptomatic eyes of patients with idiopathic central serous chorioretinopathy (ICSC) using spectral-domain Cirrus TM high-definition optical coherence tomography (HD-OCT). Methods In a prospective case series, 17 consecutive patients with unilateral ICSC underwent spectral-domain Cirrus TM HD-OCT scans for both affected and opposite asymptomatic eye. Three-dimensional single-layer RPE map was studied in both eyes for morphological alterations, and findings were correlated with clinical presentation, fluorescein angiogram, and 5 Line raster scan. Additionally, three-dimensional (3D) single-layer RPE maps done in 111 healthy volunteers served as control. Results In patients with ICSC, 3D single-layer RPE analysis of asymptomatic eyes showed presence of RPE bumps in 16 (94%) eyes and pigment epithelium detachment (PED) in 2 (11.8%) eyes. The 5 Line raster scan was normal in all eyes. Of 222 normal (control) scans, 18 showed RPE bumps and none showed PED. Conclusions 3D single-layer RPE map showed abnormal pattern in the asymptomatic eyes of patients with unilateral ICSC. Summary Spectral-domain optical coherence tomography showed morphologic alterations in retinal pigment epithelium in both eyes of patients with idiopathic central serous chorioretinopathy.

Effect of Insulin Therapy on Progression of Retinopathy in Noninsulin-dependent Diabetes Mellitus

In a six-month prospective study involving 60 noninsulin-dependent diabetics, we evaluated the effect of change to conventional insulin therapy on the pre-existing retinopathy. Ten of 15 patients in group 1 (background or preproliferative diabetic retinopathy treated with insulin) compared to one of 15 patients in group 2 (background or preproliferative diabetic retinopathy treated with hypoglycemic agents) had progression of retinopathy. Worsening of retinopathy was related significantly only to the age of the patients (r = .752, P < .001). None of the 15 patients each in groups 3 and 4 (no retinopathy treated with insulin injections [group 3] or oral hypoglycemic agents [group 4]) developed retinopathy.

Curvularia lunata endophthalmitis with secondary keratitis

PURPOSE To report a case of pseudophakic endophthalmitis with secondary keratitis caused by Curvularia lunata. METHODS A 40-year-old man presented with a fluffy mass in the anterior chamber with low-grade delayed postoperative inflammation in the right eye. RESULTS The anterior chamber and vitreous aspirate demonstrated C. lunata. A large corneal infiltrate developed after aspiration of the mass. Treatment with systemic, topical, and intraocular antifungal agents cleared the vitreous, but the cornea perforated. CONCLUSION Delayed low-grade infection with a fluffy mass in the anterior chamber after cataract surgery can rarely be a clinical presentation of dematiaceous fungal infection. Secondary keratitis may result after a diagnostic aspiration.

Detection of Mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis.

PURPOSE To compare 3 different molecular techniques to detect the Mycobacterium tuberculosis genome in vitreous fluid of eyes with multifocal serpiginoid choroiditis (MSC). DESIGN Prospective, interventional case series. PARTICIPANTS Eleven patients (11 eyes) with active MSC in at least 1 eye underwent diagnostic pars plana vitrectomy (PPV) between October 2012 and December 2013. METHODS Vitreous fluid samples were subjected to multitargeted polymerase chain reaction (PCR) for a M. tuberculosis assay, the Gene Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA), and a line probe assay (GenoType MTBDRplus; Hain Lifescience, GmbH, Nehren, Germany). The samples with positive results were subjected to rpoB gene sequencing to demonstrate rifampicin resistance. The clinical details, digital fundus imaging, and treatment details and outcomes also were noted. MAIN OUTCOME MEASURES Detection of the M. tuberculosis genome and rifampicin resistance in the vitreous samples. RESULTS Of the 11 eyes subjected to PPV, the multitargeted PCR results for tuberculosis were positive for 10 eyes, the MTBDRplus assay results were positive in 6 eyes, and the Gene Xpert MTB/RIF assay results were positive in 4 eyes. Rifampicin resistance was detected in 3 eyes by rpoB gene sequencing, in 3 eyes by the MTBDRplus assay, and in 1 eye by the Gene Xpert MTB/RIF assay. CONCLUSIONS We detected the M. tuberculosis genome in the vitreous fluid of eyes with MSC using 3 different molecular techniques. Rifampicin resistance was detected for the first time in eyes with MSC.

NOVEL FINDINGS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH TUBERCULAR SERPIGINOUS-LIKE CHOROIDITIS

Purpose: To analyze and describe the imaging characteristics of tubercular serpiginous-like choroiditis using optical coherence tomography angiography (OCTA) and to compare these findings with multimodal imaging. Methods: In this prospective cross-sectional study, multimodal imaging was performed in subjects with tubercular serpiginous-like choroiditis using OCTA (Optovue RTVue XR Avanti), enhanced-depth imaging OCT (Heidelberg Spectralis), fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. Distinct morphologic features of the retinochoroidal vasculature at the sites of choroiditis lesions were analyzed on OCTA imaging. Multimodal imaging analysis was performed to study the changes observed on OCTA. Results: Eighteen eyes (18 subjects, 16 males) were included in the study. The en face OCTA images demonstrated discrete areas of flow void beneath the retinal pigment epithelium–Bruch membrane layer suggestive of choriocapillaris hypoperfusion that corresponded well with indocyanine green angiography, especially in the chronic phase. Additional information such as areas of preserved choriocapillaris, vascular tufts, and tangled vessels were observed using OCTA among lesions in advanced stages of healing. Compared with indocyanine green angiography, the areas of choriocapillaris atrophy appeared better defined on OCTA and correlated well with enhanced-depth imaging OCT. Conclusion: The OCTA images provide high-resolution structural information of the retinochoroidal vasculature in tubercular serpiginous-like choroiditis. Morphologic information obtained from OCTA images correlates well with and supplements other imaging techniques such as indocyanine green angiography and enhanced-depth imaging OCT.

Retinal Microaneurysmal Closure Following Focal Laser Photocoagulation in Diabetic Macular Edema

OBJECTIVE To determine the temporal relationship of microaneurysmal dosure following focal laser photocoagulation in diabetic macular edema. PATIENTS AND METHODS This prospective study included 25 eyes of 23 diabetic patients with clinically significant macular edema. Ten to 20 well-defined microaneurysms were preselected and marked on an enlarged photograph of the prelaser fundus fluorescein angiogram. These preselected microaneurysms were focally lasered and followed up angiographically at 48 hours, 1 week, 3 weeks, 6 weeks, and 12 weeks after photocoagulation. Thereafter, the average time span between photocoagulation and the closure of the microaneurysms was determined. RESULTS The mean number of preselected microaneurysms at baseline was 18.24 +/- 3.51, which remained the same at 48 hours. However, the mean microaneurysmal count decreased to 11.76 +/- 2.65 (35% reduction) at 1 week, 9.12 +/- 2.53 (50% reduction), 7.12 +/- 2.26 (61% reduction), and 4.56 +/- 1.32 (75% reduction) at 3, 6, and 12 weeks, respectively. The majority of the microaneurysms (35%) closed between 48 hours and 1 week. CONCLUSIONS The microaneurysmal closure following focal laser photocoagulation is a delayed process. None of the preselected microaneurysms showed closure within 48 hours, and 75% of the preselected microaneurysms closed at the end of 12 weeks.

Epidemiology of Uveitis in a Tertiary-care Referral Institute in North India

ABSTRACT Purpose: To report epidemiology of uveitis in a tertiary-care referral institute in North India. Methods: Hospital records of patients with uveitis between June 2011 and September 2014 were retrospectively analyzed. Results: Of the 1912 patients, 56.64% were males. Anterior uveitis (43.04%) was the most common manifestation followed by posterior uveitis (24.58%), panuveitis (16.21%), and intermediate uveitis (10.66%). Specific etiologies could be ascertained in 60.56%. Tuberculosis (22.9%) was the most common infectious and HLA-B27-associated uveitis (9.46%) among non-infectious causes. Conclusions: There is a trend towards a decrease in idiopathic etiologies of uveitis. Tuberculosis remains the most common infectious etiology in North India.

Frequency-doubled Nd:YAG (532 nm green) versus diode laser (810 nm) in treatment of retinopathy of prematurity

Diode (810 nm) laser photocoagulation using the indirect ophthalmoscopic delivery system is the preferred modality for treatment of retinopathy of prematurity (ROP).1 2 Previously, an argon green laser (488–528 nm) was used for treatment but was reported to have a higher incidence of cataract and was not popular.3 A frequency-doubled Nd:YAG laser (532 nm green) is commonly used for treatment of retinal vascular disorders. However, its use for treatment of ROP is anecdotal4 and has not been compared with that of a standard diode laser. The purpose of this study was to compare both these laser frequencies in treatment of ROP. A retrospective chart review of infants treated with a laser for ROP at a tertiary care centre was done to retrieve various parameters including spectrum of ROP, type of laser used, laser parameters, complications of treatment, retreatment rate and outcome. This study included infants born at our centre and …

Pattern of Pediatric Uveitis at a Tertiary Referral Institute in North India

ABSTRACT Purpose: To report the pattern of pediatric uveitis in a tertiary care referral center in North India. Methods: In a retrospective study, records of pediatric uveitis cases presenting at our center between 1996 and 2015 were reviewed for demographic data, anatomic distribution, and diagnosis. Results: Out of 9600 patients with uveitis, 369 children (3.84%; age ≤16 years; males: 54.20%) were included in the study. Anterior uveitis was the commonest presentation (n = 158; 42.81%), followed by posterior uveitis (n = 102; 27.64%). Uveitis was bilateral in 57.18% (n = 211). Infective etiology was seen in 99 children, of which tuberculosis was the commonest cause (n = 55; 14.91%). Among non-infectious etiologies, juvenile idiopathic arthritis (JIA) was the commonest cause (n = 59; 15.99%). Conclusions: While anterior uveitis is the commonest uveitis in children, our cohort reported a high number of posterior uveitis cases compared to previous studies. Tuberculosis and JIA were the commonest causes of pediatric uveitis.