Nishant Sachdev

Bilateral acute angle closure glaucoma as a presentation of isolated microspherophakia in an adult: case report

BackgroundBilateral simultaneous angle closure glaucoma is a rare entity. To our knowledge this is the first reported case of bilateral acute angle-closure glaucoma secondary to isolated microspherophakia in an adult.Case presentationA 45-year-old woman presented with bilateral acute angle closure glaucoma, with a patent iridotomy in one eye. Prolonged miotic use prior to presentation had worsened the pupillary block. The diagnosis was not initially suspected, and the patient was subjected to pars-plana lensectomy and anterior vitrectomy for a presumed ciliary block glaucoma. The small spherical lens was detected intraoperatively, and spherophakia was diagnosed in retrospect. She had no systemic features of any of the known conditions associated with spherophakia. Pars-plana lensectomy both eyes controlled the intraocular pressure successfully.ConclusionThis case demonstrates the importance of considering the diagnosis of isolated microspherophakia in any case of bilateral acute angle closure glaucoma. Lensectomy appears to be an effective first-line strategy for managing these patients.

Intravitreal bevacizumab (Avastin) in choroidal neovascular membrane in angioid streaks

Angioid streaks are crack-like dehiscences in the Bruch′s membrane, which predispose to the development of a choroidal neovascular membrane (CNVM) that carries a poor visual outcome. We report successful treatment in a 25-year-old woman with bilateral angioid streaks and subfoveal CNVM in the left eye who received two doses of intravitreal bevacizumab (1.25 mg) injections six weeks apart, resulting in rapid regression of the CNVM.

Endogenous mycotic endophthalmitis in an immunocompetent patient

Acute and invasive fungal infections are usually seen in immunocompromised and debilitated patients. We report a young immunocompetent 28-year-old Indian male who presented with unilateral endogenous endophthalmitis in the left eye and was managed with pars plana vitreous surgery. The polymerase chain reaction from the vitrectomy specimen tested positive for the fungal genome while the cytology examination identified aseptate hyphae with wide-angle branching, most likely suggesting Zygomycosis. A detailed systemic evaluation failed to reveal any systemic focus or predisposing factor for fungal infection. The patient had received intravenous dextrose infusions while undergoing a surgical procedure for post-traumatic hydrocele elsewhere a week prior to this episode. The patient was successfully managed with pars plana vitreous surgery along with intravitreal Amphotericin-B and oral Voriconazole.

Part-time occlusion therapy for amblyopia in older children.

Aim: To compare the efficacy of part-time versus full-time occlusion for treatment of amblyopia in children aged 7-12 years. Materials and Methods: Prospective interventional case series. One hundred children between 7-12 years of age with anisometropic (57), strabismic (25) and mixed (18) unilateral amblyopia were randomized (simple randomization) into four groups (25 each) to receive two hours, four hours, six hours or full-time occlusion therapy. Children were regularly followed up at six-weekly intervals for a minimum of three visits. Statistical Analysis: Intragroup visual improvement was analyzed using paired t-test while intergroup comparisons were done using ANOVA and unpaired t-test. Results: All four groups showed significant visual improvement after 18 weeks of occlusion therapy (P<0.001). Seventy-three (73%) of the total 100 eyes responded to amblyopia therapy with 11 eyes (44%), 17 eyes (68%), 22 eyes (88%) and 23 eyes (92%) being amblyopia responders in the four groups respectively, with the least number of responders in the two hours group. In mild to moderate amblyopia (vision 20/30 to 20/80), there was no significant difference in visual outcome among the four groups (P=0.083). However, in severe amblyopia (vision 20/100 or worse), six hours (P=0.048) and full-time occlusion (P=0.027) treatment were significantly more effective than two hours occlusion. Conclusion: All grades of part-time occlusion are comparable to full-time occlusion in effectiveness of treatment for mild to moderate amblyopia in children between 7-12 years of age unlike in severe amblyopia, where six hours and full-time occlusion were more effective than two hours occlusion therapy.

Phacoemulsification in vitrectomized eyes: results using a ‘phaco chop’ technique

Purpose:  To evaluate the intraoperative and early postoperative complications of phacoemulsification using a ‘phaco chop’ technique in previously vitrectomized eyes.

Spontaneous separation of idiopathic epiretinal membrane in a young patient

Fig. 3 Optical coherence tomography (horizontal line scan) at this stage showed separation of epiretinal membrane temporal to the fovea. The membrane was still adherent between the fovea and optic disc causing traction and thickening of the underlying retina N. Sachdev V. Gupta A. Gupta (&) R. Singh Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India e-mail: eyepgi@sify.com

Anomalous bilateral lateral rectus muscles and anterior polar cataract with dysmorphic features.

Congenital anomalies, such as absence, hypoplasia, bifurcation, or reduplication of various extraocular muscles, including lateral rectus muscles have been reported previously. We report a 5-year-old girl who had posteriorly malinserted lateral rectus at 15 mm from the limbus in the right eye with multiple associated ocular and systemic congenital malformations.

Unilateral branch retinal arterial occlusion following administration of bevacizumab for branch retinal vein occlusion

Intravitreal bevacizumab has been adopted as a well-established treatment modality for the treatment of macular edema associated with branch retinal vein occlusion. It is considered a safe and efficacious option for improving visual acuity. We present an interesting case of unilateral superotemporal branch retinal vein occlusion in a 55-year-old man who received two doses of intravitreal bevacizumab one month apart. Laboratory tests including complete hypercoagulability and thrombotic work-up were completed but the patient successively developed branch retinal artery occlusion. We reviewed cases in literature and combined possible etiologies. We report a previously unpublished case of retinal artery occlusion following the use of intravitreal bevacizumab. Several studies have shown evidence of systemic thromboembolic events after the use of intravenous and systemic bevacizumab; however, to the best of our knowledge, no case has been reported of retinal artery occlusion immediately after administration of intravitreal bevacizumab.

Bilateral simultaneous endogenous Aspergillus endophthalmitis in an immunocompetent patient.

PURPOSE To report a case of bilateral endogenous Aspergillus endophthalmitis in an immunocompetent patient. METHODS We report a young immunocompetent 26-year-old Indian woman who presented with bilateral simultaneous endogenous endophthalmitis and was managed with pars plana vitreous surgery in both the eyes. RESULTS Smear examination of the vitrectomy specimen from the left eye identified septate hyphae with acute-angle branching, which on culture showed growth of Aspergillus fumigatus. A detailed systemic evaluation failed to reveal any systemic focus or predisposing factor for fungal infection. The patient had received an intravenous dextrose infusion 2 weeks before this episode while being treated at a rural hospital for malarial infection. During follow-up, she developed bilateral rhegmatogenous retinal detachment requiring revised pars plana vitreous surgery with silicon oil tamponade. CONCLUSION An immunocompetent patient can present with bilateral simultaneous endogenous Aspergillus endophthalmitis after receiving an intravenous infusion of presumably contaminated dextrose solution.

Brief Communication: French Maritime Pine Bark Extract (Pinus Pinaster ) and Its Ophthalmic Use

Bark extract of Pinus pinaster has a long history of medicinal use and is available commercially as herbal dietary supplement with proprietary name pycnogenol. It is used as a food supplement to overcome many degenerative conditions and has been ascribed a very diverse clinical pharmacology [1]. Although there are many potential uses for Pycnogenol, the well-studied use is for improving vascular health as a result of improved endothelial function and venous insufficiency [2,3]. It is known to demonstrate symptomatic improvement of blood circulation, blood pressure and platelet function normalization, and venous insufficiency [2,3].