Pramod Bhende

Retinal detachment in Marfan syndrome: clinical characteristics and surgical outcome.

Purpose To describe the clinical characteristics of retinal detachments in patients with Marfan syndrome and report the surgical outcome of vitreoretinal surgery. Methods Records relating to 53 eyes of 45 patients with Marfan syndrome who underwent surgery for rhegmatogenous retinal detachment were reviewed. Of the 53 eyes, 24 (45.3%) underwent scleral buckling as the first procedure and 29 (54.7%) underwent vitrectomy surgery with scleral buckle as the first procedure. Main outcome measures included clinical characteristics of retinal detachment, reattachment rates, and functional improvement in vision. Results Characteristic findings included total retinal detachment in 40 (75.5%) eyes, atrophic holes in 24 (45.3%) eyes, more than four retinal breaks in 21 eyes (39.6%), preequatorial and postequatorial breaks in 20 (37.7%) eyes, giant retinal tears in six (11.3%) eyes, and proliferative vitreoretinopathy (posterior, anterior, or both) in nine (17%) eyes. In 30 (56.6%) eyes, retinal breaks were located only in the temporal half of the retina. Of the 24 eyes with myopia, 13 (54.2%) had a myopic correction greater than 7 diopters. At the median follow-up of 10.7 months, complete retinal reattachment was obtained in 87.6% and 86.2% of patients undergoing scleral buckling (including additional procedures such as vitrectomy) and vitrectomy surgery, respectively. In eyes with reattached retinas, a final visual acuity of 20/200 or better was obtained in 81% of the patients after scleral buckling and in 56% of the patients after vitrectomy surgery (P = 0.07). Conclusions Retinal detachment in Marfan syndrome is complete in 75% of the eyes. More than half (56%) the eyes had a retinal break only in the temporal half of the retina, and 83% had at least a break in the temporal half of the retina. Currently available vitreoretinal surgical techniques result in successful reattachment of the retina in approximately 86% of the eyes.

Management of recurrent retinal detachment in silicone oil-filled eyes.

PURPOSE To report causes of failure, management options, and outcomes after reoperations for recurrent retinal detachment in silicone oil-filled eyes. METHODS One hundred eighteen silicone oil-filled eyes with recurrent retinal detachment were managed with revision of vitrectomy with membrane surgery with or without silicone oil removal, just scleral buckling, or both. Anatomical success was defined as complete reattachment of the retina, and functional success was defined as recovery of ambulatory visual acuity of >or=5/200 at the last follow-up (mean follow-up, 29.7 months). RESULTS In 82.2% of the cases, proliferative vitreoretinopathy was responsible for recurrent retinal detachment in silicone oil-filled eyes. Reoperations without removal of the silicone oil were performed in 65.3% of the cases. Anatomical success occurred in 62.7% of the eyes, and functional success occurred in 52.5%. Silicone oil was removed in 59.5% of the eyes with retinal reattachment; the retina remained attached in 90.9% of the eyes. Predictors of poor anatomical success were presence of posterior diffuse proliferative vitreoretinopathy and combined posterior and anterior proliferative vitreoretinopathy (P <0.02). CONCLUSION Reoperations for recurrent retinal detachment in silicone oil-filled eyes were successful in nearly two thirds of the cases, and over one half of the eyes recovered ambulatory vision.

Results of vitrectomy in Terson syndrome.

BACKGROUNDnTo report visual results of vitrectomy in Terson syndromennnMATERIALS AND METHODSnIn 11 patients, 15 eyes underwent vitreous surgery for Terson syndrome. The mean follow up was 18.3 months.nnnRESULTSnAn incomplete posterior vitreous separation was noted in 10 eyes (66.7%). An epiretinal membrane was present in 4 eyes (26.7%), and in 3 eyes, a retinal fold along the arcade was noticed. Significant visual improvement occurred in all eyes; visual acuity of 20/40 or better was achieved in 14 eyes (93.3%). Only 3 eyes developed lens opacity after surgery.nnnCONCLUSIONnVitrectomy in Terson syndrome provides excellent visual recovery. The complication rate, including the development of cataract, is low.

Boston keratoprosthesis for keratopathy in eyes with retained silicone oil: a new indication.

Purpose: To analyze the visual outcome of Boston keratoprosthesis for keratopathy in silicone oil-filled eyes. Methods: Retrospective chart review of patients with silicone oil-induced keratopathy undergoing Boston keratoprosthesis between January 2008 and June 2010 was performed. Patients received Boston keratoprosthesis as the primary procedure or after a failed penetrating keratoplasty because of silicone oil-induced keratopathy after assessing possible visual potential. Silicone oil had to be retained in all eyes because of persistent ocular hypotony. Results: Of the 8 eyes that underwent surgery, anatomic retention and visual improvement were noted in 7 eyes (87.5%). The visual acuity improved to 20/200 or better in 6 eyes (66.67%). Repeated corneal melt necessitated the removal of the prosthesis with corneal transplant in 1 eye. Membranectomy was performed twice for retroprosthetic membrane in 1 eye. Conclusions: Boston keratoprosthesis seems to be a viable option for visual rehabilitation in postvitrectomized eyes with a decrease in vision due to retained silicone oil-induced keratopathy.

Scleral buckling: implant versus explant.

Purpose To compare the implant and explant techniques of scleral buckling. Methods This prospective, randomized clinical study compared the two techniques of scleral buckling. Variables such as size and extent of the buckle, duration of the surgery, complications, and anatomical and visual outcome were studied. The height of the buckle as measured by ultrasonography was also studied. Results No significant difference was found between the two groups for total duration of the surgery, complications, anatomical results, visual outcome, and buckle height. For the 1- to 2-quadrant buckles, duration of the surgery up to initiation of subretinal fluid drainage was found to be significantly shorter for the explant group. Serial ultrasonography showed significant reduction in buckle height over 6 months in both groups to an equal degree. Conclusions Scleral buckling seems to be equally effective whether performed as an implant or explant.

Multifocal electroretinographic and angiographic changes in pre-eclampsia

Editor,—Pre-eclampsia is characterised by hypertension, proteinuria and generalised oedema developed after 20 weeks gestation. We report serial changes in multifocal electroretinography (MERG), fluorescein angiography (FA), and indocyanine green angiography (ICGA) in a patient with pre-eclampsia who developed choroidal ischaemia and serous retinal detachment.nn### CASE REPORTnnA 28 year old Chinese woman, gravida II, para I, was hospitalised at 31 weeks gestation with blood pressure of 178/98 mm Hg, 4+ proteinuria and pretibial oedema. At 34 weeks gestation, emergency caesarean section was performed because of uncontrolled pre-eclampsia. Two days post partum, she complained of blurring of vision in the right eye. On examination, her visual acuity was right eye: 20/30, left eye: 20/15. There was no afferent pupillary defect. Anterior segment and intraocular pressure was normal. Fundal examination revealed bilateral greyish-yellow lesions at the level of retinal pigment epithelium (RPE), distributed mainly in peripapillary area and posterior pole. There was …

Endogenous Endophthalmitis: A 10-Year Retrospective Study at a Tertiary Hospital in South India.

Purpose The aim of this study was to review the clinical profile including predisposing systemic conditions, microorganisms responsible, clinical presentation, and outcomes of endogenous endophthalmitis (EE) in South India. Design This study is a retrospective, noncomparative case series. Methods This study presents a retrospective analysis of records of patients with EE in a 10-year period. Results A total of 61 eyes of 58 patients were included in the study. Preceding systemic illness or surgery was noted in 31 patients (53.4%). No predisposing condition was found in 27 patients (46.5%). All eyes had severe diffuse EE. Culture positivity was seen in 34 of 58 patients (58.6%). Gram-positive organisms were isolated in 9 cases (15.5%), and Gram-negative organisms were isolated in 20 cases (34.5%). Pseudomonas aeruginosa (13.8%) was the most common isolate. Eleven eyes (18%) were managed medically with intravenous and intravitreal antibiotics, and 38 eyes (62.3%) also underwent vitrectomy. Eight eyes (13.1%) required repeat vitrectomy, and 12 eyes (19.7%) were eviscerated. The mean follow-up was 16.2 ± 13.9 months. Final visual acuity of 20/200 or better was seen in 29.5% eyes. A favorable outcome was noted in culture-positive patients (P = 0.03) and in patients with no predisposing causes. Conclusions This study provides information about the clinical and microbiologic profile of EE. Aggressive medical and surgical treatment can result in favorable outcomes.

Comparison of pH-adjusted bupivacaine with a mixture of non-pH-adjusted bupivacaine and lignocaine in primary vitreoretinal surgery.

Purpose To compare the efficacy of alkalinized bupivacaine with that of a mixture of nonalkalinized bupivacaine and lignocaine for local anesthesia in primary vitreoretinal surgery. Methods Through a prospective, double-blind, randomized, controlled clinical trial, 540 consecutive patients undergoing primary vitreoretinal surgery received either alkalinized 0.5% bupivacaine (group B) or a mixture of nonalkalinized 0.5% bupivacaine and 2% lignocaine (group BL), both of which were administered with hyaluronidase, for periocular anesthetic block. The periocular block involved two injections in the extraconal space—one in the lower temporal quadrant and the other in the medial periconal space. The efficacy of the block was graded from 0 to 5 depending on the adequacy of anesthesia and akinesia and the need for local supplementation. Results Adequate anesthesia and akinesia (grade 5) were achieved in 72.2% of the patients in group B compared with 57.4% in group BL (P = 0.0003). Intraoperative supplementation was needed in 9.6% and 20.7% of the patients in groups B and BL, respectively (P = 0.0003). Postoperative analgesics were required in 7.4% of the patients in group B and in 15.2% of those in group BL (P = 0.004). Conclusion Alkalinized 0.5% bupivacaine provides better quality of anesthesia than does the mixture of nonalkalinized 0.5% bupivacaine and 2% lignocaine for patients undergoing primary vitreoretinal surgery.

Incidence, microbiology, and outcomes of endophthalmitis after 111,876 pars plana vitrectomies at a single, tertiary eye care hospital

Purpose To describe the incidence, risk factors, clinical presentation, causative organisms, and outcomes in patients with endophthalmitis following pars plana vitrectomy (20G and minimally invasive vitrectomy surgery (MIVS). Methods Of 111,876 vitrectomies (70,585 20-G 41,291 MIVS) performed, 45 cases developed acute-onset, postoperative endophthalmitis. Results The rate of culture positive and culture negative endophthalmitis was 0.021% (2.1/10,000 surgeries) and 0.019% (1.9/10,000 surgeries) overall, 0.031% (3.1/10,000 surgeries) and 0.025% (2.5/10,000 surgeries) in 20G, and 0.005% (0.5/10,000 surgeries) and 0.007% (0.7/10,000 surgeries) in the MIVS group respectively. Potential predisposing factors were as follows: diabetes, 46.7%; vitrectomy for vascular retinopathies, 44.4%; and vitrectomy combined with anterior segment surgeries, 35.5%. The culture proven rates were 53.3% overall, 55.0% for 20G and 40.0% for MIVS. The most common organism was Pseudomonas aeruginosa for 20G. Klebsiella and Staphylococcus aureus were isolated in the two culture positive cases in MIVS group. The follow-up period for the patients with endophthalmitis was 586.14 ± 825.15 days. Seven were lost to follow up beyond one week. Of the remaining 38, 13 (34.2%) cases had a favorable visual outcome (i.e., best-corrected visual acuity [BCVA] > 5/200) and 24 (63.2%) had unfavorable visual outcome (BCVA < 5/200). Group with culture test results negative had significantly better outcomes (P < 0.05) as compared to those with positive. Conclusions MIVS does not increase the risk of endophthalmitis. Outcomes are poor despite appropriate treatment, particularly in cases with culture results positive.

Solitary retinal astrocytoma in an infant.

A 5-month-old infant presented with a solitary retinal astrocytoma that clinically and ultrasonographically mimicked retinoblastoma. The diagnosis was established on histopathologic examination. There was no systemic evidence of tuberous sclerosis or neurofibromatosis. Thus, solitary, large, retinal astrocytomas can occur in the absence of any systemic manifestations.