Ram Lal Sharma

Current spectrum of oculomycosis in North India: A 5-year retrospective evaluation of clinical and microbiological profile

Oculomycosis is a major cause of visual impairment. Eye pain, redness, discharge, diminution and photophobia are presenting features. We collected corneal scraping, vitreous, aqueous fluids and conjunctival swabs after the slit-lamp examination. Ophthalmological findings were hypopyon, stromal congestion, conjunctival congestion and epithelial defect. Direct microscopy of 10% potassium hydroxide (KOH) wet mounts, gram staining, fungal and bacterial cultures were performed. Fungal isolates were obtained in 24% patients with equal number of both sexes and average age 49 years. KOH revealed fungi in 73% samples and 43.33% were positive on Gram staining. Fusarium spp. (36.66%), Aspergillus spp. (23.33%) and melanised fungi (20%) were common etiological agents. Fusarium spp. was more often associated with complications. Trauma was a predisposing factor in 65% cases and occurred mainly with vegetable matter. The majority responded to the conservative management with 5% natamycin and four patients required surgery.

Extended lateral orbitotomy, an effective procedure to excise large orbital hydatid cyst: A rare case

Echinococcosis is an infection of humans by the larval stage of Echinococcus granulosus, Echinococcus multilocularis or Echinococcus vogeli. Orbital hydatid cyst is extremely rare and has an incidence of 1% of all the hydatid cysts. We report a case of a 6-year-old boy presenting with a large orbital hydatid cyst causing abaxial proptosis with compressive optic neuropathy and a cyst in the liver. The cyst was successfully removed from the orbit through a combined anterio-superior trans-periosteal lateral orbitotomy. Following surgery, there was immediate reduction of proptosis and healing of exposure keratopathy. The role of computerized tomography (CT) scan in early diagnosis and advantages of the lateral orbitotomy approach are discussed.

Minimal duration cataract surgery with oblique limbal stab incision technique

PURPOSE: Small incision cataract surgery (SICS) and phacoemulsification with oblique limbal stab incision technique were studied and compared. SETTING: The study was conducted in the Department of Ophthalmology, Indira Gandhi Medical College, Shimla, for 1 year. DESIGN: This was a prospective randomized study. METHODS: One hundred patients undergoing SICS (6–7 mm) were compared with another age- and sex-matched 100 patients undergoing phaco (2.8 mm) surgery with oblique limbal stab incision technique. These two groups were further subdivided into two groups of 50 each. Patients with traumatic cataract, corneal diseases, and preoperative astigmatism >1.5 D were excluded from the study. The patients were subjected to standard preoperative evaluation. Follow-up was done at 1, 2, 4, 6, and 12 weeks. RESULTS: Mean surgically induced astigmatism at 12 weeks was <1 D in both groups (+0.62 D ± 0.34 in Group A and +0.46 D ± 0.39 in Group B) (statistically significant P < 0.0010). Mean surgical duration was 690.09 s in SICS and 792.29 s in phacoemulsification (statistically significant, P < 0.0010). Visual outcome was between 6/6 and 6/9 in 86% of the patients in Group A and 97% of patients in Group B at 12 weeks. CONCLUSION: SICS and phacoemulsification with this technique yield lesser astigmatism than clear corneal and scleral incisions, with the advantage of extension without suturing in complicated cases of phaco and in patients with rigid intraocular lens phacoemulsification gives better BCVA in a larger proportion of patients at 12 weeks.

Cornea Verticillata: A Case Report

Systemic medications may reach the cornea via the tear film, aqueous humor, and limbal vasculature. The corneal changes are often the result of the underlying chemical properties of medications. Amphiphilic medications (Amiodarone, chloroquine, suramin, clofazimine, etc.) may produce a drug-induced lipidosis and development of a vortex keratopathy. it is thought that shearing force of upper lid, which is maximal at apex of cornea results in preferential loss of epithelial cells at the corneal apex acting as a stimulus for the centripetal movement of cells from limbus to central cornea The area with the radiating lines of vortex pattern concentrate just below the limit of excursion of upper lid. Any line, dot or spot on cornea needs to be examined thoroughly not to be overlooked. Vortex keratopathy also stresses the importance of scanning for accumulation of such drugs in other organs. The physician who has initiated the drug regime needs to informed about potential deposition of such drugs in other body systems. We hereby intend to report a case of clofazimine induced cornea verticillata.

Limbal carcinoma: Common malignancy at uncommon site

Limbus is the region of the eye between the cornea on one side and the sclera on the other. Limbus houses the stem cells. Neoplastic growths in limbus are the most common among growths of cornea and conjunctiva owing to the transition nature of the limbus. Although squamous cell carcinoma (SCC) is the most common carcinoma of limbus, its incidence is only 0.2–3.5/100,000. We present a 65-year-old patient with a limbal growth over a long period initially diagnosed as limbal stem cell deficiency. The patient sequentially developed epithelial dysplasia and then SCC. The complete excision of eyeball had to be done due to the recurrent nature of the lesion. The need for early detection of limbal mass and its prompt treatment cannot be overemphasized. Limbal growths have a good prognosis when treated early since they do not invade cornea and conjunctiva readily. Treatment is both surgical and medical. We present this case because of its rarity with a review of literature.

Basal and lateral block resection for residual eyelid tumor during second stage reconstruction at 3 weeks

There are different techniques for reconstructing the eyelids and canthal area which may need modifications in some situations for proper reconstruction. Three cases of sebaceous gland carcinoma of the lids were done by different techniques, where the extent of the disease required subtotal lid excision. At 3 weeks when healing was noted and the histopathology reports were available, the second stage reconstruction was done along with tissue block excision. The block was excised from the site of graft-host junction showing margin involvement on histopathology. In the first case, the base of the excised margin showed infiltration following tumor excision, and hence a basal block of tissue was excised during second stage surgery. In the second case, the excised margin showed tumor involvement, so a lateral block of tissue was excised in second stage surgery. In the third case the deep basal block of tissue was excised during first stage only. In all the three cases, the excised block was free from tumor, but patient were kept on close follow-up. The technique has worked well in all the cases as no recurrence has occurred in 1-year follow-up. None of these patients received any radiotherapy or chemotherapy postoperatively. The postoperative appearances were normal with adequate functioning lids and earlier rehabilitation.