Rishiraj Singh

Quantitative polymerase chain reaction for Mycobacterium tuberculosis in so-called Eales' disease.

Purpose: To report mycobacterial load in the vitreous of patients labeled as having Eales’ disease. Methods: Eighty-eight patients were prospectively enrolled into 3 groups: 28 patients with so-called Eales’ disease (group A); 30 positive controls with specific uveitis syndromes (group B), and 30 negative controls (group C). The undiluted vitreous humor samples were collected and subjected to real-time PCR assay for MPB64 gene of Mycobacterium tuberculosis (MTB) and load quantified. Results: Sixteen (57.14%) vitreous fluid samples in group A; 1 sample in group B, and none of the samples in group C were positive for MTB genome from the vitreous. The copies of MTB genomes in the positive samples in group A were 1.52 × 104 to 1.01 × 106. Conclusion: MTB genome was demonstrated in more than 50% of vitreous fluid samples with significant bacillary load, indicating that half of patients with so-called Eales’ disease are indeed cases of tubercular vasculitis.

Outcome of paediatric cataract surgery with primary posterior capsulotomy and anterior vitrectomy using intra-operative preservative-free triamcinolone acetonide

To evaluate the intra‐operative and postoperative outcome of paediatric cataract surgery with primary posterior capsulotomy (PPC) and anterior vitrectomy using intra‐operative preservative‐free triamcinolone acetonide.

Toric intraocular lens implantation in children with developmental cataract and preexisting corneal astigmatism

To evaluate the effect of toric intraocular lens (IOL) implantation on the refractive outcomes in children with cataract and preexisting corneal astigmatism.

Use of Scheimpflug imaging in the management of intra-lenticular foreign body

INTRODUCTION Asymptomatic traumatic intra-lenticular foreign body is very uncommon and few case reports have been published. OBJECTIVE To report a case of post-traumatic intra-lenticular foreign body and use of Scheimpflug imaging in its management. CASE A 41-year-old male with history of injury to right eye during hammering a chisel 1 year back presented with decreased vision since 6 months. An intra-lenticular foreign body was found on slit lamp bio-microscopy and was confrmed by Scheimpflug imaging. Posterior capsule was intact on Scheimpflug imaging. Thus, Scheimpflug imaging helps in exact localization of the foreign body in the intralenticular space or behind the iris. We ruled out other foreign bodies by x-ray and ultrasonography of the orbit. The foreign body with post-traumatic cataract was removed using phacoemulsification and three piece foldable intraocular lens was implanted in the bag. CONCLUSION An intra- lenticular foreign body may remain asymptomatic for months. Scheimpflug imaging can be useful in its localization. It can be removed during phacoemulsification.

Visual outcomes of pediatric traumatic cataracts

Introduction: To report visual outcomes and risk factors of pediatric traumatic cataracts in a tertiary care referral center in northern India. Methods: We analyzed medical records of traumatic cataracts in the pediatric age group (1–15 years) operated for cataract surgery with or without posterior chamber intraocular lens implantation with or without primary posterior capsulotomy with anterior vitrectomy between 2004 and 2012. Causative agents, types of trauma, demographic factors, surgical interventions, complications, and visual acuity were recorded and compared among different groups. Results: A total of 147 children were documented to have undergone cataract surgery for traumatic cataract in the study period, male-to-female ratio being approximately 5:1. Mean age was 7.67 ± 3.30 years (range, 1–15 years). Type of primary insult was penetrating injury in 100 (68%) patients and blunt trauma in 47 (32%) patients. Mean interval between injury and cataract surgery in penetrating injury cases was 3.84 ± 7.05 months and in the blunt injury cases was 6.28 ± 11.13 months. Preoperatively, only 110 patients were cooperative for visual acuity. Out of them, none had vision better than 6/18 and only 21 patients (19.9%) had vision of ≥6/60. Visual acuity of 6/18 or better (was considered good visual outcome) was achieved by 87.9%, 97.3%, and 97.9% at 1, 6, and 36 months, postoperatively. Eyes which underwent primary posterior capsulotomy and anterior vitrectomy during cataract surgery showed statistically better visual outcome than those without it. Conclusion: Phacoaspiration with posterior chamber intraocular lens implantation along with primary posterior capsulotomy and anterior vitrectomy and timely introduction of amblyopia therapy helped in gaining good visual outcome in pediatric traumatic cataract patients irrespective of the age of presentation and the type of injury.

Scleral Fixation of Sinking Bag-IOL Complex: A New Surgical Technique

Treatment options for symptomatic subluxated or dislocated IOLs include observation; and repositioning, removal, or exchange of the IOL. We describe a surgical technique of trans-scleral suture fixation for subluxated bag-IOL complex. A 29 year old male; known case of bilateral recurrent tubercular panuveitis underwent left eye phacoemulsification with three piece hydrophobic acrylic IOL implantation a decade ago. He presented with decreased vision and monocular diplopia since one week. A diagnosis of subluxated bag-IOL complex was made. A 9-0 polypropylene suture was passed beneath the opposite scleral flaps and was taken out through superior stab incision. After exteriorizing both the haptics, they were sutured with prolene. Bag-IOL complex was centered and was fixated trans-sclerally under the scleral flaps. The bag-IOL complex remained stable and well centered 12 months following trans-scleral suture fixation with good visual outcome. This technique can be used in any case of postoperative bag-IOL complex subluxation or dislocation to achieve stabilization.

Ultra-Late Onset Capsular Bag Distension Syndrome: Risk Factors and Characteristics on Scheimpflug Imaging

Background: To provide insights into the characteristic of ultra-late onset capsular bag distension syndrome (CBDS) after phacoemulsification. Design: An interventional, retrospective case series at a tertiary care institute. Participants: 5 Post-cataract surgery patients who presented with the retrolenticular fluid collection. Methods: This is an interventional, retrospective case series of 5 cases who presented with clinical signs of ultralate CBDS>7 years after uneventful phacoemulsification with in-the-bag posterior chamber intraocular lens implantation at a tertiary care institute. Scheimpflug imaging was used in all cases in addition to slit lamp biomicroscopic examination to assess and diagnose the condition. Neodymium:Yttrium Aluminium Garnet (Nd:YAG) posterior capsulotomy was performed in all to treat the condition. Main outcome measure: Results: All 5 patients presented with a milky fluid collection within the distended capsular bag without raised intraocular pressure or a shallow anterior chamber. Scheimpflug imaging confirmed the diagnosis in all cases and all eyes revealed a hyper-reflective space between the intraocular lens optic and the posterior capsule. Nd:YAG posterior capsulotomy was performed in all patients, with resolution of fluid and improvement of visual acuity. Conclusion: Our case series showed that Scheimpflug imaging is a useful modality to diagnose ultra-late onset CBDS and to differentiate this condition from intraocular lens opacification and posterior capsule opacification (PCO). Nd:YAG posterior capsulotomy proved to be successful treatment for ultra-late CBDS with no significant change in biometric or refractive parameters. Keywords: Ultra-late capsular bag distension syndrome;