Ruchi Goel

Efficacy of sutureless and glue free limbal conjunctival autograft for primary pterygium surgery.

INTRODUCTION There are numerous adjunctive measures described to reduce the recurrence rates after pterygium excision. OBJECTIVE To study the efficacy and complications of sutureless and glue free limbal conjunctival autograft for the management of primary pterygium over a period of one year. MATERIALS AND METHODS A prospective interventional case series was carried out in 40 consecutive eyes with primary nasal pterygium requiring surgical excision. Pterygium excision with limbal conjunctival autografting without using glue or sutures was performed in all the patients followed by bandaging for 48 hours. The patients were followed up post operatively on 2nd day, 1 week, 6 weeks, 6 months and 12 months. They were examined for haemorrhage, wound gape, graft shrinkage, chemosis, graft dehiscence, recurrence or any other complication. RESULTS The mean age of the patients was 42.8 years (range 23-61), 75% of which were males. Total graft dehiscence occurred in 2 eyes (5%), graft retraction in 3 eyes (7.5%) and recurrence was seen in 1 eye (2.5%). At 6 weeks postoperatively, the gain in uncorrected visual acuity ranged from 0.18 to 0.5 log MAR in 7 eyes. No other complication was noted. CONCLUSIONS Sutureless and glue free limbal conjunctival autografting following pterygium excision is a safe, effective and economical option for the management of primary pterygium.

Bilateral interstitial keratitis and granulomatous uveitis of tubercular origin.

Background: Tuberculosis (TB) is an important cause of ocular morbidity. Establishing a diagnosis may be difficult in some situations especially with unusual presentation. We report case of bilateral interstitial keratitis (IK) associated with anterior uveitis as a presenting feature of ocular TB from India. Methods: A 17-year-old woman presented with diminution of vision in both eyes. Slit lamp biomicroscopy showed central bilateral IK and active granulomatous uveitis. Laboratory investigations revealed raised erythrocyte sedimentation rate (50 mm/hr) and positive tuberculin test (22 mm induration) and QuantiFERON—TB Gold test (3.34 IU/mL), with no foci of systemic infection. Results: Presumptive diagnosis of ocular TB was made. The patient was started on antitubercular therapy and topical steroids, after which symptoms and signs resolved. There was no recurrence of the disease for 1 year after completion of antitubercular therapy. Conclusions: Bilateral central IK with granulomatous uveitis is probably related to the presence of tubercular antigen in aqueous humor. Positive QuantiFERON—TB Gold test is useful for initiating the antitubercular treatment where unusual presentation is encountered.

Nucleus management with Blumenthal technique: Anterior chamber maintainer

The Blumenthals ‘Mininuc’ technique enables nuclear expression through a 5-6.5-mm sclerocorneal tunnel incision using a Sheets lens glide and anterior chamber maintainer (ACM). A 6-mm or larger capsulorrhexis, reduction in nuclear size by hydroprocedure and its manipulation manually into the anterior chamber are performed. The nucleus is expressed out of the chamber by use of hydrostatic pressure created by balanced salt solution delivered continuously through the ACM. This continuous flow from ACM to anterior chamber keeps the eye under positive pressure physiological state besides clearing the chamber of cortex, blood and pigments offering excellent visualization. The procedure, with an initial learning curve, is highly effective, applicable to all grades of cataracts, has minimum intraocular instrumentation resulting in an early rehabilitation of the patient.

Topiramate-induced angle-closure glaucoma: cross-sensitivity with other sulphonamide derivatives causing anterior uveitis

Topiramate is a recognized cause of drug-induced acute angle-closure glaucoma. We describe a case presenting with bilateral acute angle-closure glaucoma caused by topiramate intake. Patient subsequently developed severe anterior uveitis caused by sulphonamide derivatives (acetazolamide and co-trimoxazole) due to cross-sensitivity, on two separate occasions. The present case also highlights the role of anterior segment optical tomography in diagnosis and follow-up. In a patient with known drug allergy to topiramate, other sulphonamide derivatives should be avoided to limit the ocular morbidity.

Lower eyelid suspension using polypropylene suture for the correction of punctal ectropion.

OBJECTIVE To evaluate the efficacy and complications of lower eyelid suspension with the modified Safdarjung hospital technique using 5:0 polypropylene suture for punctal ectropion. STUDY DESIGN Prospective case series. METHOD Thirty one eyelids in 19 patients with mild and moderate ectropion and all types of laxity including involutional and paralytic were included. All patients underwent lower eyelid suspension with the modified Safdarjung hospital technique. A 5:0 polypropylene suture was passed in the pre-tarsal plane between the attachments of the lateral and medial canthal tendons near their insertion at the orbital rim. Successful outcome was judged by the anatomical restoration of the apposition of the punctum to the globe in the upward gaze and the physiological relief of epiphora. The recurrence of lid laxity, overall lid/globe apposition and complications were also noted. RESULTS At 1 year follow up anatomical success was achieved in 28 (90%) patients and functional success noted in 27 (87%) patients. Recurrence of lid laxity was noted in 2 patients. There was a suture exposure in one case and a suture granuloma in another case. The results did not correlate to the degree of ectropion and type of laxity. CONCLUSION Lower eyelid suspension using 5:0 polypropylene suture is a useful procedure for the treatment of involutional and paralytic punctal ectropion. It is simple and effective with minimal complications. However, the effect on scleral show and the concern related to suture material biodegradation over years needs to be further evaluated.

Naso-cutaneous fistula following transcanalicular laser dacrocystorhinostomy.

We report a case of naso-cutaneous fistula due to thermal injury during transcanalicular laser dacryocystorhinostomy followed by superadded infection with coagulase negative staphylococcus in a diabetic patient. The case highlights the importance of meticulous wound care in the management and possibility of its occurrence even with minor thermal injury in immunocompromised patients.

Autologous serum for anterior tissue necrosis after porous orbital implant

Orbital implants are now routinely used after enucleation and evisceration. However exposure of the implant can lead to infection and extrusion. Hence, early repair of larger exposure with graft material is required. We describe three cases where early postoperative mucosal dehiscence was successfully managed with autologous serum.

Rosai-dorfman with bilateral involvement of lacrimal sac as extranodal disease.

A 45 year old female presented with painless swelling over the inner side of both eyes since one year. Magnetic resonance imaging (MRI) scan revealed well defined lesions in the bilateral lacrimal sac area with extension along the naso-lacrimal duct. Systemic work up showed polyclonal hyperglobulinemia, raised erythrocyte sedimentation rate (ESR) and anemia. The patient also had subcutaneous swelling in thoracic area over back. The histopathology of the bilateral excised tumor and fine needle aspiration cytology of thoracic swelling was consistent with features of Rosai-Dorfman syndrome.

Manual small incision cataract surgery for subluxated cataract with lens coloboma

INTRODUCTION The lens coloboma results from a segmental defective or absent development of the zonules. It is usually unilateral and bilateral cases are rare. These eyes are at greater risk of complications during cataract surgery due to ocular malformations. In addition the capsular bag requires stabilization using modified capsule tension ring, capsular tension segment or capsular anchor. METHODS Lens extraction is indicated for cataract or subluxation if visual function is sufficiently compromised. We report our surgical experience in a patient with bilateral isolated lens coloboma by performing manual small incision cataract surgery (MSICS) in left eye and phacoemulsification in right eye. RESULTS The nuclear rotation was hampered because of the lack of zonules and presence of lens coloboma. MSICS was converted to the intracapsular technique in left eye, though breaking the nucleus into pieces during phacoemulsification in right eye enabled its mobilization and successful completion with implantation of modified capsule tension ring. CONCLUSIONS A patient with lens subluxation and lens coloboma is better managed by phacoemulsification as compared to the MSICS.

Orbital Myiasis Complicating Squamous Cell Carcinoma in Xeroderma Pigmentosum

Ophthalmomyiasis is a rare infection seen in susceptible individuals. We report a case of orbital myiasis in squamous cell carcinoma (SCC) in a patient of xeroderma pigmentosum. On presentation, reddish brown ulcerated mass with numerous maggots in orbit were seen. Computed tomography scan showed the presence of soft tissue lesion without any bony destruction. Following debridement, emergency exenteration with sacrifice of eyelid skin was performed. The diagnosis of SCC was confirmed on histopathologic evaluation. The maggots belonged to family Calliphoridae and secondary bacterial infection with Klebsiella organism was identified. Management issues included extensive involvement requiring exenteration, non-availability of skin graft, delayed secondary healing and recurrence of pigmented lesions in skin lining of orbit. The skin grafting was avoided as it can harbour the neoplasm.