Sat Pal Garg

Comparison of scleral buckling with combined scleral buckling and pars plana vitrectomy in the management of rhegmatogenous retinal detachment with unseen retinal breaks.

Background: The purpose of the present paper was to compare the techniques of conventional scleral buckling and combined pars plana vitrectomy and scleral buckling procedures in rhegmatogenous retinal detachments with unseen retinal breaks.

Optical coherence tomography findings in commotio retina

A 16‐year‐old boy presented with diminished visual acuity of 6/60 following blunt trauma to his right eye with a cricket ball. Fundus examination showed commotio retinae. Optical coherence tomography (OCT) demonstrated increased reflectivity with small optically clear spaces in the area corresponding to the photoreceptor outer segment. At 2‐month follow up the visual acuity improved to 6/6. A small area of retinal opacification persisted nasally, and OCT of the corresponding area continued to show increased reflectivity in the area of photoreceptor outer segment. Increased reflectivity on OCT in eyes with commotio retinae probably denotes photoreceptor outer segment disruption and seems to be reversible to a variable extent.

Prospective Evaluation of Intravitreal Triamcinolone Acetonide in Serpiginous Choroiditis

Objective: To evaluate intravitreal triamcinolone acetonide (IVTA) in unilateral serpiginous choroiditis with macular involvement with special reference to effectiveness of treatment and its side effects. Methods: In this prospective nonrandomized, consecutive, interventional case series, IVTA was given in 8 eyes of 8 patients of unilateral active serpiginous choroiditis. Treatment was evaluated on both subjective and objective parameters: any improvement or stabilization of visual acuity, fundus and fluorescein angiography (FA) and central macular thickness on optical coherence tomography (OCT). Result: The treatment induced rapid remission clinically and vision improved or stabilized. Mean visual acuity improved from 0.93 ± 0.21 LogMAR units at baseline to 0.36 ± 0.24 (p = 0.00) LogMAR units at 6 months. A 33.73% reduction in mean central macular thickness was observed at the 6-month follow-up from 294.63 ± 17.84 to 195.25 ± 5.49 µm (p = 0.00). Lesions healed rapidly with FA and OCT proving the clinical observation. Conclusion: Intravitreal triamcinolone may prove to be a promising therapeutic approach as a rescue therapy in this recurrent sight-threatening disorder by inducing rapid remission without the systemic side effects seen with systemic immunosuppression.

Limbal patch graft in surgically induced scleral necrosis

BackgroundSurgically induced scleral necrosis (SINS) is a rare consequence of ocular surgery. Various graft materials have been recommended for the repair of scleral necrosis. We report use of fresh cadaveric limbal graft for the same purpose.MethodA 42-year-old female presented with severe pain and buckle extrusion following external segmental buckling surgery for inferior retinal detachment. Buckle removal performed under general anesthesia revealed an area of scleral necrosis with uveal prolapse. Due to non-availability of other donor material a fresh cadaveric limbal graft remnant after keratoplasty was used for the repair after obtaining informed consent.ResultsSuccessful uptake of graft was observed and the globe integrity was restored.ConclusionThe case suggests that a fresh limbal graft may provide adequate tectonic support in eyes with SINS and can serve as an option for donor graft tissue in emergency situations.

Spontaneous Resolution of Macular Exudation with Good Visual Recovery in Idiopathic Retinal Vasculitis, Aneurysms, and Neuroretinitis (IRVAN): A Case Report

A 14-year-old boy presented with decreased visual acuity in both eyes of three-months duration. Fundus examination revealed macular exudation in both eyes with aneurysmal changes at the arteriolar bifurcations. Fluorescein angiography confirmed the presence of numerous aneurysmal dilatations of the retinal arterioles and extensive peripheral capillary nonperfusion areas. A provisional diagnosis of idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) was made. Scatter photocoagulation was advised in view of the extensive capillary nonperfusion areas. The patient was then lost to follow-up. He presented a year later with bilateral nonresolving vitreous hemorrhage, more severe in the right eye. He underwent right pars plana vitrectomy. Intraoperatively, the fundus features were similar to those at the initial presentation, but with the absence of any macular exudation. IRVAN represents an evolving clinical condition, with ill-defined clinical aspects, particularly with respect to management. In view of the spontaneous absorption of the macular exudates, we would like to suggest a cautious approach to applying photocoagulation of the retinal aneurysms.

Results of Investigations for Tuberculosis in Patients with Serpiginous Like Choroiditis in Comparison to Patients with Central Serous Retinopathy and Non-Serpiginous Uveitis

Background: To compare results of tuberculosis investigations in cases of serpiginous like choroiditis (SC), central serous retinopathy (CSR) and non serpiginous uveitis. Methods: 40 patients each of SC (Group 1), CSR (Group 2) and other non serpiginous uveitis (Group 3) were studied. Mantoux test and chest radiography results were compared. P values for the results were calculated by using a Pearson Chi-square test and Fisher exact test. P value ≤0.05 was considered significant. Results: 56/120 patients (53.3%) were Mantoux positive. 23/40 were Mantoux positive in Group 1, 17/40 positive in Group 2 and 16/40 positive in Group 3. Difference between the groups was not statistically significant (p=0.237). On chest radiography four in Group 1, three in Group 2 and five in Group 3 had past evidence of extraocular tuberculosis (p=0.757). Conclusions: Mantoux positivity was similar in SC, central serous retinopathy and non serpiginous uveitis patients. In a country like India where tuberculosis is endemic, Mantoux positivity alone cannot be considered as a major criterion for making a diagnosis of presumed ocular tuberculosis.

Intraocular Penetration of Orally and Intravenously Administered Fluoroquinolones in Non-Inflamed Eyes of the Patients Undergoing Vitrectomy Surgery

Purpose: This study evaluated intraocular penetration of fluoroquinolones (FQs) viz, ofloxacin, pefloxacin, lomefloxacin and sparfloxacin in aqueous, vitreous humors, and plasma after oral/intravenous administration in the subjects undergoing vitrectomy. Methods: Ofloxacin, pefloxacin, lomefloxacin and sparfloxacin were included for oral administration. Only ofloxacin and pefloxacin included for intravenous study. Each group was sub-divided into 3 time points (3, 6 and 12hrs post dose). For each time point, 8 eyes (8 patients) were included and a total of 144 patients were enrolled. Intra-operatively, 80-110� l aqueous, 100-250� l vitreous and 2ml of venous blood samples were collected. Plasma was separated and all samples were stored at -70 o C and subjected for quantification using HPLC and compared with their known MIC90 of common ocular pathogens. Results: In oral 400mg single dose, among all 4 FQs, ofloxacin showed a maximum concentration at 3 hours in aqueous (0.98(0.12)� g/ml) and vitreous (0.78(0.12)� g/ml). Intravenous infusion of 400mg ofloxacin also showed the similar levels in the humors of the eye. Despite low plasma levels, lomefloxacin showed higher aqueous to plasma (a/p) and vitreous to plasma (v/p) ratio. Conclusion: FQs 400mg (as iv and oral) as a single dose could not reach the desired therapeutic concentration (above MIC90 for all ocular pathogens) in aqueous and vitreous humors. The concentration reached in the humors may not be directly dependent on their plasma levels. Relatively non-polar FQs such as lomefloxacin and sparfloxacin showed better a/p and v/p ratios as compared to their polar analogs such as pefloxacin and ofloxacin.