Sundaram Natarajan

Role of Photodynamic Therapy in Polypoidal Choroidal Vasculopathy

PURPOSE To evaluate photodynamic Therapy (PDT) with Verteporfin for polypoidal choroidal vasculopathy (PCV) involving the fovea in Indian eyes, through a retrospective interventional case series. MATERIALS AND METHODS We retrospectively reviewed the records of 9 patients (9 eyes) diagnosed to have PCV with foveal involvement between September 2001 and October 2002. RESULTS Nine eyes underwent PDT for PCV. Follow-up ranged from 12 to 16 months. Initial visual acuity (VA) ranged from 1/60 to 6/12 and final VA varied from 1/60 to 6/9 at the end of follow-up. VA improved in 4/9 eyes (44.4%) by one line and remained unchanged in 5/9 eyes (55.6%), hence it was considered stabilized in all eyes. No adverse effects or events were observed during or after treatment with verteporfin. CONCLUSION PDT may be beneficial for PCV with foveal involvement. Its long-term efficacy requires to be evaluated.

Management of intraocular cysticercosis.

Abstract · Background: A study was carried out to investigate the various posterior segment presentations of intraocular cysticercosis and their management. · Methods: A retrospective study of five consecutive cases of intraocular cysticercosis seen at our institute was done. Pars plana vitreous surgery for removal of intact cysts was done in all cases. · Results: Complete removal of the intact cyst through the pars plana route was achieved in all cases. Postoperative periods were uneventful, with visual recovery to 6/9 or better in all cases. · Conclusions: Complete surgical removal of the intact cyst can result in good functional recovery in eyes with intraocular cysticercosis.

Choice of Cell Source in Cell-Based Therapies for Retinal Damage due to Age-Related Macular Degeneration: A Review.

Background. Age-related macular degeneration (AMD) is a complex disorder that affects primarily the macula involving the retinal pigment epithelium (RPE) but also to a certain extent the photoreceptor layer and the retinal neurons. Cell transplantation is a promising option for AMD and clinical trials are underway using different cell types. Methods. We hypothesize that instead of focusing on a particular cell source for concurrent regeneration of all the retinal layers and also to prevent exhaustive research on an array of cell sources for regeneration of each layer, the choice should depend on, precisely, which layer is damaged. Results. Thus, for a damage limited to the retinal pigment epithelial (RPE) layer, the choice we suggest would be RPE cells. When the damage extends to rods and cones, the choice would be bone marrow stem cells and when retinal neurons are involved, relatively immature stem cell populations with an inherent capacity to yield neuronal lineage such as hematopoietic stem cells, embryonic stem cells, or induced pluripotent stem cells can be tried. Conclusion. This short review will prove to be a valuable guideline for those working on cell therapy for AMD to plan their future directions of research and therapy for this condition.

Aspergillus Iris Granuloma: A Case Report with Review of Literature

We report the case of a 25-year-old male patient who presented with complaints of redness, photophobia, and decreased vision in the right eye of a weeks duration. Slit-lamp biomicroscopic examination revealed a cream-colored, irregular elevated inferior iris mass, extending on to the anterior lens surface. Differential diagnoses of a fungal granuloma, a medulloepithelioma, and an amelanotic melanoma were considered. An excisional biopsy of the mass was performed through a superior clear corneal incision. Polymerase chain reaction analysis of the aqueous humor showed a positive pan fungal genome. Histopathology of the biopsied mass showed a giant cell granuloma with surrounding numerous branching, septate hyphae. Culture growth revealed Aspergillus fumigatus We report this case because of the rarity of Aspergillus iris granuloma as a primary presentation of endogenous Aspergillosis and review the relevant literature. Absence of a significant systemic history compounded the diagnostic dilemma in our patient. Definitive differentiation of this rare entity from a foreign body, amelanotic melanoma, and other inflammatory conditions such as sarcoidosis and tuberculosis, may be possible only on microbiological and histo-pathological evaluation.

Community-Acquired Methicillin-Resistant Staphylococcus aureus (CAMRSA)—A Rare Cause of Fulminant Orbital Cellulitis

We report a 55-year-old female patient who developed a severe right-sided orbital cellulitis. Past history was significant for a boil on the right upper eyelid 2 days prior. Visual acuity at presentation was perception of light with inaccurate projection. Orbital computed tomography (CT) scan and routine blood investigations, including blood culture, urine examination, and urine culture, were performed. CT scan showed a superonasal orbital mass suggestive of an abscess. Abscess drainage followed by pus culture, sensitivity, and pulsed-field gel electrophoresis revealed community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) resistant to all antibiotics except vancomycin, cotrimoxazole, and amikacin. The condition completely resolved post antibiotic and steroid therapy. At 3 months follow-up, the vision in the right eye was 6/9. We report this case to highlight CAMRSA as a rare but virulent cause of orbital cellulitis; empiric antibiotic therapy should include coverage for CAMRSA until susceptibilities come back.

Intravitreal triamcinolone acetonide versus combined intravitreal bevacizumab and dexamethasone in diffuse diabetic macular oedema

Background:  To compare the efficacy of a single injection of combined intravitreal dexamethasone and bevacizumab (Avastin) with that of intravitreal triamcinolone acetonide in eyes with diffuse cystoid diabetic macular oedema.

A rare case of choroidal neovascularization following macular hole surgery

BackgroundChoroidal neovascularization occurs in a wide spectrum of conditions, including degenerative, inflammatory, traumatic and hereditary conditions, all of which are characterized by breaks in Bruchs membrane. A few cases of choroidal neovascular membrane (CNVM) have been reported in the literature following macular hole surgery.MethodWe present a retrospective case study of a single patient who developed CNVM after successful macular hole surgery. The 70-year-old diabetic female underwent macular hole surgery in her right eye. Posterior hyaloid was separated with suction and vitrectomy was performed. Internal limiting membrane (ILM) was stained with trypan blue under air and ILM peeling was performed. Perfluoropropane (C3F8) gas was used as the tamponade. Six weeks post-operation, closure of macular hole was seen. Six months later, she presented with defective vision. Subfoveal classic CNVM was seen in the same eyeDiscussionAbout 1%–3% of patients who undergo macular hole surgery develop CNVM. Age-related changes and surgical trauma are considered to be the predisposing factors in reported cases. Injury to the retinal pigment epithelium (RPE) during surgery may be an important factor in our case, since there were no pre-existing age-related changes.ConclusionsCNVM though rare can occur after macular hole surgery, especially in the setting of age-related changes. Injuries to the RPE should be avoided during surgery. We report a case of CNVM after macular hole in which trypan blue was used as a staining agent.

Aditya Jyot-Diabetic Retinopathy in Urban Mumbai Slums Study (AJ-DRUMSS): Study Design and Methodology - Report 1

Abstract Purpose: To describe the methodology of Aditya Jyot-Diabetic Retinopathy in Urban Mumbai Slums Study (AJ-DRUMSS), which was designed (i) to estimate the prevalence of diabetic retinopathy (DR) in a general population, (ii) to study the risk factors associated with DR in those with type 2 diabetes mellitus (DM), and (iii) to create awareness for early detection and develop timely interventional management for DR. Methods: AJ-DRUMSS is an ongoing population-based cross sectional study conducted in seven wards of slums in Mumbai, India, wherein eligible subjects from the general population were screened for DR and profiled for their demographic, social and biochemical parameters to study the associations of these factors. Results: To date, nearly 54,000 households have been enumerated for both awareness and DR prevalence in five study areas (out of seven) during 17 awareness campaigns and 78 DR screening camps. Of these, 4295 households were included in AJ-DRUMSS. Nearly 15,000 camp subjects (including subjects from awareness-focused areas who also turned up for the screening camps) were screened from the total enumerated households, of which 16.1% were diagnosed with type 2 DM. A total of 14.5% of these had evidence of DR and 3.5% had sight-threatening DR. Conclusions: A detailed study design of AJ-DRUMSS is described. In the screening camps nearly 3.5% of the diabetic population had sight-threatening DR, which needed an active interventional strategy. This study will help in formulating efficient eye care policies, making optimum use of available resources, reorienting healthcare providers and the ignorant within the population regarding the need for periodic ophthalmic surveillance and timely intervention.

Inner and outer retinal volumetric and morphologic analysis of the macula with spectral domain optical coherence tomography in retinitis pigmentosa

Purpose: To use spectral domain optical coherence tomography (OCT) to assess the features of the inner and outer layers of the macula in subjects with retinitis pigmentosa (RP). Design: Prospective observational comparative study. Materials and Methods: Subjects with RP with reduced central visual acuity and central macular thinning (RP group) underwent spectral domain OCT evaluation along with age-matched healthy control subjects (control group). Using the E-MM5 raster protocol, a 5 × 5 mm central macular cut was acquired with inner and outer macular volumes serving as the primary outcome measures. A structural analysis of the inner and outer retinal layers at the macula in the RP group was also performed using the HD cross-line protocol. Results: The RP group comprised six eyes of six RP subjects and control group comprised six eyes of six control subjects. The outer macular volume was significantly lower (P<0.05) in the RP group (2.01±0.44 mm3) compared to the control group (4.68±0.16 mm3). There was no difference in the mean inner macular volume between the RP group (2.46±0.24 mm3) and the control group (2.55±0.22 mm3). No significant structural alteration was noted in the inner retinal layers of the RP group. There was no significant correlation (r = -0.04, P>0.05) between best-corrected visual acuity and outer macular volume in the RP group. Conclusions: Spectral domain OCT findings confirm that RP preferentially affects the outer retinal layers in the macula. Although the number of patients included in this study was small, it demonstrated relatively well-preserved volume and morphology of the inner retinal layers using spectral domain OCT.

Phacoemulsification and pars plana vitrectomy: a combined procedure.

AIM To describe the results of a combined procedure including phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL) and pars plana vitrectomy (PPV) in eyes with vitreoretinal pathology and coexisting significant cataract. DESIGN Retrospective, consecutive, noncomparative, interventional case series. MATERIALS AND METHODS Medical records of patients who had undergone phacoemulsification, PPV and PCIOL implantation as a combined procedure between January 2000 and December 2004 were retrospectively reviewed. The main outcome measures were the anatomical success of retina, defined as reattached retina, intraoperative and postoperative complications and functional success in terms of final best corrected visual acuity. RESULTS In all, 65 eyes of 64 patients were included. The mean age of the patients was 50.9 years +/- 17.1 (range, five to 82 years). Vitreous hemorrhage with or without retinal detachment (19 eyes, 29.2%) was the most common indication for the vitreoretinal procedure. Primary anatomical success of retina was achieved in 59 eyes (90.7%). Visual acuity improved in 48 eyes (73.8%), was unchanged in 12 eyes (18.5%) and deteriorated in five eyes (7.7%). Postoperative inflammation was significantly more in the subgroup of previously vitrectomized eyes (42%) (P =0.014, Fisher exact test) compared to those which underwent primary vitrectomy. CONCLUSIONS Combined surgery is a feasible option for patients with vitreoretinal diseases and cataract.