Swapnil Parchand

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.

Reliability of Ocular Ultrasonography Findings for Pre-surgical Evaluation in Various Vitreo-retinal Disorders

Abstract Objective: To find the reliability of ocular ultrasonography (USG) for pre-surgical evaluation in various vitreo-retinal conditions. Method: In a retrospective study, a chart review of patients who underwent preoperative USG for various vitreoretinal conditions was done. We correlated findings of preoperative USG with intraoperative findings. Results: 131 of 130 patients were included. Various ocular pathologies included trauma, diabetic vitreous hemorrhage, endophthalmitis, and other causes of vitreous hemorrhage. We found overall sensitivity and specificity of 92.31% and 98.31% for identification of rhegmatogenous retinal detachment, and 96.2% and 100% for posterior vitreous detachment, respectively, whereas it was 100% for vitreous hemorrhage, preretinal bleed, and vitreous exudates. In eyes with trauma, sensitivity and specificity of USG for identifying the status of retina was least (90.9% and 97.7%). Conclusion: Our study highlighted that the reliability of USG findings was least in cases of trauma, hence requiring special care while reporting.

Intractable glaucoma necessitating dexamethasone implant (Ozurdex) removal and glaucoma surgery in a child with uveitis

Although there are encouraging reports showing the use of dexamethasone implant (Ozurdex) in uveitis in adults, the literature is scanty regarding its benefits and side effects in children. A 12-year-old boy presented with intermediate uveitis with disc oedema. He had 20/20 visual acuity and intraocular pressure (IOP) of 18 mm Hg in both eyes. He was treated with intravitreal Ozurdex in his left eye (LE) due to progressive worsening of uveitis and disc oedema. He developed increased IOP (31 mm Hg) that could not be controlled on maximal antiglaucoma medications and required the removal of the Ozurdex implant at 2.5 months. His IOP remained persistently high leading to increased cup disc ratio necessitating glaucoma filtration surgery (GFS). At 9 months of post-GFS follow-up, IOP was 12 mm Hg in LE without any medication. Though dexamethasone implant is being increasingly used in children with uveitis, its potential risk factors such as intractable glaucoma should be considered.

Glued intrascleral fixation of posterior chamber intraocular lens in children.

WE READ WITH GREAT INTEREST THE ARTICLE ENTITLED ‘‘Glued intrascleral fixation of posterior chamber intraocular lens in children,’’ by Kumar and associates. The authors reported the short-term results of glued intrascleral fixation of posterior chamber intraocular lens (glued IOL) in children without adequate capsular support. It is indeed a good alternative in children without adequate capsular support. We are especially interested in the 9 eyes with ectopia lentis in this study. The authors reported excellent result with this technique, with none of the eyes developing retinal detachment, IOL dislocation, endophthalmitis, or glaucoma on follow-up. We would like to share our small study, which we abandoned in between because of serious complications in 1 group. We prospectively randomized the eyes of 5 Marfan syndrome children with bilateral ectopia lentis into 2 groups. Group A eyes underwent 23-gauge pars plana lensectomy (PPL) with anterior vitrectomy and transscleral fixation of polymethyl methacrylate (PMMA) IOL using 10-0 polypropylene suture employing ab externo technique. Group B eyes underwent 23-gauge PPL with anterior vitrectomy and glued intrascleral fixation of foldable 3-piece acrylic IOL (technique described by the authors). Intraoperative peripheral fundus examination of all these eyes was done after PPL, before inserting the implant, in both groups. The aim of the study was to compare the postoperative outcome and complications between the 2 groups. There were 5 eyes in group A and 4 eyes in group B at the time of termination of the study. Out of 4 eyes in group B, 2 developed retinal detachment (RD). One eye developed RD at 3 months and the other at 5 months. None of the eyes in group A developed RD. There was no other complication in either group during the followup period. Both of these eyes with RD were managed by pars plana vitrectomy and silicone oil tamponade. An important intraoperative finding was the presence of vitreous incarceration at the site of externalization of haptics. Both eyes required iris hooks for better visualization of the posterior segment. We offer different points of view regarding the use of this technique in these eyes. These eyes are already predisposed to retinal detachment for various reasons, with reported incidence of 8% to 25.6%. This rate further increases with surgical techniques that result in vitreous

Outcome of surgery in post-cytomegalovirus retinal detachment: Experience before and in the era of highly active anti-retroviral therapy in Indian eyes

Purpose: To evaluate the outcome of surgery for cytomegalovirus associated retinal detachment (CMVRD) in human immunodeficiency virus (HIV)-infected patients in pre-highly active antiretroviral therapy (HAART) and HAART era in Indian eyes. Materials and Methods: Retrospective, we reviewed medical records of all consecutive HIV patients, who underwent surgical repair for CMVRD from July 1998 to June 2011. We divided patients into two groups, i.e. group 1, pre HAART era and group 2, HAART era. We compared two groups for various parameters like visual outcome, surgical success, additional procedures, follow-up, etc., Results: Twenty-eight eyes of 26 patients were included; 12 eyes of the 11 patients in group 1 and 16 eyes of the 15 patients in group 2. Significant visual acuity improvement was seen in both groups. Complete anatomic success was seen in 11 eyes in group 1 and 15 eyes in group 2. One additional procedure in group 1 and 29 additional procedures were done in group 2. A mean follow-up was 16 months in group 1 and 41 months in group 2. Conclusion: There was no difference in outcome in pre-HAART and HAART group, except for longer follow-up and additional surgical procedures in HAART group.

Live Juvenile Strobilate Tapeworm in the Anterior Chamber of the Human Eye

Author Affiliations: Department of Ophthalmology, Ehime University School of Medicine (Drs Inoue, Suzuki, and Ohashi), and Department of Ophthalmology, Sumitomo Hospi ta l , Osaka (Dr Kawashima), Japan. Correspondence: Tomoyuki Inoue, MD, Department of Ophthalmology, Ehime University School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan (tomonoue@gmail .com). Conflict of Interest Disclosures: None reported.

Bilateral giant retinal pigment epithelial rip in idiopathic central serous chorioretinopathy.

A 33-year-old man presented with decreased vision in the right eye of 2 months duration. His bestcorrected visual acuity was20/40 in the right eye and20/ 20 in the left eye. On fundoscopy, the right eye showed a giant retinal pigment epithelial rip (Figure 1A). The left eye showed multiple pigment epithelial detachments (Figure 1B) for which no intervention was done. Two years later, he presented with decreased vision in the left eye. His best-corrected visual acuity was 20/ 80 in the left eye. On fundoscopy, the left eye showed a large ‘‘crescent-shaped’’ retinal pigment epithelium (RPE) rip just inferior to the fovea with exudative retinal detachment confirmed on fluorescein angiography (Figure 2). There was no history of receiving corticosteroids or evidence of systemic disease. Over the next month, the area of RPE rip increased, and exudative retinal detachment resolved with pigmentary changes (Figure 3).

Combined central retinal artery and vein occlusion in lupus

A girl aged 16 years presented with sudden loss of vision in the left eye (LE) for 1 day. Visual acuity was 6/6 in the right eye (RE) and perception of light in LE. LE had relative afferent pupillary defect. RE fundus had cotton wool spots (figure 1A). LE fundus showed combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) (figure 1B). Her history of alopecia, fever …

Combined central retinal vein and branch retinal artery occlusion in hyperhomocysteinaemia

A woman aged 30 years reported of blurred vision in the right eye (RE) for 2 days. Visual acuity was 6/24 in the RE and 6/6 in the left eye (LE). Funduscopy of RE showed combined non-ischaemic central retinal vein occlusion (CRVO) and supero-temporal branch retinal artery occlusion (BRAO) (figure 1A). LE examination was normal. Optical coherence tomography (OCT) of the RE showed thickening of inner retinal layers corresponding to the area of BRAO (figure 1A: white arrow). Thorough systemic investigations and cardiac workup revealed raised …

Dark spot in fibrinous central serous chorioretinopathy masquerading choroiditis.

Abstract Purpose: The authors observed that eyes with acute fibrinous central serous chorioretinopathy (CSC) masquerading active choroiditis had a “dark spot” within the yellow fibrinous deposit. The present study aims to describe this sign as a clinical indicator of acute serofibrinous exudative detachment, thus helping to differentiate it from active choroiditis. Method: The authors retrospectively reviewed the records of 19 patients of fibrinous CSC masquerading active choroiditis. Color fundus photographs, fundus fluorescein angiogram (FFA), and optical coherence tomography (OCT) at baseline and follow-up were studied for a dark spot. The systemic steroids were stopped and all patients were followed up. Results: There were 12 men and 7 women with a mean age of 39.8 years. Fourteen patients had received systemic steroids. Funduscopy revealed creamy yellow subretinal lesion/s simulating active choroiditis lesion in all eyes and exudative retinal detachment in 9 eyes. The dark spot was seen as a round, grayish dark spot within the fibrinous lesion in all eyes. On FFA and OCT, this dot corresponded to the site of leakage. All eyes showed resolution of CSC on follow-up. Conclusion: Detection of a dark spot within fibrinous CSC is an important clinical sign that, if present, helps to avoid misdiagnosis, unnecessary diagnostic tests, and incorrect treatment.