Upender Wali

Cerebro-rhino orbital mucormycosis: An update

Mucormycosis is an uncommon fungal infection which can lead to fulminant necrotizing infection under optimal host condition. Fungi have the ability to invade blood vessels and can affect different parts of the body. The most common, though the most aggressive, form is cerebro-rhino-orbital mucormycosis that occurs in debilitated patients, in conjunction with sinus or para-sinus involvement. Due to increased number of newly diagnosed cases of mucormycosis world-wide resulting from uncontrolled metabolic conditions, this paper intends to widen the readers scope and knowledge about the nature of the disease and its multicomplexity that require a collaborative effort for careful management. Patients who are at risks both at the onset of the disease and during its management have been identified in the paper.

Sebaceous gland carcinoma of the eyelid

Sebaceous gland carcinoma, commonly arises in the periocular area, is an uncommon condition. It represents 1–5.5% of eyelid malignancies and is considered to be the third most common eyelid malignancy after basal cell and squamous cell carcinomas, although few reports placed this tumor as second most common after basal cell carcinoma. It usually affects elderly women and characterized by high rate of local recurrence, regional, and distant metastases. A delay in diagnosis, which can be attributed primarily to ability of this tumor to masquerade as more benign conditions, often leads to inappropriate management with increased morbidity and mortality rates. In this study, the authors discuss key elements of the primary disease and therapeutic options available to treat such devastating problem.

Optical Coherence Tomography: Clinical Applications in Medical Practice

Optical Coherence Tomography (OCT) is a success story of scientific and technological co-operation between a physicist and a clinician. The concept of cross-sectional imaging revolutionalized the applicability of OCT in the medical profession. OCT is a non-contact, topographic, biomicroscopic device that provides high resolution, cross-sectional digital images of live biological tissues in vivo and in real time. OCT is based on the property of tissues to reflect and backscatter light involving low-coherence interferometry. The spatial resolution of as little as 3 microns or even less has allowed us to study tissues almost at a cellular level. Overall, OCT is an invaluable adjunct in the diagnosis and follow up of many diseases of both anterior and posterior segments of the eye, primarily or secondary to systemic diseases. The digitalization and advanced software has made it possible to store and retrieve huge patient data for patient services, clinical applications and academic research. OCT has revolutionized the sensitivity and specificity of diagnosis, follow up and response to treatment in almost all fields of clinical practice involving primary ocular pathologies and secondary ocular manifestations in systemic diseases like diabetes mellitus, hypertension, vascular and neurological diseases, thus benefitting non-ophthalmologists as well. Systemically, OCT is proving to be a helpful tool in substantiating early diagnosis in diseases like multiple sclerosis and drug induced retinopathies by detecting early changes in morphology of the retinal nerve fiber layer.

Functional Endoscopic Sinus Surgery: Indications and Complications in the Ophthalmic Field

Functional Endoscopic Sinus Surgery (FESS) is a highly sophisticated type of surgery, which has revolutionized the surgical management of chronic sinus diseases. In the ophthalmic field, FESS plays a crucial role in the management of a few conditions, but not without risks. Ophthalmic complications associated with FESS are well documented. They mainly occur due to the shared common anatomic areas between ophthalmology and otolaryngology. Ophthalmic complications can vary in severity from very trivial cases such as localized hematoma collection, which is not very problematic to very devastating cases, such as optic nerve damage, which can lead to complete blindness. In order to minimize such complications, safety measures need to be considered prio to the surgery, these include; precise knowledge of detailed anatomy, the operating surgeons ability to interpret precisely the para nasal sinus CT scan and experienced procedural surgical skills.

In vivo morphometry of corneal endothelial cells in pseudoexfoliation keratopathy with glaucoma and cataract.

Background: This study was designed to define correlations between in vivo morphometric and demographic data of pseudoexfoliation (PEX) keratopathy patients from Omani Arab origin with cataract and glaucoma. Methods: In a non-randomized controlled comparative case series, 69 adult patients (43 males and 26 females) with 78 cataract and 48 glaucoma eyes with corneal PEX material were assessed by confocal biomicroscopy (Confoscan 2, Nidek) and values compared to normative US and Omani Arab population values. Descriptive statistics. Results: The mean age of glaucoma patients was 60.81 ± 8.33 years, of cataract patients 64.65 ± 6.67 years; 109/126 eyes (74%) were from patients >60 years old (14 glaucoma and 95 cataract eyes). Age-adjusted endothelial cell counts were similar to normative values in 108/126 eyes (85.7%). Polymegathism and pleomorphism were abnormal in 124/126 (98.4%) and 122/126 eyes (96.8%), respectively. The correlation of pleomorphism and polymegathism with males (R2 = 0.6378, p = 0.05) was stronger than with females (R2 = 0.6024, p = 0.06), and stronger for patients <60 years (R2 = 0.7268, p = 0.01) than >60 years old (R2 = 0.5805, p = 0.01). Cataracts: Endothelial cell counts were normal (mean 2,483 ± 511.2). Pleomorphism was 33.12 ± 11.44% and different from Omani Arab controls (p < 0.01), polymegathism 58.14 ± 16.58% (p <0.01). Glaucomas: Endothelial cell counts were normal (mean: 2,438 ± 503). Pleomorphism and polymegathism were 37.09 ± 12.43% (p < 0.01) and 59.69 ± 16.79% (p < 0.01), respectively. Pleomorphism and polymegathism were more associated with glaucomas (R2 = 0.7652, p = 0.02) than with cataracts (R2 = 0.6041, p = 0.06). Conclusions: Endothelial cell polymegathism and pleomorphism in PEX keratopathy with glaucoma is more frequently associated with age <60 years and male gender than with cataract.

Natural course of central serous chorioretinopathy without subretinal exudates in normal pregnancy

BACKGROUND Pregnancy is a well-known risk factor for central serous chorioretinopathy (CSCR). METHODS Patients were examined using slit-lamp biomicroscopy, fundus examination, fundus photography, and optical coherence tomography, making note of best-corrected visual acuity. RESULTS All patients had resolution of CSCR. INTERPRETATION We present CSCR in 3 consecutive pregnant women without subretinal exudates.

Frosted branch angiitis, neuroretinitis as initial ocular manifestation in Behçet disease

Behçet disease is an idiopathic, multisystem disorder characterized by recurrent episodes of orogenital ulceration and vasculitis of the veins and arteries of all calibers. Ocular involvement may affect the conjunctiva, sclera, uveal tract, vitreous, blood vessels, and retina. Many theories have pointed toward an autoimmune response behind its pathogenesis, which may be triggered by exposure to an infectious agent. Frosted branch angiitis is characterized by vascular inflammation, sheathing, retinal edema, and retinal hemorrhages. The disease may be idiopathic in a majority of the cases or may be associated with ocular and systemic pathology. Association between Behηet disease, Frosted branch angiitis, and neuroretinitis is not reported in literature. This uncommon combination reflects the varied systemic and ocular manifestations in Behçet disease, especially in patients who are not diagnosed and treated in time. We hereby report a case of bilateral frosted branch angiitis and neuroretinitis in a young male from Middle-east, suffering from Behçet disease.

Total levator aponeurosis resection for primary congenital ptosis with very poor levator function.

Aim: This study was designed to evaluate the effectiveness of total levator aponeurosis resection in patients with very poor levator function secondary to primary congenital ptosis. Design: A retrospective, noncomparative single-institutional study was designed. Participants: Seven patients with very poor levator function secondary to primary congenital ptosis operated between May 2008 and May 2010 by one surgeon (AM). Materials and Methods: A retrospective study of seven patients with congenital ptosis evaluating eyelid elevation following total levator aponeurosis resection. End result is improvement of the eyelid elevation. Conclusion: Total levator aponeurosis resection is easy and effective tool in elevating the eyelid in patients with very poor levator function secondary to primary congenital ptosis.

Current Applications of Optical Coherence Tomography in Ophthalmology

Optical coherence tomography (OCT) was first reported in 1991 as a non-invasive ocular imaging technology (Huang et al, 1991; Hrynchak & Simpson, 2007). It generates a false-color representation of the tissue structures, based on the intensity of the returned light. Over years, the clinical applications of OCT have improved dramatically in precision and specificity. It has been compared to an in vivo optical biopsy. As the resolution of OCT has been getting more and more refined, the identification, detection, localization and quantification of the tissues has accordingly, become more superior and reliable (Ryan SJ, 2006). There are several nonophthalmic applications of OCT as well, but this chapter shall focus on its clinical applications in ocular diseases alone (Aguirre et al., 2003; Fujimoto, 2003).

Bevacizumab therapy for macular edema in central retinal vein occlusion: Long-term results

Background: There is no proven effective treatment for vision loss in central retinal vein occlusion (CRVO). Bevacizumab has been reported in small series with limited follow-up, to have a positive effect in reducing cystoid macular edema (CME) and improving vision in CRVO. Purpose: To report long-term results with the use of bevacizumab in CRVO. Materials and Methods: Prospective interventional case series included 15 patients, serially evaluated with best corrected visual acuity (BCVA), optical coherence tomography (OCT), fluorescein angiography, and tonometry. Results were statistically analyzed. Results: Mean follow-up was 12 ± 3.6 months (range, 6–18 months); mean number of injections was 2.2 (range, 1–4) per patient. Statistically significant reduction of macular thickness (P < 0.001) was seen at six weeks (mean, 346 μ); three months (mean, 353 μ); six months (mean, 348 μ); and final follow-up (mean, 342 μ). Significant BCVA improvement was seen at six weeks (mean, 0.27 logMAR), three months (mean, 0.3 logMAR), three months (0.15 logMAR), and final follow-up (mean, 0.21 logMAR) (P = 0.009). Also, 73.3% patients had BCVA improvement at the last follow-up. Conclusion: Intravitreal bevacizumab is an effective treatment option for CME in CRVO patients. Reinjections at appropriate timing, based on the OCT findings, are important for better visual outcome.