Vasudev Anand Rao

Oculocutaneous manifestations in xeroderma pigmentosa.

Xeroderma pigmentosum (XP) is a rare genetic disease characterised by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. The oculocutaneous features of 10 patients with XP were studied retrospectively. General features included parental consanguinity (40%), familiarity (60%), onset of symptoms in first 2 years (50%), malignant skin neoplasms (60%), and carcinoma of the tongue (20%). Among the ocular features, 50% of patients presented with photophobia. Lid freckles or atrophic skin lesions were seen in all patients. Lower lid tumours were seen in 30%, chronic conjunctival congestion in 40%, corneal opacification in 40%, squamous cell carcinoma of limbus in 20%, bilateral pterygium in 40%, and visual impairment in 50%. The clinical features (ocular and cutaneous) of the cases are discussed.

Retinopathy in preeclampsia: association with birth weight and uric acid level.

Purpose: In a retrospective study of patients with preeclampsia and patients with pregnancy-induced hypertension (PIH) who delivered at term, the association of retinopathy with various clinical and laboratory manifestations and fetal birth weight was evaluated. Methods: Medical records of patients with preeclampsia and patients with PIH who delivered at term between January 2003 and December 2004 were reviewed. Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic blood pressure (BP), fetal birth weight, and various biochemical parameters. Multivariable linear regression was used for statistical analysis. P ≤ 0.05 was considered significant. Results: Forty patients were included in the preeclampsia group (study group) as well as in the PIH group (control group). Severity of retinopathy was found to be inversely related to fetal birth weight (P = 0.044) and positively related to serum uric acid level (P = 0.022) in the preeclampsia group. All other variables in the preeclampsia group including systolic BP (mean, 154.6 mmHg; P = 0.792) and diastolic BP (mean, 105.7 mmHg; P = 0.102) were found to have no significant association with retinopathy. In the PIH group, none of the parameters analyzed were significantly associated with ocular changes. Conclusions: The severity of retinopathy in preeclampsia is directly related to the level of placental insufficiency and intrauterine growth retardation. The severity of retinopathy might be independent of systemic BP.

Corneal perforation due to Acinetobacter junii: a case report.

Acinetobacter spp. is emerging as a common cause of nosocomial infections. Community acquired ocular infections due to Acinetobacter are rare. Only one case of perforation of cornea has been reported previously, where old nomenclature was used to describe the causal agent. We report a case of corneal perforation due to Acinetobacter junii for which a therapeutic penetrating keratoplasty was conducted and the patient eventually recovered.

Nine years' review on preseptal and orbital cellulitis and emergence of community-acquired methicillin-resistant Staphylococus aureus in a tertiary hospital in India.

Context: Preseptal cellulitis is the commonest orbital disease which frequently needs to be differentiated from orbital cellulitis. Prompt diagnosis and treatment with appropriate antibiotics can prevent vision loss and life-threatening complications of orbital cellulitis. Aims: To describe the clinical profile of cases with preseptal and orbital cellulitis admitted to a tertiary care hospital during a period of nine years. The causative organisms and the clinical outcome were analyzed. Settings and Design: Retrospective descriptive case study done in a tertiary care hospital in South India. Material and Methods: The in-patient records of patients with preseptal and orbital cellulitis were reviewed from 1998 to 2006. The factors reviewed included ocular findings aiding in the distinction of the two clinical conditions, the duration of symptoms, the duration of hospital stay, microbiological culture report of pus or wound swab, blood culture, drugs used for treatment, the response to therapy and complications. Statistical Analysis Used: Descriptive analysis. Results: One hundred and ten cases, 77 patients with preseptal cellulitis and 33 patients with orbital cellulitis were reviewed. Five percent of children and 21% of adults presented with cutaneous anthrax contributing to preseptal cellulitis. Thirty-nine percent cases with orbital cellulitis were caused by methicillin-resistant Staphylococcus aureus (MRSA). Conclusions: This study has helped in identifying organisms which cause orbital infections, especially community-acquired MRSA. It indicates the need for modifying our empirical antimicrobial therapy, especially in orbital cellulitis.

Relationship between systemic hypertension, perfusion pressure and glaucoma: A comparative study in an adult Indian population

Aims: To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives. Design: Cross-sectional observational study. Materials and Methods: A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphreys central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2. Statistical Analysis: Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect. Results: There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1½ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13–45%, P = 0.001) and glaucoma suspect (95% CI = 2–21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP. Conclusion: Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.

Fetal birthweight and diastolic blood pressure: Association with retinopathy in severe preeclampsia

Purpose To find the association of retinopathy in preeclampsia with fetal birthweight and systolic and diastolic blood pressure (BP) in patients with mild and severe preeclampsia. Methods Medical records of patients with preeclampsia who delivered at term between January 2002 and December 2006 were included in the study Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic BP, and fetal birthweight. Multivariable linear regression was used for statistical analysis. p value ≤0.05 was considered significant. Results The patients were divided into two groups: mild preeclampsia (MP) and severe preeclampsia (SP). The MP had 156 patients and SP had 104 patients. The mean systolic BP in MP and SP was 147.2 mmHg and 164.6 mmHg, while the mean diastolic BP in MP and SP was 98.6 mmHg and 112.7 mmHg. Severity of retinopathy was inversely associated with fetal birthweight (p=0.022) in SP, while it was insignificant in the MP (p=0.082). Low birthweight was due to intrauterine growth retardation of the fetus. Diastolic BP in the SP showed significant correlation with retinopathy (p=0.041). The systolic (p=0.55) and diastolic BP (p=0.248) in MP and systolic BP (p=0.803) in SP were insignificantly correlated with the retinopathy. Conclusions Retinopathy in preeclampsia may indirectly indicate the level of placental insufficiency and intrauterine growth retardation. The severity of retinopathy is more closely related with diastolic BP rather than systolic BP and the significance of this correlation increases in severe preeclampsia.

Case Reports of Three Patients Showing Optic Nerve Head Melanocytoma and Systemic Hypertension

Purpose: To report the association of optic disk melanocytoma with systemic hypertension. Cases: Ocular examination of 3 asymptomatic hypertensive patients revealed a pigmented lesion over the optic disk. After clinical examination and radiological evaluation a diagnosis of optic disk melanocytoma was made. One patient had a mild decrease in visual acuity associated with an increase in size of the lesion during the follow-up. Systemic evaluation revealed increased urinary vanillylmandelic acid in all the patients. MRI showed diffuse adrenal hyperplasia while a 131I-MIBG scan showed increased uptake in 1 case. Conclusions: Optic disk melanocytoma is a benign tumor though the lesion may increase in size with the resultant decrease in visual acuity over few years. It may be associated with systemic hypertension secondary to increased levels of catecholamines in the body, which is related to the common neural crest origin of melanocytes, adrenal medullary cells and chromaffin cells.

A case to illustrate the role of ophthalmologist in systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) affects the eye as part of the disease or due to the drugs used in therapy. Ocular involvement is seen in one third of the patients with SLE. SLE is rare in India and found less frequently in males and children. SLE retinopathy is usually bilateral. We report an unusual case of unilateral macular infarction in a boy caused by systemic lupus erythematosus. A fourteen year old boy was presented with skin rashes and loss of vision in left eye. Posterior segment examination showed hyperemic edematous disc, arteriolar attenuation, venous dilatation, multiple cotton wool spots around the disc and macula in the left eye. There was no improvement in vision with pulse steroids and cyclophosphamide. The clinical implication of SLE retinopathy is that the disease is severe and warrants systemic immunosuppressive therapy. SLE-induced macular infarction is rare and has poor visual prognosis. As serious ocular complications of SLE can be silent, routine ophthalmological evaluation is warranted in all patients.

Primary orbital neuroblastoma with intraocular extension

Neuroblastoma is an undifferentiated malignancy of primitive neuroblasts. Neuroblastoma is among the most common solid tumors of childhood. Orbital neuroblastoma is typically a metastatic tumor. In this case report, we describe a 2-year-old child with a rapidly progressing orbital tumor. Computed tomography revealed an orbital mass lesion with extraocular and intraocular components. An incisional biopsy was done, and a histopathological examination showed features suggestive of neuroblastoma. Systemic workup including ultrasonography of the abdomen, chest roentgenogram, whole body computed tomography, and bone scintigraphy showed no evidence of systemic involvement. The diagnosis of primary orbital neuroblastoma was made, and the child was subjected to chemotherapy followed by rapid melting of the tumor. Neuroblastoma should be considered in the differential diagnosis of childhood orbital tumors.

Abnormalities of tear function in patients with pseudoexfoliation

Background and Aim: Pseudoexfoliation (PEX) seems to affect the tear secretion and tear film stability by altering cell morphology in conjunctiva. We aimed to study the abnormalities of tear secretion and tear film that can occur in patients with PEX material on lens. Methods: In this prospective non-randomized study, Group 1 consisted of 30 eyes of 15 normal subjects without PEX material on lens serving as controls and Group 2 consisted of 43 eyes of 30 patients with PEX at least in one eye. Patients with ocular surface disorder, PEX glaucoma, previous ocular surgeries and adnexal abnormalities were excluded. To study the tear function, Schirmers two and tear film break-up time (TBUT) were performed in all eyes. Results: Average Schirmers and TBUT in Group 1 were 22.05 ± 4.4 mm and 14.75 ± 2.5 s respectively, whereas in Group 2 they were 10.6 ± 7 mm and 5.6 ± 2.8 s and the differences were clinically significant ( P P = 0.065). Conclusion: PEX syndrome causes unstable tear film and reduced tear secretion.