Vasumathy Vedantham

Clinico-microbiological profile and visual outcomes of post-traumatic endophthalmitis at a tertiary eye care center in South India

PURPOSE To analyze the clinical and microbiological characteristics of eyes with post-traumatic endophthalmitis and factors influencing the visual outcomes in these cases. METHODS We performed a retrospective chart analysis of the clinical and microbiological data of 97 consecutive patients with post-traumatic endophthalmitis presenting to a tertiary eye care hospital in South India. RESULTS Thirty-nine (40.2%) cases were culture-positive, gram-positive cocci (n=24/42, 57.1%) being the commonest isolates. Staphylococcus epidermidis and Pseudomonas aeuruginosa were the commonest single isolates (n=10; 23.8%). Majority of the organisms were sensitive to chloramphenicol (n=27) or ciprofloxacin (n=26). Susceptibility to vancomycin (n=3) and amikacin (n=4) was poor. Cases with negative cultures at presentation were more likely to have improvement in visual acuity compared with culture-positive cases (on multivariate analysis, OR: 3.2, 95% CI: 1.1, 9.0). CONCLUSIONS In this series of post-traumatic endophthalmitis, a high prevalence of resistance of the culture isolates to vancomycin and amikacin was observed.

Atypical manifestations of acute posterior multifocal placoid pigment epitheliopathy

We report four patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) with atypical features which were unilaterality, serous detachment of the neurosensory retina, retinal vasculitis and papillitis. All patients responded well to oral corticosteroids. We suggest that systemic corticosteroids could be useful in selected cases of APMPPE with atypical clinical features.

Retinopathy of prematurity screening in the Indian population: It's time to set our own guidelines!

There is an alarming increase in the incidence of retinopathy of prematurity (ROP) in the developing countries including India today, constituting what is referred to as the third epidemic of ROP. While the incidence of ROP is on the wane in the West, thanks to the improvement in neonatal care and screening, in India we are just beginning to face the storm mainly due to increased awareness. The most important determinant of any ROP management program is an eff ective screening strategy. There are several peculiarities that preclude the application of the eff ective guidelines that exist in the West to the Indian scenario. Two questions: Whom to screen? And when to screen? have to be answered in the Indian scenario. Let us consider the Þ rst question of whom to screen? There is a geographic variation in the incidence of ROP in babies born at even similar gestational ages. 1 In the West, ROP at least of the threshold variety is not seen in higher birth weight (BW) babies! Therefore, larger babies generally are not screened since the incidence of treatable ROP is low and these infants have been observed to have a generally good outcome even without treatment. The American Academy of Pediatrics (AAP) recommends screening of infants born at ≤ 28 weeks gestational age (GA) and/or ≤ 1500 g BW (regardless of supplemental oxygen); 1500 to 2000 g BW if supplemental oxygen was administered and the infants had an unstable clinical course. 2 However, Wright et al. 3 recommended screening of all infants born at ≤ 32 weeks GA and/or ≤ 1500 g BW (regardless of supplemental oxygen) and predicted that it would lead to savings in excess of 1.5 million dollars annually in the United States; this was approved by Andruscavage et al. 4 A recent study from the US found that no infant with birth weight greater than 1500 g developed treatable ROP. 5 Similar guidelines exist in the UK as laid out by the Royal College of Ophthalmologists and the British Association of Perinatal Medicine. 6 In contrast, ROP is seen in larger, bigger BW babies in Asia and other developing countries. In south India, threshold ROP has been seen in babies born with 2000 g birth weight. 7 While partly this might reß ect the failure of very small infants to thrive, other factors such as perhaps the quality of neonatal care that …

Electroretinographic assessment and diagnostic reappraisal of children with visual dysfunction: A prospective study

PURPOSE To assess the presence or absence of a retinal cause of visual impairment using electroretinography (ERG) in children with no obvious discernable cause on ocular examination. DESIGN Prospective observational case series. MATERIALS AND METHODS A prospective study was carried out involving 120 children with the mean age 4.4+/-3.2 years with visual dysfunction. All children underwent ERG under general anesthesia using a special handheld mini-Ganzfeld (Kurbisfeld) dome. RESULTS Fifty-two (43.3%) children were male and 68 (56.7%) were female. The clinical diagnosis was as follows: Lebers congenital amaurosis (LCA) (n=47), achromatopsia (n=25), congenital stationary night blindness (CSNB) (n=9) and others (unclassifiable, n=39). The visual acuity ranged from perception of light (PL) to PL with projection in children with LCA. In the rest (n=73), some sort of visually guided behavior was discernable. Following ERG, a diagnostic reappraisal resulted as follows: LCA (n=49), achromatopsia (n=28), CSNB (n=4), cone-rod dystrophy (n=22), rod-cone degeneration (n=7), normal (n=8) and others (unclassifiable, n=2). Except for the two unclassifiable cases, ERG was successful in the diagnosis or exclusion of retinal dysfunction in the rest. By Pearson Chi-square test, there was a statistically significant association between the clinical and ERG diagnosis (P < 0.001). CONCLUSION LCA was the commonest cause of visual dysfunction in our series. A statistically significant correlation between clinical and electrophysiological diagnosis was seen. ERG helped in firmly establishing the presence or absence of global retinal dysfunction in the majority (118/120) of pediatric patients with visual dysfunction.

Double prepapillary arterial loops associated with superior branch macular artery occlusion.

Prepapillary arterial loops are congenital vascular anomalies that have been noted to cause arterial occlusions. We report a case of superior branch macular artery occlusion in an eye with two independent prepapillary arterial loops, following a Valsalva-like mechanism.

Hypotensive retinopathy in Takayasu's arteritis.

Takayasus arteritis could result in chronic ocular ischemia with a spectrum of changes that is referred to as Takayasu retinopathy. The role of an ophthalmologist includes photocoagulation, monitoring for complications, and timely referral for intervention. This article illustrates one such case that was effectively managed.

Persistent Depot of Triamcinolone Acetonide after a Single Intravitreal Injection

The persistence of depot of triamcinolone at four months following a single intravitreal injection is described.

Intravitreal injection of triamcinolone acetonide for diabetic macular edema: Principles and practice

Diabetic retinopathy is fast emerging as a leading cause of newly diagnosed legal blindness amongst the working population. Macular edema, as it is commoner, accounts for more vision impairment than neovascular proliferation in diabetic patients. Laser photocoagulation, which is the standard treatment of macular edema, is associated with significant complications and an improvement in visual acuity is unsatisfactory. Intravitreal injection of corticosteroids (especially triamcinolone acetonide) is an emerging treatment modality in the management of diabetic macular edema. This article presents an overview of the principles, technique and complications associated with this procedure.

Premacular haemorrhage associated with arteriovenous communications of the retina induced by a valsalva-like mechanism: An observational case report

A 26-year-old woman presented with sudden defective vision in the right eye following lifting a heavy bucket of water. Examination showed a dense premacular subhyaloid haemorrhage associated with arteriovenous communications of the retina (AVCRs). Spontaneous absorption of the premacular haemorrhage with consequent improvement in the visual acuity was seen after two months. The possible aetiopathogenesis of the case is also discussed.

Pigmented epiretinal membranes caused by RPE migration: OCT-based observational case reports.

Epiretinal membranes are cellular sheets on the retinal surface that are formed due to varied etiologies. We present two observational case reports to demonstrate the transretinal migration of the retinal pigment epithelium in pigmented idiopathic epiretinal membranes using optical coherence tomography.